When one of your residents is near the end of life, wound care can be challenging, and the treat-ments and goals for that resident may change. By understanding these challenges, you will be better prepared to help the resident maintain the best quality of life that’s attainable for them. In addition to considering the recommendations below, please contact your Agrace RN whenever you have questions about wound care for fragile skin. The best outcome for the resident is to maintain their skin integrity and avoid any skin breakdown; however, when people are near end of life, wounds may not be preventable and may not heal, despite attentive care. Skin is an organ that can fail, just as the heart, liver or kidneys can fail, and skin failure can lead to skin breakdown or non-healing wounds. Advanced age, malnutrition, immobility, and comorbidities such as diabetes and CHF are all risk factors that can impede the skin’s ability to heal. Nutrition is particularly essential to wound healing, so if a resident is not eating, it will be difficult for healing to occur. Without nutrients such as protein, vitamins and minerals, a person lacks the basic biological necessities for maintaining healthy skin and healing existing wounds. When supplemental interventions such as tube feedings and IV fluids/nutrition are evaluated to promote wound healing, the benefits and risks should be weighed carefully. Consistent with the philosophy of hospice, typical wound-care goals for hospice patients are to reduce or eliminate pain/discomfort, control odor

Wound-care Goals May Differ for Residents on Hospice By Deborah Jacobson, RN Clinical Outreach Coordinator

(which can be isolating) and prevent additional wounds or complications. Here are steps you can take to help meet these goals: Goal: Promote comfort and reduce pain Dressing changes can sometimes cause pain, so pre-medicating before a dressing change can improve comfort. Using a more absorptive dressing that can stay on longer reduces the need for frequent dressing changes. Adhesive foam dressings will absorb drainage and protect the wound from other body fluids, such as urine. Finally, pressure-reducing and relieving devices, such as low-air-loss mattresses, can help prevent further complications and reduce the need for pain medication for residents who have pain when positioning and moving. Goal: Manage odor and wound drainage People who have odor from their wounds can experience social isolation.1 If family members and friends stay away due to the odor, the resident’s quality of life may suffer. If a wound has considerable drainage and is infected, consider topical antibiotics rather than systemic ones. At Agrace, we recommend a Flagyl spray that can be compounded by the pharmacy to help control odor. Essential oils, such as peppermint or vanilla, applied to the outside of the dressing can also help mask odor.

Continued

Deborah Jacobson, RN

Resources for LTC staff supporting residents at the end of life

5395 E. Cheryl Parkway, Madison, WI 53711 3001 W. Memorial Drive, Janesville, WI 53548 Referrals/Admissions: (800) 930-2770

For more information about partnering with Agrace HospiceCare, please call (608) 327-7419 or e-mail denise.gloede@agracehospicecare.org.

Agrace HospiceCare’s Partners on the Journey | Winter 2013 | Page 2

Many dressings also have antimicrobial properties, and other dressings manage odors with substances like charcoal. Goal: Prevent additional wounds, and complications from existing ones

Encourage turning and repositioning for immobile residents.

Use pressure-reducing devices, cushions and surfaces to help prevent pressure- related wounds.

Use barrier films around wound edges to pre-vent skin breakdown from wound drainage. Use a barrier ointment, such as Selan® or Lantiseptic cream, to prevent skin breakdown from incontinence.

Whenever you have questions about the challenges of wound care, please contact your Agrace team. We’ll work with you to utilize treatments and processes that can help residents achieve the best possible level of comfort. 1 Douglas V (2001) Living with a chronic leg ulcer: an insight into patients’ experiences and feelings. J Wound Care 10(9):355-60

Most everyone loves the specialness of the holiday season. But what about afterward? If your residents enjoyed celebrations and extra visitors during the holidays, they may feel lonelier and experience grief more intensely as January wears on. Here are some ways you—and we—may be able to help: 1. For residents on hospice, call the Agrace care

team. A visit from their grief counselor or chaplain may be comforting and uplifting. We can also match a hospice volunteer to the resident for additional companionship.

2. If the death of another resident is affecting residents or staff, invite those who share the loss to come together informally and share memories of the person whose absence they are grieving. “One of the keys to getting through a loss is for it to be acknowledged,” explains Cheri Milton, manager of grief services for Agrace. “When the person who died is never mentioned again, others feel the person has been ‘erased,’ and their friends or caregivers may feel the loss more intensely.”

3. Periodically host a memorial service for residents and staff to remember all residents who have died recently. Agrace chaplains would be honored to lead the service, if you wish.

4. The Agrace grief counselor who serves you is available to check on an individual staff member or resident who is grieving. We can help people cope better with loss and return to functional living in a healthy way.

5. Agrace’s grief counselors will also facilitate a grief support group at your facility, if you request, or host an educational inservice for your staff and/or residents to discuss healthy ways to cope with grief.

Please contact your Agrace team leader for assistance with any of these helpful services.

Wound Care, continued

Vigil Volunteers Available in Residents’ Final Hours When your residents are at the end of life, the unknowns can be distressing for them and for their family, especially in the final hours. To help in these situations, Agrace HospiceCare offers additional trained support for our patients who have three days or less of life expectancy. Agrace Vigil Volunteers can provide experienced companionship and a supportive presence as death approaches. Their 28 hours of hospice training includes specialized training to serve people who are actively dying. Their presence can be a great comfort to the resident, their family and their caregivers. To learn more, please ask your Agrace liaison for details.

Five Ways to Help Staff and Residents Who are Grieving

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