Respiratory Therapy with Unique Care Los Angeles Hospice
Respiratory therapy is a critical component of UCLAH’s care. Respiratory infection treatments can greatly enhance the patient’s quality of life.
Respiratory Therapy in Hospice Care
Pain is one of the top complaints among hospice patients. As one of the core tenets of hospice care is to maximize comfort in patients, it comes as no surprise that our doctors, nurses, home health aides, and therapists spend a lot of time and effort trying to diminish patients’ pain. But for many terminally ill people, pain is a lesser complaint. Lung cancer, COPD, and other cardiopulmonary illnesses make the very act of breathing a struggle. Those patients cannot be comfortable without the aid of respiratory therapy.
After pain, breathing issues are the most common complaint of hospice patients. Perhaps as many as two-thirds of hospice patients will experience breathing problems during their end-of-life:
- Shortness of breath (also called dyspnea)
- Uncontrollable coughing.
- Excessive mucus production.
- Tightness of the chest.
These are all problems that require respiratory aid. Such problems can be exceedingly distressing for patients; some report that breathing issues are worse than physical pain.
It is clear, then, that whole-patient hospice care must include breathing specialists. Unique Care Los Angeles Hospice has several respiratory therapists on staff, and they will do their utmost to ensure that patients with breathing problems can enjoy their lives as much as possible.
The Role of a Respiratory Therapist
If the patient’s terminal illness affects the lungs, then our physician will likely recommend that one of our respiratory therapists evaluate the patient. The therapist will then
- Physically examine the patient.
- Analyze breath and tissue specimens to determine oxygen levels.
- Determine the therapy and medicine that will best help the patient’s comfort level.
- Communicate his findings to the family and the rest of the hospice team.
It is critical that the family and the rest of the care team understand the therapist’s findings. That way, everyone will know what to do if the patient’s problems become acute, reducing the time the patient spends in distress.
We all know that airborne illnesses can spread quickly. In the days of COVID-19, we are all acutely aware of how quickly respiratory problems can overwhelm entire countries, and all of us have suffered from colds and the flu throughout our lives. A minor cold for a healthy person could be fatal for a terminally ill person, not to mention the dangers of COVID-19, which has been disastrous for elderly and ill people worldwide.
Preventing illness is always the best possible choice, so all home hospice workers follow strict protocols to minimize the chance of giving the patient a dangerous infection—or unwittingly spreading the patient’s infection elsewhere. All UCLAH workers follow strict guidelines to lessen the spread of illness:
- Wearing facemasks and gloves in patients’ homes.
- Making extensive use of soap and hand sanitizer.
- Deploying no-touch bins to dispose of equipment.
- We do not report to work if we show any sign of illness, and workers who develop signs of illness during work immediately go home and inform UCLAH of the places they have visited that day.
Respiratory Infection Treatment
Despite our best efforts, patients still sometimes contract illnesses. Depending on the patient’s condition, respiratory infection treatment might involve medicine:
- For minor infections, over-the-counter medication can help manage symptoms.
- Dyspnea can reliably be treated with morphine, but morphine can cause nausea and constipation.
- Medicine administered through IV might be an option for severe infections, but the downsides of IV (bulky, movement limiting apparatus, for example) must be carefully considered.
For patients with persistent problems, respiratory therapy includes many kinds of equipment:
- Inhalers like the ones used for asthma can be prescribed to hospice patients for use when their symptoms become acute.
- Oxygen is commonly prescribed to hospice patients and can have great benefits, increasing mobility and comfort and diminishing the patient’s anxiety. Some medicines can even be nebulized and delivered through oxygen lines, providing another way to treat symptoms.
- CPAP (continuous positive airway pressure) machines can help patients breathe and sleep normally.
- Patients suffering from COPD might benefit from non-invasive ventilation (NIV), a treatment that is much less distressing than mechanical ventilation.
- Mechanical ventilation is the most invasive equipment used to treat respiratory problems. It is used only as a last resort.
Our therapists ensure that patients, family, and other caregivers are informed about the safe and efficient use of all equipment. Skilled nursing training involves hands-on familiarity with such equipment, so the nurse’s frequent visits will allow her to address any problems with the equipment.
Breathing problems tend to worsen in terminally ill people, so all of UCLAH’s caregivers know to look for signs of dyspnea and excessive coughing. Our concierge physicians, when performing home visits, are especially vigilant, and will react quickly to any developing breathing problems, thus maximizing the patient’s comfort.
The Respiratory Therapist at the End of Life
If a patient is completely unable to sustain her life through breathing, either because the act of breathing itself is too difficult or the lungs are not functioning sufficiently well, she may choose to be put on a mechanical ventilator. This decision requires careful consideration: tracheal intubation must occur to start mechanical ventilation, and this is painful and uncomfortable for the patient. The family must be made aware that once the patient has been put on mechanical ventilation, she will almost certainly require it to breathe for the rest of her life.
This presents a painful challenge for our therapists. It is the duty of the therapist not just to apply ventilation, but also to remove it as well—all but inevitably leading to the patient’s death within hours or days.
UCLAH workers are trained to preserve life, so taking a patient off life support can be a harrowing decision. But as always, our duty as hospice workers is to maximize the patient’s comfort. A patient on mechanical ventilation has almost no quality of life. Any moments of comfort she has are marred by the invasive tracheal intubation. Movement is nearly impossible, and she cannot breathe—perform the most basic action of survival—without mechanical assistance.
For that reason, it often falls to our respiratory therapist to tell the family when it’s time to let go. Our therapists know to use great gentleness and compassion with families in such trying times. But, as always, we are dedicated to the comfort of the patient.
Death is not instantaneous after removing life support, and the therapist, along with our nurses and chaplains, often stands by the patient into her final moments. The therapist will administer any medication that might ease the patient’s passing—and reassure the family that letting go is what’s best for the patient.