Things Your Loved One Needs in a Nursing Home

Things Your Loved One Needs in a Nursing Home






Most of us dread the thought of moving a loved one into a skilled nursing facility, and this sentiment doesn’t change for those who are fortunate enough to have a selection of stellar facilities to choose from.

We know that we are giving up a certain amount of direct oversight, which can be hard even though we are well aware of our limitations as individual caregivers.

We also know deep down that this move is an admission that a loved one has passed a certain point in their health where returning home or resuming even a few aspects of self-care is no longer a possibility.

In other words, this transition is a direct dose of reality.

As with all changes in life, knowing what to expect ahead of time can be extremely helpful mentally and emotionally as well as practically. I asked Amy Laughlin, BA, AP-BC, ADC, an Activity Professional and Senior Living Educator based in Rock Hill, South Carolina, to work out a nursing home checklist.

Amy’s comprehensive list below explains our loved ones’ rights, questions to ask the facility you are considering, and how to best anticipate and prepare for their needs.



Skilled Nursing Facilities Federal Regulations


Federal regulations, which are overseen by the Centers for Medicare and Medicaid Services (CMS), require that skilled nursing facilities (SNFs) provide the following to all residents:


  • A room with a window to the outside for natural light and orientation to the time of day, weather and season;
  • A bed of appropriate size and height;
  • A clean, comfortable mattress;
  • Bedding, which is appropriate to the weather/climate; and
  • Furniture appropriate to the resident’s needs, including a separate closet or clothing storage spaces.


These regulations also require SNFs to provide a “safe, clean comfortable and homelike environment.” In other words, the goal is for these facilities to be less institutional and more homelike, so residents have the opportunity to bring many items and personal effects with them to help create a meaningful and individual living space.




Before Moving to a Skilled Nursing Facility



Look at the room carefully. How much floor space is there, and how much storage space will your loved one have? There must be enough room to maneuver a wheelchair or other mobility aid and for caregivers to safely transfer and care for your loved one.

Check to see if the facility will remove the provided nightstand, chest, or chair so that they can bring some personal pieces of furniture. If this is an option, make sure that none of their furniture encroaches on a roommate’s space or limits mobility within the room.


Ask questions about what the facility provides that is included in the fee.

The following are common questions that can reveal a great deal about what may need to be purchased or left at home. It can also expose services and items that come at an additional cost:


  • Are bedding and towels provided?
  • Is the laundering of linen included?
  • Does my loved one’s room have cable or a digital signal, and is it included in the monthly cost?
  • What about local and long distance telephone service?
  • Is there public and/or secure wifi access available?
  • Can personal laundry services be added for an additional fee?
  • Do they provide a wall clock, TV or personal care products?


Every SNF  (Skilled Nursing Facility) is different. No family member wants to receive a terrible shock when they get the first bill and discover that all the services they thought were included were actually optional extras.


Nursing Home Packing List




What to Pack for Moving to a Skilled Nursing Facility


Aside from making the decision to move your loved one into a SNF, helping them pick and choose what to pack and what to purge is one of the most difficult parts of this transition.

Caregivers often help their family members sort through entire homes, garages and storage units full of belongings, furniture and family heirlooms. These individuals have been collecting personal items for decades, and it can be difficult for them to simultaneously “lose” their home and the majority of their possessions.

Many caregivers enable their loved ones hold onto some family heirlooms, seasonal clothing and décor, valuables, and other important belongings by storing them at their own home, dispersing them among trusted family members or renting a storage unit. This helps elders feel they still have access to their possessions or at least that these things have been passed on to individuals who will cherish and respect them.

Regardless of the method you and your loved one decide to use, there are some important considerations and limitations that apply to each category of a nursing home packing list.



Clothing and Accessories for Living in a Skilled Nursing Facility


When deciding what kinds of clothing to bring to a skilled nursing facility and how much, there are a number of practical matters that should influence your loved one’s packing list.

Remember that Clothing must be easy to get on and off and able to withstand lots of washing and drying.

Mens Fleece Open Back Adaptive Cardigan - Navy MED
Silvert’s Men’s Fleece Open Back Adaptive Cardigan
Remember that Clothing must be easy to get on and off and able to withstand lots of washing and drying.

While the temperature inside the facility is regulated to a level that would be perfectly comfortable for most active adults, the majority of Skilled Nursing Facility residents tend to be cold-natured. Make sure your loved one has warm and comfortable sweatshirts, vests or jackets that can be worn with every outfit, as well as cozy socks that can be worn in bed. 

I like Silvert’s Adaptable Clothing best for these items because they specialize in garments that make dressing easier, and their excellent quality can stand up to institutional laundering.






Men’s Acorn Moc Slipper

There is a wide variety of other high quality brands of adaptive clothing available, so you’ll have plenty of choices for comfortable basics that will be wearable and durable.  Also, don’t forget to make sure your loved one has non skid slippers.




The number of outfits they should bring depends on who will be doing their laundry and how often.

A good rule of thumb is to bring at least a week’s worth of clothing—probably more just to provide for additional changes that may be needed, and make sure you label everything.

If at all possible, it is helpful if whoever does the laundry returns their clothes to their closet clipped or hung together as outfits, so they are easily able to choose an outfit rather than having to choose separate tops and bottoms.




These AVERY Permanent Adhesive No-Iron Clothing Labels  are excellent for making sure your loved one’s items don’t get misplaced. 


Sharpie Rub-a-Dub Laundry Markers





You just write (use a permanent marker like the one above), peel and stick; no ironing required.  Their permanent adhesive will withstand multiple washing machine and dryer cycles.

Accessories are part of a person’s individual style and should be encouraged! Nothing too valuable or with sharp points or edges should be brought with, but if Mom has always worn bright scarves or glittery beads, make sure she has some she can wear every day. If Dad always wore a certain hat, make sure he has it available.

Women often want their purse close by, and men don’t feel quite right without a wallet in their pocket. Let them bring their wallet or a favorite purse. Even if they will be rarely embarking on outings, it will help them retain a sense of control and independence in a world that is completely new, strange and scary. You could even put a few dollar bills or some change in it. Just make sure you take out all insurance cards, bank cards and credit cards first.




Personal Care Products for Living in a Skilled Nursing Facility


Most of us have our favorite soap, shampoo, lotion and toothpaste that we have used for years. This is no different for a senior who is moving into a nursing home. Even something as simple as providing their favorite brands and products can help them feel that their routine hasn’t been completely turned upside-down. Some of these personal care items may be available from the facility, but be aware that they may come with extra charges.


Whitmor Rattique Storage Baskets, Set of 3

Families generally provide these items and facility staff should let you know when your loved one is running low. It can be helpful to keep a small stash of extra products in a box or basket in their closet or bathroom to avoid running out at the last minute.


  • Be sure to pick their favorite fragrances or well-loved brands. Although your loved one might be washed and bathed by someone else, using familiar products, especially familiar scents, can make the experience much more comfortable.




Linens and Bedclothes for Living in a Skilled Nursing Facility


  • Basic linen, such as bedding and towels, is provided and laundered by the facility.


  • Most individuals also love to have soft, warm blankets or quilts on their beds—perhaps a favorite from their home.


  • A small lap blanket or throw is also nice to tuck around their legs or shoulders when they are sitting in an armchair or wheelchair. Make sure these items are machine washable and able to take a fair amount of laundering.


Note:  Remember that a handmade crocheted blanket will not hold up to frequent washing and drying in the facility’s industrial machines.  And don’t forget to label it.



Electrical Items and Technology for Living in a Skilled Nursing Facility


  • Family members usually provide a small TV, sometimes also a DVD player for their loved one. Label both items, as well as the remotes, and don’t forget to provide spare batteries.
  • If your loved one will have a roommate, consider purchasing wireless headphones so that they can watch TV at any volume without disturbing anyone.
  • Ask the facility if they allow extension cords. Some facilities completely prohibit them, since they can pose a trip and fall risk, but others allow them at limited times of the year (such as one for plugging in a Christmas tree).
  • Many SNF residents love using their smart phones, tablets and laptops. If wifi is available at the facility, make sure you know of any passwords and fees associated with it, as well as if the bandwidth is sufficient to stream videos. If the wifi is not secure, make sure your loved one does not log onto online banking website or any other sites where their personal information could be vulnerable to hackers and scam artists.
  • All electronic devices should be clearly labeled with the resident’s name, and if possible, contain a GPS locator in case they ever go missing. Don’t forget chargers and connecting cords.



Decorative Touches for Living in a Skilled Nursing Facility


  • Plan to decorate their room for holidays and events. A small seasonal wreath for their door, holiday cards, and wall décor are a great way to remind your loved one of the holiday without taking up precious space on their nightstand or dresser. Window clings are an inexpensive and reusable decorative item that can be easily applied to and removed from a window or mirror. You may have to store seasonal items that are currently not being used if there is not enough storage space in their room.
  • A favorite door decoration is also a good cue for your loved one that they have returned to “their” room after a meal or activity. Many doors in the SNF look the same, but theirs will stand out.


Example: Falling Leaves Welcome Door Decor
  • Fresh flowers and plants brighten up windowsills and dressers. Just be sure to pick low-maintenance varieties that will not create any mess. If your loved one is assigned to a room with a less than ideal view from their window, this small touch can make a big difference. You and your loved one can arrange flowers or water the plants together as an activity.





Favorite Things to Have in a Skilled Nursing Facility


Your loved one should be able to look around their room and say, “these are a few of my favorite things.” These items should hold personal significance, promote happy reminiscence and stimulate the senses in some way.



Family pictures are important and can be posted on a bulletin board, stored in a scrapbook or photo album, uploaded to a digital picture frame, or displayed as a collage on the wall. It can also be helpful to stick a small label under each photo or on the back to explain the name and relationship to your loved one of those pictured. This enables them to share their pictures without having the pressure of remembering names, faces and relationships all at once.

2-in-1 Black Wood Framed Wall Mounted Combination Bulletin Cork Board & Magnetic Whiteboard



Another sentimental item may be their favorite artwork or posters. Keep in mind that wall space in SNF rooms is limited, and the facility may have rules about what hardware is allowed to hang frames and other wall decor.

Numerous vendors sell affordable prints of famous works of art, nature scenes, military memorabilia, old movie posters, and much more. The options are endless!  Posters can be placed in inexpensive poster frames to make them look more polished, and the artwork can be changed out periodically at little expense.




Two Girls at the Piano by Pierre-Auguste Renoir Poster Print, 16x20
Two Girls at the Piano by Pierre-Auguste Renoir Poster Print, 16×20

Georges Seurat (La Grande Jatte) Poster Art Print – 24×36






If nails are not allowed, poster tack or command strips may be helpful alternatives.




A CD player and CDs or a MP3 player loaded with favorite music, can also be a small, but meaningful addition to a loved one’s room. Just as with the television, headphones of some kind are probably a wise investment.

Other types of treasured items might include favorite snacks or treats (as appropriate to their current dietary needs), scented lotions, a stuffed animal, sports memorabilia or team colors, a couple of favorite books, or small pieces or items from a personal collection are helpful.

It is important to note that most facilities prohibit breakable items like china and glass, electric blankets, scented plug-ins, and, of course, any sort of open flame (candles), and weapons.



Hobbies for Living in a Skilled Nursing Facility


Days at the SNF can be long, especially at the beginning when your loved one is trying to remember new people and adapt to new routines as well as struggle with their own loss of independence.

The facility should have a diverse and interesting activities program, but your loved one will still have the opportunity to pursue their personal interests or hobbies.



One of the biggest parts of their packing list is making sure they have the items they need to remain engaged and entertained.



Newspaper and magazine subscriptions can easily be arranged and changed, and these items can be delivered directly to the facility.


USA Today

Reader's Digest




Many facilities have libraries of books, or the local public library might deliver to the facility. If your loved one is a reader, make sure they always have a couple great books on their nightstand. If they are no longer able to read, even a book of inspirational stories or favorite poems can be useful for visitors to read these aloud with them.



  • You might also consider setting them up with an Audible membership to download audio books on an MP3 player or other device.





52" x 71" Traditional High Quality Jewish Kosher Tallit / Tallis / Talit / Talis Prayer Shawl Made in Israel - White, Black and Gold



If your loved one is religious, make sure they have their religious texts of choice, plus any associated items or prayer aids, such as a rosary, shawl, crucifix, etc.



Catholic Women's Aqua Glass Bead Rosary with White Zipper Vinyl Case


Provide a labeled tote or bin of supplies for their favorite art or craft, like knitting, crocheting or painting. Adult coloring has become incredibly popular with the senior population lately. They may enjoy one of these books and a set of colored pencils.


Some Examples:


Butterflies & Flowers Adult Coloring Book
Beautiful Word Coloring Bible

Sargent Art 50 Colored Pencils




For puzzle masters, large print books of word finds, crossword puzzles, Sudoku and jigsaw puzzles are a must. Decks of cards and simple board games can also help pass the time or provide a structured activity for when grandchildren come to visit.





