Palliative care: Toronto left with few residential hospice beds #discounted #hotels

#hospice toronto

#

Palliative care: Toronto left with few residential hospice beds

Every time a Perram House patient passed away, a staff member wrote that person s name and date of death on a small white card and placed it near a candle in the front entrance.

It was the 10-bed residential hospice s way of honouring the deceased, allowing their memory to remain in the heritage home s grand foyer, if only for a few more days.

One final card was written last month, but it didn t feature a patient s name. To the disappointment of those desperately needing palliative care in this city, it read: Perram House. April 10, 2013.

The hospice a yellow brick house at 4 Wellesley Place closed suddenly after nearly a decade of providing palliative care to Toronto residents from all walks of life.

Outraged staff accused board chair Frank McCrea of shutting down the union, which had recently organized to demand a wage increase. McCrea, meanwhile, blamed dwindling donations that had forced the charity to operate at a loss for months.

Article Continued Below

Whatever the reason, the closure of Perram House leaves Toronto with only two residential hospices.

To me, it s really shocking, said Bill O Neill, executive director of Kensington Hospice, where the phone has been ringing constantly since Perram House closed. There s a real discrepancy between Toronto and other cities.

Kensington Hospice in downtown Toronto and Dorothy Ley Hospice in Etobicoke are now the city s only residential hospices, providing a total of 20 hospice beds for a population of 2.6 million. (Casey House, which serves AIDS patients, is classified as a hospital.)

By contrast, Saint John, N.B. has 10 beds for a population of 70,063.

Residential hospices are relatively new across Canada, but palliative care experts say they are a crucial option for patients who do not need to be in hospital and cannot die at home. They combine a home-like environment with 24-hour medical care and psychological support.

There are about 193 palliative care beds in Toronto hospitals, but most have a vacancy rate of close to zero and limit stays to 15 days. Patients can stay in a residential hospice for three months or longer.

As for home care, Toronto Central Local Health Integration Network (LHIN) funds three visiting hospice programs. But for patients with complex needs or without a family caregiver, it is only a short-term option.

The vast majority of Canadians say they want to die at home or in a hospice, but about 70 per cent die in hospitals. In the 2011 fiscal year, nearly 5,000 people died in an acute-care hospital in Ontario while receiving palliative care.

When there are no beds available. the patient generally ends up in a higher-cost setting, said Dr. James Downar, a palliative care physician at Toronto General Hospital. Acute-care beds are the most expensive setting in the entire system.

The daily cost of an acute-care bed in a hospital is between $850 and $1,100, compared with about $439 for a residential hospice bed.

Hospice patients receive care free-of-charge, but advocates say the savings are significant for a province trying to balance its books and hospices aren t just more efficient, they re more humane.

Coline Bettson s mother suffered a sudden brain aneurysm in March and moved into Perram House. The first night, nurses brought Bettson hot tea and set up the bed so she could cradle her 96-year-old mom in her arms.

Everything I asked for and she wanted, they agreed to. They couldn t have been more kind and caring, she said. I was stunned and appalled when I heard (the hospice closed).

In 2005, the Ministry of Health announced $115 million in palliative-care funding, including plans to fund the care costs of 34 residential hospices across the province.

Eight years later, 24 of those hospices have been built and receive annual funding of $90,000 per bed. The remainder of hospice budgets between 20 and 50 per cent must be raised through donations.

McCrea, the former Perram House board chair, said fundraising had always been a struggle.

New Democrat health critic France G linas said the ministry should fully fund residential hospices, as it does long-term care.

It s been unacceptable from the beginning, she said. Hospices deal with vulnerable people in their last days of life. It s wrong to let them rely on donations.

Health Minister Deb Matthews said in an interview that the province had come a long way since before 2005, when hospices were entirely self-funded.

We are transforming how we deliver health care, Matthews said. We are committed to investing more in the community sector and getting people out of hospital who don t need to be in hospital.

She said the health ministry dedicated $260 million to community services, including hospice and home care, in the 2013 budget. The Toronto Central LHIN has convened a working group on palliative care access.

Rick Firth of Hospice Palliative Care Ontario said most hospices are able to fundraise successfully, but Perram House may have struggled because it prioritized marginalized and homeless people.

The donations from families don t come in at the same volume, he said. That may be something we need to look at in the future.

