Select your font size

Working in an End-of-Life Care Environment

This page is also available in Acrobat PDF format. The link will load the Acrobat File in a new web browser window.

What is End-of-Life Care?

End-of-life care refers to the care of a person with a terminal illness or condition that has become advanced, progressive and incurable.  The focus of treatment is on relieving and preventing the suffering of the person.  It generally uses a multidisciplinary approach, relying on input from doctors, pharmacists, nurses, chaplains, social workers, psychologists, and other health professionals in offering care to relieve suffering in all areas of a patient’s life.  This allows the team to address physical, emotional, spiritual, and social concerns that arise with advanced illness.  Families and friends are generally involved in making decisions and supporting the person throughout the process.

How Can a Dog Contribute?
The therapy dog with a gentle, accepting nature can become an important part of the care team.  Patients, visitors, and staff will look forward to their special time with you and your dog, even if it just for a few moments.  Those who are in an end-of-life environment are subjected to many medical procedures, a loss of independence, bad news, depression, anxiety, loneliness, to name but a few.  The soft touch and the break from the routine of the day offered by your dog will help to relieve some of the feelings associated with these challenges.  Your dog might also provide some much-needed motivation to complete difficult tasks such as eating or walking a set distance.

What to Expect in an End-of-Life Care Environment

• Be aware that a patient’s condition can fluctuate greatly from one visit to another.  Expect that some visits will be shorter or longer at times and perhaps even cancelled because the patient is not feeling well enough.  Always ask if the person is interested in a visit when you arrive.
  
• Although a person is in the final stages of life, he/she still has needs, hopes, and something to contribute.  Patients still derive pleasure from even simple gestures such as brushing or cuddling your dog.
  
• Patients may become emotional when you first meet them with your dog.  Often this is related to the fact that your dog reminds them of a pet they may have lost or had to give up because of their illness
  
• Your visits benefit not only patients, but their families and friends.   They may spend many hours at a patient’s bedside and are likely to relish the short respite that your visit provides.
  
• You will be visiting a busy environment, filled with a variety of sights, sounds, and smells.  Be sure to give yourself and your dog sufficient time to adjust to this environment.

Some Tips for Working in the End-of-Life Care Environment

• Many patients count the days until your dog’s next visit, as they may be limited in their activities, mobility, and interests. Try not to miss subsequent visits
• Encourage staff to let you know if they have met someone who might benefit from your visit.  Because patients pass away on a regular basis, you are likely to meet a few new people each time you visit.
  
• Don’t feel that you have to be engaged in conversation for the duration of your visit.  A quiet exchange between the person and your dog can be as just as beneficial.  Also, there is no need to discuss the person’s illness or personal circumstances, unless he/she initiates it.  Try to focus on other aspects of the person’s life if you do talk. 
  
• Take time to visit with staff members, as they greatly benefit from a few moments with you and your dog.
  
• Be aware of your own state of mind and the emotional impact that your visits have on you and your dog.  Watch for signs of “compassion fatigue.”
  
• Remember that you will be overhearing confidential information that is not to be shared with anyone.
  
• If a staff member arrives during one of your visits, offer to return or to reschedule your time.  Health care professionals are extremely busy and end-of-life care often requires care to be delivered at precise time intervals. If you remain flexible, the staff is likely to offer you some flexibility as well.
  
• Find out if you should wake the person up if they are sleeping.  Many people are crushed to find out they have missed out on a visit because they were not awake.  If the person does not wake, leave a note indicating you stopped by.
  
• Never attempt to move or feed a person.  This is best left to qualified staff who are aware of the patient’s specific needs or restrictions. 
  
• Some patients are placed in isolation if they have a condition which can be transferred to others through contact or actions such as sneezing.  DO NOT visit these patients.  You could be placing yourself, your dog, and others at risk.  An alternative to a visit might be to offer a “hello” from the door of the room or to lend a small photo album filled with pictures of your dog.

In the Final Days

• Consider continuing to visit even if the person is unconscious.  This will allow you to continue to visit close ones who have come to enjoy your visits.
  
• If the person is alone, don’t hesitate to enter the room quietly for a brief visit.  This will give you and your dog an opportunity to say goodbye.
  
• If a person has just passed away, your visit may still be of benefit to the family.  Sometimes family members will express honest, profound feelings to your dog.  Consider being a silent and respectful witness to the exchange between them.

A Final Note
Visiting someone who is in an end-of-life care environment can appear daunting at first because it forces us to consider death and dying.  It can, however, be an extremely rewarding experience, as everyone - and your dog - provides many opportunities for laughing, caring, and living.  In order to make your experience manageable and gratifying:  Know what to EXPECT, always show RESPECT and take time to REFLECT.

Prepared by Karen Luker, OTD member and Julianne Labreche, Associate OTD Member.