What We Don’t Know We Don’t Know in Health Care
Carson Eldercare Consulting & Management
For more information about the author, click to view their website: https://www.carsoneldercare.com/
Jan 13, 2025
Pennsylvania - Greater Pittsburgh Area
“What We Don’t Know We Don’t Know in
Health Care:”
The Importance
of Keeping Our Loved One Comfortable Towards End of Life, and Why It’s Often Not
Done.
Introduction:
Maintaining comfort and peace in individuals that are
nearing the end of life is so important, yet too often I do not see this being
done. I was recently privy to a situation where, per family report, their aging
loved one was in a facility and restless for ‘days on end’ without any
intervention. I mentioned to the family that they may want to ask for some
medication to relieve their loved ones’ restlessness. One of the family members
reported back that within hours of our conversation, their loved one received
such a medication. The family stated after receiving this medication that he
was the most peaceful he had been ‘in over a week.’ I could feel the relief in
their voices. Unfortunately, I have seen this so often that it was the impetus
for my next blog subject.
Factors:
I see multiple factors accounting for why individuals
approaching the end of life are not made as comfortable as they should and could
be. At facilities, one common reason is due to the transitional period that
occurs once an individual or family decides they want to move from aggressive
treatment to hospice or palliative care. Generally, once these wishes are
expressed, a hospice consult is placed. It often takes time (sometimes up to a
day) for the hospice team to evaluate the individual. Unfortunately, facility staff
often wait until the evaluation is complete prior to initiating comfort
care protocols. This does not need to be the case. Staff can initiate comfort
protocols by reaching out to a practitioner to request orders. Many staff
either do not appear to realize that they can initiate this order set or are
too busy to do so. The bottom line is
that if the individual and/or family has consented to comfort measures and no
aggressive treatment, protocols can and should be implemented right then
and there. It often takes probing from an advocate or a family member to do so.
Another reason individuals do not receive comfort medication
at end of life is due to the practitioner being unaware of their discomfort.
With the overburdened medical system, practitioners often do not get to spend
ample time with their patients. They often only have a few minutes to round and
hence may be unaware of their patients’ pain, agitation, or restlessness. This
is where it can be helpful to have an advocate or loved one relay to a
practitioner the observation that the senior individual is in distress. Much
like a mother is attuned to her infant, often family members or others
intimately familiar with an individual’s behavior are the ones that pick up on
subtle cues of discomfort or distress. In the situation I described above, the family
of the restless individual stated the health care team appeared unaware of the
individual's discomfort. One of the family members was with the loved one for
hours on end, and she stated that his restlessness was very intermittent. With that being the case, the restlessness
could easily be overlooked by staff. In addition, facility staff are extremely
busy and may not take the additional time to communicate restlessness to
practitioners unless asked to do so by an advocate or loved one.
One final reason I see individuals at end of life not
receive adequate comfort medication is due to reluctance of staff to provide adequate
comfort medication. Many nurses are hesitant to administer reasonable amounts
of such medicine for fear of ‘hastening’ death or ‘euthanizing’ someone. I
generally do not see this with hospice or palliative care staff as they have
ample education on the importance of maintaining comfort in end of life and how
to do so. I instead see this with general facility staff who may not have the
training or experience in palliative/hospice care. Years ago I was sitting with
family in a hospital room of their loved one as he was passing. The individual
was clearly restless: pulling at his tubing and attempting to get out of bed. I
was concerned not only for the discomfort of the individual but also the toll
his discomfort was taking on family. No one should have to witness a loved one
near the end of life suffer if it’s possible for the suffering to be
alleviated. I asked the nurse if she
could administer more medication to relieve the individuals’ discomfort and she
replied that she didn’t have an order to do so. I kindly asked that nurse to communicate
to the attending MD that the medication provided was insufficient for this
individual and request a dose increase or another medication. She did so and
the individual ended up receiving the appropriate amount of medication needed
to pass away peacefully.
Conclusion:
The bottom line is that we all deserve to be comfortable at
the end of life. It often takes an advocate or loved one willing to speak up to
ensure that this gets done. Promoting comfort not only provides dignity and
peace to the dying individual but also priceless peace of mind to the loved
ones involved. I am a passionate, vocal advocate regarding the importance of
ensuring this for families and their loved ones. Any questions please do not
hesitate to contact me.
- To view the original version of this article visit www.carsoneldercare.com/
- Seniors Blue Book was not involved in the creation of this content.
