Solaris Resources



LIVE Without Pain

When you are in pain, it can be difficult to focus on anything else; pain can affect every part of your life.  You may not be able to eat or sleep well.  You may not have the energy to do the things you enjoyed doing in the past.  You may not want to talk with loved ones or maintain your relationships.  Your pain may consume your daily life.  Physical pain can take away peace of mind, comfort, enjoyment and most of all hope. It doesn’t have to be this way.

Learn more about pain, common myths, and how best to manage pain at this informative website from the National Hospice & Palliative Care Organization: LIVE Without Pain.


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What Does Hospice Care Include?

Our services are customized to meet the need of the patient. Some of the services hospice care provides includes:

  • 24 hour support by phone or personal visit
  • Physician Care – Medical Management
  • Direct Nursing Care
  • Home Care Aides for bathing and other personal services
  • Social Services
  • Spiritual Counseling
  • Volunteer Services
  • Symptom Management (pain & other symptoms)
  • Medications related to the pain and symptom management of the Hospice Diagnosis
  • Medical Equipment (wheelchairs, hospital beds, oxygen, etc)
  • Medical Supplies (incontinent supplies, nutritional supplements)
  • Nutritional Assistance
  • Bereavement Support following the patient’s death

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Where Do You Get Hospice Care?

Many people mistakenly believe that hospice is a place you go to receive care at the end of life.

One of the greatest advantages of Solaris care is that our team of nurses, aides and counselors go wherever your “home” may be, whether that is a residential home, nursing home, assisted living, or a hospital.

Many times hospice care may begin in a hospital or other facility and transition to the patient’s home when appropriate.


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Why Choose Solaris?

Physicians, hospitals, nurses, and medical professionals within our local communities and beyond, trust and rely on Solaris every day to care for their patients.

Every patient has unique needs and wishes. Solaris utilizes a team based approach to individualize care for each and every patient and family we serve.

We are recognized as industry experts in palliative medicine, which is the relief of pain and symptoms. The families we serve often say they just wish they would have called us sooner.


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Is Hospice Right for My Loved One?

Your loved one may qualify for hospice services if one or more of the following statements are true:

  • There is a life-limiting illness such as lung disease, congestive heart failure, cancer or dementia.
  • Treatment for a cure is no longer available or is not desired.
  • Relief from pain or symptoms resulting from the illness would enhance quality of life.
  • The caregivers and patient would benefit from care and assistance at home.

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How Much Does It Cost?

Most of our patients pay nothing out of pocket.

Hospice services are covered by Medicare, Medicaid and most private insurance companies.


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What is Hospice?

Hospice is a philosophy of care.

Hospice is a compassionate, patient-centered approach to enhance the quality of life and support for people at the end of life and their families. Hospice care is focused on maintaining dignity, increasing quality of life, and providing comfort, including pain and symptom management. Hospice care is for patients with a variety of diagnoses, including heart disease, stroke, liver disease, Alzheimer’s disease, cancer, and more.

Hospice is not a place; it’s a philosophy of care that enhances life as it nears its end for the patients and their families and friends. Even when medicine cannot provide a cure, it can offer comfort, care and assistance that can help maintain a better quality of life for the patient. This type of care, called palliative care, involves the aggressive treatment of physical and emotional pain and symptoms. It focuses on enhancing a patient’s comfort and improving quality of life. Hospice affirms life and does not hasten or postpone death.

Hospice care treats the person rather than the disease;

It focuses on quality rather than length of life. Hospice care is family-centered care — it involves the patient and the family in making decisions. Care is provided for the patient and family 24 hours a day, 7 days a week.

Hospice care can be given in the patient’s home, a hospital, nursing home, or private hospice facility. Most hospice care in the United States is given in the home, with a family member or members serving as the main hands-on caregiver.

One of the problems with hospice is that it is often not started soon enough.


Sometimes the doctor, patient, or family member will resist hospice because he or she thinks it means you’re giving up, or that there’s no hope. This is not true.

