Palliative Care

Providing Comfort for You and Your Loved One

At McCormick Home, we understand the difficulty of losing a loved one and the challenges that come with understanding the palliative care experience. We are here to help.

When your loved one is in a palliative state, you will be receiving a lot of information and will need to make some decisions. You may experience several powerful emotions, including feeling sad, worried or frightened. You may also feel tense and tired.

You may find yourself thinking about the past and about experiences you have shared with your loved one. You may want to reminisce and share these memories with your loved, one, other family members, friends, or staff members. Tears are a natural part of saying goodbye – you do not need to apologize or try to hide them.

Please know that we, the staff at McCormick Home, consider your loved one part of our McCormick Home family. We welcome the opportunity to give comfort to your loved one and your family and friends.

This information is designed to provide some information to assist you in this very difficult time. Please seek out staff with any questions that may arise, and we will do whatever we can to assist.

“Kind words are the music of the world. They have a power which seems to be beyond natural causes, as though they were some angel’s song which had lots its way and come to earth.” — Leo F. Buscaglia

Natural Occurrences

When a loved one is dying, it is important to understand that death is a process with changes that take place over time – allowing the body to first slow down and then release. Remember that these changes are not medical emergencies, and the goal is not to prevent them but to help your loved one remain comfortable while allowing the natural course to occur.

Each individual is unique and will experience these changes in no set pattern or maybe not at all:

• Reduced interest and intake of food and fluids
• Reduced strength and ability to move
• Decreased interest and attention
• Changing sleep and rest patterns
• Loss of control of bowel and bladder
• Described “supernatural” experiences
• Changes in senses (remember that hearing is the last sense to decrease)
• Changes in breathing
• Changes in circulation (mottling)

Reduced Interest and Intake of Food and Fluids

Your loved one will have decreases in appetite and thirst, wanting little or no food or fluids. Their body knows when it no longer desires or can tolerate food or liquids. We do not recommend starting IV’s on residents who are dying, as their bodies cannot process the extra fluid. We find, in fact that it can make them more uncomfortable by collecting in their hands, feet and lungs.

Please know that dehydration does not cause pain. As dehydration progresses, you may notice increased restlessness. Medication is available to assist in decreasing this anxiety.

Applying cool, moist washcloths to their head, face, mouth and body helps relieve the feeling of dry skin and dry mucous membranes. Moistened swabs, applications of K-Y jelly, lip balm or Vaseline and/or a fine mist spray may help keep the mouth and lips moist and more comfortable.

Reduced Strength and Ability to Move

Your loved one may seem weaker, requiring more and more rest to perform even simple tasks such as walking, sitting or eating. It is important that staff assist and supervise all of their activities to promote their safety.

Decreased Interest and Attention

As the body weakens and energy decreases, interaction with people, pets and things may also decrease.

Your loved one may lose interest in once favourite activities (drafts, hobbies, activities, small talk, etc.). They may want to be alone, with just one person or with very few at a time. They may tire easily and request that visits be shorter than usual. Although it is sometimes hard for caregivers and loved ones to feel shut out, understand that withdrawal from life is a natural part of our preparation for death.

Changing Sleep and Rest Patterns

Your loved one will spend an increasing amount of time sleeping. As the process continues, they will be unable to talk, respond or be awakened. At this point, being with them is more important than doing for them. Sit with your loved one, hold their hand, and speak softly, clearly and reassuringly.

Loss of Control of Bladder and Bowels

As the body weakens, the amount of urine normally decreases and becomes tea-coloured or darker. Your loved one may lose control of their bladder and/or bowels as the muscles in that area begin to relax.

Described Supernatural Experiences

It is common for many people as they come closer to death to describe experiences of feeling they have been in contact with people who have died.

Generally, these experiences are described as “So and so came to see me” or “I just saw so and so.”

Although these may not seem believable to many people, they feel very real to the person experiencing them. For the person who has had significant anxiety about their approaching death, this time is often one where they feel less frightened.

We encourage loved ones and care partners to accept what they have to say and to not attempt to challenge them, even though we are often tempted to say things like, “No, so and so has passed away; they couldn’t have been here…”

Changes in Senses

As our bodies weaken, so does our eyesight. Vision may decrease in clarity, becoming dim or blurred. It is important to leave indirect lights on as vision decreases.

Always assume your loved one can hear you. Hearing is the last sense to decrease. Reassure them of your presence by telling them you are there and remind them who you are.

Aromatherapy and soothing music/nature sounds are available for comfort.

Changes in Breathing

As your loved one gets weaker, you may notice that their breathing changes over time – sometimes slower, sometimes faster. As death draws closer, your loved one may experience episodes of apnea (cessation of breathing) lasting several seconds.

Oral secretions may increase and collect in the back of the throat, creating a rattling, congested sound. This is caused by their lessened ability to cough and clear these secretions. There are medications available to help dry up secretions. Suctioning is usually not offered as it often causes distress to the individual.

Changes in Circulation

Often your loved one may become flushed and develop a fever. This is the body’s way of reacting to the dying process. Cool cloths on the forehead and cheeks are comforting at this phase. The nurses can also administer Tylenol as a comfort measure.

Changes in circulation will occur causing their hands and feet to be cool to the touch and darkened in colour.