Firth said the loss of Perram House will be felt in Toronto for the time being. Two of the hospices promised funding in 2005 were supposed to be in the city, but neither has broken ground yet.

The Toronto Commandery Hospice finally acquired land last year in North York, but is awaiting approval of its zoning application. The Yee Hong Centre for Geriatric Care in Scarborough still has no timeline for opening a hospice.

But Emily s House a long-planned pediatric hospice at Gerrard St. E. and Broadview Ave. is nearing the end of construction at last and hopes to open its doors at the end of May.

As for Perram House, the stunning home of sweeping staircases and vaulted ceilings built by widower Mary Perram in 1887, it now occupies prime downtown real estate, on Wellesley Pl. between Jarvis and Sherbourne Sts.

McCrea owns the home but has said he hasn t made a decision about the property. As a designated heritage home, it would require city council approval to be demolished.

Pete Perram, Mary s 52-year-old great-great-grandson, said the worst-case scenario would be for it to be turned into a condo building.

Mary intended it to be for the good of the people, the good of the community, he said. I hope that, as a legacy to her and to our family, that continues.





Signs of Impending Death a Few Hours Before Death #royal #marine #hotel

#hospice signs of impending death

#

What are the signs of impending death a few hours before death?

What are the signs of impending death a few hours before death? Emma’s Story Part 5 will take you there.

Death is getting close. Hours close. All the signs of impending death are there. This is the final stretch. We are nearly there. Nearly there. Let’s follow Emma and her dying.

Emma’s Story Part 5:
A Few Hours Before Death

By now Emma’s daughter Jane had decided to spend the night in the spare bedroom. She had promised her mom that she would be there. Would be there to see her mother and best friend die.

Jane had the monitor to give Arthur a good night’s sleep. A monitor to hear Emma while being in another room. All through the night Jane would wake up and listen. She would make sure that she still heard Emma breathing.

Ever so often she would get up and look. Emma’s eyes were closed. No movement. She was unresponsive. As if in a deep sleep.

Early in the morning Emma’s breathing changed. She would take a breath in and then stop. Stop for as long as 20 or 30 seconds. No breath.

Then slowly her body would start reaching for the next breath. Finally the next breath came. Then the breath stopped again. For another 20 to 30 seconds.

This went on for a few hours. It felt kind of eerie as it was so easy to think: “Oh, this is her last breath.” But it wasn’t yet. Not yet.

I am available as an inspirational speaker
about all aspects of death
including the luminous side of dying
for both US and international events.
Click here to find out more about my talks
and click here to contact me
.

This close to death, as in hours away, our bodies are giving us more signs to look for. More symptoms of dying as mile markers on the final journey home. More ways to know that death is near. Very near.

Emma’s breath, as described above, is called “Cheyne-Stokes” breathing. That kind of breathing consists of inbreaths followed by periods of no breath. Another inbreath. Another pause. Another inbreath. Another pause.

This kind of breathing can last for many hours. Or just for a short while.

Here is a list of your typical signs of impending death:

  • Our breathing is becoming more irregular and often slows down.
  • Our eyes might be closed. Or they might be open or half closed, but without actually focusing on anything.

  • Lips and nail beds can look purple or bluish.

  • Fluids may gather at the back of the throat, resulting in what sometimes is called the “death rattle”. It does not appear to disturb us when we are dying. But it can sound awkward for those sitting close by.

  • Our hands and feet may look blotchy and purplish (mottled). This mottling can slowly move up the arms and legs.

  • Our hearing seems to be the last sense to go. So talk to us. Tell us that all is well. That we are going home. That you love us. That it is all right for us to die. That it is OK for us to finally go home.
  • And again a reminder: not all signs of impending death show up for all who are dying.

    Emma’s Story Part 5: A Few Hours Before Death Continued

    By this time Emma was surrounded by her husband Arthur and her daughter Jane. One sitting on each side of the hospital bed. They took turns holding her hands.

    They had lit a candle. There were flowers some good friends had brought over on a night stand. The curtains were closed to keep the bright summer sunshine out.

    Every couple of hours one of them would get up to give Emma her next dose of liquid morphine. No need to swallow. The insides of Emma’s mouth just absorbed it. Her face looked easy and relaxed under the circumstances.

    There was a pillow under her knees. Her head was still on her favorite pillow and propped up with the help of the raised head piece of the hospital bed.

