Aging can be a difficult process to accept. Many older adults associate illness with loss of independence or becoming a burden on loved ones. This may be why they don’t always tell you how they’re really feeling.
It may be up to you to recognize the signs of declining health and the need for a different type of care. Understanding potential signs that the end may be near helps reduce anxiety and allows you to honor your aging loved ones' wishes.
Many families wait to call hospice until the final days and weeks of their loved one’s life. However, if the patient is eligible, they can receive specialized care, medications, medical equipment and supplies related to the terminal illness months earlier.
How do you know when it’s time for hospice?
Here are a few signs that it may be time to consider hospice for your aging parent or loved one:
1. Treatment is no longer working and/or they no longer desire aggressive intervention.
If your aging parents or loved one has a terminal illness and their goals include comfort, time with loved ones and improved quality of life, hospice care may be the answer. Hospice care focuses on pain relief and symptom management rather than curing the illness.
Hospice care can begin when a doctor decides the patient’s life expectancy is six months or less if the illness follows its usual path. The doctor can recertify the patient for longer periods if your loved one lives beyond six months. Hospice care is covered by Medicare, Medicaid and most private insurance providers for eligible patients.
Some of the most common illnesses in hospice care are:
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Cancer
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Heart disease
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Lung disease
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Alzheimer’s disease and other forms of dementia
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Stroke
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Liver disease
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Kidney failure
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ALS (amyotrophic lateral sclerosis)
2. Their symptoms are getting harder to manage.
Research shows pain increases in the last two years of life, becoming most intense in the last four months. Uncontrolled pain can lead to other issues, including shortness of breath, restlessness and anxiety. It can also prolong the grieving process for loved ones. If you notice an increase in pain or other difficult symptoms such as nausea, vomiting, trouble swallowing or pressure ulcers that don’t improve with treatment, hospice care may help.
3. They’re visiting the doctor or hospital more often.
Use of the emergency department typically increases as people age, particularly among older adults over 75. Multiple doctor or hospital visits in the last six months can be an important sign of declining health.
Your aging parents or loved one may no longer be able to do personal care activities as they once had, such as bathing, getting dressed or eating. (Activities of Daily Living) Or perhaps they were once able to move about independently and now they are using a wheelchair or walker. If they’re not feeling well most of the time or they stopped doing things they used to do, these are signs they may benefit from hospice services.
5. They often seem confused or restless.
Older adults at the end of life may feel confused or agitated, even combative at times. They may not know where they are or what’s happening around them. Some people perceive things that aren’t there (hallucinations) or have false beliefs (delusions) that they are much stronger than they are or that people are trying to harm them.
6. They’re less able to communicate.
Decreased circulation, hearing and vision problems, and other issues may affect your aging parents’ speech and ability to follow conversations. As a result, they may start to withdraw from activities and people they love.
7. They don’t have much appetite or are losing weight for no apparent reason.
Check the refrigerator and observe their eating habits to see what they’re eating and how much. Reduced appetite and unexplained weight loss can be signs the body is slowing down or isn’t digesting food properly. For example, someone who has been on tube feedings for years may now complain of stomach upset. Or perhaps they aren’t eating much, or they don’t feel hungry but still try to force themselves to eat.
8. They sleep much of the time.
As part of the body’s process of slowing down, those at the end of life may spend more time sleeping. You may notice that they rest in a chair or bed most of the day.
9. They have multiple recurrent infections.
Progression of disease is often displayed by worsening symptoms and recurrent infections such as pneumonia, sepsis or urinary tract infections. You may notice that infections appear more frequently.
10. You’re feeling stressed and overwhelmed as a caregiver.
Your stress levels escalate as your aging parents or loved one needs more help. It is an act of love to admit you need caregiver support and use all the resources available to you to provide the best care for your parents.
How Hospice Care Helps
When people wait to get hospice care until their final days and weeks, they miss out on the full benefit of hospice services. Hospice care helps with end-of-life care by providing:
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24/7 on-call medical director and nurses available to meet patients in their home
(We provide services in private residences, skilling nursing facilities, assisted living facilities and the Trillium House)
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Medical equipment and supplies
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Symptom management
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Spiritual support with a chaplain
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Assistance with daily living activities like bathing from a hospice aide, which allows family members to focus on quality time with their loved one
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Emotional support and community resources from a social worker
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Help with household tasks from hospice volunteers
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Bereavement counseling to help loved ones process grief
How to Start the Hospice Conversation
Understand the options. Learn as much as you can about end-of-life care options such as hospice so that you can answer questions and offer reassurance to your aging parents or loved one.
Start talking early on. Talk to your aging parents about their preferences for end-of-life care, ideally before their health is failing.
Offer a listening ear. It can take time to understand the benefits of hospice care. Listen to your aging parents’ or loved ones concerns and empathize with the difficult decisions they are facing.
Ask to attend a doctor’s appointment. If your parent or loved one agrees to have you join them at the appointment, share your concerns with their doctor and ask to have a conversation about hospice.