What End of Life Conditions Can (and Cannot) be Handled at an Assisted Living Home with a Nurse on Staff

For family members looking for a home for a loved one, this is always a very tough question to ask, but an essential one, and a question that we often get asked. A full-service assisted living homes (with an excellent management team, nurse on staff, and trained caregivers) can handle most of the end-of-life care situations that arise, but not all the medical conditions that can materialize. Often loved ones want to minimize the chance that a move to another facility will be necessary before end-of-life.

What a Full-Service Residential Assisted Living Home Can Handle:

• Oxygen therapy – There are no specific best practices for the use of oxygen therapy during end-of-life care. However, if oxygen is prescribed by the person’s medical provider, assisted living homes can adequately administer and monitor its use.
• Some wound care with the help of a specialist who comes into the home. Often wound that require complex dressing changes or wound vacuum care is best suited for long-term care facilities.
• Sliding scale insulin requires close monitoring by an LPN or RN and can usually be handled.
• Antimicrobial therapy – This is commonly used to relieve symptoms associated with the end of life. Approximately half of the patients receiving end-of-life care have an infection. Assisted living care homes can work with medical practitioners to determine when antimicrobial therapy is an essential part of end-of-life care.
• Chronic Obstructive Pulmonary Diseases (COPD) – Having COPD can make end-of-life breathing difficulties more severe. Assisted living homes are equipped to handle most cases of end-stage COPD through the use of oxygen and pain medication, as prescribed by a medical professional.
• Congestive Heart Failure (CHF) – is another condition that can be monitored well in an assisted living home. It may be appropriate for hospice care to be included when the patient reaches the final stages of CHF.
• Renal failure – Renal failure usually requires dialysis to deal with decreasing kidney function. Managing chronic illnesses such as renal failure is a specialty associated with assisted living. Many can partner with nearby dialysis centers to provide in-house dialysis/ palliative dialysis with treatment goals being aimed at quality of life rather than medical parameters.
• Acute phase of strokes – Stroke patients benefit from a structure in how end-of-life care is administered. Assisted living homes are capable of providing the level of is needed, and the consistency of delivering that care.
• Dementia – Caring for anyone at the end of life is difficult, but it can be even more challenging if the person has dementia. Assisted living homes are equipped to handle these increased needs and provide the patient with the dignity and respect they deserve.
• Cirrhosis/liver failure – Pain control and the relief of symptoms associated with liver failure during end-of-life care are easily managed by assisted living homes.
• Progressive weight loss – Also called a “failure to thrive,” it is a hallmark of the end of life. It is especially concerning for patients with dementia. Assisted living homes can monitor weight loss and administer appropriate care as directed by medical providers.
• Medication administered by oral route – Assisted living homes are trained to administer oral medications to help manage end of life conditions and symptoms.

When Can An Assisted Living Not Handle End-of-Life Care

As previously mentioned, it is not always appropriate for assisted living homes to care for a patient at the end of life. There are times when a person will require care elsewhere:

• Significant wound care that involves complex wound dressing changes is best suited for long-term care facilities.
• Continuous or intermittent IV is better suited for rehabilitation facilities and long-term care facilities.
• Usually, tubes and jejunostomy tubes are better suited for long-term care facilities due to the requirement for cleaning and monitoring the tubes to prevent infection.
• CPAP, BiPAP, and ventilators require a level of care that is not appropriate for assisted living homes. End-of-life patients with these devices are better suited for long-term care.
• Total parenteral nutrition infusions are common for patients dying of cancer and other terminal illnesses. A long-term care facility best manages it.

What is End-of-Life Care?

End-of-life care, sometimes referred to as late-stage care, is the clinical term to describe the ongoing emotional support and medical care an individual receives during the time leading up to their death. The person may be in the final stages of a terminal illness, succumbing to a lifelong disease, or in the natural stages of the dying process. The length of care is dependent on the reason the person requires it and can last a few days, weeks, or even months.

Regardless of why a person needs end-of-life care, the goal is to help them live as comfortably as possible in the time they have left. Quality end-of-life care also includes:

• Management of physical symptoms to ensure comfort
• Emotional support for the person receiving the care and their family members
• Expectations for the person receiving the care and their family and friends about the process of late-stage care and the dying process
• Financial support, as needed
• Assistance in drafting a will

Knowing when it is time to consider late-stage care is an integral part of the process.

Individuals dealing with terminal illnesses or diseases with a high mortality rate are candidates for this type of care. If the person already resides at an assisted living care facility, the staff may approach family and caregivers when it is time to transition to end-of-life care and support.

Other signs it is time to consider late-stage care include:

• Multiple trips to the emergency room for the treatment and stabilization of an ongoing condition. The condition rapidly worsens between ER trips, and the person’s quality of life is not improving.
• Multiple admissions to the hospital in the same year for the same condition with worsening symptoms
• The decision to discontinue treatment for a terminal illness

What to Expect When End of Life is Near

No two people are the same, but there are some common physical symptoms experienced when the end of life is near. Breathing difficulty, digestive issues, fatigue, and pain are all normal parts of the dying process. Watching a loved one experience these symptoms can be difficult, but it is essential to stay calm so that the patient will feel at peace.

While each person is different, there are some commonalities associated with the body as it begins to break down during the end-of-life stage. What to expect:

• 1 to 3 months before death – The dying person may take more frequent naps and sleep for more extended periods; have a diminished hunger and thirst; begin to withdraw from friends and family; communicate less; stop engaging in previously-enjoyed activities.
• 1 to 2 weeks before death – Changes in sleep patterns and decreased appetite and thirst are the most noticeable signs of this stage. The dying person will also have less urine output and fewer bowel movements, increased pain; congested breathing; and changes in their blood pressure, heart rate, and breathing. It is not uncommon for the dying person to appear confused.