Hoyles Super Jumbo Single Deck



If your loved one enjoys writing and receiving letters, make sure you provide them with the materials they need. A couple of pens/pencils, a notepad or some stationary, an address book, return address labels and stamps are all musts. Even if they do not send or receive mail often, it’s good to keep a few writing instruments and some paper on hand just in case.





An attractive wall calendar that is clearly marked with family birthdays, holidays, visits and important events is a useful addition to a senior’s room. Even if they have difficulty keeping track of time, the staff and their visitors might be able to reference it and remind them of upcoming activities.


Some Ideas:


Lang 2018 Calendar – Full Bloom


Farms & Barns 18-Month 2018 Calendar
The Secret Garden Calendar

A visitors’ book where people can sign in and say what they did together might be a nice way to remember visits and family time. An example of an entry could be: Saturday, April 16: Jennifer & Brad visited with you and took you outside to see the spring blooms and listen to the birds. We drank lemonade on the porch and talked about gardening.


Vintage Style Guest Book
Journals For All Guestbook
Lang Large Welcome Guest Book



Important Tips for Personal Items in a Skilled Nursing Facility



  • All items must be clearly marked with your loved one’s name. Clothing and other items can easily be mixed up in the laundry, and if the facility has residents with dementia or memory issues, belongings can be accidentally or intentionally stolen or end up in the wrong rooms. Use permanent marker on clothing and fabrics and either purchase or make labels with your loved one’s name and room number so that all other items can be quickly and easily labeled. You can also iron or sew on decorative patches to identify clothing without it appearing like a label. Don’t forget to tag items like glasses, hearing aids, denture cases, personal care items, and durable medical equipment like walkers or wheelchairs, and furniture.
  • Remember that many people will be coming and going in and out of your loved one’s room on a daily basis. This includes caregivers, nurses, housekeeping staff, activities staff, visitors, volunteers and family members. At some point, items will go missing. Hopefully they have just been misplaced and will be returned, but, for this reason, do not bring anything valuable.
  • Some nursing homes take inventory of a new resident’s belongings upon move in. Ask if this is something that your loved one’s facility does, and if it isn’t, then consider creating your own Facility Inventory form to keep track of their things and better determine if something has been lost or stolen. Ask for the Admissions Coordinator or Director of Nursing to sign this inventory on move-in day. If an item goes missing, you are much more likely to have the facility replace it if you have a documented move-in list.


Keep in mind that this is not an all-inclusive list. Bring in the basics and see how your loved one fares for the first couple of weeks. Maybe they will need more clothes, an extra lamp on the nightstand so they can read better, or maybe you will realize that they are no longer interested in an activity, so you can take those supplies away and free up some space for other items.



Final Thoughts

This is a challenging time for both you and your loved one. A room in a Skilled Nursing Facility is never going to be comparable to your loved one’s home.


Minding Our Elders: Caregivers Share Their Personal Stories by [Bursack, Carol Bradley]Treat this move as an opportunity to create your loved one’s last home: a comfortable, safe environment filled with happy memories and fun activities.

This is a place where they can thrive and receive the higher level of care they need.

Based on an article by Carol Bradley Bursack

Over the span of two decades, author, columnist, consultant and speaker Carol Bradley Bursack cared for a neighbor and six elderly family members.

Her experiences inspired her to pen, “Minding Our Elders: Caregivers Share Their Personal Stories,” a portable support group book for caregivers.



Other Recommended Resources:






Thanks for visiting and reading … I hope this article provided you some helpful ideas.  I welcome your comments below.








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Washing Your Senior’s Hair in Bed: Step-by-Step Instructions


How to Wash Your Senior’s Hair in Bed

Step-by-Step Instructions







When they’re not able to get into the shower or bath, it can seem impossible to keep their hair and scalp clean. No-rinse shampoos, dry shampoo, or wiping with wet cloths are helpful, but aren’t quite as good as a thorough hair washing.


A real wash with water and regular shampoo will make your senior feel more comfortable and keeps their scalp healthier.


Most of us have experienced (at least second-hand) the issues that arise when someone is sick and in bed for an extended period of time. The hair gets limp and often oily, matted with sweat and will tend to begin to smell after a few days.



Short Term Solutions


The short-term solution is the use of a “dry shampoo” or a “no-rinse” shampoo. These are typically similar in purpose, but are intended for differing hair types.


Batiste Dry Shampoo

Dry shampoo is typically packaged as an aerosol spray that contains an oil-absorbing ingredient that can be brushed out of the hair once it has done its job.

It’s typically used with those who have oily hair or straight-to-wavy hair types.

You simply spray the powdery spray onto the hair at the scalp, let it dry (meaning allow the fast-drying propellant to evaporate) and use a natural-bristle brush to brush out the residue.

Before the creation of specific products for this purpose, many people would use talcum powder or corn starch in small amounts to produce the same effects.



No Rinse Shampoo Cap


No-rinse shampoos are liquid based, and usually come in a foaming formulation that is applied liberally to the hair and allowed to dry on their own without rinsing.

They often contain alcohol or other quick-drying ingredients as well as including leave-in conditioners to soften the hair and make it more manageable. These are used more with individuals with wavy-to-curly hair types and those whose hair tends to be dry or fly-away.

When my mom was in the hospital, the nurse used a No Rinse Shampoo Cap to wash Mom’s hair.  She just warmed the cap briefly in the microwave, put it on, and massaged Mom’s hair through the cap. Then she towel dried Mom’s hair a little, and let it air dry.  I was surprised to see what a good job it did at getting her hair and scalp clean.  This is a great option for a fast, no mess wash. 



Long Term Solution – A Thorough Cleansing


While dry and no-rinse shampoos are great for the short-term, after a while, they seem less effective as the hair begins to develop build-up. When this happens, you want to be able to give the hair a thorough cleansing. To do this, you need to look at the process a little differently than you might normally consider it.



What You’ll Need


Johnson's Baby Shampoo, Calming Lavender, 20 Ounce


  • Garbage bags and/or a few towels to line the bed and keep it dry
  • Washcloths
  • Towels
  • Bucket of warm water
  • Cup for scooping water
  • Empty bucket to drain dirty water



Follow These 12 Steps


1.   Lay out all your supplies so you know you have everything you’ll need

2.   Line the bed to keep it from getting wet

3.   Fill one bucket with warm water

4.   Gently place your senior’s head into the inflatable basin

5.   Make sure the basin is set up to drain into the empty bucket

6.   Scoop warm water from the full bucket to wet their hair

7.   Use a small amount of shampoo; using too much will make it difficult to rinse out

8.   Scoop warm water to rinse hair completely

9.   If hair is very dirty, shampoo and rinse again

10. When hair is clean, gently remove your senior’s head from the basin

11.  Wrap their head in a dry towel to keep them warm and comfortable

12.  Make sure the basin is fully drained – you might need to tip it over into the bathtub



This video shows how to wash a bed bound person’s hair using an inflatable shampoo basin:





The DMI Basin is easy to inflate and stores easily and compactly when not in use. It has a convenient tube attached so you can drain the water into a large basin or the sink if it’s nearby. The bed shampooer is constructed of heavy duty vinyl for durability and is easy to clean. It even has a little built-in pillow for the head.




DMI Deluxe Inflatable Bed Shampooer Basin, White




The basin is extra deep and constructed of easy-to-clean heavy duty vinyl, and includes a 40″ drain tube.  It measures 24 x 20 x 8 inches.  Read the reviews.





Some Nice Extras for Comfort


  • Plugging ears with cotton balls to keep water from getting in
  • Lining the neck opening with a small towel to protect from scratchy plastic seams
  • Giving them a washcloth to hold on their face if they’re concerned that you might get water in their eyes
  • Using a soothing lavender-scented shampoo for a relaxing experience



It can be challenging, but it’s definitely doable.  The most important things to remember are to have everything you need in easy reach before you begin, and to do what you can to make the experience both relaxing and pleasant for both of you.


Please share your tips with washing a bed-bound person’s hair in bed.


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Dental Care in the Elderly Helps Prevent Heart Attacks and Stroke


Dental Care in the Elderly Helps Prevent Heart Attacks and Stroke





Due to advances in medicine and an increase in prolonged life expectancy, the number of older people will continue to increase worldwide. It is essential that all older adults practice and maintain good oral hygiene due to the high correlation between oral health and general health.



In fact, a report from The Netherlands adds to the evidence tying chronic gum disease to heart disease and stroke.

In a study published in the Journal of Epidemiology and Community Health, of more than 60,000 dental patients, those with periodontitis were twice as likely to have had a heart attack, stroke or severe chest pain.


Previous studies have linked periodontitis and atherosclerotic cardiovascular disease, but this is the first to investigate the link in a group of people this large, the researchers say.


At the Academic Centre for Dentistry Amsterdam, investigators reviewed the medical records of 60,174 patients age 35 and older.


About 4 percent of patients with periodontitis had atherosclerotic cardiovascular disease, compared to 2 percent without periodontitis, the researchers found.


Even after taking other risk factors for cardiovascular disease into account, such as hypertension, high cholesterol, diabetes and smoking, those with periodontal disease were still 59 percent more likely to have a history of heart problems, according to a report in the Journal of Epidemiology and Community Health, August 8.


“It’s clear that periodontitis is associated with chronic inflammation, so it makes sense biologically that if you have a heavy infection in your mouth, you also have a level of inflammation that will contribute to heart conditions,” said Panos Papapanou of Columbia University in New York, who has studied the association between gum disease and heart disease but wasn’t involved in the current study.


The research team suggests that gum disease develops first and may promote heart disease through chronic infection and bacteria in the circulatory system.


Dr. Bruno Loos, the senior author of the new report, said by email that “plausible mechanisms to explain the relationship” may include a common genetic background for the way the body handles inflammation, oral bacteria and immune responses.


Still, this kind of observational study can’t prove that gum disease causes heart problems.


“The association . . . does not provide proof (of causation), even when the results from our study corroborate findings from previous similar research,” study coauthor Geert van der Heijden said by email.


Papapanou said that while the new findings are from patients with a relatively high socioeconomic status, “we’re repeatedly seeing the same conclusion.”


“It seems all over the globe we have to consider this relationship,” Loos said.


Dr. Frank Scannapieco, chairman of the Department of Oral Biology at the University at Buffalo in New York, who wasn’t involved with the study, told Reuters Health that while the association of periodontitis and coronary disease is “robust,” the strength of the link is “moderate compared to traditional risk factors such as hypertension.”


Papapanou advises: “Take care of your oral health for oral health itself. If you know there’s a positive association between oral health and other diseases, would you ignore it? I wouldn’t.”



What You Can Do


Maintaining good oral health is not only vital to your systemic health—it can keep you smiling well into retirement. Brushing at least twice a day with fluoridated toothpaste and a soft-bristle brush is as important as ever. Flossing is very important, too—it helps to remove plaque from between teeth and below the gumline that your toothbrush cannot reach.


As you age, you may be more likely to develop gingivitis. Gingivitis is caused by the bacteria found in plaque that attack the gums. Symptoms of gingivitis include red, swollen gums and bleeding when you brush. If you have these symptoms, see a dentist.


Gingivitis can lead to periodontal disease if problems persist. In the worst cases, bacteria form in pockets between the teeth and gums, weakening the bone and causing the gums to recede, pulling back from teeth. This can lead to tooth loss if left untreated.


As you age, changes in salivary flow and content may further lead to gingivitis, as well as cavities. Because approximately 80 percent of all American adults suffer from some form of gingivitis, it’s important to see your dentist twice a year for regular cleanings and checkups. If regular oral care is too difficult for you (see below), your dentist can provide alternatives to aid in brushing and flossing.




Certain dental products are designed to make dental care less painful for people who have arthritis. It is sometimes recommended that people with arthritis try securing their toothbrush to a wider object, such as a ruler, to ease arthritic hand pain while brushing. Electric toothbrushes also can help by doing some of the work for you. Ask your dentist for other suggestions.

Try these Radius brushes – their ergonomic handles are great for arthritis and other muscular disabilities, as well as for aid in home care.



Oral cancer is one of the most common cancers, with roughly 35,000 new cases reported annually in the United States. Oral cancer most often occurs in people who are older than age 40. Oral cancer can form in any part of the mouth or throat. If not diagnosed and treated in its early stages, oral cancer can spread, leading to chronic pain, loss of function, irreparable facial and oral disfigurement following surgery, and even death. Oral cancer has one of the lowest five-year survival rates of all cancers; this is primarily due to late diagnosis.


See a dentist immediately if you notice any of the following: red or white patches on your gums or tongue, a sore that fails to heal within two weeks, bleeding in your mouth, loose teeth, problems or pain swallowing, or a lump in your neck. Your dentist should perform a head and neck exam to screen for oral cancer during routine checkups.



As you age, you may develop dry mouth. Dry mouth (xerostomia) happens when salivary glands fail to work due to disease, certain medications, or cancer treatment. The condition can make it hard to eat, swallow, taste, and speak. Drinking lots of water and avoiding sweets, tobacco, alcohol, and caffeine are some ways to fight dry mouth. Your dentist also can prescribe medications to ease the symptoms of severe dry mouth.