If you get better or the disease doesn’t progress, you can be taken out of the hospice program and go into active treatment. You can go back to hospice care at a later time, if needed. The hope that hospice brings is the hope of a quality life, making the best of each day during the last stages of advanced illness.


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Some Facts About Hospice

Here are some quick facts about hospice that you may not know:

  • Hospice is a special concept of care designed to provide comfort and support to patients and their families when a life-limiting illness no longer responds to cure-oriented treatments.
  • Hospice care neither prolongs life nor hastens death. Hospice staff and volunteers offer a specialized knowledge of medical care, including pain management.
  • The goal of hospice care is to improve the quality of a patient’s last days by offering comfort and dignity.
  • Hospice care is provided by a team-oriented group of specially trained professionals, volunteers and family members.
  • Hospice addresses all symptoms of a disease, with a special emphasis on controlling a patient’s pain and discomfort.
  • Hospice deals with the emotional, social and spiritual impact of the disease on the patient and the patient’s family and friends.
  • Hospice offers a variety of bereavement and counseling services to families before and after a patient’s death.

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Common Myths

There are many myths associated with hospice. At Solaris we are constantly working to educate families about these myths by shining a light on common misconceptions. Here are just a few…

Myth

Hospice is where you go when there is “nothing else to be done.”

Reality

Hospice is the “something more” that can be done for the patient and the family when the illness cannot be cured. It is a concept based on comfort-oriented care. Referral into hospice is a movement into another mode of therapy, which may be more appropriate for terminal care.


Myth

Families should be isolated from a dying patient.

Reality

Hospice staff believe that when family members (including children) experience the dying process in a caring environment, it helps counteract the fear of their own mortality and the mortality of their loved one.


Myth

Hospice care is more expensive.

Reality

Studies have shown hospice care to be no more costly. Frequently it is less expensive than conventional care during the last six months of life. Less high-cost technology is used, and family, friends, and volunteers provide 90% of the day-to-day patient care at home. Additionally, patients eligible for Medicare or Medicaid will pay few out of pocket expenses related to their hospice care. Most private insurers also cover some or most hospice related expenses.


Myth

You can’t keep your own doctor if you enter hospice.

Reality

Hospice physicians work closely with your doctor of choice to determine a plan of care.


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Additional Resources

The following links are resources to more information that will benefit you and your loved one:

AARP

www.aarp.com/endoflife
Here you will find useful information on estate planning, end of life care and legal issues to consider.

Living Will / Advance Directive

A Living Will or Advance Directive is an important form. It helps communicate your medical treatment wishes to family and medical staff for a time in the future when you are unable to make your wishes known due to injury or illness.
Click here to download an Advanced Directive Form

Medical Power of Attorney

Medical Power of Attorney allows you to designate a person to make all health care decisions based on your wishes when you are no longer able.
Click here to download a Medical Power of Attorney Form

Out-of-Hospital Do Not Resuscitate

An Out-of-Hospital Do Not Resuscitate order instructs medical staff to forgo resuscitation and allow a natural death with peace and dignity. This form can be completed by the patient or a legal designee of the patient is unable.
Click here to download an Out-of-Hospital Do Not Resuscitate form.

Medicare Website

For more information regarding the Medicare Hospice Benefit, go to www.medicare.gov.


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Signs of Death

What Will Happen Next?

We realize this particular time is very difficult for you and your family members. Our approach in all matters that effect you and your family is to be honest and straightforward. We realize that fear of the unknown is common when caring for a dying loved one. Because of this, we share the following information to help you understand and anticipate symptoms.

The information includes signs of the dying process and their general time frames along with signs of when death has occurred. Remember each person is different and the following information is offered only as a guide to the often asked question, “What’s going to happen next?” Your hospice team is always available to help clarify any of your concerns about this information. Not all of these symptoms will appear at the same time, in the order listed, or in some cases may never appear at all. Our goal is to share possible signs and symptoms to help decrease fear and anxiety should one or more appear with your loved one. These symptoms are how our bodies prepare us for the final stages of life.

