I work in an Assisted Living Facility. The qualifications to reside at an ALF is to be medically stable. Since I started working there 5 people have passed away.
The lastest death, last Friday, died at about 3:30 in the afternoon. The body was taken out at 5:30, while 64 residents ate dinner, a body bag was rolled out, literally in front of their eyes, and from the front windows they viewed the body bag being hoisted into the hearse.
Should the rest of the "medically stable" residents be exposed to such things??
This is the scam. In order to keep census up they admit people who are declining, stick them on hospice so they can be "covered" medically under the hospice umbrella. We are not responsible for their medical care at that point, hospice is.
This is not at all where I wanted to go with this post ....What happened??
O.K. this is what I really wanted to talk about.
Actively Dying
I hear this term over and over again at work. It's a term used when someone starts the process of dying. It's like fingernails on a chalkboard to me. "Mary is actively dying." said in the whispering tone...like "the cancer." I hear this in report from little snotty nosed girls and think.. what the hell...did you learn a new catch phrase?? And seriously...aren't we all actively dying to some degree. I don't know why I hate the term, I just do.
Active Dying is the final phase of life, which is usually measured in months, weeks, days or hours. Once a person has entered the actively dying phase, the focus of their care shifts from aggressively treating medical problems to providing comfort or palliative care.
Some of the more common symptoms that occur during the last days or hours of life are listed below.
Decrease in appetite and thirst. Along with inability to swallow, decreases in appetite and thirst affects the amount of food or fluids taken by mouth.
Nausea and vomiting. Will also contribute to the decrease in appetite. Nausea and vomiting can be side effect of some of the pain medication, which can be managed by adjusting the medication or the dosing.
Change in breathing patterns. Breathing patterns may become becomes irregular--shallow breaths followed by deep breath, periods of panting Cheyne-Stokes breathing pattern develops - several rapid breaths, followed by time of no respirations. Difficult or painful breathing, shortness of breath (dyspnea) Gurgling - noisy and moist breathing Congestion - Building up of fluids in the lungs.
Incontinence. Loss of bladder or bowel function in patient who was previously not incontinent.
Change in circulation, blood flow. Along with decrease in blood pressure, circulation or blood flowing out to extremities decreases, so hands and feet start to feel cooler to the touch. Person may complain of numbness in the legs and feet.
Restlessness, agitation and confusion. Restless, agitation such as jerking, twitching, pulling at bed linens or clothing. Disoriented and confused unsure about the time and place, identity of people even close family members.
Hallucinations. Person may report seeing people who have already died. Acting in a manner that is nor normal for the person. Withdraws and decrease interactions with friends and family. Withdraws from actively participating in social activities. Begins to progressively detach, slowly narrowing the circle of people and caregivers allowed to visit.
Less verbal. Less communication. Less interested in surroundings.
Change in skin color. Change in skin color as circulation decreases the arms and legs cool and turn blue, purple (cyanosis) or mottled.
Change sleeping and in level of consciousness. Increased periods of sleeping. Decrease in consciousness and responsiveness. Difficulty rousing patient or only able to arouse with great effort.
Eventually coma state occurs (unable to arouse at all) minutes to hours before death.
~~~~~~~~~~~~~~~~~~~~~~~~~~
I guess I have been a bit spoiled in the last few years of my career. I didn't have to witness or take part in this stage as much as I would in a Long Term Care Facility. My role in this, I provide the medications to keep them comfortable, usually scheduled morphine. I turn them and keep them clean. I keep the family updated as well as the hospice agency that is overseeing their medical care.
I know this is part of my job, dealing with the elderly I know what lies ahead for them. Should they have to see it ?? Should they see people they were eating dinner with the week before rolled out in a bag, NOT in an Assisted Living setting in my opinion....and don't say ACTIVELY DYING!! Think of a better, more dignified term.
Whew, I'm done I think.
My checking account remained out of the "red zone." 
