Terminal Care

Terminal care is health care given to people at the end of life when curative measures have been exhausted and supportive palliative care is more appropriate. Terminal care focuses on maintaining good quality of life, relief of suffering, and physical, psychosocial, and spiritual support during the last days and weeks of living.

Recipients of Care

The terminally ill person and family or significant others are the focus for terminal care. Professional caregivers provide the physical care for the patient, or assist the family in giving care, but the psychosocial and spiritual care is appropriate for all. The patient may be in a hospital, a nursing home, an inpatient hospice, or at home. A criterion for hospice care is a life expectancy of six months or less as determined by two physicians. Though hospice personnel are well known for excellent end-of-life support, well-trained professionals can provide appropriate terminal care to patients in all the previously mentioned settings.

Providers of Terminal Care

The providers collaborate with the patient and family to give comprehensive, holistic, compassionate care. The head of the health care team is the physician who determines that curative care is no longer indicated and that the patient is terminally ill. The physician, in consultation with the patient, family, and other caregivers, orders medications and other therapies for symptom relief. In home care, a family member is usually the primary caregiver, with assistance from other relatives and friends or professionals. In the inpatient setting, nurses are the primary caregivers, but family members are often involved there as well. A social worker assists with financial concerns, evaluates the home for adequate facilities for home care, and may serve as a counselor. The pharmacist is available for consultation regarding medications and dosages, particularly for pain management. The chaplain provides spiritual support. A physical therapist may assist the patient to retain strength and flexibility to increase comfort. Professionals from other specialties may also be called in to offer nonpharmaceutical alternative approaches for relaxation, pain management, and psychological support. These may include a music therapist, an acupuncturist, and/or a specialist in healing touch, massage therapy, and/or guided imagery.

The majority of patients in hospice care have a diagnosis of cancer. Other diagnoses include chronic respiratory disease, congestive heart failure, stroke, Parkinson's disease, amyotrophic lateral sclerosis (ALS), multiple sclerosis (MS), and congenital syndromes that shorten life. The terminally ill patient may also be the victim of trauma [Page 935]or another sudden event for whom curative care is no longer effective or appropriate.

Aspects of Terminal Care

The focus of terminal care is comfort. The interventions are directed toward that goal. Some have described terminal care as necessary when “nothing else can be done.” It is helpful for the family and caregivers to recognize that terminal care involves “doing” many things to bring good quality to the patient's last days.

The initial assessment of the terminally ill person includes a determination of distressing physical symptoms: emotional, social, and financial concerns; worries about “unfinished business”; anxiety about symptoms and approaching death; and spiritual concerns. In the ideal situation, every effort is made to relieve both physical and emotional suffering.

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