Dying Alone

No-one should leave this world alone. My frame of reference is primarily nursing home, home health, and hospice. In those settings, I can't recall a situation where a patient died alone. Of course, there are those unexpected deaths that catch family and staff off guard, but what is the practice or policy when staff knows that a patient is actively dying? On a busy hospital floor, I can see how a patient without a family member or significant other present could die without someone present. Technically, they are not be completely alone on a hospital floor, but I doubt that a staff person is holding their hand at the time that they take their last breath. Several weeks ago I was on a hospital floor. A terminally ill patient died at 0945 and the family was not present. I have been thinking about it ever since.



What about the patients that have no one? To have no-one is more common than one may think. The Adult Guardian Services (AGS) of Cleveland provide volunteer court appointed guardians for people who have no-one. In 2005, they had 502 clients. I have 2 "wards" through AGS that reside in a nursing home and they have no-one in the world willing to be a part of their lives or advocate for them, but me. No-one visits them, but me. Unless I am present when they die, they too may die alone.



What can nurses do to advocate for their health care facility to address this issue and provide someone to be present when a person is actively dying (changes in breathing, congestion, unresponsiveness, and decreased circulation)? I had the pleasure of visiting Malachi House in Ohio City (Cleveland neighborhood) which serves terminally ill persons who may other wise be homeless. It is a wonderful program with an active volunteer group. Staff or volunteers sit vigils with a resident who is actively dying until they die. I also know that hospice programs have volunteers that could be used in that capacity as needed and to support a family for respite.



What a wonderful volunteer opportunity to have the honor of being with someone as they take their last breath. Hospitals and many nursing homes have organized volunteer programs already. Why not add this to your palliative care services? A volunteer can be trained with much of the same programming that a hospice provides to its volunteers. This relieves some emotional burden from nurses who are also tending to other patients. I believe that nurses may be the only health care staff that would recognize this as a concern. Nurses need to address this in their next practice committee or management meeting.