Tag: end-of-life planning

by Karen Wyatt MD

When Gail and Gloria admitted their elderly mother to hospice as she neared the end of her life, they mentioned that they had a younger brother who had been estranged from the family for the past twenty years. The sisters agreed that they did not want him to be notified of their mother’s condition or to be part of the decision-making process. But then they learned from the hospice nurse that their mother had confided her deepest wish: to see her son again and to have her children reconcile their relationships. Finally Gail and Gloria agreed to reach out to their brother and ultimately the three of them were able to heal their differences and care for their mother as a united team. The sisters admitted that they were relieved to see their mother truly at peace at the end of life after they welcomed their brother back into the family.

Stories like this are repeated on a daily basis within hospices around the country. In fact one of the most rewarding aspects of working in hospice is the opportunity to see how families come together and strengthen their bonds when they learn that a loved one is nearing the end of life. Even families that have experienced stress and tension for years have managed to heal their differences when they are called to be at the bedside of a terminally ill family member. Here are some of the ways in which hospice helps to foster this type of reconciliation:

Teamwork is necessary to provide care.

A patient who receives hospice care at home must have family or paid caregivers available around the clock, which takes cooperation to arrange. Family members have to create a schedule for care and decide how to meet the needs of their loved one. This allows an opportunity for negotiation, which can bring out the best (or sometimes, the worst) of each person in the family.

Priorities shift at the end of life.

As patients and their families face their own mortality they often come to see that what really matters at the end of life is different than what mattered before. In the case of Gail and Gloria, their determination to keep their brother away soon faded when they saw how much their mother wanted them to forgive one another. Suddenly their old anger and resentments were no longer the most important issue driving their decisions and they began to see their relationship in a new light. 

Focus is on the needs of the patient.

When families come together to help a loved one they tend to focus their efforts on what is best for the patient, and harmony between family members is always better for the wellbeing of the patient than conflict. Dying people often want to know that their children, parents or siblings love one another and will take care of each other after they are gone. These wishes at the end of life can be powerful motivators for family members to heal their relationships.

Hospice staff helps with communication.

The hospice team includes a social worker, chaplain and often a counselor who are trained to help families with communication. These staff members can facilitate family discussions and mediate when conflicts arise. In our hospice we frequently reached out to estranged family members on behalf of our patients to invite them to reconnect with their loved ones. With help, the majority of these families were able to find peace after many years of disruption.

Caregiving can foster forgiveness.

The act of caring for an ill loved one requires determination and sacrifice, but also leads to deeper connection and intimacy. As family members work together to provide care and meet the needs of the patient they may soften their hard edges and let go of their demands for perfection from one another. This is a scenario that then leads to forgiveness as each person recognizes their interdependence and finds value in being close rather than being at odds with one another.

Hospice teams model compassion.

One of the greatest benefits of working with hospice is the heart-centered focus of the people who make up the hospice team. The nurses, aides, chaplains, social workers, volunteers, and even the administrators of the hospice are all trained to be comfortable with death and have developed their capacity for compassion as well as their medical expertise. When hospice team members visit their patients, family members have the opportunity to observe how to be present with a dying person and how to bring love and calmness to any situation. This powerful learning experience is available to families who choose to admit their loved ones to hospice at the end of life.

Of course, not every family will find a way to come together in peace and reconciliation when their loved one nears the end of life. In fact, some families are split even further apart over conflicts around how and where their loved one should receive care. But the likelihood of healing family disruption is increased when a decision to utilize hospice is made early on in the end of life process. It takes time to let go of past difficulties and find forgiveness so it’s never too soon to begin working toward that outcome. Patients and families both benefit from having more days together to focus on love, care and respect as life is nearing the end—and hospice team members are the perfect teachers and guides for that journey.