Hospice has been a big part of end of life care since 1970. It is an essential comfort giving service to the dying. It allows the terminally ill to receive the pain management and comfort they need in their final days. Many unfortunately never utilize this service and instead suffer more than they need to in the final days.
Hospice has always been about improving care and comfort for the dying. In the article, “Hospice: Improving Care at the End of Life”, the author, Mary Kane, answers some basic hospice questions and why it so critical to better care at end of life. She states,
“When hospice first started to take off, there was a lot of enthusiasm and a sense you were rescuing a person from the clutches of a medical care system gone mad. That has eroded. Hospice has become both a business, in the sense people are making a lot of money on it, and it’s become routine. Now just about half of Medicare recipients use hospice before they die.”
Hospice is growing and it is being seen more important everyday, but many still need to understand its importance in their own end of life care. To learn more about thanatology and the needs of the dying, please review our Pastoral Thanatology program
Palliative care helps individuals face life threatening illnesses with compassion and care. Hospice helps those who are terminal. Both can give the comforts of home during an illness or near death. Is dying at home overrated or is it truly better?
The article, “Is Dying at Home Overrated?” by Jon Han looks at this question in detail. He states,
“It is emotionally and intellectually compelling that patients should die in their own homes, surrounded by loved ones in a comfortable, familiar environment. For patients dying of end-stage disease, be it cancer, heart disease or something else, even the best hospitals are unlikely to be able to “fix” the underlying problem.”
Dying at home has many benefits if possible. It can give the emotional and spiritual needs a person needs. Please review our Pastoral Thanatology Program and see if it meets your educational and professional needs.
As a counselor who deals with death and dying, it is important to have a strong grasp of different cultures and their views of death. Pastoral Counselors and chaplains come across many different views on death not only within main stream creeds but also other religions not as common in the United States.
The article, “Living with dying: Different cultures treat death in different ways” by Rev. Matthew von Behrens discusses how chaplains need to be aware of the differences of the people they come into contact with. He briefly describes a few different cultures on their views of death. The article states,
“Experiencing differences in how various cultures view the end of life can help us understand our own traditions better, as well as develop a greater appreciation and respect for others. Here are three traditions I have encountered in my work as a chaplain at the UVMHN’s Porter Hospital and Helen Porter Rehabilitation and Nursing and practices within them”
Pastoral Thanatology is the study of pastoral care of the dying. It is a study but also a active ministry dedicated to the dying and applying the principles of care. Pastoral Thanatology deals with not only understanding the process of death but also helping individuals and families face death.
While it is a difficult reality to accept, one must eventually accept death. Death visits many people in different forms throughout their lives. Many experience death at a young age through the loss of a pet. Others may experience death all to commonly but the the reality that death occurs will manifest in one’s life. Those who seek to deny this and live in a world where death has no power are the most profoundly wounded when death strikes.
It is important to have a healthy respect for death. One does not need to have a morbid obsession with it but a healthy respect. A respect for the reality of death means one is not fearful to discuss it. One should not fear to discuss the death of oneself in the future or the death of a loved one. Many fear these discussions of death but by postponing these discussions they only make death worst when it does arrive.
Those who fear death are not prepared for death. Their Will is not in order, nor their future wishes. This leaves families without guidance after death. Others who refuse to discuss death with dying family members miss out on close and personal good byes that may not be able be said on the eve of death. Discussion of death is critical to a prepared death. One cannot allow a morbid fear of death and dying to complicate future issues.
It is hence important to understand the reality of death. It is important to know that when death is on the horizon not to dismiss it but to prepare for it. Many look to hospice to find relief. Some see hospice as a death sentence and refuse to utilize its services. This fear of death prevents important care to minimize pain and discomfort. Hospice is about quality of life. It looks care for terminal cases with 6 months or less to live. This does not mean one surrenders to death or gives up on life but instead one realistically is trying to limit symptoms. Shortness of breath, intense pain and other symptoms can be successfully dealt with by a hospice team. (1)
One can still have a medical team dedicated to treating the disease or looking to treat the disease itself but hospice will attempt to make the time more comforting. This is far from surrender but a realistic but also optimistic approach. Why should one live in discomfort? Instead minimize the symptoms of death and terminal disease while still looking for a cure. This is the proper mindset one should have in regards to the utilization of hospice.
A more acute form of care is Palliative Care. Palliative Care does not necessarily deal with oncoming and approaching death but is a special care unit designed to treat symptoms associated with a particular type of disease. They work with the primary caregivers and other healthcare team members in helping the person deal with the ongoing illness. Many units deal with cancer and other dangerous diseases. While both Palliative Care and Hospice deal with symptoms they do differ. Hospice deals with the dying while Palliative Care deals with those who are dealing with an onset of a disease that could possibly kill. (2)
Pastoral Caregivers, ministers, family and other care givers need to understand the phases of death. They need to recognize the reality of death and discuss it with individuals who are dying or with family members who are losing individuals to death. The care and counsel of a minister or caregiver certified and trained in Pastoral Thanaotology is important. The training helps ministers and family help the dying face death from an emotional and spiritual aspect.
The training in death and dying from a theological and philosophical standpoint help the counselor or minister better able to explain death and suffering from multiple cultural, social and religious views. They become equipped to answer questions and help emotionally guide the dying through death. With the combined understanding of the physiology of death, with this philosophical and theological training, a minister or caregiver can confidently help the dying and family.
Doctors, nurses and other primary caregivers should also be trained in Pastoral Thanatology. They need to be able to help their patient beyond just the physical but also treat them in mind and body. Many healthcare professionals lack a good bedside manner. This is unfortunate. With training in Pastoral Thanatology, healthcare providers can become better equipped in the care of the dying.
