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I am currently studying Aged Care Cert III, the current topic i am studying is Palliative Care. A part of my assessment i was asked a conflicting question i seem to be having a little trouble with. The question being 'If the client i am supporting is receiving palliative care are they able to receive visitors whilst they are sleeping?'

After doing a bit of research online for a more constructive lead i am left with a conflicting issue, i understand the importance of a patients rest time, and have read that refusing a visitor on their behalf (when they are sleeping) and advising them to return at a more suitable hour is more appropriate. However i also understand that some clients like the comfort factor in having guests visiting during this time.

I am hoping that someone will be able to give me a more 'policy and procedure' lead on this question.

Any help would be muchly appreciated. :)

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Dee1990, Just saw your reply tonight and you are a very sweet person.. I can tell you have a lot of intuition that will guide you throughout your career. It's certainly not an easy path you have chosen, but will be very rewarding. Blessings to you along the way!
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I think of hospice as a specialized type of palliative care, intended for persons in the final stage of a terminal illness. Medicare has its own rules for the two types of care. For example, palliative care may be appropriate for someone fighting cancer, and may offer comfort as they go through chemo. Hospice would be for someone in the final stage of cancer, who is no longer seeking chemo or other therapies for the cancer, and the goal is only to offer comfort.
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My MIL was in hospice (which is what I think you mean by palliative care) at a free standing hospice facility. Visitors were allowed at any time and encouraged to speak to her. Apparently hearing is one of the last abilities to go.....

If a hospice worker kept me from seeing a family member, I would file a complaint and have another hospice group take over the care ASAP. Hospice is paid by Medicare and switching providers (which there are many, many companies both large and small out there) is very easily done. Also I could can file a complaint with Medicare via the CMS system on-line easily. Also a complaint to the medical director of the hospice group and the county medical society. The probability is that the worker will be looking for another job.

The worker is not the DPOA, MPOA of the patient and unless there are significant health care issues - like the person has a highly contagious disease - they do not make the decisions regarding visitors. I'd go to the MD regarding this.

The facility may have rules regarding the # of persons in the room or the age of the visitors and that is a whole other issue.
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What is palliative care vs. hospice - are they the same??? Just curious.
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People on palliative care at home are not there alone. The caregiver should be the one to decide about visitors.

If a health care professional insisted on overriding my judgement in this manner he or she would not be welcome back, and I would file a complaint with the employer.
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Personally, I think it's rude to not consider the patient's wishes - they may want to spend as much time as possible with their friends and family before they "sleep" forever. I say go with your gut.
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I have the exact same outlook on this situation as you all do. I have had no experience of even knowing someone who is in palliative care but i was always been taught that a dying man/woman's wish is always to be highly considered. I believe it is their right. I approached my trainers about this, and voiced my opinion in agreeance to all of your comments, insisting that asking the client what he or she would prefer would be the correct way to go about it. However there response was not one i was expecting, one of my trainers believes visitors whilst the patient is sleeping is rude and detrimental to their rest time and failed to see my point, which has resulted in me doubting her own abilities as a trainer. As hard as i am trying to understand her point of view, i can't. I refuse to comply with her for the sake of an assessment. Thank you for all your answers and inputs it has been immensely appreciated.

P.s: windytown, your story made me very sad, but i am thankful that you decided to share it with me, for me it has reaffirmed why i wanted to be apart of this industry.

Dee :-)
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My father died in a hospice house of a Glioblastoma. That greatly affected his ability to communicate during his last two weeks, heck his last three months. The last week he was 'sleeping' for the most part. Close family and friends were allowed in to say their goodbyes for their own closure and health. To the person, they were all quiet, calm and respectful.

My father always expressed a wish to die alone. When it became clear the time was close, I bid him my final farewell. My brother, who spent many decades away in Europe (with visits every three years), could not tear himself away from dad. I had to get back to the house to take care of my immobile mom. At three in the morning, my father who hadn't spoken in days and days, managed to get out "Go away," to my brother. That's some kind of miracle in itself.

My brother got back to the family home at 3:15. At 3:20, hospice called to tell us he had passed. My brother was heartbroken, but I finally convinced him later that was dad's wish.

Every single situation is different, by person, and by family. In my experience, the dying spend a lot of their final days sleeping. I don't feel like I violated my dad's wishes to 'die' alone. He was still living at the time visitors were allowed to see him. These were all dear people that loved him in life and needed a chance to see him and say goodbye. I believe it helps in achieving closure for the ones that love the person. We all need to process the 'process' and realize they just didn't disappear in a poof of smoke. We have to go on living and learn and absorb that someday our time will come too.

My son was 14 when his Grandpa died and he spent quite a few hours with him before he passed. Gramps was his hero. He witnessed a lot of love and kindness during that hard time. He's 16 now and has a reverence for life for someone so young. It's my belief that people are too sheltered today from the realities of dying, from the natural rhythms of life. It makes the bonds of love here on earth that much stronger and precious to be a witness to caring for a dying loved one. For my family and I, it has reaffirmed our faith in God and that He is love.
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I agree completely with what Jeanne wrote. A person may not want a casual visitor to sit with them while they sleep. However, they may welcome the presence of a loved one. Many people rarely wake up during their final days. It would be terrible if loved ones were kept from the bedside because of some generic rule.
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Can the "correct" answer be to ask the patient what he/she prefers?
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What do you trainers think the correct answer should be?
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Hi Jeannegibbs,

I appreciate your response, it was helpful. My take on the question was much like yours, there isn't nor should there be a 'one size fits all' answer, my trainers however seem to disagree.

Thank you for taking the time to answer my question.
Kind Regards.
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My husband was on Palliative Care and then Hospice, at home. I advised casual friends to send cards instead of visit, but when family or close friends came I was no reason not to let them sit with him a while. And in some cases I woke my husband up, judging that seeing a particular visitor would be more important than his rest, particularly once he was on hospice.

But that is me, making a judgment on behalf of someone I know intimately. I imagine it is quite different for a health care professional. I that case I would try to find out the wishes of the client. No visitors when I sleeping, except Aunt Martha, and try to make her comfortable until I wake up? Please wake me up if my brother Bill shows up? Anyone who wants to sit with me as I sleep is welcome to it? I don't even want visitors when I'm awake, until I'm feeling better? If you can find out the preferences of the client, I think I'd follow them unless the clearly interfered with his or her care.

Palliative care is supposed to be calming and soothing. But what is comforting to me might be distressing to my mother, so I don't see how this can be a one-size-fits all answer.

Good luck on your studies.
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