    Emma was as comfortable as she could be in these last hours.

    The Gifts of These Last Hours

    These last hours filled with signs of impending death can feel very special. They can be like a moment of hushed silence in the middle of a busy street. Like the sense of wonder just before a sunrise on the ocean. Like a holy moment in church full of imagined angels singing. Like a long prayer deeply soothing us.

    They have a similar quality to the time right after a baby is born. That same feeling. That same sense of wonder.

    As if they are like gateways. Gates to the other side. Gates to our souls.

    As if the veils keeping us here on this earth get lifted around death. As if we can reach across to the other side together with our loved ones who are dying.

    We only visit for a short time. They are the ones going there for good.

    Can you sense the sounds
    touching your heart?

    Are you feeling the call
    reaching for you?

    Do you know the voices
    singing your name in light?

    You are so close
    Dear One
    You are so close





    Palliative care: Toronto left with few residential hospice beds #coylumbridge #hotel

    #hospice toronto

    #

    Palliative care: Toronto left with few residential hospice beds

    Every time a Perram House patient passed away, a staff member wrote that person s name and date of death on a small white card and placed it near a candle in the front entrance.

    It was the 10-bed residential hospice s way of honouring the deceased, allowing their memory to remain in the heritage home s grand foyer, if only for a few more days.

    One final card was written last month, but it didn t feature a patient s name. To the disappointment of those desperately needing palliative care in this city, it read: Perram House. April 10, 2013.

    The hospice a yellow brick house at 4 Wellesley Place closed suddenly after nearly a decade of providing palliative care to Toronto residents from all walks of life.

    Outraged staff accused board chair Frank McCrea of shutting down the union, which had recently organized to demand a wage increase. McCrea, meanwhile, blamed dwindling donations that had forced the charity to operate at a loss for months.

    Article Continued Below

    Whatever the reason, the closure of Perram House leaves Toronto with only two residential hospices.

    To me, it s really shocking, said Bill O Neill, executive director of Kensington Hospice, where the phone has been ringing constantly since Perram House closed. There s a real discrepancy between Toronto and other cities.

    Kensington Hospice in downtown Toronto and Dorothy Ley Hospice in Etobicoke are now the city s only residential hospices, providing a total of 20 hospice beds for a population of 2.6 million. (Casey House, which serves AIDS patients, is classified as a hospital.)

    By contrast, Saint John, N.B. has 10 beds for a population of 70,063.

    Residential hospices are relatively new across Canada, but palliative care experts say they are a crucial option for patients who do not need to be in hospital and cannot die at home. They combine a home-like environment with 24-hour medical care and psychological support.

    There are about 193 palliative care beds in Toronto hospitals, but most have a vacancy rate of close to zero and limit stays to 15 days. Patients can stay in a residential hospice for three months or longer.

    As for home care, Toronto Central Local Health Integration Network (LHIN) funds three visiting hospice programs. But for patients with complex needs or without a family caregiver, it is only a short-term option.

    The vast majority of Canadians say they want to die at home or in a hospice, but about 70 per cent die in hospitals. In the 2011 fiscal year, nearly 5,000 people died in an acute-care hospital in Ontario while receiving palliative care.

    When there are no beds available. the patient generally ends up in a higher-cost setting, said Dr. James Downar, a palliative care physician at Toronto General Hospital. Acute-care beds are the most expensive setting in the entire system.

    The daily cost of an acute-care bed in a hospital is between $850 and $1,100, compared with about $439 for a residential hospice bed.

    Hospice patients receive care free-of-charge, but advocates say the savings are significant for a province trying to balance its books and hospices aren t just more efficient, they re more humane.

    Coline Bettson s mother suffered a sudden brain aneurysm in March and moved into Perram House. The first night, nurses brought Bettson hot tea and set up the bed so she could cradle her 96-year-old mom in her arms.

    Everything I asked for and she wanted, they agreed to. They couldn t have been more kind and caring, she said. I was stunned and appalled when I heard (the hospice closed).

    In 2005, the Ministry of Health announced $115 million in palliative-care funding, including plans to fund the care costs of 34 residential hospices across the province.

    Eight years later, 24 of those hospices have been built and receive annual funding of $90,000 per bed. The remainder of hospice budgets between 20 and 50 per cent must be raised through donations.

