Elderly care

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Short/long term illnesses
Normal Emotional, Spiritual, and Mental Signs and Symptoms and your Appropriate Responses

The person may seem unresponsive, withdrawn, or in a comatose-like state. This indicates preparation for release, a detaching from surroundings and relationships, and a beginning of letting go. Since hearing remains all the way to the end, speak to your loved one in your normal tone of voice, identifying yourself by name when you speak, hold his or her hand, and say whatever you need to say that will help the person let go.

Saying Good-bye
When the person is ready to die and you feel that you are able to let go, then is the time to say good-bye. If you do not get a chance to do this, don't feel guilty.  The majority of people never get to do this.  If you do however have the opportunity, you may feel that it helps you achieve closure and makes the final release possible. It may be helpful to lay in bed and hold the person, or to take his or her hand and then say everything you need to say. If you don't feel that you can say goodbye, use phrases like:  "Dad, it's okay to let go when you are ready", "I will be fine and we are ready when you are" , "We will see you one day on the other side" "Mom is waiting for you, it's okay to go". It may be as simple as saying, I love you. It may include talking about favourite memories, places, and activities you shared.  It may also include saying, Thank you for...
Tears are a normal and natural part of saying good-bye. Tears do not need to be hidden from your loved one or apologized for. Tears express your love and help you to let go.

Limited Socialization
The person may only want to be with a very short period before they let you know that they need to rest.  They may even only want to see one particular person. This is a sign of preparation for release and will indicate from whom the support is most needed in order to make the appropriate transition. If you are not part of this inner circle at the end, it does not mean you are not loved or are unimportant. It means you have already fulfilled your task with your loved one, and it is the time for you to say Good-bye. If you are part of the final inner circle of support, the person needs your affirmation, support, and permission.

Giving Permission
Giving permission to your loved one to let go, without making him or her guilty for leaving or trying to keep him or her with you to meet your own needs, can be difficult. A dying person will normally try to hold on, even though it brings prolonged discomfort, in order to be sure those who are going to be left behind will be all right. Therefore, it is important to release the dying person from this worry and give him or her assurance that it is all right to let go whenever he is ready.

How Will You Know When Death Has Occurred?
Although you may be prepared for the death process, you may find that at the moment death occurs, that you feel that you are not prepared at all. In fact, most people feel a sense of shock and disbelief; some do not know how they feel at all and feel quite numb.  Some cry and some don't.

You will never know how you will respond until you are in the situation yourself.  Many people feel a surge of relief that suffering is over and then feel guilty that they have felt this way.  How you respond has nothing to do with how much you loved the person who has passed away. It may be helpful for you and your family to think about and discuss what you would do if you were the one present at the death moment. The death of a terminal patient is not an emergency. Nothing must be done immediately.

The signs of death include such things as no breathing, no heartbeat, release of bowel and bladder, no response, eyelids slightly open, pupils enlarged, eyes fixed on a certain spot, no blinking, jaw relaxed and mouth slightly open.

What to do immediately afterwards                                                

Our caregivers are all trained to assist and support you.  There is nothing to fear and you may be encouraged to sit with your loved one, hold his/her hand and say your final goodbyes. If a nurse or caregiver is not on duty at the time, and you are clients of ours, please feel free to call our nursing sister, if she is not able to come out, she will gladly talk you through what to do next as well as make arrangements for the funeral home to take care of your loved one.

Collection: The body does not have to be moved until you are ready. If the person dies in the middle of the night, you are quite welcome to wait until the morning to call the funeral home but all funeral homes are available to take your call and do collections 24 hours a day. Some families want time to sit quietly with the body, console each other, and maybe share memories. You could ask a member of your religious community or a spiritual counselor to come. If you have a list of people to notify, this is the time to call those who might want to come and see the body before it is moved.                                                                                                                                               

The doctor: It is a good idea to inform your doctor when the person has died as some doctors still prefer to come out to the home and certify the death.  This does not happen very often nowadays, especially if the patient is under the care of hospice or a nursing agency who will notify the doctor. The police do not need to be called.  Dignity after death: If our caregiver is on duty, she will make sure that your loved one is clean and dressed.  If the family wants to assist the caregiver in preparing the body by bathing or dressing, they will be most welcome.                                                                                                               

Soiling: It is common for a person, who has died, and who still has contents in their bowel and/or bladder, to soil themselves slightly.  If we are present, we will take care of this.  Our caregivers will treat the deceased person with just as much care, gentleness and dignity as when they were alive.                                                                                                                                        