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Carson Eldercare Consulting & Management
Geriatric Care Management Sewickley Heights, , Pennsylvania, 15143Are you feeling overwhelmed by the complexities and difficulties associated with aging? Have the responsibilities in caring for your loved one become unmanageable? Do you live far away and are unable to provide reliable senior care management? If you answered yes to any of the above questions, you may want to consider hiring an eldercare manager. Hi, my name is Laura. I have been a Registered Nurse (RN) for over 20 years and have witnessed firsthand the challenges and complications that aging presents. It affects not only the aging themselves but also their families and loved ones. Health care is complex, and in this increasingly fragmented and overburdened system, it can be extremely helpful to have a professional oversee all aspects of care. As your eldercare manager, I will comprehensively assess the needs of your loved one and we will work together in establishing a care plan. I will assist you and your family with difficult decisions and help promote healthy communication on issues that are often difficult to address and navigate. An expanded version of my core services are summarized below: MANAGE health care needs, chronic conditions, illnesses, and coordination of careOPTIMIZE health outcomes via my extensive knowledge and experience in the healthcare system. I provide necessary education on chronic diseases and treatment plans, promote collaboration and communication amongst the health care team, ask the right questions of health care personnel, and any other needed activities in order to promote the safety and wellness of my clientsNAVIGATE the complex health system ADVOCATE for individuals to receive high quality care. I do this by such actions as asking the right questions of health care personnel, requesting a referral, second opinion, or further resources when appropriate, and anticipating/ planning for future health care needsTRANSITION clients to appropriate living conditions and proper levels of care. This may be from out of a private home into independent or residential living. It can also entail transition to a skilled nursing facility, assisted living, long term acute care, and hospice. There are many factors and variables to be considered when making these changes, and I provide assistance and support. The above services represent the bulk of my client/family needs. Some other services provided are:Comprehensive health status assessmentAssistance with medication complianceAssessing safety of the home and providing measures to reduce falls Helping clients/ families make difficult health decisions while navigating familydynamics and promoting effective communicationBeing present with client during doctor appointments etc. to ask the rightquestions and help assimilate health informationVisiting and interacting with clients at hospitals and facilities to assess healthstatus, monitor progress, and assist with any needs upon discharge or transfer Contact me today for a free 20-minute consultation!
Carson Eldercare Consulting & Management
Elder Care Planning & Consulting Sewickley Heights, , Pennsylvania, 15143Are you feeling overwhelmed by the complexities and difficulties associated with aging? Have the responsibilities in caring for your loved one become unmanageable? Do you live far away and are unable to provide reliable senior care management? If you answered yes to any of the above questions, you may want to consider hiring an eldercare manager. Hi, my name is Laura. I have been a Registered Nurse (RN) for over 20 years and have witnessed firsthand the challenges and complications that aging presents. It affects not only the aging themselves but also their families and loved ones. Health care is complex, and in this increasingly fragmented and overburdened system, it can be extremely helpful to have a professional oversee all aspects of care. As your eldercare manager, I will comprehensively assess the needs of your loved one and we will work together in establishing a care plan. I will assist you and your family with difficult decisions and help promote healthy communication on issues that are often difficult to address and navigate. An expanded version of my core services are summarized below: MANAGE health care needs, chronic conditions, illnesses, and coordination of careOPTIMIZE health outcomes via my extensive knowledge and experience in the healthcare system. I provide necessary education on chronic diseases and treatment plans, promote collaboration and communication amongst the health care team, ask the right questions of health care personnel, and any other needed activities in order to promote the safety and wellness of my clientsNAVIGATE the complex health system ADVOCATE for individuals to receive high quality care. I do this by such actions as asking the right questions of health care personnel, requesting a referral, second opinion, or further resources when appropriate, and anticipating/ planning for future health care needsTRANSITION clients to appropriate living conditions and proper levels of care. This may be from out of a private home into independent or residential living. It can also entail transition to a skilled nursing facility, assisted living, long term acute care, and hospice. There are many factors and variables to be considered when making these changes, and I provide assistance and support. The above services represent the bulk of my client/family needs. Some other services provided are:Comprehensive health status assessmentAssistance with medication complianceAssessing safety of the home and providing measures to reduce falls Helping clients/ families make difficult health decisions while navigating familydynamics and promoting effective communicationBeing present with client during doctor appointments etc. to ask the rightquestions and help assimilate health informationVisiting and interacting with clients at hospitals and facilities to assess healthstatus, monitor progress, and assist with any needs upon discharge or transfer Contact me today for a free 20-minute consultation!