    McCrea, the former Perram House board chair, said fundraising had always been a struggle.

    New Democrat health critic France G linas said the ministry should fully fund residential hospices, as it does long-term care.

    It s been unacceptable from the beginning, she said. Hospices deal with vulnerable people in their last days of life. It s wrong to let them rely on donations.

    Health Minister Deb Matthews said in an interview that the province had come a long way since before 2005, when hospices were entirely self-funded.

    We are transforming how we deliver health care, Matthews said. We are committed to investing more in the community sector and getting people out of hospital who don t need to be in hospital.

    She said the health ministry dedicated $260 million to community services, including hospice and home care, in the 2013 budget. The Toronto Central LHIN has convened a working group on palliative care access.

    Rick Firth of Hospice Palliative Care Ontario said most hospices are able to fundraise successfully, but Perram House may have struggled because it prioritized marginalized and homeless people.

    The donations from families don t come in at the same volume, he said. That may be something we need to look at in the future.

    Firth said the loss of Perram House will be felt in Toronto for the time being. Two of the hospices promised funding in 2005 were supposed to be in the city, but neither has broken ground yet.

    The Toronto Commandery Hospice finally acquired land last year in North York, but is awaiting approval of its zoning application. The Yee Hong Centre for Geriatric Care in Scarborough still has no timeline for opening a hospice.

    But Emily s House a long-planned pediatric hospice at Gerrard St. E. and Broadview Ave. is nearing the end of construction at last and hopes to open its doors at the end of May.

    As for Perram House, the stunning home of sweeping staircases and vaulted ceilings built by widower Mary Perram in 1887, it now occupies prime downtown real estate, on Wellesley Pl. between Jarvis and Sherbourne Sts.

    McCrea owns the home but has said he hasn t made a decision about the property. As a designated heritage home, it would require city council approval to be demolished.

    Pete Perram, Mary s 52-year-old great-great-grandson, said the worst-case scenario would be for it to be turned into a condo building.

    Mary intended it to be for the good of the people, the good of the community, he said. I hope that, as a legacy to her and to our family, that continues.





    Signs of Impending Death a Few Hours Before Death #hospice #and #palliative

    #hospice signs of impending death

    #

    What are the signs of impending death a few hours before death?

    What are the signs of impending death a few hours before death? Emma’s Story Part 5 will take you there.

    Death is getting close. Hours close. All the signs of impending death are there. This is the final stretch. We are nearly there. Nearly there. Let’s follow Emma and her dying.

    Emma’s Story Part 5:
    A Few Hours Before Death

    By now Emma’s daughter Jane had decided to spend the night in the spare bedroom. She had promised her mom that she would be there. Would be there to see her mother and best friend die.

    Jane had the monitor to give Arthur a good night’s sleep. A monitor to hear Emma while being in another room. All through the night Jane would wake up and listen. She would make sure that she still heard Emma breathing.

    Ever so often she would get up and look. Emma’s eyes were closed. No movement. She was unresponsive. As if in a deep sleep.

    Early in the morning Emma’s breathing changed. She would take a breath in and then stop. Stop for as long as 20 or 30 seconds. No breath.

    Then slowly her body would start reaching for the next breath. Finally the next breath came. Then the breath stopped again. For another 20 to 30 seconds.

    This went on for a few hours. It felt kind of eerie as it was so easy to think: “Oh, this is her last breath.” But it wasn’t yet. Not yet.

    I am available as an inspirational speaker
    about all aspects of death
    including the luminous side of dying
    for both US and international events.
    Click here to find out more about my talks
    and click here to contact me
    .

    This close to death, as in hours away, our bodies are giving us more signs to look for. More symptoms of dying as mile markers on the final journey home. More ways to know that death is near. Very near.

    Emma’s breath, as described above, is called “Cheyne-Stokes” breathing. That kind of breathing consists of inbreaths followed by periods of no breath. Another inbreath. Another pause. Another inbreath. Another pause.

    This kind of breathing can last for many hours. Or just for a short while.

    Here is a list of your typical signs of impending death:

    • Our breathing is becoming more irregular and often slows down.
  • Our eyes might be closed. Or they might be open or half closed, but without actually focusing on anything.

  • Lips and nail beds can look purple or bluish.

  • Fluids may gather at the back of the throat, resulting in what sometimes is called the “death rattle”. It does not appear to disturb us when we are dying. But it can sound awkward for those sitting close by.