Covering the face:  If a person dies at home, we recommend that the sheet be pulled up to the chest level and for the face to be left uncovered.  It can be very scary for a loved one to arrive and have to pull the sheet off their beloveds face. It is better to be left with a final memory of a person who appeared to be sleeping when you said your final goodbye.
Please note that some hospitals or Frail care facilities do cover the deceased persons face.                                                                                                                                      

Positioning: The person must be placed as flat as possible with their arms straight along their sides or may even be crossed hands over their lap.  It is fine for their head to rest on one pillow.                                            
Eyes:  You may notice that the eyes remain slightly open. This often frightens people but it is quite normal.  As the muscles in the face relax, the eyelids cannot be controlled and open naturally.  Take a warm cloth and gently push the eyelids closed, holding them in place for a minute. Closing the eyes quickly with a gentle wave does not happen as it does in the movies! 
Jaw:  As the muscles all over the body are now completely relaxed, the deceased persons jaw will often hang open. It is common for some hospitals or nursing homes to place a bandage around the jaw.  We prefer to rather place a pillow under the jaw with slight upwards pressure for a few minutes. 
Don't worry if you cannot get the jaw to close.  
Jewellery and valuables: All jewellery and valuables must be removed. Our staff will ask a witness to be present when removing and handing over the jewellery to a family member.  The witness will have to sign that the jewellery has been handed over as well as record a description of each item.                                                                                                   

Dentures:  If your loved one has dentures in place, leave them in. If the dentures are out of the mouth and you are hoping to have a viewing at a later stage at the funeral home or an open coffin at the funeral, place them in a packet with a name tag recording the name of the deceased and hand them to the funeral representative when they collect the body.  Record on the page they ask you to fill out that the dentures have been handed over and who they were handed to.                                                                                                                      

Catheters, Stoma bags or IV tubes: If they have a catheter or stoma bag or IV in place, leave these in place.  There are qualified people at the funeral home that will take care of all of this gently and respectfully


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When to make the call to have your loved one collected                                               

The funeral home only needs to be called when you are ready to have the body moved. It usually takes about 30-60 minutes for them to arrive, depending on your location and traffic.  When they do arrive, feel free to ask them to wait a little if you wish to hold your loved one for the last time or say your final goodbye.

I always feel that when the members of the funeral home arrive, and prepare and transfer the person on onto the stretcher, that you should leave them in privacy to complete their task. Rather leave the room until they remove the deceased from the house.  This can often be quite a traumatic moment for the family, particularly young children, watching their loved one being wheeled out the house. Once they have placed the person safely in the car, they will come back inside to inform you that they are ready to depart.  I encourage the family members to go out and watch the car drive away.  As sad as this is, it is also a valuable part of saying goodbye and letting go.                                                    

If one of our team is present at this time, she will not leave until the room is tidy and the linen has been changed.

When the funeral home representatives arrive, they will ask you for a copy of your ID document (next of kin) and the ID document for the deceased. This is needed for the registration of the death.  If you do handover the actual ID book, this will be returned to you but it is needed for home affairs.                                                                                                  

They will give you a simple form to fill out which will ask for details of the doctor and the deceased as well as any religious preferences or customs.  They will even ask if you wish to have the person buried or cremated.  If you are not sure about this yet, indicate that you are not sure.  This is not important right away. 
If your loved one has a pacemaker, it is vitally important for you to give this information to the undertaker collecting your loved one.

The funeral home will tell you that they will call the next day and will guide you through the next few steps as well as advice about arranging the funeral. They will most often ask you to go through to their offices.  Part of their services can include collection of the death certificate from the doctor and registering the death at the department of home affairs. There will be a small charge for this and the service is optional but by opting for this service, you can save you a lot of time running around and waiting in queues. If you as the spouse are elderly or cannot make the trip to the funeral home, enquire if they can come to you.

It is good idea to ask a friend or a family member to do some homework on your behalf and phone various funeral companies in your area and get some idea of the costs involved, even before the person has died.  You will notice a huge difference in the rates for similar packages offered by different companies.
I personally recommend Bell Funerals, a local Durban company. They have provided so many of our own clients with an exceptional, well-priced door to door service over the past few years and offer a huge amount of compassion and understanding too.

My Final words

The death of someone precious to you is a terribly difficult process to work through - no matter how much we know we will never be completely prepared when the time comes. 

My best advice is to keep your support system close; use those around you and work together.  No soldier has fought a war and won without an army at his side.

I sincerely hope that all the information I have put together has in some way been of help to you and your family.

Sr Wendy MacNicol