Hospital facilities in final days (possible TW)

@doodleschnoodle that is very beautiful -

I’m a doctor in an elderly specialty. In your situation I would speak to the GP to agree a clear Palliative ‘treatment escalation plan’ for your relative not to be admitted to a hospital unless it was needed for symptom control eg sometimes after a fall surgery for fracture might be considered for pain relief . It sounds like infections / heart attack or stroke should be treated with nursing care only in the care home and do not need admission to hospital with the aim of prolonging life. Your GP can advise on this but all too often this is omitted and the elderly die in unfamiliar hospital environments .

In all the wards that I have worked on, staff try to give end of life patients a side room with room for an arm chair for the family member but this is not always possible . I would not expect blankets or a camp bed. Staff are actively told not to offer food or drinks to relatives but a kindly soul might rule break to make you a cuppa.

Sorry this is happening... I've stopped by to say that as a community nurse that has previously started out as a care assistant in a nursing home, I stand by the opening of a window after death to set their spirit free.

End of life care usually means all active treatment withdrawn and just medication by injection for comfort such as morphine.

There's no protocol as such but they will usually offer from the patient tea trolly once or twice a day. You can go to the hospital coffee shop and bring back. Or pop to the canteen.
Patients are sometimes discharged to a care home with a palliative plan too for end of life.

My DDad was in hospital for 5 days before passing. Initially A&E but then moved into his own room as he was end of life care. No offer of anything for family but we used the hospital cafe. We didn’t stay over mainly as my mum is v frail but I did the night he passed (just had a feeling it was imminent). Lovely evening nurse got me a mattress and offered tea. I would take soft drinks and lots of snacks. Blankets, pillow if staying over.

We took it in turns to sit with my Dad so he always had someone with him and we were allowed in and out any time. We were allowed more than one person although it was awkward because we were on a ward as he had to leave his private room, so I don't think they would've allowed the whole family. Whoever was there was allowed to eat his meals ourselves, although we didn't get offered drinks as the curtain was drawn. We were given an armchair that lays flat and a blanket for whoever was doing the overnight shift.

My nan was moved to a side room when they deemed her 'ens of life'. I was never offered a cup of tea, they were rushed off their feet tbh. There was a cafe and shop downstairs though so we could get snacks and drinks. She was moved to a care home for her last days which was better and quieter. Sending strength xx

If you have LPOA for health then i think you need very clear guidelines of treatment options agreed with the care home. Are you happy for IV's, nasal ng feeds, CT scans etc? Is it residential, emi or nursing? For me I would like to be a 'not for escalation' in the event of a large stroke or heart attack.

I think it's vanishingly unlikely your loved one would be moved from care home to hospital.

My mother is in a care home with late stage dementia and recently had a suspected stroke, and the paramedics were called. The paramedic spoke to me and very firmly said they would not take her to the hospital (I completely agreed with him). She is far too frail to withstand or benefit from treatment, and she was better off remaining in the care home. The care home staff and her GP said exactly the same. Someone with late stage dementia who has had a stroke needs to die in peace in familiar surroundings.

Ddad died in hospital. DSIS asked if he could be moved to a hospice but the doctor said that the act of moving him might mean that he would due mid transfer and did we really want him to die in a bed or in the back of an ambulance? We decided to leave him in hospital where he was warm and comfortable as could be and not in the cold as he would have been as he was put into the ambulance.

The only thing I would say is if you've gone home to rest just throw some clothes on and dash . DH and I were staying the night with DM when she got the call about 7am. DH and I just got dressed and were ready to go in minutes. It was DM we were waiting for, as she insisted on having a wash, brush her teeth and dig out clean clothes. We missed dDad going by a matter of minutes.

Nowadays hospitals will even write on discharge letters 'please do not admit to hospital again' or similar for patients with dementia that they do not feel are going to benefit from anything hospital has to offer.

Being blunt your relative is not going to have any treatment for a stroke or heart attack in hospital when they are end stage and nursed in bed.

You may need to be clearer with the care home and professionals that unless they have injuries that require treatment such as stitches they do not need to keep sending to hospital 'for a check up'.

Expect nothing. My elderly dad and I sat by my dying mother for six days. Not once were we offered a hot drink. Not one nurse spoke to us or asked how we were. I had to take a twenty minute round trip to the hospital restaurant to get my dad a hot drink. As a nurse myself I was appalled.

Oh ok sorry, I didn’t realise.

It really doesn't sound like it would be in MIL's best interests to end up dying in hospital. Assuming she is currently in a care home, it ought to be possible for her to stay there for end of life care.

Does she have an 'advance care plan' in place? If not, you really need to liaise with her GP practice to ensure that she doesn't get admitted to hospital unless there are really clear reasons why it is necessary. District nurses can visit the care home to administer pain relief etc if needed.

