Quality Home Health Care

Elderly Loved Ones With Terminal Illness, Connect With Their Spirituality

Working in Home Health Care, we work with people in their late eighties and nineties. We assist them and their families to be safe and cared for. A significant number of clients have advance stages of terminal diseases. Death is the final stage of their journey. As  a society, we have difficulty in dealing with people and those who are our loved ones as their life on earth dwindles.

At some point we will all die. We live with this knowledge and usually avoid it. When we are going through the last phases of an illness with a parent or other aging adult in our life we are facing their mortality and our own. It is a difficult time, usually made more difficult by not knowing what to do or say. The hired caregiver/aide helps with the most personal physical needs and may be the ones who are around during the quiet times. They have experience with seeing someone out of this world. Few if any of us want to die alone. Hospice, Palliative, Home Care and Hospital care are what we will most likely experience.

Perhaps staff, usually the Nurse, is trained about these things, family members usually are not. Here are some “starting point” tips of how to get through, care for yourself and be of true support to a loved one who is in the dying process.

Beyond being comfortable, cared for, safe and pain free; all of which the “skilled” staff will oversee,  it is usually the “civilian” family member who must learn rather quickly how to act, what to say and how to get through this painful period.

First comes a recognition that your loved one (or yourself) is in fact dying – symptoms are worse, treatments aren’t working, energy is gone.  It is important to have hope and it is also important to face the reality of the situation.  A person can go on for many months being fatally ill – what do we say to them and how do we interact? Do they know they are dying? At some point, on an intuitive level, a person and loved one  knows  they are not improving and that in fact death is approaching. This realization itself can have a cathartic release. There can be an emotional shift from fighting the disease to giving meaning to the remaining time. There is no right or wrong way to begin the grief process, only your own personal way. There is still time for new memories and possibly even nobility in how you handle this stage.

Emotions will be very strong and may be fleeting or coming in waves, singularly or in combinations. There may fear, anger, sadness,  denial, a sense of urgency, a sense of relief and acceptance. It is critically important that the person dying and their loved ones have someone to share their feelings with and to cry and laugh with.

Doctors and hospital staff differ – some may make it more difficult and others may be more helpful. Few doctors will give specifics but you and the patient have the right and need to know some general things so that your mind can focus on what to expect or do. Ask their professional opinion as to a timeline – best and worst case scenarios. What is the progression of the disease like and the last weeks or days? Not everyone will benefit from this information. Ideally, someone of influence in the family whose personality is to get the information and work with it, may be the best person to get the overall medical perspective.

Begin focusing on priorities. What do you need to get done? Put in order? Indulge your fantasy with and so forth. When you figure out what is most important to you or your loved one, the other things will become more trivial and take less of your attention and energy. Some of the first things are the mundane – putting things in order – wills, directives, some good-byes,  Besides the “business” of dying, there is the emotional side of all of your meaningful relationships. Erickson named this final stage – Integrity vs. Despair. We all need to find meaning in what our life meant – to ourselves, to family and to the world. What did we overcome and what did we shy away from? Speak to each other, share your feelings, positive and negative. If you are dying, you have certain liberties to do away with pretense – do what matters most to you or your loved one.

With what can almost be a “planned” death, there is opportunity to indulge the spirituality of life and death.  Try doing a Spiritual Evaluation of your life and relationships. We so often ignore or are unaware of our spiritual selves. Most everything else will be taken care of by someone else: doctor, lawyer, clergy, family, friends etc. Your spirituality is yours. Ask yourself or your parent some of the following questions to begin the first of many conversations – the sort of “stranger on a train” or “drunk in the bar at 2:00 a.m. type of things:

Ask “Who have I/you been?

What do I need to finish or release so that I can be more at peace?

What am I proud of, grateful for?

How do I want to be remembered?

What have I learned in this life that I want to teach to someone else?

What are my regrets? What could I have done with more grace? Can I still do it?

There can be something almost liberating to have an idea of when you will pass on, use it! Let yourself be comforted or to comfort the person you will be using. Speak of serious things – they are on your mind and likely on others. If not, then you can say “no” or your loved one will. Sometimes receiving the “permission” to speak about serious, meaningful things will allow these subject to flow.

Learn or discuss with your loved one, their thoughts on the afterlife, their religious beliefs and how their spirituality helps with their current condition and the transition of their spirit.

No doubt these are difficult conversations through a very serious situation. Reality at the end of life forces one to react – either by shutting down  or showing amazing grace. Your understanding, acceptance and courage to share this journey with your loved one has the power to transform you both.

