Few tasks are as profound or as emotionally charged as providing comfort to someone who is nearing the end of their life.
Aged care staff often find themselves bearing a significant responsibility during these final moments, balancing the physical, emotional, and sometimes spiritual needs of the dying with the other demands of the job requires a unique blend of compassion, patience, and resilience.
New staff in aged care may feel scared or awkward when faced with the responsibility of comforting a dying person. To help ease these concerns, we enlisted the expertise of Kate Swetenham, President of Palliative Care Nurses Australia, to offer practical advice on providing compassionate end-of-life care.
“Palliative care is not about a checklist of tasks; it’s a philosophy of care,” Swetenham explains.
“This philosophy applies universally, including in aged care settings. Even if a person is not fully aware due to cognitive decline, presence and support remain significant.”
Swetenham points out that hearing is believed to be the last sense to fade. This understanding reinforces the importance of continued communication with those nearing the end of their life.
“Having someone with a dying person, especially a loved one, allows for meaningful final conversations. Even if they are semi-conscious or unconscious, they can hear words of reassurance and love,” she says.
She recounts a poignant anecdote illustrating the power of hearing and presence.
“I once cared for a man who had been holding on to life, waiting to meet his grandchild. When his daughter finally delivered, she brought the newborn to him. Although he was unconscious, when I told him, ‘Your grandchild is here,’ he opened his eyes. We placed the baby in his arms, and he had just enough strength to acknowledge this moment.”
For aged care staff, Swetenham recommends a range of practical measures to comfort dying residents.
“Even if residents are not responsive, continue to talk to them. Inform them about the care you’re providing. For instance, say, ‘I’m going to change your pad now,’ or ‘It’s a cold and rainy day, but you’re warm and comfortable in bed.’ This kind of interaction maintains their dignity and provides comfort.”
In addition to verbal communication, Swetenham advises gentle physical care. “Moisturise their lips, give gentle hand or foot massages, and ensure they are regularly turned to prevent discomfort. These small acts of care can significantly enhance their comfort.”
Engaging the family in the care process is crucial. “Families know their loved one’s preferences and can guide staff on how to provide the best comfort. Whether it’s playing their favourite music, reading passages from a beloved book, or simply being present, involving the family helps tailor the care to the individual’s life and preferences,” Swetenham notes.
For residents without families, aged care staff can step in to provide that essential human connection. “Encourage carers to overcome any fear of being with the dying. Speaking to them, even if there’s no response, can be comforting. Say things like, ‘Hi Mary, it’s Kate. I’m here to give you a bed bath,’ and keep them informed about what you’re doing. This approach ensures they don’t feel isolated.”
Swetenham also touches on the ‘death rattle,’ a common phenomenon at the end of life. “It’s caused by secretions collecting at the back of the throat, creating a rattling sound during breathing.
While it can be distressing to hear, it’s usually more upsetting for those around the patient than for the patient themselves. Repositioning the patient can help, but aggressive interventions are often unnecessary.”
Respecting a resident’s preferences, even as they near the end of life, is vital. “If a resident has expressed a desire for solitude, honour that wish.
Be respectful in your interactions, providing care without intruding on their peace. Knowing your residents well before they reach this stage can guide you in respecting their wishes.”
Swetenham emphasises the advantage aged care staff have in building long-term relationships with residents. “Unlike hospital staff who might only see a patient briefly, aged care workers often know their residents well. This familiarity allows for more personalised and comforting care as residents approach the end of their lives.”
