Dylan’s Thomas warns us in his poem
Do not go gentle into that good night,
Old age should burn and rave at close of day;
Rage, rage against the dying of the light.
But today a care manager or geriatric social worker can help an older client go gentle into that good night, they do not have to burn and rage at the close of their day because you will be giving them as Atul Gawande suggest – a good death – not a cold terrifying dying of the light.
The terminal phase of any life-threatening illness is the time between diagnosis and the final decline when no cure or extension of life is in the offing. The individual confronts progressive decline and deterioration. Death is imminent. The care manager has a role.
The focus of doctors and patients now changes from attempting to cure the illness or prolong life to trying to provide relief from pain and to comfort the sufferer. Religious concerns such as what happens after someone passes away or how to handle the suffering at the end of life or how to give comfort to family members are the focus during this time as well as trying to tie up any loose ends.
Care Manager tasks:
Make referral to hospice if family has not already reached out
Partner with hospice and work under them
Monitor anticipatory grief needs
Communicate that this is the end (and time to say goodbye)
Assess spiritual needs and contact the appropriate religious spiritual counselors to provide comfort and healing.
Encourage family members to say The Four Things That Matter Most “Please forgive me”, “I forgive you”, “Thank you”, and “I love you”.
Assess the need for paid caregivers to help the family or help family members share round the clock care among family and friends
Support the family members in their need to
grieve and have respite by continuing to assess for overload and burn out with a caregiver assessment tool
Prepare family for active phase of dying which can be loud and disturbing to someone who is not aware of what will occur
Gwendolyn LAZO Harris MA, CT, Seniors at Home, San Francisco and Diane LeVan MA both highly expert care managers, created a seminal chapter “Palliative Care and End of Life Care Manager ” in my book Care Manager’s Working With the Aging Family