Comfort Measures

In order to keep your loved one comfortable, staff may administer comfort medications by inserting a butterfly (small plastic needle) into the upper leg or chest area. A therapeutic mattress is also available to provide greater comfort for your loved one.

Taking Care of You

We recognize that this is a very stressful time for you and your loved ones. It is important for you as family members or friends to rest when possible and eat well. McCormick Home staff are available to listen and provide support for you and your family. Volunteers are available to sit with your loved one while you rest.

If you have gone home for the night to rest, please inform staff if you wish to be called during the night or wait until morning should death occur.

Funeral Homes

For your reference, please visit our list of funeral homes in London and the surrounding area.

Important Decisions

During this difficult time, there are several decisions to be made. Here at McCormick home, our staff would like to help any way possible. For example, we will provide assistance when contacting other family members, the funeral home, and in the selection of appropriate clothing to be sent with your loved one.

When you contact a funeral home, you will set up an appointment with the funeral director, who will be able to walk you through all the necessary arrangements. If you know your loved one’s wishes, simply share them with the director. If you do not know their wishes, it may be a good idea to sit as a family prior to meeting so that you can decide what arrangements you want. The following are some areas you may wish to address:

• Cremation or burial
• Open or closed casket
• Religious or non-religious services
• Private services (only family members)
• Casket/urn present during the service
• Eulogy delivery, if desired
• Music, if any
• Who will preside over the service
• Pall bearers
• Cemetery/columbarium plot purchase
• Burial clothing
• Death announcement
• Memorial donation, if desired

Once these decisions have been made, you will want to notify all immediate family members, relatives and friends regarding the service arrangements.

Honour Guard

Subject to times when infection outbreaks are declared at the home, as a sign of respect, our volunteers, residents and staff are invited to form a silent honour guard at the front entrance as your loved one leaves the home for the final time. Family members are welcome to choose a staff member to recite one of the poems below:

Perhaps they are not stars in the sky, but rather openings where our loves ones shine down to let us know they are happy. – Eskimo Legend

As long as we live, they too will live; for they are now a part of us; as we remember them. – Jewish Prayer

Those we love don’t go away; they walk beside us everyday. Unseen, unheard, but always near. Still loved, still missed and very dear. – Jewish Prayer

Although it’s difficult today to see beyond the sorrow, may looking back in memory help comfort you tomorrow. – Unknown

After the Funeral

The funeral home will give you Proof of Death certificates, which can be used when contacting:

• Government departments
• Financial institutions
• Insurance companies

A Certified Death Certificate can also be obtained by application from the Office of the Registrar General, Thunder Bay, Ontario, 1-800-461-2156 or 416-325-8305. This process can take about six to eight weeks and will cost approximately $20 to $30.

Who May Need to be Contacted?

• Human Resources Development Canada (pensions and benefits) 1-800-277-9914
• Veterans Affairs Canada 1-519-873-2477
• Revenue Canada 1-800-959-8281 or 519-645-4560
• Provincial Health Coverage (OHIP) 1-800-387-5559

Supports and Resources for London/Middlesex

Daya Counselling Centre

• Subsidized/sliding scale services
• Access to online resources for finding counsellors and groups in the community
• Information about bereavement with listings for suggested web-based information, books, videos and guidelines
  

St. Joseph’s Hospice of London

• Offers bereavement follow-up by trained volunteers for up to one year after death

Canadian Mental Health Association

• Keeps a registry of counsellors and programs available in the area
• Provides suicide prevention and survivor programs

Journey Through Loss Bereavement Support Group

Other Online Resources

• Web Healing
• Grief Healing
• Open to Hope

Helpful Documents

Please consider that you may need the following documentation:

• Marriage certificate
• Birth certificates for your loved one, his/her spouse and any children less than 25 years of age
• Death certificate
• Social Insurance Number for your loved one and his/her spouse
• Divorce or separation documents and any prenuptial or postnuptial agreements
• Naturalization papers, passports
• List of credit cards, separate or joint accounts
• Burial plans, cemetery deed
• Safety deposit box – location and keys
• Most recent statements for chequing and/or savings accounts, joint or separate
• The will
• List of debts, and most recent mortgage statement
• Note of any money owing to the deceased
• Recent tax returns
• List of insurance policies (life, house, etc.)
• Armed services record and veteran’s number
• A recent statement of mutual funds, securities and/or stocks, joint or separate
• Any property deeds, partnership or trust agreements

Room Release

While we recognize that this is a difficult time for you and your family, the Fixing Long Term Care Homes Act 2021 requires that after a resident has passed, his/her room must be cleared out within 24 hours. Please note this requirement and plan ahead for any assistance you may need to remove personal belongings from the room. We have carts available to assist you in moving larger items. Also, please also ensure that any phone or cable service is disconnected.

Donations and Acknowledgements

Many families and loved ones choose to make a donation to a charity in memory of their loved one. McCormick Home is a non-profit, charitable organization, and donations in memory of past residents are both welcomed and appreciated. Memorial donations may be made through the McCormick Care Foundation, which was established in 1984.

Today, the mission of the Foundation is to enhance the quality of life for McCormick Home residents and for those attending our McCormick Day Program at McCormick Dementia Services.

Donation cards are available at the Foundation office, located on the first floor by the Tuck Shop, at the reception desk, or by calling 519-432-2648 ext. 2318.

Produced in partnership with the Ontario Health West.