Try Biotene Dry Mouth Oral Rinse

Studies have shown that maintaining a healthy mouth may keep your body healthier and help you to avoid diabetes, heart disease, and stroke. Older patients who are planning to enter a nursing home should inquire about on-site dental care. People who do not have teeth still need to visit the dentist regularly, since many aspects of oral health, such as adjusting dentures and oral cancer screenings, can be handled during routine dental visits. The best way to achieve good oral health is to visit your dentist at least twice a year.



Advice for Caregivers


Today, many older adults are keeping their natural teeth longer than in the past. This is a good thing, but medical conditions can create a risk of serious dental problems. Also, elderly people may be dealing with serious illnesses, mobility issues or mental health conditions that make it even harder for them to take care of their teeth. If our parents are in assisted living or nursing homes, oral hygiene may get overlooked.


Potential Dental Problems

According to the American Dental Association (ADA), as our parents age, they are increasingly at risk for periodontal (gum) disease, especially if they are not able to keep up with good oral hygiene practices. This disease is often painless; but when left untreated, teeth can become loose and eventually lost. Also, diabetes increases the risk of infection and can worsen gum problems. In fact, a recent study by the ADA concluded that diabetes was connected with one in five cases of total tooth loss.

Older adults are often taking many medications that have dry mouth as a side effect, or they may have a medical condition that has dry mouth as a symptom. Without saliva to balance acids in the mouth, tooth decay becomes a potential problem along with painful mouth infections, such as oral thrush.

It’s not just our parents who are aging; their dental work is as well. Fillings, crowns, dentures and partial dentures sometimes become worn out and need to be replaced just when it becomes hard for them to get to a dentist.

Another serious risk for older adults is oral cancer, especially if they are or were smokers. According to the ADA, the average age when oral cancer is diagnosed is 62. Dentists always do cancer screenings during routine examinations because early detection saves lives.


How Caregivers Can Help

Just as our parents did for us, we can remind our parents to brush and floss daily. If they wear dentures, they also need them to be cleaned every day. With all the risks to their oral health, get them to a dentist regularly, and take a list of their medications along. If your Mom or Dad has arthritis or another disability that makes it difficult for them to brush or floss, ask their dentist to recommend some modifications to make the task easier.

If dry mouth is an issue for your parents, you can discuss the side effects of their medications with their physician. You want to help them get relief. Over-the-counter oral moisturizers, alcohol-free mouthwashes and sugar-free gum and lozenges can help. Make sure they are using fluoride toothpaste. Encourage them to drink plenty of water and to avoid drinking acidic fruit juices and carbonated sodas.

Keeping on top of your parents dental care is challenging when they are in a nursing facility. Having to deal with so many other health care needs, caregivers often don’t rank dental hygiene as a top concern. You may have to communicate specific oral hygiene needs to the staff. Also, be mindful of your parents’ eating habits. If necessary, get input from the nursing staff. If they are not eating as much as usual, they could be experiencing dental pain or dealing with an ill-fitting denture.

It may feel like a strange role reversal, but now it’s our turn to do for our parents what they did for us. Their quality of life depends on good dental health, and we must ensure that their dental needs are met for as long as they are with us.


Here are some suggestions to help you help your elderly parent maintain
their dental health


1.  Be proactive:  if your parent is dependent on you to  take them to dental appointments there is no better time than now to do it than now to get things back into good health and set a dental checkup instead of waiting for something to hurt.


2.    If you have a parent at home with you or in a long term care facility brushing 2 to 3 times a day would go a long way to reducing cavities and promoting better gum health.


3.    Use of a daily fluoride mouthwash or high fluoride content toothpaste can also help reduce cavities.  Speak to your dentist about these products.

Try ACT Sensitive for an alcohol-free, non-burning flouride mouthwash option.




4.    A chlorhexidine mouthwash can help reduce cavities and gum disease in patients that are not able to brush effectively.


Gum Gingidex Short Term Treatment Mouthwash 300ml
Gum Gingidex Treatment Mouthwash with chlorhexidine digluconate

5.  You could also be trained to brush for your parent if they are unable to do so themselves.


6.   An electric toothbrush can also be helpful in getting the teeth cleaner.

Oral B CrossAction Power Anti-Microbial Toothbrush


7.   If they are okay with gum chewing, chewing a piece of sugarless, xylitol containing gum for five to twenty minutes after a meal or snack out can help reduce cavities.

Trident Sugarless Gum with Xylitol, Wild Blueberry Twist Flavor, 12/18 Stick Packs -(216 Sticks Per Box!)
Trident Sugarless Gum with Xylitol, Wild Blueberry Twist Flavor


Good dental health is something that many take for granted.  Being able to eat whatever we want, to speak without fear of a loose denture falling out or being too self conscious to smile due to cavities or missing teeth is a hardship faced by many older adults. 

Poor dental health can result in health problems.  For example, if you have missing teeth or loose teeth you may out of necessity choose softer foods to eat ,  which tend to be more more processed, with little or no fiber;  a  diet low in fiber  can lead to a greater incidence of colon cancer.

I hope this article has shed a little light on a common issue of dental health in the aging adult.  Remember that by being proactive, you can help prevent not only dental issues, but other, potentially life-threatening complications.





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About Me

A Hospice Reflection

Reflecting on My Experience With Hospice

by Ute Freitag


Ten years ago, as the caregiver of my father, it was a privilege for me to be present when he reached the final stage of his life. One evening while I was out, he was rushed to the hospital. When I arrived, the doctor came and told me he was stable and I could see him. When I walked into the room, the same doctor, looking at the machines my father was hooked to, realized he was dying that very moment. “Your father must have been waiting for you,” he said. My father passed away while I was sitting at his bedside, holding his hand and talking to him. The first thought that came to my mind was, “Now he knows the secret of dying.”

Maturing is a long, slow process but in time we learn to accept what we cannot change. Why do we make such a “fuss” about dying? Billions have done it before us!

Dying is probably the only real adventure we face after a fulfilled life but, of course, we don’t know how we will experience the last chapter of our lives before we get there. The quality of death matters as much as the quality of life, and it’s an issue that should be discussed before the crisis of death appears. We should learn to live in the moment and feel the inner peace within us. When we suffer pain during our later years, we should admit the truth: “TMB” (too many birthdays). Hopefully, we will reach the stage where we can enjoy life like the calmness of an evening river, looking at the reflection of the grey and blue water, before the darkness of the night ends the day.

When a loved one becomes terminally ill, we need help. When we realize that their life expectation is probably no longer than six months, what choices do we have? The person can stay at home with the family as long as possible and move to a hospital or a care home when it gets too difficult for the family to handle or, with the support of the family and a palliative care team, he or she can remain at home until the end.

In some cities, there are hospice houses where a person can choose to go for their final days, weeks or months, and which sometimes allow the caregiver to move in with them. The options of where to go should be discussed with the family members closest to the dying individual, but the final decision should be left up to them. What do they really want?

Under the care of hospice nurses, the quality of life for both the dying individual and the caregiver is enhanced. Hospice nurses guide families through the last chapter of a loved one’s life. They help the person to be as comfortable and pain free as possible, which sometimes extends their life longer than expected.


Hospice at home

What is hospice care at home? It means dying with dignity. A hospital bed can be provided and the caregiver can be instructed on how to handle pain medication. The caregiver and their loved one can enjoy their time together, including going out for a meal or a walk. They needn’t worry about symptoms they don’t understand or doing the wrong thing because there’s an emergency hospice helpline they can always call when they need it.

In the hospital, doctors abide by the Hippocratic Oath to prolong life as long as possible; but is what a doctor prescribes today still “good” tomorrow? With hospice, the person who is ill is in charge and treatment can be stopped any time he or she feels it is pointless to go on and would rather enjoy their remaining life without treatment. When a person chooses to stop treatment, there should be no fear of hurting the feelings of the caregiver or the family, who should respect the decision. We occasionally read about people who miraculously survive their terminal illness, but very few will be so lucky. We hope this will be the case with our loved one, but it’s important to prepare for a normal ending.

Even with hospice care, pain is sometimes unavoidable. But each day can still be special—waking up in the morning with curiosity, hoping for a pain-free day and being grateful in the evening for the beauty of another unique day. Remaining active is the best therapy; being active means getting away from fear and misery.


Working together

In my 20 years of volunteering, I have learned how important it is for the patient and caregiver to work together. A patient can choose to be unhappy and depressed or choose to be content and grateful for all the help and love caregivers and hospice nurses provide. How can supporters show empathy and be cheerful and warmhearted if the patient is miserable and rude?

They have to be a team, helping each other through a very difficult time. They still have their past, remembering the Easters, Christmases and birthdays with family and friends, and all the care and help they’ve given each other. It needn’t be that life is meaningless at this stage, unreal, and as though the patient doesn’t have a future anymore. They can still hold hands with those they love and revisit their lives together. At the end of the day, the only thing that matters is love.

Perhaps the caregiver is waiting for the loved one to share their feelings, open their heart and talk about their fear and hope while they both feel the illness creeping out of every corner of the room.

As a caregiver, I ask myself: What does my loved one expect from me? And I ask them: What can I do while your bed is your world and you are too weak to handle your daily affairs? Is there anything I can do to comfort you or is it better to be silent? Only recently you were one of us, active and full of energy and humor. You made us laugh and sometimes we were angry with you, but now we both have only one thought: You won’t get better, this is the end. But as long as you breathe, you are still alive. When you stop breathing, you will be in a safe place. But I, as the one who still loves you and cares for you, I have to live with your death.

It can be helpful for a caregiver to write down those experiences they shared with their loved one throughout the years that shaped their life together. Then later, when the pain of loss is unbearable, they can be reread until the pain lessens. In our local hospice house, we have beautiful heart-shaped pillows that are comforting to hold and have a pocket with just enough room for a little notebook and a pen. Whenever the dying individual wants to write something important for their family or friends to read, it is there right at their bedside.

Sometimes a person who is dying has difficulty talking about their feelings. The caregiver can encourage them to write down their thoughts about what is and was important in their life, something beyond what one normally finds in the average obituary. It can be a pleasant surprise for the family to learn something about their loved one they never knew. It might be a very personal story and something they want to be read at their Celebration of Life.


Passing the time

It is important to give a person who is dying something to fill the day, something to help them feel needed. It can be very healthy to read a book together, because a good book is like a garden, it needs time to grow and develop, allowing the reader to fully relax and refresh themselves in it.

To work with paint is another wonderful tool to deal with fear and anger. When neither the dying individual nor their caregiver wants to talk about their feelings because it is too painful, they can close their eyes, pick up a brush and paint. Sometimes their subconscious speaks to them through their art. And then, like the studio of an artist, the caregiver can make the room around their loved one’s bed a sacred place where imagination can gently run free, a place for their spirit to breathe.

Those people who are painting or being creative in other ways live in the present. My friend Josh, just 55 years-old, lived his final weeks in hospice house surrounded by his three beautiful daughters. Lots of laughter erupted while they were painting together. At the end, there were over 50 paintings in his room. His last painting had two different shades of blue—water and sky—and in the middle he painted a flying bird. He died shortly after. Perhaps he wanted to tell us that he was finally free.


Stopping eating and drinking

In the final stage of life, we want to have our loved ones around us as long as possible, so we make them eat. But is it really good for them? Withholding food and water becomes a highly emotional question that many caregivers have to deal with at the end. If a person is still enjoying food, we are happy to feed them, but what about those dying individuals who want to stop eating and drinking?

When it comes to the end of life, many people don’t feel hungry and thirsty anymore. In this case, the person’s wishes should always be respected. If they want to shorten their remaining life span, stopping eating and drinking will probably accomplish that. Ideally the dying individual is able to make this decision, but often the caregiver is in charge. Common thinking is that we die in agony and great pain without food and liquid. However, scientists have found higher levels of endorphins (morphine-like chemicals) in the brain of the people who stopped eating and drinking. As a result, there should be less pain and suffering. The question of how much liquid a patient needs depends on the dryness of the mucous membrane of the mouth. The benefits of less liquid are less coughing, less throwing up, less mucous, and less chance of water in the lungs.

There will be suffering and mourning for everyone who chooses to take care of a loved one. And yet every caregiver will experience a kind of happiness nobody can take away. The greatest present caregivers can receive for all the work they do is the opportunity to say “Good bye” to the person they love so much. This closeness will be within them forever.


Ute Freitag is a former family caregiver, longtime hospice volunteer and author of the book  “It Is What It Is.


It Is What It Is gives us an inside look at hospice care through the eyes of a volunteer who has worked for the last seven years at a hospice house. Featuring the artwork of Canadian artist Francine Gravel, the stories of hospice residents are beautifully interspersed with poems and quotes.

“We all know that we have to go one day and leave everything we love and treasure behind. It is not easy to accept that the world will go on and we will no longer be part of it.

But remember. . .we are responsible for how we want to live our lives and it is also up to us to determine how we want to die. I believe that we live a much happier and more meaningful life when we make death our friend.

“The stories and poems I have collected provide comfort as we prepare for our last journey, the greatest adventure, and perhaps the only really new thing that will happen to us. The stories in this book are real. Every death is unique. There can be so much beauty in dying, we only need to be open to seeing and feeling it.” – Ute Freitag

It Is What It Is is written for families, patients, caregivers, volunteers, hospice houses, medical personnel and all those facing death one day (everyone). For those working with the dying or those who are now at this stage in their lives, It Is What It Is is a heartfelt and meaningful resource.


