Can end-of-life care be received at home, and how can families prepare?

Yes, end-of-life care can be received at home. This care focuses on improving the quality of life for the patient and their loved ones, providing comfort during the final weeks or months of life. Available services include medical, psychological, social, and spiritual support for both the patient and the family [1].

Planning Home Care

Advance planning for end-of-life care is crucial to ensure the patient's wishes are met and to reduce the burden on the family. It is important to discuss care options with the medical team early, as this reduces stress levels and increases the patient's ability to cope with the illness [1]. Patients should complete advance directives, which are documents that outline their care preferences and designate a decision-maker if they become unable to make decisions themselves [1]. Even if these documents are not completed, the family's knowledge of the patient's preferred type of care can be extremely helpful [1].

Symptom Management and Medical Support

End-of-life care continues to focus on controlling pain and other symptoms such as constipation, nausea, and shortness of breath [1]. Pain medication can be administered in various ways, including injections or infusions if the patient is unable to swallow [2]. Home caregivers must monitor the patient's comfort and any physical issues. A doctor or nurse should be contacted in the following situations: pain that does not resolve with the prescribed dose, the appearance of new symptoms (such as nausea, vomiting, increased confusion, or anxiety), worsening of previously controlled symptoms, signs of discomfort (such as grimacing or moaning), difficulty breathing, inability to urinate or have a bowel movement, falls, severe depression or talk of suicide, difficulty administering medications, or if the caregiver feels exhausted or overwhelmed [1].

Emotional and Social Support for the Family

Patients at the end of life often face common fears, such as the fear of abandonment and the fear of being a burden [1]. Caregivers can provide comfort by spending time with the patient, listening to their concerns, reminding them of happy memories, and affirming that advance directives are being respected [1]. It is also important for caregivers to look after their own physical, mental, and spiritual health, and to seek support from friends and family members to alleviate the heavy workload [1]. Families can also benefit from palliative care programs, which offer comprehensive and coordinated services [1]. For more information on end-of-life planning, you can visit the page: End-of-Life Planning: Care Decisions, Medical Directives, and Family Support (Arabic).

Signs of Approaching Death and How to Manage Them

Some signs may appear that indicate death is approaching, such as withdrawing from friends and family, changes in sleep, increased weakness, and difficulty controlling pain [1]. Family members may also notice physical changes, such as coldness in the extremities, discoloration, decreased blood pressure, and changes in breathing patterns [2]. During these times, it is important to continue talking to the patient, even if they appear unresponsive, as they may still be able to hear [1]. The medical team can provide additional information about what to expect and how to provide comfort to the patient [1].

Medical references

• End-of-Life Care for People Who Have Cancer
• Last Days of Life (PDQ®)–Patient Version