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Terminal Discharge: Understanding Care Options and Preparation

Close Up Nurse Comforting Ill Patient Hospital Ward (1)

One of the most painful moments for families, aside from hearing that their loved one is nearing their final moments, is witnessing the last hours until they breathe their last. Despite providing terminally ill patients with the best medical care, there will come a point when family members must accept that death is inevitable and may soon come.

When your loved ones want to return home to spend their final days feeling comfortable and surrounded by their families while waiting for the day, you must make an informed decision regarding terminal discharge.

What is terminal discharge, and what are the equipment, resources, caregiver, doctors, and other things you need to arrange before the patients return home? Let’s delve more into terminal discharge and what you can do to make the most convenient end-of-life care for a terminally ill loved one.

All You Need to Know About Terminal Discharge

If a patient has been receiving terminal care in a hospital despite the doctors telling their family members that they are nearing the end of life, they may request to spend their last moments at home. The patient’s comfort is now the primary concern, and a terminal discharge may now be taken into consideration.

Before releasing a patient with a terminal illness home, hospital officials will assess the caregiver or intended care team to make sure they can handle the patient’s care requirements and symptoms. In some circumstances, additional equipment like hospital beds or oxygen supply and oxygen concentrators could be needed.

Moreover, private nurses could be required if the patient’s caregiver is unable to handle end-of-life care requirements to ensure the patient is comfortable in their remaining time.

Once a terminal discharge is decided, the hospital staff or home hospice care team will inform the designated caregiver of the patient regarding end-of-life symptoms and how to deal with them.

The caregivers of the patients will also be briefed about palliative care, top caregiving tasks, how to handle specialised equipment, and how to communicate with the multidisciplinary team while giving end-of-life care. Moreso, the caregivers and loved ones of patients in their end-of-life journey are reminded about everything they need to know about terminal discharge, including dealing with death.

Aside from providing care to patients in their final journey, the patient’s family and care team are taught what to do when the patient passes. After the hospital has decided on a terminal discharge of the patient, the doctors or nurses will arrange for an ambulance to take the patient home after they’re done briefing the caregiver, family, and the patient’s care team.

The hospital may tell the patient’s hospice provider about the terminal discharge and refer the patient to them if they are already receiving care from a home hospice team.

Terminal discharge is sometimes called palliative care, which focuses mainly on end-of-life support rather than curing the illness weighing down a patient. Aside from the palliative care team, caregiver, and doctor, a patient’s loved ones must learn how to cope physically and provide care and emotional support to their dying family member.

It’s a difficult ordeal not only for the patient but everybody who loves them. But terminal discharge aims to make life or end of life as comfortable and happy as possible for a loved one facing death without ever feeling alone. A government article on considering terminal discharge can further enlighten you about the process and what you need to prepare for if you’re a loved one of someone whose life is about to end.

What Are the Palliative Care Options for Patients After Terminal Discharge?

You have three options when thinking about the care needs of a patient after a terminal discharge: home of a patient, home hospice care teams, and hospices.

Home

If it’s the wish of a patient to spend end-of-life moments at home with their loved ones instead of having home hospice care or being sent to a hospice, you must set up the house to accommodate the needs of your ill loved one before their terminal discharge.

The hospital will help you with the ambulance to make the journey home comfortable. But you must prepare and arrange your place to turn it into a home hospice.

You must set up a hospital bed and complete all the equipment necessary to relieve pain and provide for all the care needs of a patient showing symptoms and signs of someone who’s about to pass away.

This choice may be more expensive, but it gives you more freedom to oversee your loved one’s care as you see fit, with little assistance from a medical social worker, hospital emergency department, caregivers, or a doctor and plan visitation schedules.

Hospice Care Teams

If the patient is at home after terminal discharge, but the family’s ability to delegate tasks and manage and support a loved one through their pain, symptoms, and signs are lacking, you can choose to get the services of a nursing agency Singapore to hire private nurses and other pros that will comprise a home hospice care team. Aside from nurses, they may also include a doctor, social workers, and caregivers. This medical care team will regularly visit the patients at home to check their health and provide for their needs.