One to Three Months before Death

  • The patient becomes more aware that he/she is dying.
  • The patient may lose interest in community events, friends, or family.
  • The patient seems to emotionally “separate” from family and friends.
  • The patient may become more internally focused (self or inner centered).
  • Sleeping increases. This results as the body’s metabolism changes.
  • Verbal communication may become less important.
  • Touching and caring may become more important but the patient may not acknowledge it.
  • Appetite decreases. The body will naturally begin to conserve energy which has up until now been spent on tasks like eating and drinking. Offer only what your loved one seems to tolerate. Avoid placing guilt on the patient for refusing to eat. We eat to live so when a body is preparing to die, it is perfectly natural that eating should begin to decline. While it is hard on you as family and friends, it is okay not to eat.
  • The patient’s tastes may change. You may hear them say things like “nothing tastes good anymore”.
  • Liquids may be preferred over solid food.

One to Two Weeks before Death

  • Sleeping increases and at times it may be difficult to wake the patient. This is related to changes in the body’s metabolism. Try to arrange visit times to happen when the patient is usually awake.
  • The patient may have difficulty holding eyes open or focusing.
  • Some mild confusion may occur. The patient may not recognize everyone all of the time. Again, this is a result of metabolism changes. Gently remind the patient about the day and time and who is in the room.
  • The patient may talk with people already dead or with religious figures. The patient seems to literally have one foot in each world. Focus may seem to change from this world to the next as the patient loses grounding to this life.
  • The patient may pick at his/her clothing or bed linens. Talk calmly to the patient to reassure them.
  • The patient may barely eat or drink at all.
  • Lips may become dry and cracked and need moistening with a wet towel or a few drops of water.
  • Changes in blood pressure and pulse may occur.
  • Skin may become moist. It may become hot then cold. A drenching sweat can occur as the peripheral circulation fails and the body cools. The internal body temperature rises. Regardless of the room temperature, the patient is usually warm so use only light covering, like a sheet.
  • Breathing may increase then decrease. It may appear to stop and then start again.
  • Chest and throat congestion may lead to a rattle that can be heard. Ask your hospice nurse how to help with this.
  • Clarity of hearing and vision may decrease. Keep lights on as appropriate. The patient will hear what is distinctly spoken to him/her. Sit at the head of the bed to converse with the patient and don’t speak in whispers. Never assume that the patient can’t hear you. Hearing is believed to be the last of the five senses to be lost.

Two Days to a Few Hours before Death

  • The patient may have a burst of energy. For example, the patient may awaken, talk clearly and be alert even though he/she was almost comatose before.
  • Appetite may return and your loved one may ask for a favorite meal or drink.
  • The patient may be keenly aware of imminent death and may want to express his/her feelings and even talk about death. Avoid telling the patient that he/she is not going to die. The patient needs for those nearby to listen and hear his/her awareness of impending death.
  • The patient may not be able to talk, but hearing seems to remain very sharp. It is good to tell the patient that you love them and reminisce about good memories.
  • The patient may become very restless. Some patients will talk about “got to get going” or other traveling language.
  • Breathing may become very irregular with pauses for 10-45 seconds or longer. This is called “apnea” and is very common.

How Will You Know When Death Has Occurred?

Dying may take hours or days. No one can truly predict the time of death, even if the patient is exhibiting signs and symptoms of dying. Although you may now be prepared for this event, you may not be prepared for the actual death moment. It may be helpful for you and your family to think about and discuss what you would do if you were the one present at the time of death. The death of a hospice patient is not considered an emergency so please do not call 911. Instead, please contact us immediately at 1-888-3SOLARIS (1-888-376-5274) at any hour. A hospice nurse will come to the home and make the necessary phone calls to the doctor and other team members as well as to the funeral home. We will also arrange to have any equipment picked up.

