February 12, 2026   |  Hospice (Quarterly) Inservice & Quiz

What is Hospice?
Hospice is a specialized form of care for individuals who are nearing the end of their lives, focusing on addressing their physical, emotional, and spiritual needs. The primary goal of hospice care is to enhance the quality of life, ensuring that patients spend their final days as free as possible from pain and discomfort.

More than 50% of hospice patients have cancer, but other common reasons for hospice care include heart disease, lung disease, end-stage Alzheimer’s, AIDS, kidney disease, and cerebrovascular accidents (CVA). Patients with a life expectancy of six months or less who choose to forgo aggressive treatment are eligible for hospice care.

A patient or their family member can revoke or change their decision about hospice care at any time. If a hospice patient or their family informs you of a change in their decision, please notify the office immediately so we can contact the hospice team to tell them. It is essential to note that hospice care is supportive in nature; it neither hastens death nor prolongs life.

DO NOT RESUSCITATE (DNR)
A DNR order means that the patient does not want CPR when they stop breathing or have cardiac arrest. A patient or their family can “REVOKE” or change their mind about a DNR at any time and request resuscitation. It is not required to have a DNR order to be in hospice. Please ensure you inquire about the DNR status when initiating a hospice case. Most patients in hospice will have a DNR.

If there is no DNR order, start CPR and call 911.
- After 911 arrives and takes over, call the office.

If there is a DNR order:
• Be supportive of the family.
• Call the hospice company, then the office.

WHAT TO DO WHEN A HOSPICE CLIENT PASSES AWAY
If there is no DNR order, start CPR and call 911. After 911 arrives and takes over, call the office.

If there is a DNR order:
1. Be supportive of the family
2. Call the hospice and a nurse will come to the home and pronounce the patient and take care of final arrangements with the family.
3. Call the office Care and let the staffing coordinator know about the death.
4. While you are waiting for the hospice nurse-
5. Allow the family the necessary time to grieve. Straighten the bed linens and lower the head of the bed. If needed, wash the patient's face. Other family members may come to view the body at home, so make the area as pleasant as possible. Remove any unnecessary supplies and clutter. Never cover the client's face unless requested by the family. Do not leave before the hospice nurse arrives unless instructed to do so by the staffing coordinator.

Signs & Symptoms of a End of Life Client
Lack of Appetite - The dying patient may not want food or fluids; this is a natural part of the dying process. Do not force fluids or food on a patient who does not like them. The patient may “aspirate” or choke on the food or fluid, causing pneumonia or other complications. Many dying patients have dysphagia or an inability to swallow. If a patient requests food and fluid and can swallow, allow them to eat and drink what they can tolerate. Family members will often have anxiety when their loved one stops eating and drinking, and they will be supportive of the family.

Increased sleeping and drowsiness- Dying patients will spend a lot more time asleep and may be challenging to awaken. There may also be periods when the patient is wide awake; encourage the family to visit when the patient is awake.

Decreased urine output - The dying patient may experience reduced urination and irregular bowel movements.

Nausea and vomiting - Nausea is an uncomfortable feeling in your stomach, which may or may not lead to vomiting. If your client is nauseous, ask the family if they have medication to relieve it. The medication may be a suppository, a pill, or a topical cream. Vomiting is the throwing up of stomach contents; it is not the same as coughing up drainage from the lungs and throat. Common causes of nausea and vomiting are chronic pain, intestinal blockage, and fatigue. Patients may also experience these symptoms as a result of the medication they are taking.

What should you do when a patient is vomiting?
- Raise the head of the bed or keep the client in a sitting position
- If the client is not responsive or can not sit up, roll them on their side, and do not leave the client is unattended.
- Apply a cool, wet cloth to the forehead
- Avoid fatty foods and those with a strong odor
- Offer fluids as tolerated, ice chips, ice pops, Jell-O, Gatorade, ginger ale, and other
- Encourage fluids to be sipped slowly through a straw
- NEVER FORCE A CLIENT TO EAT OR DRINK
- If the client starts running a fever or has a new cough or congestion after vomiting, notify the office ASAP. These are signs that your client has aspirated food or fluid into their lungs and will need medical intervention.

Constipation- Dying patients are prone to constipation due to immobility and as a result of taking pain medication. Medications can be effective in treating constipation. Notify the nurse and family if the client has had no bowel movement in 3 days.

Diarrhea- Diarrhea is loose, watery stools more than 3 times a day. Common causes include intolerance to certain foods, underlying disease processes, anxiety, the effects of medications, and viral infections.
What can I do?
Increase fluids if tolerated.
Offer small, frequent meals instead of 3 large meals
Record bowel movements and report to the nurse
Keep the anal area clean and dry

Dehydration (in Hospice Care)
Dehydration is not painful; studies suggest that dehydration may act as a natural analgesic (painkiller) in dying patients. It is a natural process at the end of life, and there is evidence that patients do not die sooner than those on artificial hydration (IVs). In fact, hydrating a dying patient can cause other problems, such as fluid overload, placing an undue burden on the body. It is tough for family members to watch their loved ones not taking food and fluids, and to be supportive of their feelings. The nurse or hospice team can help with the family if needed.

Signs and symptoms of dehydration include decreased urine output, reduced congestion, fever, decreased swelling, poor skin turgor (the skin is dry and has poor elasticity), and a dry mouth. Frequent mouth and skin care are needed.