This home hospice team will assist the families of patients in providing help with activities of daily living and scheduling a visit from a doctor or nurse.

Hospices

Hospices specialise in providing care for patients who are suffering from terminal illnesses. Since patients admitted to hospice facilities typically have a protracted illness and little time left, their attention is on enhancing the patient’s quality of life.

Hospice care is suitable for those who fit the following category:

  • Desire to give curative treatment less importance than the quality of life
  • Become more sleepy or confused
  • Have a loss of appetite and major physical changes, such as weight loss
  • Have uncontrollable and persistent discomfort, dizziness, nausea, or shortness of breath
  • Having trouble with ADLs like using the restroom, dressing, walking, eating, and maintaining one’s hygiene
  • Repeated visits to the emergency room or getting hospitalised
  • Have given their consent not to continue with the treatment that seems to be ineffective

Crucial Considerations for the Terminal Discharge of a Patient

More often than not, terminal discharge is a part of the treatment plan of the care team of a patient after being diagnosed with a terminal illness. The family of a patient must think hard and consider the following factors before agreeing on a terminal discharge:

  1. Transportation

Be clear with the hospital, who would arrange and manage to get an ambulance to take the patient home after getting a terminal discharge. If, by any chance, the patient passes away in an ambulance, the driver should continue the journey home while arranging for a home medical visit to confirm the patient’s cause of death.

A loved one must arrange and plan for the logistical issues beforehand. They must take into consideration the distance from hospitals to their home and the availability of support services.

  1. Equipment and resources

A patient’s prognosis is bad, and their life expectancy is constrained when terminally sick. As a result, they have highly distinct treatment demands from other patients.

Additionally, a lot of terminally ill patients need specialised tools like oxygen tanks or feeding tubes. Giving adequate care at home without special equipment may be challenging or impossible.

Ensure you have all things and tools ready before your loved one comes home. This way, they will continue getting the best care possible after their terminal discharge.

Consider a home hospice team if you are unsure of whether you have enough support at home. For both patients and caregivers, these teams can offer additional medical assistance, pain management, and emotional support. They may also assist in educating caregivers on how to treat patients who are near death.

  1. Family and loved one

To be ready for what to expect as the inevitable draws nearer, the family should be informed of the procedures, symptoms, and indicators connected with terminal care. You must always assign people to look after the patient despite the presence of a caregiver. You must ensure the patient’s last days are spent with the people they care about.

  1. The patient

You must try your best to abide by the patient’s wishes or desires, whether they say it orally or in writing. Advance care directives and lasting power of attorney should also be taken into account if the patient has one.

What To Do After the Patient Has Gone Home?

Depending on what care options your loved one requires or what you have requested for them to get while at home, a doctor, caregiver, or other specialists will schedule their visit to your house to monitor the patient. They will check that the patient is receiving proper care and getting the required medications on time.

Other than looking after the patient, families of a patient must also prepare themselves for what’s to come. However, this is not easy, and many family members go through the following when taking care of a patient at home after their terminal discharge:

  • Grief and loneliness at the thought of losing a loved one soon
  • The guilt of feeling weak and tired of the tasks involved in caregiving despite knowing your loved one won’t be around for long
  • Stopping yourself from saying everything to a loved one to avoid stressing them out
  • Burnout

You don’t have to do everything on your own, and you also must not feel guilty about being unable to care for a sick loved one 24/7. You have to take care of yourself as well, so you will have more energy and emotional strength to deal with what’s next to come.

To help you care for the patient, you can look into the services of elder care Singapore and hire someone to help you manage the home hospice you’ve set up for your loved one. This way, you can delegate tasks accordingly, and your health won’t suffer while doing your best to make the remaining days of a loved one happy and memorable.

Joshua is the founder of RC Caregivers. Having been the primary caregiver of his father, he has been undertaking ways to provide affordable and quality care, not just to his father, but to all elderly in Singapore. He has founded multiple care companies, such as Red Crowns Senior Living, and has been featured in Straits Times, Zaobao and Money 93FM. He has also been lauded by DBS, with the company being the recipient of the DBS foundation grant.
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