Dealing with Death
One of the greatest fears most people express is that of dying alone. Hospice hopes to allow families and dying patients to put those fears to rest. Most hospice care takes place in the home, which allows many freedoms from rules and restrictions on visitors and hours of visitation. However, some hospice is provided in facilities such as skilled nursing homes. In these instances, there is often a lot of bending of the rules, especially in the last hours.
In some instances, hospices have their own in-house facilities, but these are rare. Most of these facilities are run by specialty groups for AIDS patients. The need for these homes grew mostly out of ignorance, family members' fears of working with AIDS patients, and homophobic responses. Many AIDS patients were left alone to die, so support organizations formed in-house hospices to provide them a place to die with love and dignity.
Facilities such as assisted living and skilled nursing homes can provide hospice under waivers from the Department of Health Services. Sometimes the hospice care is provided in these settings and sometimes a patient is placed for a short term to give the caregivers some respite. Sometimes the patient actually requests to be placed near the time of death rather than to die at home.
There are many signs and symptoms of impending death (See Chapter 17) that will provide patients and caregivers the clues necessary to ensure the likelihood of being together at the moment of death. However, it should be noted that in many cases patients tend to take the opportunity to slip away quietly when family members leave the room, even momentarily.
The last sense to go is hearing, and patients are comforted by knowing their family is with them. Gentle voices and soft touches seem to soothe them during their last hours. However, many times they can hang on too long if there is too much loving stimulus or they have some unfinished business. When they are ready, they often will wait for family members to leave to go to the bathroom or to get a snack or cup of coffee.
There should be no feelings of guilt. It's never easy to face the final goodbye, but a death with dignity and without pain or suffering was achieved; the ultimate goal was reached, and you as a caregiver did your very best to make that happen. They knew you were present in spirit.
What Do You Do Now?
If you haven't already done so with your parent, you'll need to make arrangements for a funeral or other service. If friends are available to help carry out these plans and notify family and friends of the ceremony, by all means ask them to help.
After that, there are a number of other affairs to oversee. You will need to order at least a dozen copies of the death certificate to accomplish many of these. These can be obtained from the funeral director or from the county clerks office. You will need to:
Take a copy of the death certificate to the Social Security office and apply for death benefits. This is about $250. Apply for death benefits from any life-insurance policies and retirement plans.
Take a copy of the death certificate and your parent's will to the local county government office of probate to file for probate. If you have joint tenancy on property, or your other parent is still alive and has joint tenancy and the estate is valued at less than $600,000, you may not need to go through probate — discuss this with your attorney. You will need to change the names on the deed(s) at the local county registrar's office.
Notify creditors of your parent's death and settle debts. Make sure to pay any taxes due on the estate until it is closed.
If your other parent is still alive, assist with making all beneficiary changes on wills, insurance policies, investments, and any joint accounts. Discuss how and when to dispose of personal belongings and property.
Don't make changes without consulting your surviving parent. Thinking that you are making things easier for the surviving spouse by quickly getting rid of all reminders of your deceased parent may be the worst thing possible. Even though they may present painful reminders, there may be some great comfort derived from holding on to some personal items and being able to sit in a loved one's favorite chair.