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Introduction to Palliative and Hospice Care

Book Review – “Can’t We Talk About Something More Pleasant”?

Dying Process – Dehydration

End of Life Nutrition

Make a Living Will/Health Care Directive

10 Myths About Hospice

About Me

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Brain Disease Swallowing Problems


Brain Disease Swallowing Problems


Swallowing problems in degenerative brain diseases

People who have degenerative brain diseases, such as Alzheimer’s, other dementias, Parkinson’s disease and Amyotrophic Lateral Sclerosis (ALS or Lou Gehrig’s disease), often develop swallowing problems (dysphagia) as their disease progresses. This is because the degeneration of the nerves and their complex connections often spreads throughout a person’s nervous system.


Why does swallowing become a problem?

We take swallowing for granted until we have trouble doing it. Most of us have experienced an episode of choking when food or fluids enter the trachea (windpipe). This is called aspiration, and our lungs respond with a fit of coughing to clear our airway.

Swallowing is a complex action that requires the sensory and motor parts of our brain to work together. When we eat and drink, the brain senses food and fluids in our mouth, moves them safely into the esophagus, and protects the trachea at the same time. Food or fluid then moves down the esophagus into the stomach. Swallowing requires 40 muscles working together with both the sensory and motor parts of the brain. A degenerative brain disease can affect a person’s ability to swallow in different ways, depending on which parts of the brain are affected and how quickly the disease progresses.


Swallowing problems are serious

When swallowing begins to fail, it signals that a person’s degenerative brain disease is at an advanced or life-threatening stage. Serious infections (pneumonia and lung abscess) develop in the lungs when food and fluids are aspirated into the airways. Almost half of patients with dementia who develop “aspiration pneumonia” will die within the next six months. 

Oral or intravenous antibiotics may cure pneumonia, but the more frequently infections occur, the more likely antibiotics will be ineffective. This is because the person is repeatedly aspirating either food and fluids or saliva, which is an indication that the disease is progressing. In order to clear pneumonia, antibiotics need the help of an effective cough and a strong immune system, both of which are lacking in this phase of illness. Also, with each infection, the person becomes weaker and can harbor more resistant organisms. Complications such as a C. difficile infection in the bowel can arise from repeated courses of antibiotics.


How can the risk of infection be reduced?

To reduce the risk of aspiration, a speech language pathologist (speech therapist) or occupational therapist with training in this area first conducts a swallowing assessment. Once the specific swallowing problem is identified, the pathologist or therapist recommends strategies for preventing aspiration.



Ensuring that the person is awake, sitting upright and concentrating on eating or drinking is essential for reducing the risk of aspiration regardless of the swallowing problem. Avoiding foods that are particularly difficult to swallow can prevent choking.

Changing the texture of other foods (for example, by mincing or pureeing) and thickening fluids can make them easier to swallow safely.

Try Thick-It Instant Food and Beverage Thickener


Thick-It 36 OZ
Feeding a person in this way has been called “feeding at risk” but a better name for it is “careful hand feeding.”

Despite these measures and vigilant feeding by family or staff in a facility, aspiration and infection can still occur. This is because swallowing problems worsen over time and a person’s chest muscles become too weak to cough. As a result, he or she cannot expel fluid or food, and the airway is unprotected. When this occurs, it is called “silent aspiration.” Saliva too can be aspirated, and bacteria in the mouth can cause infections in the lungs.


Is a feeding tube helpful?

Recurring infections and more trouble swallowing signal advanced degenerative brain disease. Often by this stage, the person is no longer able to understand his or her medical issues. Family members are often asked to step in to decide whether their loved one would accept a feeding tube.


What is a feeding tube?

A temporary feeding tube is passed through the nose and into the stomach. Rarely is a temporary tube used for more than a few days, because it is uncomfortable and easily pulled out. 



A long-term feeding tube called a PEG tube (percutaneous gastrostomy tube) is surgically inserted. A scope is passed through the mouth and into the stomach. It presses the stomach against the abdominal wall and a tube is passed from outside the patient’s body into the stomach.

With PEG tubes, there is a one-in-ten chance of painful ulcers, infection or tube leakage at the abdominal wall. There is a three-in-a-hundred chance of severe complications, such as serious bleeding, perforation of the bowel, secondary pneumonia, or breakdown of the abdominal wall.


How effective are feeding tubes?

Many family members feel a feeding tube may prolong life, improve its quality, and possibly reverse their loved one’s degenerative brain disease. However, multiple studies show that people who have degenerative brain diseases do not live any longer with a feeding tube than a similar group of people who are fed carefully by hand. Studies also show that a feeding tube does not reduce the risk of aspiration. It is still possible to aspirate saliva and develop a serious pneumonia. 

The progressive weakness related to degenerative brain disease isn’t because of lack of intake. It is the outcome of the natural progression of the illness. The tube does not affect the progression of the disease nor does it improve a person’s quality of life. 

Many family members want a feeding tube for their loved one because they do not wish him or her to feel hunger. However, a person’s desire to eat lessens as end of life approaches. As well, many people with advanced degenerative brain diseases are not very active. They do not need as many calories as they did when they were mobile.

See End of Life Nutrition



While the feeding tube can get food safely to a person’s stomach, it cannot prevent aspiration of saliva into the lungs. As well, the feeding tube cannot prevent aspiration of food into the lungs if the person has gastric reflux (food passing from the stomach back into the esophagus because of a leaky stomach valve). 


Advantages of careful hand feeding




Careful hand feeding has many advantages over tube feeding. It allows the person to still experience the taste of food and interact with others. Preserving these important parts of eating may result in a higher quality of life for a loved one. Careful hand feeding reduces the use of medications needed to treat the discomfort of the tube.



Careful hand feeding is the simplest and most satisfying way for a person to continue eating. The recommended approach is small amounts of favorite foods. If the person refuses food, then basic mouth care is offered.



How do you make the best decisions?

Dealing with complex decisions in advanced disease can be very stressful for the family. So it is important for family members to support each other through these times.

It also is not uncommon for family members to have differing opinions about what is best for their loved one. This is when it is essential for family members to focus on what they believe their loved one would prefer rather than on what they would wish to see happen. The health care team can help support families through these difficult conversations.

Decisions at this time are best made with the health care team and family working together. The health care team can explain the options available for a loved one, given his or her stage of illness. The health care team can also outline what is and isn’t medically possible and appropriate. The family can give insight into what their loved one would prefer if he or she were able to speak for themselves.

Adapted from an article by Romayne Gallagher MD, CCFP


Recommended Reading:

The Dying Process – A Hospice Social Worker’s Perspective On End Of Life Care: A helpful guide for coping and closure during end of life care

The Dying Process – A Hospice Social Worker’s Perspective On End Of Life Care provides a detailed exploration of issues pertaining to patient and family grief reactions, the duration and preparation for death, closure support needs, understanding pain, pain management and avenues to create a positive death experience for both the patient and family.

Over a decade of work in the hospice field, author and social worker, Dana Plish offers professional insight regarding his experiences with patients and families who are in the dying process.

 He elaborates on the process of death which impacts family coping, patient and family closure, barriers to acceptance, and examines negative and positive death processes. He concludes with ways in which family can aid the patient during life to death transition and support ongoing bereavement and grief needs. Dana comments on patient grief related to the loss of pets and supporting patient closure with their pets when possible.

Dana has worked in the social services field for 30 years and he presents the subject matter in a simple, easy to read and understand format which serves as a practical guide for anyone who has a loved one in the dying process.



Thanks for visiting and reading …

I hope this article provided you some helpful ideas.  I welcome your comments below.





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Caregiving for Parkinson’s Disease

Parkinson’s Swallowing and Dental Problems

Parkinson’s Disease and Low Blood Pressure

Parkinson’s Disease Myths – Know the Facts!

About Me

Create Your Own Blog


Dying Process – Dehydration

Dying Process – What to do about Dehydation



Image result for personal note

When my mother was in hospice, our family was always concerned about her diminished capacity to eat and drink.  The medical staff had to remind us (many times) that Mom was at the stage where eating and drinking was for comfort only (not for hydration or nutrition). 

This was a very difficult concept to accept emotionally, because it goes against our instinct to care for our loved one by insisting that they continue ingesting food and water as an ill person “should.”

It is heart-wrenching to watch someone you care for slow down, and then stop eating and drinking.  One of the most difficult, I think.  I really had to fight a sense of panic as time passed without seeing my mother eat or drink.



What is Dehydration?

Image result for hospice dehydration


Dehydration is a condition that results from the excessive loss of water from the body. Diarrhea and vomiting are two of the most common causes of dehydration. Some medications can also reduce body water by increasing urine production. These drugs are called diuretics and are sometimes referred to as ‘water pills’.

When people are nearing death, it is quite common for them to drink smaller and smaller amounts of fluid.

Dehydration may occur even without being caused by any specific complication or medication. Many health care providers specializing in end-of-life care believe that people can be comfortable with small sips of fluid or ice chips, and may not experience thirst in the same way that healthy individuals do.


Causes of Dehydration


Water is a vital component of the body. It plays a critical role in the proper functioning of the different body systems, such as the production of urine in order to remove toxins. There are many complex processes involved in maintaining the proper balance of body water. The body can sense how much fluid needs to be taken in to keep this balance, and the sensation of thirst is triggered when more fluids are needed.

Generally, dehydration is part of the normal process of the body shutting down at the end of progressive serious illness, and is a factor in the natural cycle of changes that occur as death nears.



What Happens When People Become Dehydrated?


  • People become weak, and take in less fluid. They become even weaker, and tend to sleep more, resulting in even less fluid intake. This cycle continues over a matter of days or weeks, and is part of the dying process.
  • Because the mechanism that triggers the sensation of thirst is often weakened in advanced serious illness, people generally do not feel thirsty as long as the mouth is kept moist. So although dehydration is a common and natural part of the dying process, “dying of thirst” is not.
  • Normally, the kidneys try to save water when a person is dehydrated. Less urine is produced, and the urine becomes darker and more concentrated. If the body cannot spare enough water to allow the kidneys to remove toxins from the body, then the kidneys will start to fail and shut down.
  • The toxins, which are the normal by-products of the ongoing functioning of the body, will build up and contribute to the overall weakness and sleepiness of the person.


Sorting Out Symptoms


To determine possible causes of dehydration, the health care team will often ask questions, conduct a physical examination, or order some tests. This will help them to make decisions about how best to manage the dehydration.


Questions You’ll be Asked by the Health Care Team


The medical team may ask some of the following questions in order to understand to what extent the patient is dehydrated, and what might possibly be causing it:


Has there been a change in the amount of fluid (water, juice, popsicles or ice chips) that the person is drinking?

  • If so, when did that change happen?
  • Is less fluid being taken in, or is there increased thirst and drinking?



If there have been difficulties drinking fluids, what are they related to?

  • Too weak to drink or suck from a straw?
  • Too sleepy to drink safely?
  • Can’t seem to swallow well. Just holds fluid in the mouth, or chokes and coughs when trying to swallow?
  • Tries to swallow, but everything seems to get stuck on the way down?


Is there nausea and/or vomiting?


Has the urine changed?

  • Less urine or more urine?
  • Has the colour changed (darker and more concentrated, or lighter)?


How have the bowels been functioning?

  • Is there diarrhea? Constipation?
  • Has there been any output at all… stool or gas?
  • Is there bloating?
  • Is there any pain or discomfort in the abdomen?


What medications are being taken?

  • Diuretics? (“water pills”, which can increase water loss)
  • Laxatives? (which can cause diarrhea)
  • Steroids? (such as dexamethasone, prednisone, which can cause blood sugar to rise, and which may result in increased urination and water loss)
  • Opioids? (may have by-products that build up when someone is dehydrated)


What are the effects of the person drinking less fluid?

  • Have there been any disagreements between the patient and family members about fluid intake?
  • Are there feelings of depression, sadness, or frustration because of the amount of fluids being taken in?
  • Sometimes family and friends are more concerned about this lack of fluid intake than the person who is experiencing it. How much concern does the patient have about not drinking much?



Physical Examination


Certain physical clues (such as dry mouth) can help determine if dehydration is present, and how severe it is. Since dehydration can be caused by many different problems, the health care professional will usually do a general physical examination. The exam may provide some ideas about what could be causing the problems, and will help guide decisions about tests that may be needed.




Usually, blood tests are done to help confirm that dehydration is present, and to help assess how severe it is. Other tests may be considered, depending on what is suspected after asking questions and the physical examination.


Managing Dehydration


The topic of dehydration and its management is one of the more controversial issues in palliative care.


  • Some consider dehydration a normal part of the dying process that should be left to run its natural course, and that treating dehydration only serves to prolong dying.
  • Others may view dehydration as an easily treatable condition, whose correction may improve alertness, communication and interaction with loved ones, and general well-being.
  • Still others consider it unethical to withhold fluids, even if it means that fluids must be given by administering fluids continuously into a vein (intravenous) or under the skin (hypodermoclysis) in a person who is near death.



