Terminal Care at Home

１. The points of terminal care at home

［Purpose］	[How to care]
1. Relief from physical pain	Relief from an acute pain. Regulation of body temperature. (a hot-water bottle, massage, etc.) Management of breathing. (body position, removing phlegm)
2. Observing the condition and consulting the family about predictable problems	Observation of body condition, etc. (vital signs, intake of food, amount of bodily wastes, etc.)
3. Dealing with a change in the condition	Reporting to the family doctor. The doctor's visit. Dealing a request for hospitalization from the family.
4. Death (a prompt visit in　response to a request by the family)	The condition of the deceased and confirmation of the time breathing stopped. Corresponding with the family doctor (when this has not yet been done). Offering condolences and words of support to the family, after confirmation of the death by the doctor
5.Treatment of the deceased	Treating the dead body (the family may take care of the procedure with a public health nurse's help, but usually a private mortician is entrusted, nowadays). Removing any apparatus (tubes, etc.), cleaning the bed and the body, making up the face and so on. Putting things in order around the bed.
6. Supporting the family	If necessary, supporting the family and helping the family get over their grief by consulting an MSW (Master of Social Welfare) after the funeral.

（ Reference data: “Guidance of Health for the Elderly" by Medical Friend Corp.）

２. Assessment of the care service provider
in the personal care of the elderly person at home.

1. Basic knowledge of medical treatment and nursing science.

2. Observation, judgment, technical skills, anticipating problems, applying practical knowledge.

3. Total assessment of the situation.

4. A proper understanding of medical treatment.

5. Understanding the family of the deceased and understanding Perkinsonism.

6.　Involving the welfare service by use of good cooperation and management.

7.　Judging the situation in the context of the whole life of the elderly making use of hospitalization, care at home, short stay and day care systems.

8.　Having awareness of one's role as part of a larger body of careres.

9. Having energy and the desire to study.

10. Having human compassion.

11. Others

３．Assessment of the receiver of care services at home.

［Assessment item］	［Examples］
1. Physical change	Planning a diet of nutritious food, the use of active ADL, relieving pain, cleaning the body, adopting good bed bath or outdoors bath procedure to avoid troubles caused by a dysfunction organ.
2. Emotional change	Maintaining a stable emotional condition, accepting sickness and handicap, having a good attitude to be supported, having positive facial expressions and body language.
3. A change in their way of living	Extending their field of activity, improving their customary way of daily life, judging what things matter and what they must or must not do, taking positive steps.
4. Dealing with the terminal stages	Whether to have pain or not, stabilizing the emotional state, whether medical treatment is needed or not, accepting the inevitability of death, terminal treatments.
5. A change of a carer's attitude	Accepting more care, accepting a changing relationship with the patient and a care manager, accepting to changes of attitude in the carer.
6. Effectiveness of bringing services into home	Accepting new services at home, deciding if the treatment is suitable.
7. Relationship with a community	Having visitors, places to go and activities to take part in, the need of volunteers, motivation to out, etc.
［ Medical treatment ］	Trusting in the doctor, having a medical examination, relieving the ill condition, whether the medicine causes side-effects, etc.

４．Issues to relating the care and supervising of the terminal patient's deathbed at home.

Supporting the family members emotionally and preparing them for the patient's death that they will be able to accept the patient's terminal stages.
Helping the patient and the family to clarify the place the patient wants to die.
Making sure there are enough family members to care for the patient
Cooperating with the family doctor.
Supporting the care of the patient by the family members.
Supporting the family after the death.

５．The meaning of the elderly's death for the family

The death interpreted as the completion of the given life.
The death as a great loss.
The death as a resolving of troubles.
The death that leaves problems.

６．The process of grieving (Classified by A.Deeken)

1. Shock and mental paralysis	A state of mental dysfunction when faced with the temporal realities of life, shock at the death of the beloved one, as a kind of self-defense mechanism.
2. Denial	Refusing to accept the fact of the death of the beloved one.
3. Panic	Sudden uncontrollable fear caused by facing death closely.
4. Anger and sense unfairness	Being angry and resenting against the perceived unfair mental pain undergone.
5. Hostility and resentment (ressentiment)	Venting the sorrow on people around in the form of hostility or resentment.
6. Feeling of guilty	Being self-accusing as an expression of remorse, a feeling of failing the deceased during their life as a typical response and act of grief.
7. Forming an imaginary world in mind	Behaving and believing as if the deceased is still alive, fantasizing.
8. Sense of isolation and depressive feeling	A part of a healthy grieving process. It is important to make an effort to overcome the sorrow swiftly and receive the support from people around at this time.
9. Confusion and apathy	Confusion caused by a feeling of emptiness, i.e. a loose of the purpose of life.
10. Renouncement and acceptance	Accepting honestly the situation that one is in, and trying to brave the reality.
11. Find new prospect, humor, and smile again	Humor and laughing are essential for a healthy life, therefore their restoration is a symptom of the end of the grieving process.
12. The steps of recovery new-identity	Not going back how one used to be, but being shaped into a man of fine character through facing the sorrowful grieving process and overcoming it.

（ written by Alfons Deeken: "Hanryo ni Sakidatareta Toki" )

About the Last Will and Testament Information.

［A signed last will and testament executed by the Testator.］

The testator or a testatrix draws up a will with the year and date, and signs and seals it, without a witness or observer.
This is very simple and effective way because no one knows when it has been made, on the other hand it might be lost or someone could hide it, so it is difficult to ensure the will will be proved.

［A last will and testament in formal ］

The testator or testatrix verbally makes the will in the presence of two or more witnesses, and a notary takes notes of it, then the tester or testatrix and witnesses, each confirm the notes and sign them.
The will is precise because a notary has made it, and the original won't be lost in the notary's office. However the contents of the will cannot be completely kept secret.

［A last will and testament in secret ］

A testator or testatrix draws up the will himself or somebody draw it up or type it for them. Then after signing and sealing it the testator or testatrix puts it in an envelope. The envelope is then testified as containing the last will of the testator of testatrix and a notary and two or more witnesses and together with that sign and stamp the envelope.
This maintaining the secrets of the will, but could result in an imperfect worded will.

E.& O.E.

Bedridden | Personal Care | Terminal Care
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Last modified: 2004/2/1