As a caregiver how do I respond to a client who wishes to die instead of live like this?

My dad often felt like this. My mom too.

People know when they are going to die.

They are tired of suffering. They are ready to leave the misery behind.

In reality, what is there to look forward to?

I suppose you could pass their feelings along to a social worker or clergy if they are religious.

My brother realistically felt very much this way. He was in Assisted Living, and as a rather Monk-like man, never overly social, he attempted to make the best of it. He oft told me "Like being in the army when I was a young man; I don't like it but I make the best of it". He was well aware of his "probable" early Lewy's Dementia. He knew the long slow slide he faced of nothing but loss, and was fiercely into control, resented the loss of it. Made the best of it. We often talked of his worry and sadness of what was ahead. I think too often we go to the "depression; get them a pill" route. This is reasonable. Are these losses not worth grieving? I think a response of "I wish I could make it better; is there something more you can tell me about what is so hard right now for you?" I agree with those who tell you that this is reportable to the person you are directly responsible to, either his family if they hired you, or your agency manager.

Are you directly employed by the client? Or by an agency, the family, someone else? Who do you report directly to?

I have reported these sort of comments to my supervisor. Pastoral Care services or Psychology is then usually summoned.

Sometimes it is fear - especially fear of pain. Good hospice care can help tremendously. Sometimes it is grief & counselling helps. There are many reasons.

But take it seriously.

I'm going to give you a quote from a handbook from the Canadian Nurses Association that I think is somewhat relevant

"If a person in a nurse’s care expresses a wish to die, the nurse should consider it “an opportunity to open a dialogue. Such comments might be transient, the result of a temporary distress or an expression of suffering due to unmet needs”that could be treated or addressed. The role of the nurse is to identify and alleviate the factors prompting such requests, whether these stem from physical symptoms like pain or are related to anxiety or fear. Nurses have an obligation to try to understand the person’s request and to bring in appropriate resources to address unmet needs. Nurses are accountable and responsible for listening to and acknowledging the suffering of every person in their care since failure to do so can increase suffering unnecessarily"

https://www.cna-aiic.ca/~/media/cna/page-content/pdf-en/cna-national-nursing-framework-on-maid.pdf

Although this is directed at RN's and NP's I think that front line caregivers are an integral part of the care team and are no doubt the people who know the client's needs better than anyone, if there is an unmet need there should be a process in place to report it.

If the client's reasons are blindingly obvious - e.g. pain, loss, grief, new/extreme disability - acknowledge and sympathise.

If the "like this" part is not so obvious, ask gentle questions about what the client is finding difficult. It may be possible to assist a change in perspective.

Widen the discussion and encourage the client to express feelings, which you then acknowledge and validate.

Does this particular client, if you're talking about one in particular, have any realistic prospect of improvements in quality of life?

As a working caregiver here, you don’t have many rights. It would be best to talk to family members, particularly one who has POA, to pass on the comments, and discuss it with them if they are open to it.

There are probably two lines to look at. Is the person you are caring for being kept alive by drugs that prolong life but don’t provide quality? If so, has the option of hospice been discussed? Hospice will aim for quality of life but not to prolong it if the person doesn’t wish it. For many older people blood pressure drugs and cholesterol drugs are the ‘prolongers’, but there may be others.

The other thing to consider is whether the person is depressed and that is the main reason for the wish to die. If so, different medications might help. Most suicide phone lines will also help to talk a person through this. Wishing to die can be ‘a permanent solution to a temporary problem’.

Perhaps your knowledge could be helpful to the family, but it will probably not go down well if you try to talk it through yourself with the person you are caring for. It’s a tricky situation, when you obviously care yourself.