There are different reasons for these conflicting approaches to dehydration:


  • There is no clear and strong scientific evidence to guide an overall approach to dehydration in the palliative care setting.
  • Cultural, religious, and ethical/moral considerations may influence the views of patients, families, and health care providers about whether withholding fluids is ever appropriate.


As with most decisions about care in advanced illness, each situation should be approached individually, reviewing the wishes of the patient and family, the overall goals of care, the scientific evidence for different treatment choices, and potential burdens and benefits of the existing options.



When Treating Dehydration May Help


There are specific circumstances in which treating dehydration has the potential to significantly improve quality of life and overall well-being.


  • Confusion (delirium)
    Dehydration can result in a build-up of toxins and medications when there is not enough water to help the kidneys remove them from the bloodstream. This can result in delirium, which is upsetting and difficult for everyone involved. Giving fluids may allow increased alertness and more clear thinking, and improved ability to interact with others.


  • Opioid side effects
    Opioid medications can build up in the body, particularly when someone is dehydrated. This can result in delirium, and irritation of the nervous system which may cause muscle twitching and possibly seizures. Giving fluids sometimes helps the kidneys clear these medications.


  • Nausea, vomiting and diarrhea
    These digestion problems can often be helped once the cause of the symptom is found and treated, but in the meantime, the symptoms may lead to dehydration. Dehydration often makes nausea and vomiting worse, resulting in a cycle of further dehydration. When the health care team is trying to reverse the problem that is causing nausea, vomiting or diarrhea, giving fluids by infusion intravenously or under the skin should be considered early.


  • High calcium levels in the blood
    Sometimes cancer causes a high level of calcium in the bloodstream, which results in increased sleepiness and confusion. High levels of calcium can eventually be fatal. There are times where, through discussion with the patient and/or family of all factors involved, a decision is made to not treat the high calcium. However, if treatment is chosen, administering fluids is an important part of the management of high calcium.


Tip: Let your health care team know if your loved one is experiencing nausea, vomiting or diarrhea. Early treatment of these symptoms can help to reduce the severity of dehydration.


When the Benefits of Treating Dehydration Are Unclear


There are a couple of situations where the evidence is not clear as to whether fluids are helpful or harmful.


  • Thirst
    It is not clear from studies whether dehydration in people with advanced illness causes thirst. In those who are unconscious, it is very unlikely that a sensation of thirst can be felt. In people who are awake but unable to drink, it is generally thought that maintaining a moist mouth with vigilant mouth care is the most effective approach to relieving thirst. However if this is not effective, it is reasonable to try administering fluid into a vein intravenously or under the skin.


  • Congestion in the lungs when death is near (“death rattle”)
    Some health care providers may feel uncomfortable administering fluids when congestion is present. They may argue that fluids will only worsen the build-up of secretions in the lungs. However, there is no strong evidence to support this concern. The secretions are the result of pooled collections of mucus rather than water, except in the circumstance of heart failure. There are times when such secretions can be quite substantial even though no fluids have been given for many days.


Some families (and health care providers) feel that it is never ethical to withhold fluids, or perhaps doing so is not consistent with their faith. These concerns may be very strongly held. Heath care teams involved in decision-making have every reason to respect differing points of view on this question, as there is not sufficient evidence that administering fluids worsens congestion.


What You Can Do


When someone who is dying is drinking poorly and becoming dehydrated, family and friends often feel helpless and want to “fix” the problem by improving the person’s fluid intake. We hope the sick person will feel better, get better, and even live longer as a result of drinking more.

However, towards the end of serious illness, it is quite common for people to drink smaller and smaller amounts of fluid. Dehydration may occur even without being caused by any specific complication or medication. Many health care providers specializing in end-of-life care believe that people can be comfortable with small sips of fluid or ice chips, and may not experience thirst in the same way that healthy individuals do.


Talk to the Health Care Team


When discussing concerns about fluid intake with your health care team, it may be helpful to consider these questions:


  • Who is actually concerned? Often the person who is ill is less concerned about fluid intake than family and friends. The wishes and goals of the patient should direct the approach to care.
  • What do you think the patient would want?
  • What will happen with and without fluids being given?
  • What can be done to ensure comfort and relief of the sensation of thirst, no matter which choice is made?
  • Are there safety concerns about swallowing? Your health care team may be able to suggest ways to help swallowing to reduce the risk of aspiration into the lungs (“going down the wrong way”).
  • How complicated and burdensome will it be to treat dehydration? For example, would transfer to hospital from home be required?
  • What is the evidence that giving fluids will help the problem at hand or achieve the goals of care?


If possible, the best approach to drinking is to let the person with the illness make the decisions about what to drink, when to drink or whether to drink at all.

Family members are sometimes asked to decide whether or not fluids should be given to a loved one who is dying, can no longer swallow, and cannot direct the health care team in what to do. This decision is made even more difficult if there is no health care directive or living will,  and if the wishes of the patient to guide the decision are unknown.

This can be a very challenging and distressing situation, as it may feel that the choice is between letting death occur without doing anything – not even giving a drop of water and perhaps prolonging the dying. Neither seems like a good option.

There is actually no evidence that giving fluids to a person who is imminently dying will prolong the dying process. If family members are unsure about the decision to give fluids, it is usually best to lean towards giving rather than withholding; there seems to be less likelihood of looking back with regret for what might have been done.



Make Taking Fluids Easier


  • Offer people fluids they enjoy – water, juice, jello, popsicles or ice chips. Avoid juices high in acid, such as orange juice, as they may irritate the mouth.
  • Have a variety of fluids available. People may change their fluid preferences often.
  • Offer a straw for drinking. One advantage of drinking from a straw is that straws are less likely to cause choking than cups, as they can more easily deliver small amounts.
  • Do not give fluids to people who are not able to swallow safely.
  • Do not force someone to drink.
  • Offer small, frequent sips of fluid rather than a whole cup at one time.
  • When someone is too weak to swallow, provide mouth care to keep the person’s mouth moist and comfortable.



Care For the Mouth


How often should the mouth be checked for dryness?
Mouth care should be done at least three or four times a day, or even every hour or two if the mouth is very dry. People taking medication under the tongue should have their mouths moistened frequently; otherwise, the medication may not be properly absorbed.


How often should the mouth be checked for dryness?
Mouth care should be done at least three or four times a day, or even every hour or two if the mouth is very dry. People taking medication under the tongue should have their mouths moistened frequently; otherwise, the medication may not be properly absorbed.


You could try a swabstick like Dynarex Lemon-Glycerin Swabsticks – have a pleasant taste, while soothing and refreshing dry mouths of patients with restricted oral intake, lemon flavor.

Dynarex Lemon Glycerin Swabs, 75 Count


Other factors that may contribute to dry mouth
Sometimes people are only able to breathe comfortably through the mouth. These people may find that their mouths are especially dry. Certain medications can also be very drying to the mouth.




What Your Health Team Can Do


Giving fluids (rehydration or sometimes simply hydration)

The health care team will consider several different options for giving fluids:


Fluids can be given through a small plastic catheter placed into a vein. This is the most common route of fluid administration in hospitals if the oral route is not used. This option may or may not be available in other settings (for example at home, in a hospice or personal care home).

Personal note: This option was not available in the hospice facility where my mother was being cared for; they had a “no intravenous” policy (which I believe is common).  They did however, keep my mother comfortable with any fluids or popsicles she was able to take by mouth, and by regular mouth care.


By Mouth

Oral rehydration can be effective if fluids can be swallowed and ‘kept down’. Giving frequent sips of water or a commercial preparation such as Gatorade®, Powerade®, or Pedialyte® can maintain hydration.

If the medical staff think these products might be helpful, but are not available at the hospital or hospice, you can bring them with you when visiting.


Gatorade Frost Thirst Quencher, Glacier Freeze, 32 ozPOWERADE, Strawberry Lemonade, 32 Fl oz BottlePedialyte, Strawberry Flavored, 1 qt 1.8 Fl Oz. (33.8 oz)  Pedialyte Freezer Pops - Assorted Flavors - 2.1 oz - 16 ct
Generally, the goal is to drink one to two litres per day but it is important not to ‘force fluids’ if a person does not feel like taking them.


Under the Skin (Subcutaneously)

Using small needles known as butterfly needles, or, preferably, using small plastic catheters placed under the skin, fluids are administered by continuous infusion into the tissues under the skin, which are then absorbed into the rest of the body. This method is called hypodermoclysis, (or simply clysis). This method can be useful when it is difficult to find veins for intravenous infusions and may be more readily available in settings outside of the hospital.


Care  When Fluids Are Not Given


Health care providers have noted that patients can be very comfortable even if they drink very little fluid. These people may experience a dry mouth, or the occasional feeling of thirst. However, such symptoms are usually easily managed with sips of fluid, ice chips, and regular mouth care.

When someone is nearing death, dehydration is inevitable as the person loses the desire and ability to take in fluids.  This is a very challenging time for family members.  It may help to remember that the goal of treatment at this stage is to promote comfort (not to hydrate for recovery).


Final Thoughts

Personal note: When I was upset over my mother’s lack in fluid intake, nurses would ask me “what is the goal of treatment now?” This would lead to a reminder that hydration (or nutrition, for that matter) could not prolong my mother’s life at this late stage of the disease process.




Recommended Reading:


A doctor on the front lines of hospital care illuminates one of the most important and controversial social issues of our time.

It is harder to die in this country than ever before. Though the vast majority of Americans would prefer to die at home—which hospice care provides—many of us spend our last days fearful and in pain in a healthcare system ruled by high-tech procedures and a philosophy to “fight disease and illness at all cost.”


Dr. Ira Byock, one of the foremost palliative-care physicians in the country, argues that how we die represents a national crisis today. To ensure the best possible elder care, Dr. Byock explains we must not only remake our healthcare system but also move beyond our cultural aversion to thinking about death. 

The Best Care Possible is a compelling meditation on medicine and ethics told through page-turning life-or-death medical drama. It has the power to lead a new national conversation.





Thanks for visiting and reading …

I hope this article provided you some helpful ideas.  I welcome your comments below.





You may also be interested in:

Make a Living Will/Health Care Directive

End of Life Nutrition

Introduction to Palliative and Hospice Care

10 Myths About Hospice


Prevent Bed Sores

How to Prevent and Treat Bed Sores


Anyone who remains lying or sitting in one position for more than a couple of hours is at risk for skin breakdown. This can lead to pressure sores, which are also known as pressure ulcers or bedsores. These skin problems can be painful and decrease a person’s quality of life. 




Causes of Bed Sores


Someone who cannot change position in bed or is limited to sitting in a chair needs to be helped to change position every hour or two.


Repositioning, pressure reduction, and good skin care are all necessary to prevent skin problems and to keep small problems from getting worse.


Bedsores are caused by pressure against the skin that limits blood flow to the skin and nearby tissues. Other factors related to limited mobility can make the skin vulnerable to damage and contribute to the development of pressure sores.




Three primary contributing factors of bed sores are:


  • Sustained pressure. When your skin and the underlying tissues are trapped between bone and a surface such as a wheelchair or a bed, the pressure may be greater than the pressure of the blood flowing in the tiny vessels (capillaries) that deliver oxygen and other nutrients to tissues. Without these essential nutrients, skin cells and tissues are damaged and may eventually die.
  • This kind of pressure tends to happen in areas that aren’t well-padded with muscle or fat and that lie over a bone, such as your spine, tailbone, shoulder blades, hips, heels and elbows.
  • Friction. Friction is the resistance to motion. It may occur when the skin is dragged across a surface, such as when you change position or a care provider moves you. The friction may be even greater if the skin is moist. Friction may make fragile skin more vulnerable to injury.
  • Shear. Shear occurs when two surfaces move in the opposite direction. For example, when a hospital bed is elevated at the head, you can slide down in bed. As the tailbone moves down, the skin over the bone may stay in place — essentially pulling in the opposite direction. This motion may injure tissue and blood vessels, making the site more vulnerable to damage from sustained pressure.



Risk of Bed Sores


People are at risk of developing pressure sores if they have difficulty moving and are unable to easily change position while seated or in bed. Immobility may be due to:


  • Generally poor health or weakness
  • Paralysis
  • Injury or illness that requires bed rest or wheelchair use
  • Recovery after surgery
  • Sedation
  • Coma


Other factors that increase the risk of pressure sores include:


  • Age.  The skin of older adults is generally more fragile, thinner, less elastic and drier than the skin of younger adults. Also, older adults usually produce new skin cells more slowly. These factors make skin vulnerable to damage.
  • Lack of sensory perception. Spinal cord injuries, neurological disorders and other conditions can result in a loss of sensation. An inability to feel pain or discomfort can result in not being aware of bedsores or the need to change position.
  • Weight loss. Weight loss is common during prolonged illnesses, and muscle atrophy and wasting are common in people with paralysis. The loss of fat and muscle results in less cushioning between bones and a bed or a wheelchair.
  • Poor nutrition and hydration. People need enough fluids, calories, protein, vitamins and minerals in their daily diet to maintain healthy skin and prevent the breakdown of tissues.
  • Excess moisture or dryness. Skin that is moist from sweat or lack of bladder control is more likely to be injured and increases the friction between the skin and clothing or bedding. Very dry skin increases friction as well.
  • Bowel incontinence. Bacteria from fecal matter can cause serious local infections and lead to life-threatening infections affecting the whole body.
  • Medical conditions affecting blood flow. Health problems that can affect blood flow, such as diabetes and vascular disease, increase the risk of tissue damage.
  • Smoking. Smoking reduces blood flow and limits the amount of oxygen in the blood. Smokers tend to develop more-severe wounds, and their wounds heal more slowly.
  • Limited alertness. People whose mental awareness is lessened by disease, trauma or medications may be unable to take the actions needed to prevent or care for pressure sores.
  • Muscle spasms. People who have frequent muscle spasms or other involuntary muscle movement may be at increased risk of pressure sores from frequent friction and shearing.