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DNR Orders – What You Need to Know About “Do Not Resuscitate”

At a hospital admission they will ask if you have a DNR order – Do Not resuscitate? It is an important question as it answers one of your end of life, medical emergency questions. Have you thought about your wishes? Have you made them known through a DNR order? Learn more about it.


If you are rendered unconscious and the Paramedic is in your home, would they know or would there be someone there to tell them that you have a Do Not Resuscitate Order? If you are in the hospital emergency room, would anyone there know your wishes? Your doctor, a family member, your lawyer? If your wish is to NOT be resuscitated, you do NOT want your heart to be Restarted, then you must make it legally known and easily accessible. You must have a copy of your DNR visible to  Emergency or Ambulance personnel and with you at the hospital, to be put on your chart.

If you are in a hospital, nursing home, have home care, in a rehab facility or in hospice care and there isn’t a copy of your DNR, then staff is required to perform lifesaving measures, CPR and so forth – whether this is what you want or not. If you stop breathing, like on television, the crash cart will come to your bedside and medical procedures will continue.

Once in the hospital following a surgery, a monitor just kept beeping, it was the middle of the night and i recall thinking, I must be crashing, why aren’t the nurses rushing in? It turned out the magnesium drip was finished. I told the RN what I had been thinking and she said “if you were crashing, you’d be unconscious”. Oh gee, I didn’t know that, I’m not a medically trained person. I know medical things from Television — I know very little and part of that is probably wrong. The heavy chest compressions needed in CPR can cause  broken ribs, heart damage or a punctured lung in the elderly. If not done quickly and correctly, your heart may come back, but not all of your brain capacity as it may cause brain damage.

Beyond CPR, EMT workers or hospital staff may need to uses breathing tubes- in-tubate the patient, electrical shocks (the paddles) to bring the heart back into its rhythm, start many IV lines to deliver fluids and medications, if you are unconscious they can go ahead and connect you to life support machines – family may not be notified till afterwards. This happens daily around the country. It can happen to you.

The outcomes aren’t very good in the elderly who undergo these life saving measures. The statistics show low survival rates for the elderly who have multiple medical conditions or morbidities. This begs the question of ourselves and society wide – is it worth it – the efforts and costs for these extraordinary measures if the positive outcomes are so low and the patient will still be ill.

Only a doctor can sign DNR orders, also known as “No Code” orders in hospitals. If at time of admission you or your family member is not asked about their preference to be resuscitated or not, then you must ask your doctor. Speak to the nurse, the social worker, get to the doctor and get the order written if your wish is to be let go and not be resuscitated.

In other long term care settings, DNRs are part of the admissions process. If you wish to have a DNR order, have your doctor sign one and include it with your admissions paperwork. Have a family member also have a copy.

Once you are already thinking about a DNR order, consider the other end of life or serious medical decisions which may be needed to be made, but you may not be conscious to do so. Anyhow, it has to be made into a legal document. Whether it is a PIC form (Preferred Intensity of Care) or an Advanced Medical Directive, you must have it drawn up, completed and signed. There are several choices of just how much lifesaving procedures you want, or dont’ want, including durations of time before you wish to be let go. Who have you designated as your Medical Surrogate or has Medical Power of Attorney for you?

These are serious and unpleasant things to think about but so are having your wishes for medical care and end of life wishes honored, respected and fulfilled. It is also a kind consideration to put these CHOICES down on paper, made into legal documents for your loved ones. It will prevent anyone having to make these heartwrenching decisions for you, it will mitigate feelings of guilt as well.

So, if you do not want to be resuscitated then you must follow through and get these legal matters taken care of. Speak to your doctor, get it on record, get copies of your DNR and Medical Directives to your trusted family members and into your medical chart. If you live alone, or have a caregiver, you may want to put them in and envelope MARKED DNR or EMT Paramedic and place it on the refrigerator or near the front door so that it can be seen, followed and brought with you to the hospital.








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Home Care or Communal Living – How to Know What is Best?

This is a difficult decision to make. Boca Home Care Services offers some suggestions and recommendation on how to make this decision with a loved one or for a spouse or parent. Best to look at what is best for the person and the primary caregiver. What can be gained, what is lost and how to strike a balance in your aging loved one’s favor.

Since most people prefer to remain in their own homes, this is usually the goal. If it is truly the best place for an elderly parent or spouse to be, then help is brought in to assist with personal care and/or household help – as needed. Safety and Care ought to be the guiding principles.