  • Our hands and feet may look blotchy and purplish (mottled). This mottling can slowly move up the arms and legs.

  • Our hearing seems to be the last sense to go. So talk to us. Tell us that all is well. That we are going home. That you love us. That it is all right for us to die. That it is OK for us to finally go home.
  • And again a reminder: not all signs of impending death show up for all who are dying.

    Emma’s Story Part 5: A Few Hours Before Death Continued

    By this time Emma was surrounded by her husband Arthur and her daughter Jane. One sitting on each side of the hospital bed. They took turns holding her hands.

    They had lit a candle. There were flowers some good friends had brought over on a night stand. The curtains were closed to keep the bright summer sunshine out.

    Every couple of hours one of them would get up to give Emma her next dose of liquid morphine. No need to swallow. The insides of Emma’s mouth just absorbed it. Her face looked easy and relaxed under the circumstances.

    There was a pillow under her knees. Her head was still on her favorite pillow and propped up with the help of the raised head piece of the hospital bed.

    Emma was as comfortable as she could be in these last hours.

    The Gifts of These Last Hours

    These last hours filled with signs of impending death can feel very special. They can be like a moment of hushed silence in the middle of a busy street. Like the sense of wonder just before a sunrise on the ocean. Like a holy moment in church full of imagined angels singing. Like a long prayer deeply soothing us.

    They have a similar quality to the time right after a baby is born. That same feeling. That same sense of wonder.

    As if they are like gateways. Gates to the other side. Gates to our souls.

    As if the veils keeping us here on this earth get lifted around death. As if we can reach across to the other side together with our loved ones who are dying.

    We only visit for a short time. They are the ones going there for good.

    Can you sense the sounds
    touching your heart?

    Are you feeling the call
    reaching for you?

    Do you know the voices
    singing your name in light?

    You are so close
    Dear One
    You are so close





    Signs of Approaching Death a Few Days Before Death #how #to #start

    #hospice signs of dying

    #

    What signs of approaching death can we expect
    a few days before death?

    Read about the signs of approaching death a few days before death occurs by following Emma’s Story Part 4.

    Our journey into dying is moving closer to its final destination. There are more signs of approaching death. We are down to a few days.

    Just a few more days to be in this particular body at this particular time. Nothing more to do. Just letting go. Just letting go.

    Emma’s Story Part 4: A Few Days Before Death

    One afternoon close to sunset Emma woke up out her slumber. First she looked at Arthur with her big blue eyes. Then she looked out of the window of her living room.

    She asked whether Arthur would help her go outside. She wanted to sit on her lovely deck, look out at her back yard and enjoy the warm summer breeze. It was June and all her pots were in bloom.

    Emma and Arthur sat out there for while. Not saying much.

    Arthur told her about the friends who had brought over her favorite pot roast dinner. And some home grown raspberries. Freshly picked that morning.

    Small things. Things that are part of the fabric of life between two married people. Married for a long time.

    After about an hour Emma was ready to go back to bed.

    That was the last time Emma left the house and her bed.

    I am available as an inspirational speaker
    about all aspects of death
    including the luminous side of dying
    for both US and international events.
    Click here to find out more about my talks
    and click here to contact me
    .

    A few weeks before death one day might be very different. Different in terms of all the other days. It will stand out, for sure. It has a definite place among the signs of approaching death.

    When we are dying we might be deeply lost in our inner world. Not wanting to see anyone. Or talk to anyone. Not even to our closest friends or family members.

    All days are the same. Look the same. Not much happening.

    One day is different.

    We might want to go for drive to see the colorful fall leaves. We might ask for some food from our favorite restaurant. A whole meal. We might want to take a roll in our wheel chair through the neighborhood.

    This different day is called a Golden Day or Golden Moment.

    As if our life force flares up one more time. In brilliant colors. In a spectacular display of one more day of life. One more hour of life. One more moment of life.

    Just one more time.

    And then – time to go now. Time to let the body do its thing. Time to move a step closer to death. We passed another sign of approaching death.

    Emma’s Story Part 4: A Few Days Before Death Continued

    After Emma’s one more Golden Afternoon with Arthur she went back to bed and back to sleeping. Her sleep was getting deeper. She was harder to rouse. She would not talk anymore. Even if we asked her a question. There was no response.

