Terminally ill: Extended care
Assessing Patient Needs (Magill’s Medical Guide, Sixth Edition)
Difficult decisions await those trying to care for a patient with a terminal condition. Many families are faced with these decisions soon after the patient leaves the hospital, unable to function alone at home. Physicians and family members are able to choose among several options, depending on the needs and desires of the patient.
The decision process should start when the patient is still in the traditional hospital setting. The decision process should explore all alternatives, based on many factors. The degree of physician involvement is important, since not all doctors make monthly trips to visit patients at other facilities. The possibility of rapid deterioration of health or mental status is a vital concern, and nursing needs and other nonphysician services are also of utmost importance. The patient’s desires and the wishes of the family can be addressed through the patient’s legal rights to have a living will or durable power of attorney for health care decisions. Both can document, either through the patient’s own written directions or through the appointment of a relative as a legal representative, where the patient stands on the issue of being kept alive by artificial means. Specific requests regarding the use of cardiopulmonary resuscitation (CPR) should be made to the physician. These wishes are best discussed long before the patient is near death.
When the terminally ill patient also has a...
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Options for Long-Term Care (Magill’s Medical Guide, Sixth Edition)
One of the first options available for a terminally ill patient is to return to his or her own home or to live with relatives. This decision of home health care must be based on the support available from the family: who will help provide care, when, and how. The need for home modifications to make the patient more independent or more comfortable may be a concern. If outside services are needed, such as therapy, family members must determine how they can be obtained. Another difficult question is identifying responsibility for the financial costs of special care.
These questions are difficult to ask and even more difficult to answer. Families may underestimate the additional stress involved in caring for a terminally ill person in the home. Fortunately, services are available to help relieve the additional stresses encountered, such as respite care. Having someone come into the home or having the patient placed in a day care facility can relieve some of the stresses temporarily. One of the first types of stress encountered is one of a physical nature, especially fatigue arising from the additional housekeeping activities of cleaning, laundering, shopping, and cooking. Additional emotional stress results from trying to balance time, responsibilities, and pressures. Financial worries may also cause stress, even though the costs of home care are often much less than for care in a hospital or other facility....
(The entire section is 1004 words.)
Perspective and Prospects (Magill’s Medical Guide, Sixth Edition)
Caring for a terminally ill family member can be a rewarding experience as well as an exhausting one. The location where this care is traditionally given has changed over time and will continue to change in the future. Care in the patient’s home or with relatives is the least restrictive and one of the less expensive of the many options available. In fact, care in the home is often the only option because outside care is too expensive. Some family members are motivated to select home care because of a sense of obligation or a fear that no one else can care for the patient as well.
More supplemental resources are available than ever before, allowing home care to be a viable option for some. For many others, however, the additional stresses of responsibility for a terminally ill relative, especially an elderly one, are too high. At this point, tough decisions must be made about where the patient should live. Family members may not be prepared to care for the patient at the home. Despite the high costs of extended care facilities, this option is sometimes the only choice available. An emphasis on quality of life makes placement in the least restrictive environment a common choice. Concerns about pain management and the need for a caring staff may change this choice, however, when the terminally ill face the end of life.
In the United States, the high cost of health care makes such decisions even more...
(The entire section is 522 words.)
For Further Information: (Magill’s Medical Guide, Sixth Edition)
Appleton, Michael, and Todd Henschell. At Home with Terminal Illness: A Family Guide to Hospice in the Home. Englewood Cliffs, N.J.: Prentice Hall Career & Technology, 1995. This popular work examines hospice care and home nursing for the terminally ill.
Beerman, Susan, and Judith Rappaport-Musson. Eldercare 911: The Caregiver’s Complete Handbook for Making Decisions. Rev. ed. Amherst, N.Y.: Prometheus Books, 2008. A practical guide for elder care. Includes topics such as locating services, managing medications, understanding benefits, choosing a nursing home, coping with memory loss, hiring and handling in-home help, helping a parent who refuses help, and recognizing signs of elder abuse.
Corr, Charles A., Clyde M. Nabe, and Donna M. Corr. Death and Dying, Life and Living. 6th ed. Belmont, Calif.: Wadsworth/Cengage Learning, 2009. This book provides perspective on common issues associated with death and dying for family members and others affected by life-threatening circumstances.
Forman, Walter B., et al., eds. Hospice and Palliative Care: Concepts and Practice. 2d ed. Sudbury, Mass.: Jones and Bartlett, 2003. A text that examines the theoretical perspectives and practical information about hospice care. Other topics include community medical care, geriatric care, nursing care, pain management, research, counseling, and hospice management.
(The entire section is 489 words.)