My mum passed away in June. She was in hospital after a fall, they put her on end of life care. The Dr asked did I want her to stay in hospital or go back to her care home.
I opted for the care home and so pleased I did she had amazing care. The district nurse came everyday, on the 6th day she put her on a syringe driver and she passed away peacefully two days later. One of the carers opened a window two hours before she passed.
We were treated very well could have any meals we wanted plus loads of coffee and biscuits. Don't forget to take your own medication with you plus paracetamol I had a constant headache.
Hope you have the same experience as us ❤️

It would be very poor practice for a care home resident to be moved into hospital for an expected death, away from the staff and environment they know and are safe in

Exactly.

I'm not sure why you think your MIL will die in hospital @BibbityBobbityToo because as she's already in a care home, it would be very bad practice to move her when she's dying.

Dying people need kind, experienced carers.

Please discuss this with the Matron or Manager.

@LLresident in the update, OP says her relative is in a care home.

It would be very poor practice for a care home resident to be moved into hospital for an expected death, away from the staff and environment they know and are safe in.

My heart goes out to you

I would recommend taking a cushion, maybe a neck pillow, a blanket and a footstool. You can get inflatable footstools that are very portable. Also some pain medication for yourself if several days in a chair will cause you to ache. My Mum spent about 4 days at the "don't leave as she could go at any minute " stage. I spent the time in a chair. My legs swelled up so much that I could barely walk by the time she went. Having my feet up for some of the time could have prevented this.

Been there (hospice). Have a 'go' bag ready and waiting including change of clothes, toothbrush, and snacks. Wish I'd thought of a cool bag.

I agree with all of these, esp blankets as they are always in short supply.
I would add - tooth brush and tooth paste or at least some mouthwash to make you feel a bit more human
Jumper and warm slipper socks along with the blanket as the ward gets cold overnight
Flask or a mug to have a hot drink; you can usually refill on the ward. Tea bags or coffee in case there is none.

For when the time comes. I found this really helpful when my DM passed away. I took those minutes to just sit and be with her.

When someone dies, the first thing to do is nothing.
Don't run out and call the nurse. Don't pick up the phone. Take a deep breath and be present to the magnitude of the moment.
There's a grace to being at the bedside of someone you love as they make their transition out of this world. At the moment they take their last breath, there's an incredible sacredness in the space. The veil between the worlds opens.
We're so unprepared and untrained in how to deal with death that sometimes a kind of panic response kicks in. "They're dead!"
We knew they were going to die, so their being dead is not a surprise. It's not a problem to be solved. It's very sad, but it's not cause to panic.
If anything, their death is cause to take a deep breath, to stop, and be really present to what's happening. If you're at home, maybe put on the kettle and make a cup of tea.
Sit at the bedside and just be present to the experience in the room. What's happening for you? What might be happening for them? What other presences are here that might be supporting them on their way? Tune into all the beauty and magic.
Pausing gives your soul a chance to adjust, because no matter how prepared we are, a death is still a shock. If we kick right into "do" mode, and call 911, or call the hospice, we never get a chance to absorb the enormity of the event.
Give yourself five minutes or 10 minutes, or 15 minutes just to be. You'll never get that time back again if you don't take it now.
After that, do the smallest thing you can. Call the one person who needs to be called. Engage whatever systems need to be engaged, but engage them at the very most minimal level. Move really, really, really, slowly, because this is a period where it's easy for body and soul to get separated.
Our bodies can gallop forwards, but sometimes our souls haven't caught up. If you have an opportunity to be quiet and be present, take it. Accept and acclimatize and adjust to what's happening. Then, as the train starts rolling, and all the things that happen after a death kick in, you'll be better prepared.
You won't get a chance to catch your breath later on. You need to do it now.
Being present in the moments after death is an incredible gift to yourself, it's a gift to the people you're with, and it's a gift to the person who's just died. They're just a hair's breath away. They're just starting their new journey in the world without a body. If you keep a calm space around their body, and in the room, they're launched in a more beautiful way. It's a service to both sides of the veil.
Sarah Kerr, Death Doula

As my mum was in a single room (albeit in a covid ward) the hospital breached all protocols and let us sit with her 24 hours including a pull out chair. We were offered (again against all rules) the odd cup of tea - especially by the palliative team. We took it in turns to be with her for 3 days without leaving her and lo and behold she passed away when I had stepped out of the room to speak with the palliative nurse....

That’s not necessarily the best advice. People are not always equipped to have a relative dying at home and some families find it more stressful in ways that they had not expected, eg dealing with any end of life medication, bodily fluids and breathing at the end of life etc