Elizabeth Kubler Ross was a pioneer in the care of the dying. Her study on the stages of death provided psychological chart for ministers and care givers in understanding the mindset of the dying. While this model is still useful, one must understand that reaction to death, or grief is not always ordered but these various emotions may come in any order. The classic stages include, denial, anger, bargaining, despair and acceptance. One can include many other emotions in the acceptance of death but these are the primary stages. (3)
Again it is imperative to emphasize that many individuals face these stages in various orders and not neatly put together steps. Some may even revert back to previous stages. So one certified in Pastoral Thanatology or ministers to the dying need to acknowledge that different patients react differently to death and need their own unique care.
Ultimately, death must be accepted. How we accept it, how we discuss it and how we deal with it throughout our life will determine our life. We need to be prepared for death and have a healthy acceptance for it.
The American Institute of Health Care Professionals and the American Academy of Grief Counseling acknowledges the need for good care to the dying and the families. AIHCP offers a certification for qualified professionals and clergy to be better equipped to help patients face death.
The program is online and independent study. Students can complete the required courses and then proceed to earn a four year certification in Pastoral Thanatology. The certification helps prepare ministers and other care givers the necessary training in Pastoral Thanatology. If you would like to learn more about care of the dying then please review our Pastoral Thanatology Program and see if it meets your academic and professional goals.
One of the greatest burdens is to receive a bad medical diagnosis. Some may be terrifying and involve a chance of death while other cases are terminal pronouncements. These challenges involve first digesting the terrifying diagnosis. This alone is a challenge and can cause time to adjust to the challenge ahead. Whether its a long road to recovery or potential death, one must eventually overcome the initial shock wave of grief and denial and move forward.
The article, “The Importance of Grief and Acceptance After a Diagnosis” by Jori Hamilton states,
“Many people, after learning any type of serious diagnosis go through different stages of grief. Grief doesn’t just apply to death, it applies to other types of loss as well.”
Please also review our Grief Counseling Program as well as our Pastoral Thanatology program. Both programs can help professionals with the training they need to help others through the process of grief and death.
There is much to learn about life from the elderly. In their dying days they can also teach us how to reflect on life and live it to the fullest. In many ways we can help them and they can help teach us. In Pastoral Care, those who help the dying can help and learn.
The article, “Lessons on Living From My 106-Year-Old Aunt Doris” by Barry Eisenberg discusses how much we can learn in our care of the elderly. She states,
“I have been involved in health care for my entire professional life, as a hospital executive, consultant and professor of health care management. But the time spent with my aunt at the end of her life taught me more about living and dying than all my experience had prepared me for.”
A discussion about cancer is everyone’s greatest fear. Noone wishes to face the reality of death and its possibility. Cancer brings that. In the case of a loved one, discussing what could happen is even more painful. It is important to learn how to talk to our loved ones about cancer or the great “what if”. It is important to have that conversation without losing hope.
The article, “How to Talk to a Loved One Dying From Cancer” by John Edwards states,
On the other hand, avoiding talking about death can create unnecessary tension, irritation, and that can detach you from having some memorable moments with the people you care about. And it will only elevate the sense of loneliness, excessive fear, and sadness for both of you.
Grief and loss are difficult themes. It is hard for the individual to overcome basic loss, but complications can even make grief more difficult. One time of grief is ambiguous grief, or the type of grief that is lost in between, or the grey areas of loss.
The classic example of someone who is dying slowly is an example of ambiguous grief. The family is left with the long awaited death, but still try to keep hope. The family sees the person suffer, with some hoping for the suffering to end, with others sometimes unknowingly selfishly cannot let go.
The purgatory of ambiguous grief can later lead to other complications. Some may feel guilty over the death of a loved one for having caregiver fatigue, while others may feel guilty they wished the person would finally die to find peace.
Complicated grief can emerge from many of these scenarios later in the grieving process. For some though, ambiguous grief is just a period of conflicting emotions where one finds joy then sadness with also hope and despair.
While dealing with long term illness of a family member, family members need to just be free to feel. They should not feel guilty or resentful, but respect the process, cherish the time left, and allow the grieving process to continue. In fact, such long term deaths, prepare many for the death of the a loved, and while the loss is still impactful, it is not sudden. The grief process has already begun well before the death.
When dealing with long term grief over a terminal illness of a loved one, it may be good to consult a certified Grief Counselor or speak with a someone educated in Pastoral Thanatology. One can find the guidance and relief they need during this process.
Please review our Pastoral Thanatology program, as well as our Grief Counseling program to see if they meet your academic and professional needs.
Good article looking at how skilled nursing facilities could also play a role in end of life care, especially in palliative care where the treatment is still in process.
The article, “Turn-Key CEO: Why Palliative Care Must Soon Come to Skilled Nursing” by Maggie Flynn looks at how SNF have in the past have their own limitations but could in the future be an excellent fit. The article states,
“The first thing I think we would do would be really look at it from a regulatory perspective, to better understand the credentialing process, and how to work with SNF concentrations. Because some of our partners do have preferred SNFs, and have expressed serious interest in having this type of service in that SNF population.”
When facing death, people need more than physical care but also emotional as well as spiritual care. Part of that care entails helping the person transition from this life to the next. Pastoral Thanatology is the science of helping people face death.
The article, “Why help is needed when facing death” by John Dolan looks to answer the question of why individuals need help when facing death. The article states,
“In my nearly 30 years as a priest, I have had the privilege of visiting the homebound, and those in convalescent homes, hospice and/or in palliative care. I have witnessed many families gathered together, accompanying their parents or grandparents as they died peacefully.”