    By that time she was neither eating nor drinking anymore. She was not moving her body on her own anymore. She just lay there in her bed. Her head raised up. Resting peacefully. On her way home.

    A Few Physical Signs of Approaching Death

    At this point most of the signs that death is getting close, are physical signs. These are signs of our bodies shutting down dying. Just shutting down. Slowly but surely for some. Rapidly and all at once for others.

    My friend Allison was caring for an 85 year old gentleman, called Bill. She had been with him for 2 years. A few days ago he had been admitted to hospice as he was going down fast.

    It was a Sunday afternoon. Bill was dozing in his favorite chair. Allison had just turned around to put away some towels.

    When she looked back at Bill he had died. Just like that. No build up. No waiting for him to take his last breath. He just died.

    The following changes in our bodies can be clearly observed when we look closely. When we allow ourselves to get close to this loved one dying. Our loved one dying.

    Here are a few typical symptoms of our bodies shutting down while dying:

    • Our bodies are too weak to stand up or even sit up anymore.
  • We may be sweating more.

  • Our body temperature can be lower by a degree or more.

  • Our pulse may become irregular and may either slow down or speed up.

  • Our blood pressure can be lower.

  • We are unable to swallow fluids anymore. Even those muscles are too weak.

  • Our stomachs cannot digest food anymore. Not enough stomach acid is being produced.

  • No more bowel movements without suppositories. Our bowels have stopped moving food along.

  • Very little to no urine output. As there is no liquid going in, there is very little or no liquid coming out.

  • Our skin color may change as circulation becomes diminished.
  • As you can see from this list, a number of processes in our bodies are slowing down or stop altogether. As preparation for our dying.

    Just another miraculous thing our bodies know how to do without us telling them.

    Dying is so much part of being human. As much a part as living is. As much a part as being born is.

    Emma’s Story Part 4: A Few Days Before Death Continued

    By the next morning Emma was not looking so peaceful anymore. There was a frown on her face. Especially between her eyebrows.

    Ever so often she was moving her head back and forth. She was even moaning a bit.

    Emma was definitely not feeling comfortable. Something was irritating her. This was hard to watch.

    Sometimes we can feel uncomfortable when our bodies are breaking down. It can be like one big irritation.

    One of the signs of approaching death is called “terminal agitation”. It is most visible in our faces. But we can feel it all over our bodies.

    We might have a frown between our eyebrows. We might moan and groan. We might move our heads back and forth.

    This phase can be intense for the one dying as we are not used to seeing a body breaking down. A body stopping all its normal functions. At this point in our journey modern pain medication definitely can make a difference.

    Imagine being in a body where you cannot move your limbs anymore. You are too weak. You cannot say anything. Your mouth is too dry. You are only half awake. But you are feeling very uncomfortable.

    To me this would be hell. Feeling in pain and not being able to do anything about it. Or even say anything about it.

    When this happens, it really helps to have been admitted to hospice (at least in the USA). Or to get admitted. Even at that late stage.

    By being on hospice a trained nurse will stop by daily to prescribe and often deliver any pain medication that would be helpful. The hospice nurse is also able to help us decipher some of the signs of approaching death. Plus a nurse is on call 24/7 in case additional help or medication is needed.

    A Word About Knowing When Death Might Occur

    Caregivers, nurses and doctors are often asked: “How much longer till my loved one will die?”. To be honest, no one can accurately predict, when our loved ones will actually die. There are too many factors involved which determine the time of death.

    Jerrye Wright, the director of Ashland Hospice, shared with me an interesting observation: What we can do, when we are around someone who is dying, is to simply watch for any changes occurring.

    If the changes occur every few weeks, we or our loved ones have weeks to live. Changes like loss of appetite or emotional releases.

    If the changes occur within days, we or our loved ones have days to live. Changes like being unable to swallow fluids.

    If the changes occur within hours, we or our loved ones have hours to live. Changes like terminal agitation.

    I liked this way of looking at dying as it empowers us to watch for these changes and then make our own rough estimates.