Stages of Bed Sores and Pressure Sores


Bedsores fall into one of four stages based on their severity. The National Pressure Ulcer Advisory Panel, a professional organization that promotes the prevention and treatment of pressure ulcers, defines each stage as follows:



Stage I Bed Sores


  • The beginning stage of a pressure sore has the following characteristics:
  • The skin is not broken.
  • The skin appears red on people with lighter skin color, and the skin doesn’t briefly lighten (blanch) when touched.
  • On people with darker skin, the skin may show discoloration, and it doesn’t blanch when touched.
  • The site may be tender, painful, firm, soft, warm or cool compared with the surrounding skin.


Stage II Bed Sores


  • The outer layer of skin (epidermis) and part of the underlying layer of skin (dermis) is damaged or lost.
  • The wound may be shallow and pinkish or red.
  • The wound may look like a fluid-filled blister or a ruptured blister.


Stage III Bed Sores –  the ulcer is a deep wound:


  • The loss of skin usually exposes some fat.
  • The ulcer looks crater-like.
  • The bottom of the wound may have some yellowish dead tissue.
  • The damage may extend beyond the primary wound below layers of healthy skin.

Stage IV Bed Sores –  ulcer shows large-scale loss of tissue:


  • The wound may expose muscle, bone or tendons.
  • The bottom of the wound likely contains dead tissue that’s yellowish or dark and crusty.
  • The damage often extends beyond the primary wound below layers of healthy skin.


Unstageable Bed Sores


A pressure ulcer is considered unstageable if its surface is covered with yellow, brown, black or dead tissue. It’s not possible to see how deep the wound is.

  • Deep tissue injury
  • A deep tissue injury may have the following characteristics:
  • The skin is purple or maroon but the skin is not broken.
  • A blood-filled blister is present.
  • The area is painful, firm or mushy.
  • The area is warm or cool compared with the surrounding skin.
  • In people with darker skin, a shiny patch or a change in skin tone may develop.


Common Sites of Bed Sores and Pressure Sores





For people who use a wheelchair, pressure sores often occur on skin over the following sites:


  • Tailbone or buttocks
  • Shoulder blades and spine
  • Backs of arms and legs where they rest against the chair



For people who are confined to a bed, common sites include the following:

  • Back or sides of the head
  • Rim of the ears
  • Shoulders or shoulder blades
  • Hip, lower back or tailbone
  • Heels, ankles and skin behind the knees


When to See a Doctor for Bed Sores or Pressure Sores


If you notice early signs or symptoms of a pressure ulcer, change your position to relieve the pressure on the area. If you don’t see improvement in 24 to 48 hours, contact your doctor. Seek immediate medical care if you show signs of infection, such as fever, drainage or a foul odor from a sore, or increased heat and redness in the surrounding skin.


Complications of Pressure Ulcers


  • Sepsis. Sepsis occurs when bacteria enter the bloodstream through broken skin and spread throughout the body. It’s a rapidly progressing, life-threatening condition that can cause organ failure.
  • Cellulitis. Cellulitis is an infection of the skin and connected soft tissues. It can cause severe pain, redness and swelling. People with nerve damage often do not feel pain with this condition. Cellulitis can lead to life-threatening complications.
  • Bone and joint infections. An infection from a pressure sore can burrow into joints and bones. Joint infections (septic arthritis) can damage cartilage and tissue. Bone infections (osteomyelitis) may reduce the function of joints and limbs. Such infections can lead to life-threatening complications.
  • Cancer. Another complication is the development of a type of squamous cell carcinoma that develops in chronic, nonhealing wounds (Marjolin ulcer). This type of cancer is aggressive and usually requires surgery.


Treatment for Bedsores


Stage I and II bedsores usually heal within several weeks to months with conservative care of the wound and ongoing, appropriate general care. Stage III and IV bedsores are more difficult to treat.


Addressing the many aspects of wound care usually requires a multidisciplinary approach. Members of your care team may include:


  • A primary care physician who oversees the treatment plan
  • A physician specializing in wound care
  • Nurses or medical assistants who provide both care and education for managing wounds
  • A social worker who helps you or your family access appropriate resources and addresses emotional concerns related to long-term recovery
  • A physical therapist who helps with improving mobility
  • A dietitian who monitors your nutritional needs and recommends an appropriate diet
  • A neurosurgeon, orthopedic surgeon or plastic surgeon, depending on whether you need surgery and what type

Reducing Pressure to Heal Bed Sores


The first step in treating a bedsore is reducing the pressure that caused it. Strategies include the following:


  • Repositioning. If you have a pressure sore, you need to be repositioned regularly and placed in correct positions. If you use a wheelchair, try shifting your weight every 15 minutes or so. Ask for help with repositioning every hour. If you’re confined to a bed, change positions every two hours.
  • If you have enough upper body strength, try repositioning yourself using a device such as a trapeze bar. Caregivers can use bed linens to help lift and reposition you. This can reduce friction and shearing.
  • Using support surfaces. Use a mattress, bed and special cushions that help you lie in an appropriate position, relieve pressure on any sores and protect vulnerable skin. If you are in a wheelchair, use a cushion. Styles include foam, air filled and water filled. Select one that suits your condition, body type and mobility.


Cleaning and Dressing Bed Sore Wounds


Care that helps with healing of the wound includes the following:


Cleaning. It’s essential to keep wounds clean to prevent infection. If the affected skin is not broken (a stage I wound), gently wash it with water and mild soap and pat dry. Clean open sores with a saltwater (saline) solution each time the dressing is changed.


Applying dressings. A dressing promotes healing by keeping a wound moist, creating a barrier against infection and keeping the surrounding skin dry. Dressing choices include films, gauzes, gels, foams and treated coverings. A combination of dressings may be used.


Your doctor selects a dressing based on a number of factors, such as the size and severity of the wound, the amount of discharge, and the ease of placing and removing the dressing.


Removing Damaged Bed Sore Tissue


To heal properly, wounds need to be free of damaged, dead or infected tissue. Removing this tissue (debridement) is accomplished with a number of methods, depending on the severity of the wound, your overall condition and the treatment goals.


  • Surgical debridement involves cutting away dead tissue.
  • Mechanical debridement loosens and removes wound debris. This may be done with a pressurized irrigation device, low-frequency mist ultrasound or specialized dressings.
  • Autolytic debridement enhances the body’s natural process of using enzymes to break down dead tissue. This method may be used on smaller, uninfected wounds and involves special dressings to keep the wound moist and clean.
  • Enzymatic debridement involves applying chemical enzymes and appropriate dressings to break down dead tissue.



Other interventions that may be used are:


  • Pain management. Pressure ulcers can be painful. Nonsteroidal anti-inflammatory drugs — such as ibuprofen (Motrin IB, Advil, others) and naproxen (Aleve, others) — may reduce pain. These may be very helpful before or after repositioning, debridement procedures and dressing changes. Topical pain medications also may be used during debridement and dressing changes.
  • Antibiotics. Infected pressure sores that aren’t responding to other interventions may be treated with topical or oral antibiotics.
  • A healthy diet. To promote wound healing, your doctor or dietitian may recommend an increase in calories and fluids, a high-protein diet, and an increase in foods rich in vitamins and minerals. You may be advised to take dietary supplements, such as vitamin C and zinc.
  • Management of incontinence. Urinary or bowel incontinence may cause excess moisture and bacteria on the skin, increasing the risk of infection. Managing incontinence may help improve healing. Strategies include frequently scheduled help with urinating, frequent diaper changes, protective lotions on healthy skin, and urinary catheters or rectal tubes.
  • Muscle spasm relief. Spasm-related friction or shearing can cause or worsen bedsores. Muscle relaxants — such as diazepam (Valium), tizanidine (Zanaflex), dantrolene (Dantrium) and baclofen (Gablofen, Lioresal) — may inhibit muscle spasms and help sores heal.
  • Negative pressure therapy (vacuum-assisted closure, or VAC). This therapy uses a device that applies suction to a clean wound. It may help healing in some types of pressure sores.


Surgery for Bed Sores and Pressure Sores


A pressure sore that fails to heal may require surgery. The goals of surgery include improving the hygiene and appearance of the sore, preventing or treating infection, reducing fluid loss through the wound, and lowering the risk of cancer.


If you need surgery, the type of procedure depends mainly on the location of the wound and whether it has scar tissue from a previous operation. In general, most pressure sores are repaired using a pad of your muscle, skin or other tissue to cover the wound and cushion the affected bone (flap reconstruction).



Preventing Bed Sores at Home




  • Look at the person’s skin daily. Tell the health care team about any changes you notice, such as red areas. These are the first signs of skin breakdown, and will lead to sores if left untreated.
  • Clean skin daily.



Calmoseptine Ointment Tube 4 Oz (3 Pack)
Recommended: Calmoseptine Moisture Barrier Ointment helps to protect and heal skin irritations from incontinence, minor burns, scrapes, diaper rash or wound drainage; temporarily relieves discomfort and itching; and provides multipurpose moisture barrier. Contains calamine, zinc oxide, menthol and lanolin.
  • Use mild cleansing products.
  • Avoid using hot water to clean the skin.
  • Use moisturizers for dry skin.
  • Check to make sure clothing and bed linens are clean, dry and free of wrinkles. Wrinkles increase friction and may lead to skin discomfort or pain.


Bedsore Pressure Reduction


  • Relieve any constant pressure on areas at greatest risk for skin breakdown. These include the site of existing pressure sores, the site of previously healed sores, scars, and bony areas.


  • If the person is in bed, remind, or help, the person to change position every two hours.


  • If the person is in a chair or wheelchair, remind, or help, the person to change position every hour. If possible, help the person stand briefly, or alternate between sitting and lying. It is best if the person avoids sitting for long periods.

Positioning Wedge



  • Use pillows like this repositioning wedge between legs, under arms or elsewhere. This separates bony areas, prevents direct skin-on-skin contact, and may make swollen legs and ankles feel better.






The Med Aire Alternating Pressure Pump and Pad System with Low Air Loss by Drive Medical provides alternating pressure and is designed to be used in the prevention, treatment and management of Pressure Ulcers.



  • Have the person avoid lying directly on the side, that is, with the front of the body facing sideways, at right angles to the mattress. A better position is to lie slightly sideways, that is, using supporting pillows to help the front of the body tilt about thirty degrees to the mattress.


  • Avoid using air rings or other donut-shaped cushioning devices.


  • Ask your local home care or palliative care program if they have a loan program for pressure-reducing mattresses.

How to Move Someone in Bed



Some people may find it uncomfortable to be moved, but staying in the same position for more than a couple of hours may lead to even greater pain or discomfort.


Changing positions is important, except in cases when someone may not live more than a few hours. These are some general tips for moving someone in bed.


If possible, watch a member of the care team do a move, so you can see how it is done.


If the person finds it painful to be moved, talk to the health care team about giving the person pain medication beforehand. They can tell you the best type of medication to use for this purpose, and explain how and when to give it.


Moving someone from one position to another is easier with two people, with each standing on opposite sides of the bed.


Take care to keep your knees slightly bent (not locked) when you do any sort of lifting. This gives your back proper support.


When moving a person, lift the person off the surface below, rather than dragging the person in direct contact with the surface.


Moving someone is much easier if the person is lying on a turning sheet or a cloth absorbent pad.


Turning sheets are small sheets that run from the person’s head to buttocks.


Any sheet can be made into a turning sheet by folding it in half and laying it over the full sheet. The sheet or pad allows two people to grab onto the corners to lift or move the person on the bed.


Recommended: SafetySure MovEase Under Pad

 SafetySure MovEase Under Pad


After the move, pull on the sheet or pad from top to bottom, to smooth out wrinkles.


Before starting a move, lower the bed to a flat position, or recline the bed as far as the person’s condition allows. Lower the bed slowly, as rapid movements can cause discomfort.



Moving Someone From Their Back Onto Their Side


Place a pillow under the person’s head before starting the turn and have pillows ready to place under legs, arms, and behind the back.


If the person is going to be turned onto the right side, take the left arm, bend it gently at the elbow, and place it over the stomach.


Bend the left leg at the knee, and place a pillow between the person’s legs.


Place one hand behind the person’s buttocks and the other underneath the shoulder.