A plan can be put together to have a caregiver come into the home. A schedule worked out between family, friends and a hired aide.

If your elderly family member lives alone, is lonely, depressed, can’t really manage alone, needs more attention, help with medication and really a lot more supervision than hourly help, then a move to congregate living may actually be the best thing if live in care isn’t feasible.

Incontinence is usually the straw that changes the situation for family. It becomes more physically and emotionally draining for the family caregiver. Certainly if live in care is not an option but the level of need is that of someone requiring supervision, then it is time to look at and find a suitable living facility.

Any move to an Independent facility ought to have an Assisted side as well. Important to look down the road a bit. Nursing home care is for someone who needs 24 hour nursing care for either a physical problem or Alzheimer’s Dementia – at an advanced stage.

Group homes are a very nice alternative to be considered as it is an actual home with about 6-8 residents.

There are many professionals who can help with your assessment and search. A Geriatric Care Manager is one. A Pllacement professional is another.

First discern if it is best to stay at home and realistic with regard to costs and availability of help.

If the decision is to leave the home, is it more sensible to move closer to family or remain in the area currently lived in?  I always ask (here in Florida) is there a compelling reason to remain in Florida?  Weather is not a compelling reason.

Once the decision is made to make a move or it is clear that such a move will need to be made within the year, then start looking at places. Level of care is based on need. If need is for Dementia or Alzheimer’s care, then a dementia specific facility is most desirable.

Decide what area to look in and then set a few appointments. You don’t need to make a “sneak visit” the first time. You’ll want a tour, and time to ask questions.

How do you know? Trust your gut. It is like any other house or home hunting really. You want to see if it has a pleasant energy to the place, any smells, how the residents look and how they may interact with one another. If you have a visceral dislike of the place, cross it off your list.  Find out what staff ratios are, activities, what staff is on and at which shifts, medical supervision, field trips out to restaturants, events and shopping?

Once you’ve narrowed down the place or actually picked it, visit at different times of day, speak with residents, visit on weekends and speak with other family members if they are there. Then figure out the finances of what is possible, what to bring to the facility to make it homey and the basic details of a move. Plan to visit regularly at the beginning so your loved one isn’t “abandoned” and so that the facility sees an involved family.

If possible, do a trial move in – for at least a month. Don’t sell the apt. or home just yet in case it doesn’t work out.

Do your research,  hire a professional, trust your gut and move forward. If staying at home is the right choice, or for as long as possible, then hiring an aide is a solution. If moving to a more social environment or one that meets your health and safety needs, then that is more sensible. Either way, planning is crucial and should start a year or so in advance, if possible.  It is a family decision so include the primary family members.

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After a Family Loss – Still Much To Do

Boca Home Care Services with our sister Medicare certifies agency, Boca Home Care, are able to take care of you or an aging parent both medically and assist in keeping you safe in your own home. In working with such an elderly population – folks in their 80s, 90s and even up to 104 (thus far), we also want to help families after a loss of their loved one.  Many of our clients live out of state so coordinating and managing the tasks after the funeral is also important to us. We work with a unique company, Family Transition Services and wish to inform you of their services.


A Social Work Based Home Care Company


Death is a scary and perhaps to some, an unseemly topic. Who among us is not going to die? Thought so. After all, in a way, life is a dead end. Even working in the Geriatric field, it isn’t often discussed, outside of Hospice care. We recommend Hospice care to anyone who is facing the end stage of their life. It may be the most humane, dignified approach we have to suffering and death. It is also covered by Medicare. There are three excellent Hospices in the  Broward and Palm Beach county areas: Hospice by the Sea, VITAS and Hospice of Palm Beach County.

As our Blog often urges, plan ahead. Do you and your loved ones have their Medical Directives & Surrogates in place? Burial plans? Arrangements for out of state issues? The time to do so is NOW.

A new company whose owner, Arnie Brownstein, is very familiar to us, is Family Transition Services. He and his team will help a family deal with the concrete things which need to be done following a family member’s death.  This is a most difficult time to have to deal with mundane bureaucratic things when you are mourning and in grief. The tasks are all the more difficult if you live out of Florida.

Some of their services include: emptying out belongings, closing accounts, real estate sales,  the legal and financial paperwork, guarding against identity theft, discontinuing of services and more.

You and family may wish to do all this yourselves. It may even be helpful to you. If not, you may wish to call for a consult.  As a Social Work based home care company, we continue to care about our client families and want you to know about this service which is new to South Florida.  