    Click here to read Emma’s Story Part 5: A Few Hours Before Death

    Return from Signs of Approaching Death to Emma’s Story Part 1

    Return from Signs of Approaching Death to A Good Dying Home

    In loving and celebrating our letting go into death’s arms
    We are graced with being birthed breathtakingly into more living

    I give permission to copy and redistribute this content as long as full credit is given and it is distributed freely. © 2013 A-Good-Dying.com
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    Signs of Impending Death a Few Hours Before Death #the #lowry #hotel

    #hospice signs of impending death

    #

    What are the signs of impending death a few hours before death?

    What are the signs of impending death a few hours before death? Emma’s Story Part 5 will take you there.

    Death is getting close. Hours close. All the signs of impending death are there. This is the final stretch. We are nearly there. Nearly there. Let’s follow Emma and her dying.

    Emma’s Story Part 5:
    A Few Hours Before Death

    By now Emma’s daughter Jane had decided to spend the night in the spare bedroom. She had promised her mom that she would be there. Would be there to see her mother and best friend die.

    Jane had the monitor to give Arthur a good night’s sleep. A monitor to hear Emma while being in another room. All through the night Jane would wake up and listen. She would make sure that she still heard Emma breathing.

    Ever so often she would get up and look. Emma’s eyes were closed. No movement. She was unresponsive. As if in a deep sleep.

    Early in the morning Emma’s breathing changed. She would take a breath in and then stop. Stop for as long as 20 or 30 seconds. No breath.

    Then slowly her body would start reaching for the next breath. Finally the next breath came. Then the breath stopped again. For another 20 to 30 seconds.

    This went on for a few hours. It felt kind of eerie as it was so easy to think: “Oh, this is her last breath.” But it wasn’t yet. Not yet.

    I am available as an inspirational speaker
    about all aspects of death
    including the luminous side of dying
    for both US and international events.
    Click here to find out more about my talks
    and click here to contact me
    .

    This close to death, as in hours away, our bodies are giving us more signs to look for. More symptoms of dying as mile markers on the final journey home. More ways to know that death is near. Very near.

    Emma’s breath, as described above, is called “Cheyne-Stokes” breathing. That kind of breathing consists of inbreaths followed by periods of no breath. Another inbreath. Another pause. Another inbreath. Another pause.

    This kind of breathing can last for many hours. Or just for a short while.

    Here is a list of your typical signs of impending death:

    • Our breathing is becoming more irregular and often slows down.
  • Our eyes might be closed. Or they might be open or half closed, but without actually focusing on anything.

  • Lips and nail beds can look purple or bluish.

  • Fluids may gather at the back of the throat, resulting in what sometimes is called the “death rattle”. It does not appear to disturb us when we are dying. But it can sound awkward for those sitting close by.

  • Our hands and feet may look blotchy and purplish (mottled). This mottling can slowly move up the arms and legs.

  • Our hearing seems to be the last sense to go. So talk to us. Tell us that all is well. That we are going home. That you love us. That it is all right for us to die. That it is OK for us to finally go home.
  • And again a reminder: not all signs of impending death show up for all who are dying.

    Emma’s Story Part 5: A Few Hours Before Death Continued

    By this time Emma was surrounded by her husband Arthur and her daughter Jane. One sitting on each side of the hospital bed. They took turns holding her hands.

    They had lit a candle. There were flowers some good friends had brought over on a night stand. The curtains were closed to keep the bright summer sunshine out.

    Every couple of hours one of them would get up to give Emma her next dose of liquid morphine. No need to swallow. The insides of Emma’s mouth just absorbed it. Her face looked easy and relaxed under the circumstances.

    There was a pillow under her knees. Her head was still on her favorite pillow and propped up with the help of the raised head piece of the hospital bed.

    Emma was as comfortable as she could be in these last hours.

    The Gifts of These Last Hours

    These last hours filled with signs of impending death can feel very special. They can be like a moment of hushed silence in the middle of a busy street. Like the sense of wonder just before a sunrise on the ocean. Like a holy moment in church full of imagined angels singing. Like a long prayer deeply soothing us.

    They have a similar quality to the time right after a baby is born. That same feeling. That same sense of wonder.

    As if they are like gateways. Gates to the other side. Gates to our souls.

    As if the veils keeping us here on this earth get lifted around death. As if we can reach across to the other side together with our loved ones who are dying.

    We only visit for a short time. They are the ones going there for good.

    Can you sense the sounds
    touching your heart?

    Are you feeling the call
    reaching for you?

    Do you know the voices
    singing your name in light?

    You are so close
    Dear One
    You are so close