Roll the person in the direction of your helper, and have the helper hold the person in place.


Once the helper is holding the person, place your hands under the person’s buttocks to move the body back toward the center of the bed.


You may need to pull the right (bottom) shoulder forward if it looks uncomfortable. This places the person in more of a fetal position rather than lying completely straight.


Arrange the pillows comfortably between the person’s shoulder and head, and also between the legs. When you return the person onto their back later, place a pillow under the head and one under each shoulder, positioned to make the person as comfortable as possible.



Raising Someone in Bed With a Turning Sheet


People who are sitting up in bed will naturally slide down over time. Before you raise the person, lower the bed until it is flat, or as flat as the person’s condition allows.


If possible, ask the person to tuck their chin into their neck during the move, so their head is protected.


Take hold of a bottom and top of the turning sheet on your side, and have your helper do the same on the other side.


On a signal, such as the count of three, gently lift the person toward the head of in bed.


Once the bed is raised again to a comfortable position, you can place a pillow under the person’s knees to prevent slipping.



Raising Someone in Bed Without aTurning Sheet


Stand near the person’s shoulder, with your helper on the opposite side.


Look toward the head of the bed, and place one of your arms under the person’s shoulder closest to you.


Use your free arm to support yourself by leaning into the bed.


On a signal, such as the count of three, lift the person toward the head of bed.


If possible, ask the person to bend their knees and dig into the bed with their heels to help with the move.


Once the bed is raised again to a comfortable position, you can place a pillow under the person’s knees to prevent slipping.



Remember, it is much easier to prevent bedsores with proper care at home, than to treat a bedsore once it has developed. 



Watch for signs of pressure points and reduce pressure with regular turning and moving, and examine the skin for signs of pressure.



If you have had experience dealing with bedsores, please share your thoughts below.


You may also be interested in:

Best Mattresses and Pads for Pressure Relief

How to Give a Sponge Bath in Bed

Coping With Incontinence

Risks of Bed Rails

Caregivers Can Reduce the Risks of Heavy Lifting

Caregivers Need Sleep!

The Drunk Caregiver

Natural Depression Remedies – What Works?

Top Pillows to Relieve Neck Pain

Make a Living Will/Health Care Directive

End of Life Nutrition

Dying Process – Dehydration

Introduction to Palliative and Hospice Care

10 Myths About Hospice

About Me

Create Your Own Blog




Painkiller Induced Constipation



Help For Painkiller Induced Constipation – OIC




Many prescription and nonprescription medicines can cause constipation.


Examples include:

  • Antacids.
  • Antidepressants.
  • Some blood pressure medicines.
  • Cold medicines (antihistamines).
  • Calcium and iron supplements.
  • Narcotic pain medicines.


If you think that the constipation is caused by a medicine:

  • For prescription medicines, call the doctor who prescribed it to see whether you or your child should stop taking the medicine or take a different one. An appointment may not be needed.
  • For nonprescription medicines, stop using the medicine. Call your doctor if you feel that you or your child still needs to take the medicine.


Opioid (Painkiller) Induced Constipation




What are Opioids?


Opioids are a class of drugs that are commonly prescribed for their analgesic, or pain-killing, properties. They include substances such as morphine, codeine, oxycodone, and methadone. Opioids may be more easily recognized by drug names such as Kadian, Avinza, OxyContin, Percodan, Darvon, Demerol, Vicodin, Percocet, and Lomotil.


Opioids may be classified as natural, semi-synthetic, fully synthetic, or endogenous. Natural opioids such as codeine and morphine are derived from opiate alkaloids contained in the resin of the opium poppy. Semi-synthetic opioids such as oxycodone and hydrocodone are created by chemically altering the natural opioids. Fully synthetic opioids such as methadone are synthesized from non-opioid substances in laboratories. Endogenous opioids are naturally produced by the body and include substances such as endorphins.



How Do Opioids Work?



Opioids bind to specific proteins called opioid receptors that are located in the brain, spinal cord, and gastrointestinal tract. Through this mechanism, opioids are able to block the brain’s ability to perceive pain. Instead, opioids tend to stimulate the pleasure centers of the brain, inducing euphoria.



When Are Opioids Used?


Opioids are used in medicine because they can block the perception of pain. Patients receiving palliative care frequently report pain as one of the most distressing factors as they approach the end of life. About 70% of patients with advanced cancer and 65% of patients dying from other non-malignant diseases commonly complain of pain. Opioid-based medicines are prescribed to these patients to reduce their pain and increase their quality of life. The vast majority of patients receiving long-term opioid pain medication are in advanced stages of their disease.



What are the Side Effects of Opioids?



Opioid use carries several side effects. These include drowsiness, nausea, slower breathing, and a general depression of the respiratory system. Further, opioids often cause constipation, or opioid-induced constipation (OIC). OIC is an uncomfortable side-effect that occurs in many patients who receive opioid treatments to relieve pain.



How Do Opioids Cause Constipation?




Opioids are effective pain relievers, but often have the side effect of constipation. These medicines affect the gastrointestinal tract in a variety of ways. Opioids increase the amount of time it takes stool to move through the gastric system. They increase nonpropulsive contractions in the middle of the small intestine (jejunum) and decrease longitudinal propulsive peristalsis – motions critical to moving food through the intestines. This results in food that fails to travel through the digestive tract.




Opioids are also able to partially paralyze the stomach (gastroparesis) so that food remains in the digestive organ for a longer period of time. Additionally opioids reduce digestive secretions and decrease the urge to defecate.



Symptoms of OIC



Several physical and other symptoms are prevalent in sufferers of opioid-induced constipation (OIC). Physicians usually will gather patient history information to check for standard problems associated with constipation such as too little fiber and fluid intake, too little exercise, underlying medical problems, and current medications. Be prepared for a physical assessment that requires oral, abdominal, and digital anorectal examinations.


Common physical symptoms of OIC include:


  • Stools that are hard and dry
  • Difficulty such as straining, forcing, and pain when defecating
  • A constant feeling that you need to use the toilet
  • Bloating, distention, or bulges in the abdomen
  • Abdominal tenderness


Other symptoms of OIC include:


  • Feeling and being sick
  • Tiredness and lethargy
  • Appetite loss
  • Feeling depressed


Treatment Options for OIC


Although opioids are very effective for treating and managing pain, their use frequently results in opioid-induced constipation (OIC). Treatment options for OIC may be as simple as changing diet or as complicated as requiring several medicines and laxatives.


Lifestyle Changes

Changing lifestyle factors is usually the first recommendation that physicians make for the prevention or treatment of constipation. This includes:



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  • Increasing dietary fiber


  • Increasing fluid intake
  • Increasing exercise or physical activity
  • Increasing time and privacy for toileting



Cure Constipation Now


Changes in lifestyle, however, may not be possible for many patients. In addition, these changes may be ineffective in treating OIC.


If there is a concurrent underlying disease or medicine that is causing constipation, the disease may need to be treated separately or another treatment regimen may have to be considered.

Drugs and Medications to Treat OIC


OIC treatment usually requires additional medicines to be prescribed along with the opioid painkillers that are causing the constipation. Withholding the opioid treatment is ill-advised because it results in a decrease in the patient’s quality of life. Often, laxatives and/or cathartics are prescribed at the same time as the opioid painkillers so that treatment for the constipation beings immediately. A cathartic accelerates defecation, while a laxative eases defecation, usually by softening the stool; some medicines are considered to be both laxatives and cathartics.


For the treatment of OIC, doctors may prescribe:


Osmotic laxatives – increase the amount of water in the gut, increasing bulk and softening stools.

Recommended: ClearLax Osmotic Laxative


GoodSense Clearlax, Polyethylene Glycol, Osmotic Laxative 3350 Powder for Solution, 17.9 Ounce
  • Emollient or lubricant cathartics – soften and lubricate stools.


Recommended: Phillips’ Stool Softener


Phillips' Stool Softener Liquid Gels, 60-Count
  • Bulk cathartics – increase bulk and soften stools.
  • Stimulant cathartics – directly counteract the effect of the opioid medications by increasing intestinal motility, helping the gut to push the stools along.


Recommended: Ex-Lax Stimulant Laxative

Ex-Lax Stimulant Laxative, Maximum Strength, 25 mg, 90 Count Box


  • Prostaglandins or prokinetic drugs – change the way the intestines absorb water and electrolytes, and they increase the weight and frequency of stools while reducing transit time.
  • Other medicines block the effects of opioids on the bowel to reverse opioid-induced constipation.


Although the treatments listed above are usually successful in treating OIC, sometimes a physician will recommend rectal intervention. As discussed, prophylaxis with laxatives are/or cathartics is considered usual – as some clinicians assume [constipation] to be virtually universal in patients who are prescribed opioid analgesics.


Rectal interventions are indicated if the appropriate oral measures have been ineffective.


Rectal intervention means the following treatments:


  • Suppositories


Recommended: Dulcolax Medicated Laxative Suppositories


Dulcolax Laxative Suppositories, 28 Count


  • Enemas (micro and larger volume)



Enema Bag Kit

Superior Enema Bag Kit | 2 quart Fountain (Open) top | 28-page Instruction Manual | Silicone Hose with Robust Metal Suspension - Blue
  • Rectal irrigation (sometimes known as colonic irrigation)
  • Manual evacuation


The first choice rectal intervention for uncomplicated constipation is glycerine suppositories.


Fleet Glycerin Suppositories 24 CT

Fleet Glycerin Suppositories Laxative


If these are ineffective, then a stimulant enema might be administered. Oral and rectal stimulant laxatives should be avoided if there is possible or proven bowel obstruction.


Gentle rectal measures can sometimes be effective in emptying the rectum and lower colon. Oral softening agents are useful if the obstruction is incomplete. It should be remembered that constipation can cause bowel obstruction.


If none of the rectal laxatives above prove adequate to remove impacted feces, rectal irrigation with normal saline can be performed. Manual evacuation should be used as a last resort when all other methods of bowel management have been shown to be ineffective.


Combination Therapy Treatment for OIC


Constipation is a known side effect of opioid analgesics and should be addressed before opioid therapy begins. As opioid-induced constipation can be severe and adversely impact quality of life and compliance with therapy, prophylaxis with laxatives is considered to be the best approach.


Concurrent management on initiation of opioids frequently includes recommending certain lifestyle or dietary adjustments (as listed above) and initiating a scheduled regimen of laxatives. Laxative and cathartic therapy may be needed throughout opioid therapy and beyond. Effective management requires a composite of strategies, including behavioral and lifestyle changes (diet, activity, and fluid intake, as appropriate).


However medications used to manage opioid-induced constipation, such as laxatives, do not address the underlying opioid receptor-mediated cause of constipation and are often ineffective.


Newer Therapies for OIC


Methylnaltrexone (available as Relistor(R)) helps restore bowel function in patients who have advanced illness and receive opioids for pain relief. Methylnaltrexone is delivered via subcutaneous injection and specifically targets opioid-induced constipation. When given alongside opioid therapy, it is designed to displace the opioid from binding to peripheral receptors in the gut, decreasing the opioid’s constipating effects and inducing laxation.


Methylnaltrexone is a peripherally acting mu-opioid receptor antagonist that decreases the constipating effects of opioid pain medications in the gastrointestinal tract without diminishing their ability to relieve pain.


Methylnaltrexone blocks peripheral opioid receptors in the gut and unlike other opioid antagonists has restricted ability to cross the blood-brain barrier. As a result, it antagonizes only the peripherally located opioid receptors in the GI tract, so it’s action reverses opioid-induced constipation without precipitating withdrawal symptoms or affecting or reversing the central analgesic effects of opioids.


Another new medication for severe pain (long-term pain that can be experienced as a result of conditions such as back pain, arthritis and osteoarthritis) are tablets combining prolonged release oxycodone, an opioid which treats pain, and prolonged release naloxone, a compound which counteracts the potential negative effects of the opioid on the GI function (available as TarginactTM).



TarginactTM has been proven to provide equivalent pain relief to oxycodone alone, whilst significantly improving bowel function. Naloxone is an opioid receptor antagonist that, when taken orally, has negligible systemic bioavailability providing a full inhibitory effect on local opioid receptors in the gut – counteracting opioid-induced constipation – without impacting on the centrally acting analgesic efficacy of oxycodone.



If someone you care for is experiencing opioid induced constipation, start on the lifestyle changes in this article and speak to your doctor about other treatment options.  This is a condition that can be managed.


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Coping With Incontinence

Coping With Incontinence – A Guide for Caregivers




Many family and partner caregivers say that heavy incontinence would tip their decision towards moving a loved one to a nursing home.

What makes this such an emotionally difficult turning point?


Incontinence can be the last straw in a stressful caregiving situation.  Providing for the personal care needs of someone with bladder or bowel control issues will always be an unwelcome task, but there are many effective solutions to managing incontinence that can result in increased dignity and improved quality of life for your loved ones, and less frustration and difficulty for you.


Below are some of the issues that make incontinence so difficult to deal with, and tips on how to cope with these concerns.





What should you do when your loved one is resistant to using pads or protective underwear?


