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Caring for loved ones at home at the end of life – lessons from Zimbabwe

Author: Audrey Palterman, Island Hospice and Healthcare, Zimbabwe
10 August 2017

Audrey Palterman, a nurse working at Island Hospice and Healthcare, Harare, Zimbabwe, authored a short presentation on place of care of a loved one at the end of life.

She noted: “This is a short presentation to set your minds thinking about the impact this situation brings to the patient and the family.”

Cancer diagnosis has become more common than marriage. Quoted from a statement in Medscape July 11 2017.

Many of us have faced, are facing or will be faced with the decision on how to care for a loved one or family member with debilitating ailments and life threatening illness – like cancer, dementia, heart disease or Chronic Obstructive Pulmonary Disorder.

When this happens there are many things to think about when planning to make sure the person is cared for properly.

Hospital or home care?

Here in Zimbabwe we do not have in-house hospice care or care homes, which leave us with two basic options, hospital or home care.

A huge factor influencing choices is the financial constraints and unemployment where many can’t afford hospital care, forcing them to opt for home care.

When considering basic home care vs hospital care for the people with life limiting or terminal illness, there are a number of things to consider. The patient’s needs first, and secondly the impact on the family. It could be for a few weeks, a few months, or even years.

These include:

  • In the majority of cases people, especially the elderly, would prefer to be in their own home or with family in a familiar environment, maybe with their children or a sibling.
  • If they remain in their own home, a family member should be present with them to attend their needs.
  • Home based nursing care is a priority, either by a trained person or family member who can be taught basics.
  • If a spouse is still present, he/she would need a lot of support and help – emotionally and physically.
  • In all cases, obviously the patient’s needs will overtake many daily routines. These would have to take second place, which may cause disruption and often tension in the family.
  • The lack of medical knowledge and fear of not knowing what to do can cause a huge amount of stress, e.g.: understanding the disease and its progression.
  • If a patient should die, is the family happy to accept their death in their home?

Advantages of home care

Medicines can be given in correct timings, rather than waiting for rounds at set times in hospital wards.

Food and drinks can be encouraged when patient feels like it, rather than waiting for set meal times, as frequent small meals and drinks are often better for people in this situation.

Bathing and toilet needs can be taken care of as required, rather than waiting for staff to help which may take time and be too long, as well as less embarrassing for the elderly in their home environment.

Visitors can come when convenient and not all together at set limited visiting hours, with only two allowed in at a time. This can be exhausting for the patient, feeling they must acknowledge people who have come. Children can also visit at home.

The patient can be included in daily home and family activities if they wish. In hospital they are isolated and can feel cut off. They can also be moved into family rooms or to the garden to be included in family functions.

Most patients are more comfortable in their own bed and not sharing with strangers, also away from possible infections.

Being present during the last days of the patients life and it may be several days, allowing a final goodbye is a sad and difficult time, but is also a very special time, which if the patient were not at home could be missed.

This is where the multi-disciplinary community services of Island Hospice and Healthcare comes in, with our team providing holistic care. Our first priority is to assist with controlling pain and symptoms of the patient, followed by supporting and counselling the patient and the family.

Follow IslandHospiceZW on Twitter, Instagram and Facebook, and donate to support their important work via Global Giving: https://www.globalgiving.org/projects/island-hospice-and-healthcare/

Make sure you visit the Island Hospice and Healthcare website to keep up to date with their work.

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