Translation by Unix, Inc.

P.  The points of terminal care at home

mPurposen [How to care]
1. Relief from physical pain
  • Relief from an acute pain. 
  • Regulation of body temperature. (a hot-water bottle, massage, etc.)
  • Management of breathing. (body position, removing phlegm)
2. Observing the condition and consulting the family about predictable problems
  • Observation of body condition, etc. (vital signs, intake of food, amount of bodily wastes, etc.)
3. Dealing with a change in the condition
  • Reporting to the family doctor. 
  • The doctor's visit.
  • Dealing a request for hospitalization from the family.
4. Death (a prompt visit in@response to a request by the family)
  • The condition of the deceased and confirmation of the time breathing stopped.
  • Corresponding with the family doctor (when this has not yet been done).
  • Offering condolences and words of support to the family, after confirmation of the death by the doctor
5.Treatment of the deceased
  • Treating the dead body (the family may take care of the procedure with a public health nurse's help, but usually a private mortician is entrusted, nowadays). Removing any apparatus (tubes, etc.), cleaning the bed and the body, making up the face and so on.
  • Putting things in order around the bed.
6. Supporting the family
  • If necessary, supporting the family and helping the family get over their grief by consulting an MSW (Master of Social Welfare) after the funeral.

i Reference data: gGuidance of Health for the Elderly" by Medical Friend Corp.j

Q.   Assessment of the care service provider
in the personal care of the elderly person at home.

1. Basic knowledge of medical treatment and nursing science. 

2. Observation, judgment, technical skills, anticipating problems, applying practical knowledge.

3. Total assessment of the situation.

4. A proper understanding of medical treatment.

5. Understanding the family of the deceased and understanding Perkinsonism.

6.@Involving the welfare service by use of good cooperation and management.

7.@Judging the situation in the context of the whole life of the elderly making use of hospitalization, care at home, short stay and day care systems.

8.@Having awareness of one's role as part of a larger body of careres. 

9. Having energy and the desire to study.

10. Having human compassion.

11. Others

RDAssessment of the receiver of care services at home.

mAssessment itemn

1. Physical change Planning a diet of nutritious food, the use of active ADL, relieving pain, cleaning the body, adopting good bed bath or outdoors bath procedure to avoid troubles caused by a dysfunction organ.
2. Emotional change Maintaining a stable emotional condition, accepting sickness and handicap, having a good attitude to be supported, having positive facial expressions and body language.
3. A change in their way of living Extending their field of activity, improving their customary way of daily life, judging what things matter and what they must or must not do, taking positive steps.
4. Dealing with the terminal stages Whether to have pain or not, stabilizing the emotional state, whether medical treatment is needed or not, accepting the inevitability of death, terminal treatments.
5. A change of a carer's attitude Accepting more care, accepting a changing relationship with the patient and a care manager, accepting to changes of attitude in the carer.
6. Effectiveness of bringing services into home Accepting new services at home, deciding if the treatment is suitable.
7. Relationship with a community Having visitors, places to go and activities to take part in, the need of volunteers, motivation to out, etc.
m Medical treatment n  Trusting in the doctor, having a medical examination, relieving the ill condition, whether the medicine causes side-effects, etc. 

SDIssues to relating the care and supervising of the terminal patient's deathbed at home.

  1. Supporting the family members emotionally and preparing them for the patient's death that they will be able to accept the patient's terminal stages. 

  2. Helping the patient and the family to clarify the place the patient wants to die.

  3. Making sure there are enough family members to care for the patient

  4. Cooperating with the family doctor.

  5. Supporting the care of the patient by the family members. 

  6. Supporting the family after the death.

TDThe meaning of the elderly's death for the family

  1. The death interpreted as the completion of the given life.

  2. The death as a great loss.

  3. The death as a resolving of troubles.

  4. The death that leaves problems.

UDThe process of grieving (Classified by A.Deeken)

1. Shock and mental paralysis A state of mental dysfunction when faced with the temporal realities of life, shock at the death of the beloved one, as a kind of self-defense mechanism.
2. Denial Refusing to accept the fact of the death of the beloved one.
3. Panic Sudden uncontrollable fear caused by facing death closely.
4. Anger and sense unfairness Being angry and resenting against the perceived unfair mental pain undergone.
5. Hostility and resentment (ressentiment) Venting the sorrow on people around in the form of hostility or resentment.
6. Feeling of guilty Being self-accusing as an expression of remorse, a feeling of failing the deceased during their life as a typical response and act of grief.
7. Forming an imaginary world in mind Behaving and believing as if the deceased is still alive, fantasizing.
8. Sense of isolation and depressive feeling A part of a healthy grieving process. It is important to make an effort to overcome the sorrow swiftly and receive the support from people around at this time.
9. Confusion and apathy Confusion caused by a feeling of emptiness, i.e. a loose of the purpose of life.
10. Renouncement and acceptance Accepting honestly the situation that one is in, and trying to brave the reality.
11. Find new prospect, humor, and smile again Humor and laughing are essential for a healthy life, therefore their restoration is a symptom of the end of the grieving process.
12. The steps of recovery new-identity Not going back how one used to be, but being shaped into a man of fine character through facing the sorrowful grieving process and overcoming it.

i written by Alfons Deeken: "Hanryo ni Sakidatareta Toki" )

About the Last Will and Testament Information.

mA signed last will and testament executed by the Testator.n

mA last will and testament in formal n

mA last will and testament in secret n

 E.& O.E.

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 Last modified: 2004/2/1