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A Brief Overview of Pancreatic Cancer


Learn a very basic overview about Pancreatic Cancer. Its possible causes, symptoms, and treatments. The word “Cancer”  still causes fear. Medical science has come a long way. Many cancers are treatable or manageable much longer than even 10-15 years ago. Still, Pancreatic Cancer is usually a killer in the end. Remember, we all can take better care of ourselves, learn about ways to help our bodies stay healthier, plan for care and options should illness strike and get the care we need when we need it. Boca Home Care Services is here to help you and your family.


Sometimes at Boca Home Care Services certain medical diagnoses seem to come in clusters.  It can be a few Hip Fractures in a row and often it is a stream of Alzheimer’s Disease. Lately we’ve noticed more than a few calls from people have Pancreatic Cancer.  We get involved at a mid to later stage when the person is weaker and consequently in need of more care in their home.  Often too we refer the client’s family to our three area Hospices so that they can acquaint themselves with the numerous services they provide and are covered by Medicare. In such instances, we dovetail our services with Hospice and supplement shifts with caregivers.  Thankfully it is not too prevalent a Cancer but I realized I didn’t know very much about it, other than it affects the Pancreas. So, let’s learn a little about Pancreatic Cancer together.


Behind the Stomach lies the Pancreas. A spongy, six inch long, fishlike organ spread across the back of the abdomen. It has glands (endocrine & exocrine) which create insulin, hormones and enzymes (pancreatic juices). These help digest fat, carbohydrates and proteins.  Some of the hormones released manage sugar levels in our blood. Diabetes can result when they are not working the way they should.


Pancreatic Cancer happens when cells in the Pancreas begin to grow uncontrollably.  These abnormal cells continue dividing and form masses or lumps in the tissue. These are commonly known as tumors. Over time, the tumors interfere with the normal function of the pancreas. Unfortunately, Pancreatic Cancer is often diagnosed at a later stage in its growth and therefore mortality rates after 5 years are high. The more common type of this disease affects the exocrine functions. Tumors affecting the endocrine function are far less common.


Like other Cancers, the cells grow out of control and do not follow the normal arc of cell life and death. We don’t know why the cells continue to grow and divide but scientists have identified some risk factors: damaged or mutations in the DNA, Genetic predisposition inherited in families, carcinogens (pesticides, dyes or chemicals) which damage the DNA and allow the cancer to grow, aging  can increase the  cancer causing changes in our DNA.


Pancreatic cancers occur more often in men and smoking increases one’s chances to get this disease. Diet and exercise matter with pancreatic cancer, like with overall health. A diet with fruits and vegetables, less red meat and fat is recommended. Long term heavy drinking can lead to chronic pancreatitis which is a known risk factor for the development of pancreatic cancer.


Pancreatic cancer is referred to as a “silent disease” because early symptoms rarely show up. Tumors in the pancreas are usually too small to cause symptoms. Once it grows you may experience:


*Pain in upper abdomen as the tumor presses on nerves.


*A yellowing of your skin and eyes, darkening of urine (jaundice).


*Loss of appetite, vomiting or nausea


*Significant loss of weight and increased weakness


*Pale or gray colored stool


As you can tell, these symptoms can be caused by many different things which contribute to the difficulty of diagnosis until the tumors have advanced. Doctors will most likely order many blood tests, urine and stool samples and a battery of imaging test like ultrasound, Angiograms, MRI, PETs and a biopsy of the tumor itself.


As with other cancers, there are stages of pancreatic cancer.  Identifying the stage is important in choosing treatment options. There are 4 stages


Treatment Options:


Cancer treatment options depend on the type and stage of the cancer or tumor and how much it may have spread to other organs, age, overall health and other characteristics of the patient. It is most likely a combined treatment approach but often curable if detected in the earliest stages and treated. Options include Surgery, Chemotherapy, Radiation and medications. Today, positive outcomes are increasing for pancreatic cancer survivors. 


Each person must take responsibility for their overall health. Eat better, smoke and drink less, or quit entirely, exercise more, have regular checkups as per your doctor’s recommendation. In short, increase your odds of staying healthier longer. Each person must also take responsibility for their treatment and care to the extent possible.


 Any major disease is a personal, family and medical matter to a large extent. Get educated get support to stay positive and physically stronger. Treatment itself is likely to be difficult and draining so you can’t go it alone no matter how independent you are. Family and friends most probably want to help. Their availability may be limited so some extra planning is in order which may include hired home health care and investigating Hospice care in the latter stages. Most important is to speak to your oncologist and primary physician and together create a plan to activate and follow.

Read more: www.medicalnewstoday.com


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