Oral/Mouth Care
Use a soft toothbrush and flavored toothpaste, if the mouth is too sore soft swabs or toothettes may be used
Dilute mouthwash- regular mouthwash may be to strong and cause pain
Leave dentures out until the pain is better
A prescription pain reliever for the mouth can be ordered by hospice
Keep lips moist using chap-stick type lip balm

Skin Care
Bathing can be a very tiring process for a dying patient. Patients will often only need sponge bath with mild soap and water with good peri care alternating with a full bed bath. A dying patient’s skin is usually dry and fragile, do not rub skin wash gently and pat dry. NEVER LEAVE A WEAK PATIENT UNATTENDED IN THE TUB OR SHOWER.

Turning and Positioning
A patient who is confined to bed and can not turn himself should be positioned every 2-3 hours. If your client has severe pain and is comfortable, this may be delayed.
Use a draw sheet under the patient for positioning, do not pull the patient the patient across the sheets, to prevent skin BURN from friction. Look for RED areas or skin breakdown and report it ASAP. Massaging skin with lotion will keep skin moist and help prevent breakdown. Use a light circular motion and do not RUB.

Breathing Difficulty
Dying patients often become short of breath or have increased congestion in their airways. This may be due to the disease process or a sign that death is near. The patient may start to breathe rapidly and turn a bluish color. You may notice noisy breathing or wheezing.

What To Do:
- Remain calm
- Elevate the patients head – NEVER LEAVE THE PATIENT FLAT
- If the patient has , turn it on or increase the liter flow if the patient is already on oxygen.
- The patient probably has medication to ease their breathing, ask the family if the patient has medication.
- Notify the hospice nurse

Oxygen Therapy
Oxygen therapy is a critical component of care for many home patients and must be handled with caution and precision. First and foremost, caregivers must never smoke or use open flames such as matches, lighters, or gas stoves near oxygen equipment, as oxygen is highly flammable. Oxygen may be delivered through a nasal cannula or a face mask. The nasal cannula must be properly positioned with the prongs inserted into the patient’s nostrils to ensure effective delivery. If using a mask, it should fit snugly but comfortably on the patient’s face, and can be adjusted using the elastic strap to avoid excessive tightness.

Most home patients use an oxygen concentrator that plugs into a wall outlet. These machines typically have one or two sponge-like filters located on the sides or back. These filters should be removed and rinsed with warm water every other day or whenever they appear dirty, as clogged filters can restrict oxygen flow. On the front of the concentrator, there is usually a humidifier bottle with two marked lines indicating the acceptable water level. The water should remain between these lines. To refill, unscrew the bottle from its cap, fill it with tap water, and reattach it securely.

In the event of a power outage, a portable green oxygen tank should be available for temporary use. Caregivers must locate this tank in advance and be familiar with its operation. If assistance is needed, they should contact the office for training. Note that the humidifier bottle is not required when using a portable tank. If the power remains out for more than one hour, the caregiver must notify both the office and hospice to arrange alternative oxygen support. Depending on the tank size and prescribed liter flow, portable tanks typically last between four to eight hours.

If oxygen is not flowing through the tubing, caregivers should first test the flow by placing the end of the cannula into a glass of water. The absence of bubbles indicates no oxygen flow. Next, check the humidifier bottle—if there are no rapid bubbles, the issue may lie beyond the bottle. Ensure the bottle is tightly connected to the machine and that its screw-on lid is secure. If bubbling is present, inspect the tubing for tight connections and follow its path to the patient, checking for any obstructions such as furniture pressing on the tubing. If the flow is still blocked, replace the tubing if a spare is available. If the problem persists, contact the hospice nurse for further assistance.

Itching
Itching is a common concern among hospice patients and may result from the disease process, dry skin, or side effects of medications. To help relieve discomfort, caregivers should bathe the patient using warm—not hot—water, and consider adding baking soda or bath oil to the bath. Skin should be washed gently without rubbing to avoid irritation. Maintaining a cool room temperature can also help reduce itching. Encourage fluid intake as tolerated, and dress the patient in loose, breathable clothing. Applying a gentle skin cream can soothe dry or irritated areas. Caregivers should ask the family if the patient has any prescribed medication for itching, which may be in the form of an oral medication or topical cream. If itching persists despite these interventions, notify the hospice nurse for further evaluation and support.

Active Dying Process
When a patient enters the active dying phase, several physical and behavioral changes may occur. One of the most noticeable signs is a bluish or purplish discoloration of the hands and feet, which may extend to the arms and legs. These areas will often feel cool or cold to the touch due to reduced circulation. The patient will likely sleep most of the time and may become unresponsive to verbal or physical stimuli. However, it is important to remember that hearing is often the last sense to fade, so speaking gently and offering comforting touch can be meaningful during this time.

Breathing patterns will typically become irregular and may sound noisy or congested. Periods of no breathing, known as apnea, may occur and become more frequent as the process continues. This is often due to the patient’s inability to clear secretions from the throat. Vital signs will also change significantly. Blood pressure may become undetectable, and the pulse may be irregular, rapid, or slow. Radial and pedal pulses may be difficult to detect as circulation declines. The patient may also develop a sudden fever. Urine output will decrease, and the urine may appear dark and have a strong odor. These changes are natural and expected as the body begins to shut down.