Advanced aging leads to the breakdown of the body and its ability to function. Eventually, there is no more medical intervention that can manage disease progression, and the focus shifts towards palliative care.
The main purpose of palliative care is to help those that are actively dying or near the end of life to achieve maximum comfort and dignity as they pass away.
Palliative care can usually be provided in several settings:
- Hospital inpatient palliative care unit
- Dedicated hospice facility
- Hospice care at home
Oftentimes, people decide that they wish to pass away in their own home, surrounded by family and friends.
An important step of preparing for hospice at home is to obtain equipment that improves a caregivers ability to provide support with daily activities, such as bathing and personal care, and to maximize comfort and dignity for the individual that is passing.
A typical hospice supply list includes the following equipment:
- In Bed Hair Washing System
Near the end of life, some people may be bed ridden and unable to get up to go to the shower or transfer into the bathtub to wash.
In situations where someone is unable to get out of bed, an in-bed hair-washing system can help maintain someone’s personal hygiene and feeling of cleanliness.
Simply replace the pillow with this device and lower the head onto the neck rest. A caregiver can then drape water over the head to wet the hair and apply shampoo to wash it.
Any water that is used to rinse the hair clean drops into a sealed container that can be emptied afterwards. The wastewater is self contained to eliminate the risk of spills on the way to the drain.
- Bedside Commode
Some people involved with palliative care suffer from generalized weakness and this limits their mobility. When this is combined with health conditions that cause an urgency of the bladder or bowels, it may be challenging to make it to the bathroom on time.
To avoid having an accident, a commode can be placed near the bed to reduce the distance someone has to walk to empty their bladder or bowels. The commode’s seat has a hole in it that leads to a removable pail. This pail collects any urine or excrement and needs to be cleaned afterwards.
Furthermore, commodes have armrests that can be pushed on to help with standing up if there is any muscle weakness in the legs. Additionally, these arms can be grabbed to guide someone with sitting down as they back step towards the commode.
- Commode Liners
Cleaning urine and fecal excrement from the commode pail can be messy and may expose the caregiver to hazardous bodily fluids.
A good way to make cleaning a commode easier and safer is to line the pail with a disposable toilet paper bag.
After voiding in the bag, it can be closed and disposed of easily to reduce odors from being emitted in the room.
- Unisex Bedpan Urinal for Men and Women
Near the end of life, it is not uncommon to be very weak and bed bound. In situations where someone cannot get out of bed, it is not realistic to use a nearby commode to empty the bladder.
Another option is to void into a unisex urinal while in bed. These are designed with a funnel that allows both men and women to use it and can be sealed tightly to reduce leaks and spills when not in use.
This equipment can also be used by more able bodied people that can walk, but only with the help of a caregiver. For example, when a caregiver Is not available, such as overnight, one can pee in the container and have it emptied in the morning.
This eliminates the need to get up and potentially having an unwitnessed fall or accident along the way to the bathroom.
- Transport Wheelchair
Not every physician performs home visits for palliative patients, so it may be necessary to visit the doctor’s office from time to time.
By using a transport chair, individuals that have trouble with walking long distances can get from door to door with the help of a caregiver pushing and navigating the wheelchair.
This equipment is foldable and can be stored in the trunk of a car during transportation and unfolded to use again when you have reached your destination.
The seat of a transport wheelchair does not have any customization or special cushion to improve comfort. So while it grants someone the ability to access the community, it is not meant to be sat in for long periods of time. Essentially it is designed for short trips to a doctor’s appointment or medical test.
- Tub Transfer Bench
When stepping over the bathtub edge is difficult due to weakness or trouble controlling the legs, a tub transfer bench can help someone maintain their personal hygiene.
A tub transfer bench sits partially inside and outside the bathtub to facilitate getting in and out more easily.
To use a transfer bench, sit on the exterior portion and then rotate the body while lifting the legs over the tub wall and placing them inside on the floor. Then shower while sitting on the bench and do the reverse to exit the bathtub when done.
Overall, this bathing aid is helpful for people that struggle with poor energy levels and cannot stand for long periods of time and for those with trouble climbing over the tub’s outer wall.