What Questions to Ask an Assisted Living Facility About End-of-Life Care

Create a list of questions to have on hand when touring an assisted living facility to ensure it matches your loved one’s needs. Some of the things to ask are:

• What is your patient to staff ratio?
• What type of training does your care staff receive?
• Is your staff trained in Alzheimer’s disease and other memory-care needs?
• Are staff members on-site 24/7?
• Are staff members trained to administer medication?
• Do you have in-house nurses and doctors on staff?
• What are your security measures?
• Are there additional services available if care needs change?
• Do you offer end-of-life care?
• Can you provide references?

There are red flags to watch for when asking your questions and touring assisted living facilities. The biggest red flag is a lack of respect. Pay attention to how staff members interact with residents and with one another. Are they spending more time socializing with each other than caring for the residents?

Other red flags include:

• Managers are unavailable to answer questions on request. If they are missing in action during your visit, it may be a sign they are overworked or inattentive.
• The facility lacks choices for everyday living needs, such as your loved one’s choice of food, clothing, and sleeping time. While some routine needs to occur, you don’t want your loved one to feel like they are in prison.
• The facility is located in an unsafe neighborhood.
• The staff is rude to you or uncaring toward residents.
• The residents do not look well cared for, and the facility is cluttered or dirty.
• There are violations or complaints against the facility.
• The administration avoids discussing fees for services.

With Which End-of-Life Conditions Can Assisted Living Provide Comfort?

Some assisted living communities do not provide end-of-life care. For those that do, there are conditions with which they can provide comfort and support.

1. Pain and discomfort

Pain and discomfort are common at the end of life, especially during the final weeks leading to a person’s death. It can be difficult for loved ones to watch, but there are things assisted living providers can do to help.

Because there is no need to worry about the long-term effects of pain medication – including addiction – pain medication will be administered to ensure the patient is comfortable and with pain management in mind. Morphine is commonly prescribed during the end of life, but other pain medications can be used. Assisted living providers can work with palliative medical specialists to find the right fit.

2. Breathing problems/shortness of breath

Just as it can be challenging to see a loved one in pain, it also is painful to watch them struggle to breathe. Shortness of breath and the ability to take a deep breath is common during the end of life. Sometimes it may even sound like rattling in the chest. This is caused by fluid collecting in the dying person’s throat. Assisted living providers can ease breathing difficulty by elevating the patient, using a humidifier, and using a fan to circulate the air in the room.

3. Skin irritation/skin breakdown

As we age, our skin naturally becomes drier. Once a dying person begins to experience a diminished desire to eat and drink, dry skin can worsen. Sitting or lying in one position for too long also can cause bed sores. Assisted living care teams can use lotions to help keep the dying person’s skin moisturized. Shifting their position throughout the day will help to prevent bedsores.

4. Digestive problems

It is not uncommon for people near the end of life to lose their appetite. The natural result can be nausea, vomiting, and constipation. Pain medication can make constipation and nausea worse. Assisted living care staff can work with the patient’s medical providers to find a balance of pain medication and other intervention measures to ease these symptoms. Assisted living centers may suggest offering smaller meals to the patient to help encourage eating, prevent dehydration, and help the person to eat if they feel too weak to feed themselves.

5. Temperature sensitivity

Shifting from being too hot to too cold is common at the end of life. If the patient is constantly kicking off a blanket, they may be trying to tell you they are too warm. Shivering can be a sign the person is too cold. Assisted living facilities capable of handling end-of-life patients are trained to watch for these signs and ensure they are comfortable.

6. Fatigue

When we do not eat or drink as frequently as we once did, fatigue is natural. Assisted living care staff can help ease fatigue by keeping activities simple for the person. This may mean switching to sponge baths instead of showers and placing a portable toilet next to the person’s bed to reduce the number of trips to the bathroom.

How to Evaluate if an Assisted Living Home is Equipped to Handle End-of-Life Care

When it comes to evaluating whether an assisted living home is equipped to handle end of life care, safety is the bottom line. You can ask questions to determine if an assisted living home is the right choice for you:

What can I expect from end-of-life care in your home?

• Who will be administering the care? What are their qualifications?
• Do you have a plan for the administration of my care?
• How will my pain be managed?
• How will you communicate with my family about my care and ongoing needs?

Assisted living homes that fail to answer questions of this nature, or offer only vague answers are incapable of providing the quality care you deserve during the end of life.

Comparing End-of-Life Options

Assisted living homes are not your only end-of-life option. It is best to compare all of your choices before making a decision.

Both hospice and palliative care provide comfort. Palliative care can begin at diagnosis and occur in conjunction with treatment. It focuses on providing relief from the symptoms and stress of the illness. Hospice care begins after treatment of the disease is stopped and when it becomes clear the person will not survive the illness. Hospice care is generally recommended for persons with six months or less to live and can be provided at home or at an assisted living home under the guidance of a hospice physician and nurse.

Other options for care include:

• Home-based care is possible but depending on the level of care the person requires, it may not be ideal. Caregivers involved with an in-home care situation will need to be well organized and consistent. The benefit is the person will feel more comfortable in their home environment. A significant drawback is the lack of access to the kind of medical equipment that can make end-of-life care easier for all involved.
• Long-term residential facilities are ideal for end-of-life care that requires access to a variety of medical and personal care services.
• Hospital-based care should be reserved for only those who require intensive levels that frequently require the supervision of medical professionals.

Choosing Vista Living as the Right Assisted Living Facility for You

Vista Living’s caring and compassionate staff understand the stress and anxiety involved with end-of-life care. We ensure the dying person and their loved ones are treated with the dignity and respect they deserve through every step of the process. Contact us today to learn more about how Vista Living can help your loved transition.