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Desirae Tangen

Rebecca Goossens

Senior Seminar

12 February 2018

Life’s Last Moments

“We trouble our life by thoughts about death, and our death by thoughts about life”

Michel de Montaigne. One thing, that’s for sure is that everyone’s life will come to an end.

Death is inevitable, but it does not have to be lonely. People should not have to leave this world

alone; they need companionship until they take their very last breath.

Hospice has been a term used since the medieval times, it was referred to as shelter for

the weak and ill. “The name was first applied to specialized care for dying patients by physician

Dame Cicely Saunders, who began her work with the terminally ill in 1948” (National Hospice

and Palliative Care Organization ). Dame C. Saunders created the first hospice facility located in

the suburb of London. She named it Saint Christopher’s. Today the building still thrives as a

hospice facility and continues to make families lives better.

In the year 1965, a man named Florence Wald, the Dean of Yale school of nursing,

invited Saunders to visit the campus and speak of the facility she created, and spread the idea of

a more personal and loving matter to help those who will not have much more time left. A

woman by the name of Kubler-Ross knew she needed to defend her thoughts on how she

believed people should be taken care of so in the trials of court she stated, “We live in a very

particular death-denying society. We isolate both the dying and the old, and it serves a purpose.

They are reminders of our own mortality. We should not institutionalize people. We can give

families more help with home care and visiting nurses, giving the families and the patients the
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spiritual, emotional, and financial help in order to facilitate the final care at home.” The People

that are sick and dying should not be limited to last resorts, such as hospitals or nursing homes,

but they deserve a place where they feel safe and comfortable. Resources provided by hospice

staff will ensure the patient is protected and secure.

Hospice has their own philosophy of care. The mission statement the all volunteers and

employees hold dear states “St. Croix Hospice will provide the highest quality hospice services

to those affected with a life-limiting illness.” St. Croix vows to provide gratitude and make sure

whomever is involved retains their integrity as well as their own dignity.

The hospice patient bill of rights is one of the most important aspects of the organization.

Dignity and respect are concepts that everyone expects to be treated with. A patient has the right

to be informed of the procedures being provided to them. The property belonging to the patient

will continue to belong to the patient, and will be respected by the staff involved in the care of

the individual. The patient has the right to be a part of all decision making processes. They have

the right to refuse care without consequences or discuss a new approach to care that will better

suit the needs and wants of the recipient (Volunteer Orientation Manual). Confidentiality is the

number one right the hospice staff must obey. Financially a patient must be informed with any

changes regarding Medicare or Medicaid. Patients have the right to receive the highest quality of

care. If in any way a care plan is modified the patient must be notified.

Hospice has grown and developed into a wide variety of associations. St. Croix,

Heartland, and Seasons are some of the many branches of hospice care facilities. “As of the year

of 2013, the average number of patients in a year is said to be about 1.3 million people in the

United States alone” (Monitoring the Nation's Health). The number of “For St. Croix, about

seventy residents is the average amount of people in the Hospice facility branch located in
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Rochester MN, said by Marcia Johnson, the Hospice volunteer coordinator” (Johnson). Staff that

works in areas like Rochester have a full census of people to look after with a very few amount

of workers to fulfill the amount of care that must become provided.

Patient confidentiality is the most important factor in the protection of those in need of

care. “The HIPAA Privacy Rule establishes national standards to protect individuals' medical

records and other personal health information and applies to health plans, health care

clearinghouses, and those health care providers that conduct certain health care transactions

electronically” (HIPAA Privacy Rules). HIPAA stands for; health insurance portability and

accountability act of 1996. This was created to provide privacy for others. Braking this law can

obstruct and even terminate a position in any kind of medical field. “An example of a minimum

violation of an unknowingly done act is a $100 per violation or an annual maximum of $25,000

for repeat violations. Another more extreme measure that can be taken for a willful neglect that

is not corrected within a required time period, the maximum penalty consist of $50,000 per

violation, with an annual maximum of $1.5 million” (American Medical Association). Any and

all violations of HIPAA are not acceptable and may result in the termination of a position in the

line of work. As well as jail time if the violation is severing enough.

Reaching out to hospice is simple. Most people who end up in hospice care had been

referred them by a doctor, or even family can set up a time where patients can be viewed as a

candidate for hospice facility care. There are some qualifications that must be met to be found

eligible to be a part of hospice.

Hospice does not judge against religion. “All religions try to benefit people, with the

same basic message of the need for love and compassion, for justice and honesty, for

contentment.” This was stated by Dalai Lama. Ignoring another’s wishes to want to be blessed in
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their own faith is cruel and unjustified. One’s religion is an important part of the person’s peace

of mind, feeling free and loved. Everyone deserves a chance to feel like they have a future

calling of a life after death. The volunteers and staff who are apart of hospice will go the extra

mile to learn the ways to make the religion of the patient show that each person cares for them

and want the best of what they believe. “Even though we may all take different roads, the

destination is very similar” (Volunteer Orientation Manual). Hospice will respect and honor

those wishes and be there while the patient moves on to the better place that awaits them.

To qualify for the extra care that hospice provides, the patient in most cases must be at

least the age of 65. If in the past 6 months, prior to the apply for hospice care. If a patient has

been diagnosed with a life-limiting condition with a prognosis of six months or less if their

disease runs its normal course, and frequent hospitalization in the same time frame. to go

comfortable and give them the feeling that they are loved and not alone.