An individual asked to use incontinence products daily may feel that they are no longer capable of taking care of themselves at the most basic level. Their response to you might be one of denial, anger, refusal or passive inaction.



Coping: It is important to talk with your loved one in a calm, understanding, and honest way about how their incontinence is affecting you and your ability to provide the best possible care for them. This can make acceptance easier—of the incontinence as well as the incontinence products.  If the care receiver lives with a mental or cognitive condition like dementia, learn the best approaches by taking a class or attending a support group where you can learn useful tools for more successful communication.

Be tactful; walking in and saying the house smells may offend the care receiver and cause a defensive response rather than one of cooperation.



You might feel a sense of embarrassment not only for yourself but also for the care receiver. It’s hard to be responsible for caring for someone, like your parent, in this very personal and often invasive way. If you are caring for someone of the opposite sex, it can be awkward having to see, touch and care for their private areas. If you are caring for a parent of the same sex, it may still feel like you’re invading their privacy.  And finally, there is compassion for the loss of dignity felt by a loved one who now needs care at this level.

Coping:  Talking it out with supportive family, friends, or professionals can be helpful. Acknowledge your uncomfortable feelings. Hire a home care worker or recruit another family member or friend to provide care when is too hard for you to do.



Caregivers are often not at their best when dealing with incontinence.  It might feel like the care receiver allowed an incontinence episode to occur on purpose to punish you. You might find yourself getting angry or impatient, especially if help is needed at an inconvenient time, such as when preparing dinner or sleeping. The cost of incontinence supplies can be a concern in the budget of the caregiver/care receiver. And if the care receiver is not cooperative, it puts even more strain on your relationship with them. Some people may also have physically reactions and discomfort to bodily fluids and odors.


Coping: Admitting to your discomfort is a good first step.  Pretending this is not an issue for you, if it is, only makes matters worse for both you and the care receiver.  Know that the care receiver is not trying to make your life harder; they have no control over what is happening.  This is difficult for them, also. Seek out help through an in-person or online support groups, from a friend or family member who has had a similar experience, or from a Social Worker, Nurse, Occupational Therapist or other health professional.



You might find yourself getting angry or resentful for having to deal with this situation. Maybe it’s just too hard for you to do. Sometimes it may feel easier to just not clean someone up, but this is neglectful of the care receiver and puts the care receiver at risk for skin breakdown and infections, particularly urinary tract infections.



Coping: Acknowledge the many feeling you might have about dealing with incontinence and ask for help.  Support groups, either in-person or online, can offer you both emotional encouragement and tried and true practical strategies. No doubt other caregivers will share their research and experience with various products. Get product recommendations from your doctor, pharmacist or an occupational therapist.


Seek out products that make it easier for you and the care receiver. Having the right product for the right situation can make a big difference.



Consider hiring a personal care aide or allowing other family members help whenever they can. You don’t have to do it all.


Physical Limitations


Mismatched body types, physically disability, or age or disease related physical weakness may make providing incontinence care for your loved one difficult.   A small person trying to help a much larger person out of bed might risk hurting their back or straining other muscles.

You might be at risk for falling when roused in the middle of the night to aid the care receiver in getting to the bathroom or using a urinal.  And the lack of sleep that results from getting up several times during the night will definitely affect your functioning and capacity to cope the next day.

Coping: If you are caring for someone with a physical disability, such as paralysis or weakness, make sure you have a physical therapist or occupational therapist teach you how to use your body so that you don’t hurt yourself while trying to help the care receiver. Work with your physician to make sure any plan of care includes what YOU need as well as what the care receiver needs.  It’s okay to acknowledge your own limits and set limits when something might be harmful to you.


Going out with someone who is incontinent takes some advanced planning. Caregivers and care receivers often become socially isolated because of concerns about dealing with incontinence outside of the home setting.


Coping: Prepack two small shoulder bags with everything you might need such as incontinence pads, wipes, gloves, change of underwear and other supplies you require. Be sure to include a couple of plastic bag to stash soiled products.  Keep one bag with you and one in the car, just in case.

If traveling, look for a family/companion bathroom that allows two people to go in together. Or carry a laminated flyer that you can affix to the entrance of a public bathroom that says, for example, “wife caring for disabled husband inside”.

Know that in some states, like California, a state law allows a family caregiver or paid attendant of either sex to assist a care receiver in a public bathroom. Arrange to have a seat near the bathroom in an airplane or on other transportation. 

Keep in mind where bathrooms are on an outing, which will reduce anxiety for both of you. Stop by a rest room frequently, even if the care receiver has not said they need to go.

Time and Resources


Incontinence makes the caregiver’s job harder in many ways. Incontinence product leaks, their inconsistent usage, or even lack of use when called for, will result in more loads of laundry and more time consumed cleaning up the bathroom and around the house. Additional time is required if help is needed to bathe your loved one after a urine or bowel accident.



As personal care takes more and more time, you may find yourself growing less patient and more frustrated.  These feelings are only compounded if cleaning and bathing demands occur throughout the night leaving the caregiver without adequate sleep. Increasing time demands needed for incontinence care will influence when more help is needed, e.g. recruiting another family member or hiring an attendant, and possibly if it’s time to look into residential care placement.


One additional factor that cannot be overlooked is the cost of incontinence care products and keeping track of having enough stock on hand to meet the need.


Coping: Hiring help can take some of the strain off of the caregiver.  Many caregivers suggest searching online to find the best price for incontinence supplies and for finding coupons to help reduce the cost at the store.  Don’t hesitate to ask another caregiver – in person or on an online caregiver support groups – for their suggestions on the best places to buy products. 


You may ultimately decide that placement is the best choice both for you and the care receiver – even if you promised never to move then to a nursing home. Then the caregiver can return to being a partner, adult child, friend, sibling and not the personal care attendant. The change from loving partner to caregiver can result in grief, guilt and depression. Taking care of your own needs is most important in being able to care for someone else.

You are not alone . . .


It will be easier for you, as a caregiver, as well as for the care receiver if you can make incontinence care as natural as possible. It is, after all, very common—25% of women and 15% of men experience incontinence at some point in their lives.  It is also a symptom common to many advanced diseases.



Get a medical evaluation to see if there is something that can be done to decrease the urgency of needing to use the bathroom and to find out if it’s a treatable condition,  such as a urinary tract infection or prostate problem. Discuss with the care receiver’s physician if medication or bladder training would be effective in this situation.  Above all, seek out and get help from family, friends and paid help if possible so it is not all on you to do all of the care.

Important Tips for Caregivers Dealing With Incontinence



There are many things you can do to help a person manage incontinence. In some cases you can help decrease the number of incontinence episodes by making a few simple changes about the home.


Focus on identifying ways you can facilitate easy access to the toilet, transferring on and off the toilet and faster removal of clothes.


Things you can try:


  • Ensure the bathroom is easily accessible, relocating a bedroom to be close to the toilet can help
  • Install grab rails or bars in the bathroom and by the toilet if a person is unsteady on their feet
  • Keep lights on in the bathroom at night



Final Thoughts


If you are caring for someone with incontinence, you may find it to be one of the most difficult aspects of caregiving. 

Incontinence can be unpredictable, add dramatically to your workload and be very costly.  Follow the tips above and seek further advice from a healthcare professional.  Having the right products, the right advice and support can help make this aspect of caregiving more manageable.




Thanks for visiting and reading … I hope this article provided you some helpful ideas.  I welcome your comments below.




Incontinence Care Products at Northshore Care!





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Make A Living Will Today

What is a Living Will or Healthcare Directive

And  Do You Need One?


Prepare for unforeseen circumstances to save yourself and your family needless pain.

We have all heard stories of people who, because of a terrible accident or illness, become unable to make health care decisions for themselves. It may happen gradually, when someone develops dementia, for example. If he or she did not previously designate another person to do so, the matter can end up in the courts.

Having a health care power of attorney  is the best way to make sure that your wishes are followed and that you receive the level of care you choose.

In this video by Milwaukee Public Television, attorney Betsy Abramson, deputy director of the Wisconsin Institute for Healthy Aging, offers pointers on how you can put your mind at ease by filling out the vital paperwork.


Living Will states your wishes regarding life support in the event that you cannot communicate your end-of-life wishes yourself. Your Living Will only comes into effect if you are in a persistent vegetative state or irreversible coma and can no longer make and communicate your own wishes. A Living Will spares your family the anguish of making life-support decisions without your input. A Living Will also ensures that your doctor understands your end-of-life wishes and treats you accordingly.

Living Wills can be very specific or very general. Living Wills that are too general may not provide sufficient direction and serve only to create confusion and conflict between medical personnel, your health care agent, and your loved ones. More specific Living Wills are preferred. These are shown to be most successful when they include informed, thoughtful reflection on your wishes and values supported by personal communication between you and your health care agent before a medical crisis occurs.

Recently, Living Wills have moved away from focusing on specific treatments and medical procedures to focus on patient values, personal goals, and health outcome states. For example, a Living Will might: designate an agent to make care decisions; dictate what kind of life support treatment that patient does or does not want; discuss pain management, personal grooming and bathing instructions; address how the patient wants to be treated, including religious, spiritual, and emotional support; and detail funeral or memorial plans.

Choosing an Agent for Your Living Will

When you become unable to make medical decisions for yourself, the power to make life-support decisions for you is transferred to the person you designate as your agent in your Living Will or Health Care Power of Attorney. 

This person must act according to the directives set out in that document. The person that you designate as your agent should be someone you know and trust. Some states refer to the agent as an “attorney-in-fact,” “health care agent,” “health care proxy,” “health care representative,” “patient advocate,” “proxy” or “surrogate.”

The statutes of most states require that your agent be an adult. In addition, under most circumstances, your agent cannot be your health care provider (for example, a physician, nurse, employee, officer, director, or operator of a home health agency, hospital, nursing home, or residential care facility) unless that person is related to you. In selecting an agent for your Living Will, you should not designate a person who is, or may become, directly involved in providing health care to you unless that person is your spouse or a family member.

Make sure your agent is willing to assume responsibility for your medical decision making. If she agrees to be your proxy, talk with her about your values, beliefs and desires. Good health care agents are able to separate their own feelings from yours and your wishes, but may feel guilt and anguish at having to make such difficult end-of-life decisions. Communicating early and often with your agent can help ensure that both you and your agent are comfortable and at peace with your life-support wishes.

Choose just one person to serve as your agent at a given time to avoid conflicts. But choose an alternate agent in case the primary agent is not available. Once you have selected an agent, make sure they get a copy of your Living Will, and tell your family and physician whom you’ve selected.

Many individuals give their health care agents broad authority to override their written Living Will. Other individuals give the written Living Will priority. Make sure to articulate which instruction to follow when there is a conflict between your agent and your Living Will.


Summary For Americans:

Create your US Citizen Living Will today.  Call your lawyer or prepare one simply and inexpensively yourself online at Law Depot.

What is a Living Will?

A Living Will lets you specify your choices for medical treatment. A Living Will documents your preferences for the time when you are no longer able to communicate or provide consent.

What is a Medical Power of Attorney?

A Medical Power of Attorney allows you to designate someone (your Agent) to make health care decisions for you when you are no longer able to do so.

What are my rights?

If you have a Living Will, the decisions made by your Agent will be constrained by that document. The Medical Power of Attorney is useful for those issues that are not covered by your Living Will. In those cases, your Agent can ensure the intent of your wishes are followed.

The U.S. Constitution allows people to determine the kind of health care they will receive. However, many states limit the types of health care decisions that can be made, and the instructions that you provide below may go beyond what is allowed in your state. This will not invalidate your instructions, but your health care providers may be limited to what is legally permitted.


Summary For Canadians:!/httpImage/image.jpg_gen/derivatives/landscape_960/image.jpg

Create your Canadian Citizen Living Will today.  Call your lawyer, or prepare one inexpensively yourself online at Law Depot.

What is a Representation Agreement?

A Personal Directive or Living Will allows you to designate someone who will make health care and personal care decisions for you when you are not able and also to provide instructions for future care while you are still capable of making decisions for yourself.  A Personal Directive provides an opportunity for you to discuss treatment options with your medical staff as well as to discuss and resolve difficult issues with your family and friends.  Your directive must be made while you are still capable of giving consent.  Note that a Personal Directive is also called a Living Will, Advance Directive, Health Care Directive, or Power of Attorney for personal care.

Every adult who is 19 years of age or older is presumed to be capable of making, changing or revoking a representation agreement, and making decisions about personal care, health care and legal matters and about the adult’s financial affairs, business and assets.In addition the following will apply:

  • You must be mentally competent.
  • You must be fully informed of your treatment options for all possible medical outcomes.
  • You should not be unduly influenced by anyone else during your decision making process.

Who can write a Heath Care Directive?

Every adult who is 19 years of age or older is presumed to be capable of making, changing or revoking a representation agreement, and making decisions about personal care, health care and legal matters and about the adult’s financial affairs, business and assets.In addition the following will apply:

  • You must be mentally competent.
  • You must be fully informed of your treatment options for all possible medical outcomes.
  • You should not be unduly influenced by anyone else during your decision making process.

Other Countries:

Create your  UK Living Will Today.

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