Signs of death include:

  • No breathing
  • No heartbeat
  • Release of bowel and bladder
  • Jaw relaxed and slightly open
  • Eyelids slightly open, pupils enlarged, eyes fixed on certain point
  • No blinking
  • No response

The patient’s body does not have to be moved until you are ready. If the family wants to assist in preparing the body by bathing or dressing, that may be done. Your hospice team members can talk with you about options at this time to best help you prepare.


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Practical Tips for Caregivers

To be able to take care of another, you must first take care of yourself.

Tips on taking care of yourself:

  • Get enough rest, perhaps naps during the day. Conserve your energy.
  • Exercise. Even a short walk improves sleep and gives energy.
  • Eat well. Choose a variety of foods and drink plenty of water.
  • Reduce stress. Think about what has helped in the past.
  • Take breaks. Relax and think of other things.
  • Pay attention to what your body is telling you. Is it tired, stressed, tense?
  • Nurture your spiritual side. Pursue those things that are uplifting to you.
  • Pamper yourself, especially on difficult days.
  • Avoid unrealistic expectations of yourself.
  • Recognize your needs and limitations and allow others to help you.
  • Set limits. It’s ok to say “no” sometimes.

Tips on helping loved ones:

  • Allow them to talk. Listen without judgment and with only occasional comment.
  • Acknowledge and validate their feelings and let them express their feelings in many ways.
  • Avoid taking any negative feelings personally.
  • Let them have control over their situation as much as possible.
  • Include them in decision making and discussions.
  • Let them do as much as they want to and have the energy for, no matter how slow, painful or difficult it seems to you.
  • Don’t underestimate their pains, symptoms, and fear. They are real and valid.
  • Avoid judging
  • Talk about subjects you used to discuss together, the times you shared.
  • Laugh.

Experience gleaned from years of work with patients and families has shown us that often the best patient care provided is that given by family and friends. Regardless of how capable and efficient a professional’s care may be, the presence and touch of a person who has a close relationship with the patient will provide the greatest gift.

Eating & Nutrition Loss of appetite is a common complaint among people with terminal illness. The many causes for loss of appetite include: pain, fatigue, stress, anxiety, depression, nausea, vomiting, changes in taste sensations, side effects of medications, breathing problems, and constipation. Some patients say their appetite comes and goes while others say they rarely feel hungry.

Some patients say they eat less because food tastes bad, that they have a bitter metal taste in their mouth, or they simply get full too soon. All of these factors are considered a normal part of a terminal illness. If the patient is depressed, antidepressant medications may improve appetite and the patient’s outlook.

If the patient’s disease is advanced and the loss of appetite profound, it is appropriate to recommend food and fluids only as the patient requests. In truth, most hospice patients would prefer to have their families focus less on eating problems and more on other physical symptoms, spiritual issues, and emotional concerns. Following are some tips for particular problems your loved one may be experiencing which may lead to loss of appetite.

Problems with Constipation If the patient is on pain medication, your nurse will ask you to follow a schedule for laxatives and stool softeners to prevent constipation. The usual recommendations for preventing constipation such as increasing intake of food high in fiber and drinking more fluids will not be enough. If the prescribed laxatives are not taken regularly, constipation can lead to impaction, nausea, vomiting, poor appetite and more pain. It is important to take this medication even if bowels are moving. Talk to your nurse if the patient’s bowels become loose so the amount of medication can be adjusted.

Patient tips:

  • Try drinking warm water with lemon juice added in the morning or at bedtime.
  • Try to sit quietly on the commode at the same time each day.

Difficulty Swallowing (Dysphagia) The difficulty or lack of ability to swallow is called “dysphagia.” Often patients with terminal illnesses have nerve or muscle diseases that affect the ability to swallow. Any of the following can alter the ability to swallow: stroke, brain tumors, head injuries, Parkinson’s, ALS, cancer of the mouth, throat, tongue or esophagus, and dementia such as Alzheimer’s disease. Your nurse can evaluate the patient’s ability to swallow foods and liquids and make suggestions to increase food intake if necessary. For example, some patients cannot swallow water or similar liquids but can swallow liquids thickened to a consistency of fruit nectars or pudding. Patients who are unable to swallow should never be forced to eat or drink.