There are multiple causes that reside in patients needing the more intensive care that is

hospice. “Most of the terminal diseases that are presented to hospice facilities consist of aids,

dementia, cancer, heart failure, and liver diseases” (Crossroads). One of the leading causes

leading to the need of hospice is dementia. Dementia is not one specific disease. “It's an overall

term that describes a group of symptoms associated with a decline in memory or other thinking

skills severe enough to reduce a person's ability to perform everyday activities” (Alzheimer's

Assosiation ). Vascular dementia is one of the many branches of dementia, it is about 10%

likelihood of having that type. It is most commonly found in patients that have had a stroke in

the past. It affects blood vessels in the brain, and the damage can lead to bleeding on the brain.

Alzheimer’s is the most common dementia. “Every 65 seconds, someone in America develops

Alzheimer's. It is estimated that nearly 500,000 new cases of Alzheimer's disease will be
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diagnosed this year” (Bright Focus Foundation ). Difficulty remembering recent conversations,

names or events is a sign of early Alzheimer’s. Later on in the disease, impaired communication

and disorientation occur, resulting in completely different personality and in most cases an

inability to perform any kind of activity, including eating, using the bathroom, and conducting a

conversation.

Patients usually come into hospice very ill and many times unaware of their surroundings

and they tend to become very upset and heartbroken about their life coming to an end. People

need to know they are not alone, having someone to depend on can raise emotions of

worthlessness and loneliness. The job of the care giver is to give the patient peace at mind and

provides a safe environment. They also need to help the family with the loss and hard time that

are happening.

Loss is a very difficult notion to grasp. “Mourning is the open expression of your

thoughts and feelings regarding the death and the person who died. It is an essential part of

healing” (St. Croix Hospice). Loss can happen to anyone, it can show itself in the loss of a child,

friends, and family.

Hospice deaths are supposed to be as peaceful as possible for everyone involved. The

patient has the right to request any kind of pain relief they want such as a new prescript drug.

There are seven states that allow an aid in dying. Death with Dignity statutes allow mentally

competent adult state residents who have a terminal illness with a confirmed prognosis of having

6 or fewer months to live to voluntarily request and receive a prescription medication to hasten

their inevitable, imminent death (Death with Dignity ). The gift of presence may be the only

thing hospice can offer a particular patient but never the less the presence is acknowledges and

respected by the patient, family and anyone else providing care for the individual. For whatever a
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patient’s choice may be, they will not go through it alone. Hospice staff will be there for any

family member, dealing with the tremendous loss that has burdened the family with grief, and

mixed emotions.

There are five stages of grief, the first being denial. Denial occurs quickly when the

person feeling the grief does not accept what has happened or what might happen. The second

stage is anger. It is among one of the more profound stages of grief, blame occurs sometimes to

other or in some cases to one’s self, or the subject that caused the grief such as losing a loved

one. Bargaining is the third process of grief, in this stage people tend to turn to a higher power

weather that be the law, a family member, or in my cases a God. Thinking of ways, the incident

could have been done differently or putting a blame on one event that had taken place is the most

frequent occurrence in this state of mind. “Guilt is often bargaining’s companion. The “if onlys”

cause us to find fault in ourselves and what we “think” we could have done differently”

(Grief.com ). Following the bargaining stage comes depression. This phase haunts people, there

is no true time limit to how long this stage last. Every person goes through this stage differently,

for some it comes and goes, for others it can last for days, weeks, months, and in some cases

even years. Not everyone gets passed this part of grief, in certain occasions suicide can occur.

The loss can be too much to comprehend, and life seems pointless and the loneliness becomes

overpowering. The final grief process is acceptance, acknowledging all the previous stages of

grief and moving on to live a happier life, knowing that the ones lost will always be with them

and that the memories will last a lifetime.

Life after death is a concept that has been a mystery to man for centuries. The final

moments of life are important, but the moments leading up to it are what make being alive so

unforgettable. Hospice care staff will provide companionship and care that will forever change
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the lives of family and friends associated with the patient whose final moments of life has

reached their end. The trouble of understanding why death happens may remain unsolved for

now, but the thoughts about life, makes the final chapter of ones being lift the burden of death

with the memories of happiness, love, and friendship.

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Works Cited

Alzheimer's Assosiation . n.d. 25 March 2018. <https://www.alz.org/what-is-dementia.asp>.

American Medical Association. n.d. 14 March 2018. <https://www.ama-assn.org/practice-

management/hipaa-violations-enforcement>.

Bright Focus Foundation . n.d. 25 March 2018.

<https://www.brightfocus.org/alzheimers/article/alzheimers-disease-facts-figures>.

Crossroads. n.d. 28 February 2018. <https://www.crossroadshospice.com/about-

hospice/hospice-eligibility-criteria/>.

Death with Dignity . n.d. 28 March 2018. <https://www.deathwithdignity.org/learn/death-with-

dignity-acts/>.

Grief.com . n.d. 28 March 2018. <https://grief.com/the-five-stages-of-grief/>.

HIPAA Privacy Rules. n.d. 27 February 2018. <https://www.hhs.gov/hipaa/for-

professionals/privacy/index.html>.

Hospice Foundation of America. n.d. 16 February 2018. <https://hospicefoundation.org/Hospice-

Care/Hospice-Services>.

Johnson, Marcia. Interview. Desirae Tangen. 22 Febuary 2018.

"Monitoring the Nation's Health." Long-Term Care Providers and sevices (n.d.). 24 February

2018. <https://www.cdc.gov/nchs/data/series/sr_03/sr03_038.pdf>.

National Hospice and Palliative Care Organization . n.d. 21 February 2018.

<https://www.nhpco.org/history-hospice-care>.
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St. Croix Hospice. n.d. 16 February 2018. <http://stcroixhospice.com/>.

"Volunteer Orientation Manual." Mantual. 2016. 25 July 2017.

what happenes after death. n.d. 16 February 2018. <http://metro.co.uk/2015/09/28/putrefying-

bloating-and-blistering-this-is-what-happens-to-your-body-after-you-die-5411303/>.