- Hospital Bed
During palliative care, caregivers usually need to provide an increased amount of help with personal care, dressing and incontinence product changes at the bedside. Furthermore, people at the end of life tend to struggle with getting out of bed and repositioning while sitting in it.
For these reasons, it is common to use a hospital bed during palliative care at home. Beds can be rented or purchased from medical equipment vendors, however some social assistance groups or home care may be able to offer it on loan for a short period of time.
In contrast to a traditional bed, hospital beds are designed to be highly customizable to meet the rapidly changing needs of their users. Hospital beds can be customized with the following accessories and features:
- Special therapeutic mattresses – hospital beds can come with a standard foam mattress or more advanced therapeutic surfaces that maximize comfort or pressure relief
- Partial side railings – used for repositioning and transfers in or out of bed
- Full bed railings – used to prevent falls out of bed when a caregiver is moving the hospital bed from one location to another
- Wheels on the bed frame – allows for easier transportation from room to room
- Adjustability – the footrest, headrest and overall height of the hospital bed can be raised or lowered as needed to get into a more optimal position for transfers or for a healthcare aide to assist with personal care
Most commonly, a hospital bed’s headrest is angled upwards to facilitate getting out of bed, reduce pressure on the chest, control acid reflux complaints or help someone engage in table top activities from an upright sitting posture.
Another common adjustment is to raise or lower the overall bed height so personal support workers can provide personal care to a bedridden individual while reducing the risk of back injuries from bending.
- Alternating Pressure Mattress Topper
People near the end of life may be bed bound with a poor ability to move around in bed. This makes them at high risk for developing a pressure sore and having complications from poor wound healing.
A caregiver can help prevent pressure ulcers from developing and promote healing of any existing sores by frequently weight shifting and repositioning the individual. But someone may not always be available to assist or this may not be sufficient to fully heal a wound.
Using an alternating pressure mattress topper is a good addition to any pressure relieving strategy. This equipment has a specially designed electric pump to inflate or deflate air cells throughout the mattress to evenly distribute a patient’s weight and eliminate bed sores.
Using this device can help relieve pressure points on key parts of the body such as the tailbone (coccyx), heels, and shoulders.
- Overbed Table
For people that cannot get out of bed, they need a surface to put meals to eat and somewhere to engage in recreational activities such as a card game or puzzle.
This can be done with an overbed table. Key features of this equipment include a height adjustable surface that can be raised or lowered as needed. It can also be moved around the room easily on its four wheels.
More importantly, its base can go underneath the bed frame to position the table overtop of the bed and allow someone to use the surface while they are sitting up. This equipment is frequently used by those in a hospital bed, where the headrest can be elevated so someone is in a sitting position.
- Incontinence Pad
Trouble controlling the bladder and bowels is quite common for individuals at the end of life.
While incontinence diapers can be worn to absorb any urine and catch any feces, leaks do still happen. To protect the bedding and sheets, an incontinence pad can be laid down on top of the mattress.
Someone then sleeps on the incontinence pad and it is washed or changed as needed if there are any accidents or if it becomes soiled.
- Blood Pressure Monitoring Machine
Individuals near the end of life are usually given medication to help manage pain and provide symptom control. An important part of administering this treatment is to regularly check blood pressure to ensure it is within a normal range and has not been altered by the medication.
With a blood pressure monitor, any available caregivers can have vitals such as pulse rate, systolic and diastolic pressure measured and recorded.
This information can then be shared with the palliative care nurse or physician who can evaluate if any changes or treatment adjustments need to be made. Together these professionals speak together to achieve more optional comfort and pain control for the patient.
- Pulse Oximeter Blood Oxygen Saturation Monitor
It is quite common to have shortness of breath, also known as dyspnea, during palliative care. Having trouble catching one’s breath can be particularly distressful and anxiety provoking.
To help monitor this, a pulse oximeter can be used to check the oxygen levels in the blood. This device is placed on the fingertips, and the value can be monitored throughout the day by a family member or caregiver.
This information should be recorded and communicated to the healthcare team who will then decide if any medications are needed to help control any attacks of breathlessness.
With dyspnea well controlled and improved ability to breath, some people find their energy levels recover and do not fatigue as easily.