Dehydration Hospice patients often become dehydrated with decreased intake of food and fluids or with excessive fluid loss. Common causes of poor intake are weakness and difficulty swallowing. Excessive fluid loss is common with diarrhea, vomiting, and fever. When the patient is unable or unwilling to consume adequate fluids, the symptoms of dehydration can be treated. The patient can be encouraged to suck on ice chips, popsicles, and juice bars when awake if there is no swallowing difficulty. Mouth care is important in a dehydrated patient to prevent dryness and infection of the mouth and lips. The lips can be moistened with lip balm; the mouth can be moistened with mouth rinses and cleaned by brushing and/or using mouth swabs.

As the patient approaches death, the lack of food and fluids is not associated with suffering. Research has shown that dying patients do not experience hunger and thirst since a normal part of the dying process allows the body to “shut down” gradually to avoid these symptoms. In fact, the forcing of food or fluids in a patient whose heart, lungs, and kidneys are shutting down may actually cause discomfort as the body systems become unable to handle the increased intake.

The positive effects of dehydration in those who are dying:

  • Decreased urine output, incontinence, and need for toileting
  • Decreased production of gastric fluids with less nausea and vomiting
  • Decreased production of secretions from the lungs
  • Less fluid retention or edema in the legs and abdomen
  • Changes in the body chemistry caused by dehydration produces a kind of “natural anesthesia” which is soothing for the patient

The negative effects of hydration therapy (IV’s) and artificial feeding:

  • Patient requires being stuck by invasive needles and tubes.
  • Caregivers are required to manage artificial feeding in the home setting.
  • Irritability and mental disturbances in the patient.
  • Digestive problems (with tube feedings).
  • Overload of fluids on the heart, lungs and kidneys leading to heart failure, swelling of the extremities and lung congestion.

Your patient’s nurse is always available to discuss the status of the patient and the appropriateness of artificial feedings and/or IV fluids.

Grieving
Grief is a normal reaction to the loss of a loved one. When death occurs in the family, children, adolescents, and adults struggle to understand the loss and the often painful, overwhelming emotions that go with it. Individual reactions vary as well as the intensity and duration of grief.

With Solaris Healthcare, families are offered a 13 month bereavement program. Our program focus is educational and supportive. Assessment for families is done with follow-up and counseling as needed. Our counselors and chaplains will maintain contact through mailings, phone calls, and visits over time in order to support a healthy grieving process.

Do Children Grieve?
A better question is, “Do we let them grieve?” Many times, well meaning adults try to protect their children from the painful realities of life and death. We use expressions like, “Daddy went to sleep,” or “We lost your brother,” which can be frightening or confusing to a child. Gentle honesty is better.

This is a very hard time for a family, with many stresses. But as painful as the grieving process is, the family can be strengthened if all are allowed to share in it. Children can learn valuable lessons about compassion, love, support and emotional healing. They need to be reassured that they are still loved and are a part of the family.

Sometimes adults feel they should hide their feelings and “be strong.” However, when we share our feelings with children they are encouraged to share with us, and they can learn that feelings are not “bad” or “wrong.” Sometimes we are hurting so badly we have no comfort to offer anyone. That’s when other family members, friends, and professionals like our hospice staff can help.

Children can show their pain in many ways: bedwetting, temper tantrums, acting out, or doing poorly in school. They might seem more mad than sad. Sometimes children even feel guilty – they think they might have caused the illness or death. Remember that each child, just like each adult, may grieve differently, and that there is no one right way to take this journey.

Some of your child’s behaviors may make you angry, but it is important to remember that your child is doing the best he or she can. You will make it through this process.


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