In this episode of Caring Conversations, Melissa Therrien and Liz Lewington delve into the sensitive topic of palliative care, discussing its importance, misconceptions, and the emotional aspects surrounding end-of-life care. They explore the differences between palliative care and hospice care, share personal experiences, and emphasize the need for early conversations about palliative options. The episode highlights the role of healthcare teams, the significance of family support, and the active management involved in providing comfort to patients. Ultimately, the conversation aims to demystify palliative care and encourage open discussions about dying and the care that can enhance the quality of life during this challenging time.
Episode Transcript:
Melissa Therrien, RN (00:01)
Hello and welcome to Caring Conversations episode 6. Liz, six episodes down. How incredible is that? I know.
Liz Lewington, LPN (00:07)
Yeah. Who knew it? Who knew? I know. We survived it. We’re just getting
started getting the steam going, I guess.
Melissa Therrien, RN (00:16)
Yeah, and I like to say that we are getting better at this. Who knew?
Liz Lewington, LPN, LPN (00:20)
Yeah,
I like to say it too, whether it’s true or not, you be the judge.
Melissa Therrien, RN (00:23)
Yeah.
So, contrary to the fun that we’re having today, today, or right now, today is a very big topic. It’s a sensitive topic, some trigger warnings, perhaps. We are talking about palliative care. Lots of misnomers, lots of misconceptions, lots of unknown when it comes to palliative care. So I’m really excited to chat about this and hopefully demystify it all.
and share some of our phenomenal experiences when it comes to palliative care in hopes that everyone can have a really wonderful, peaceful, comfortable dying process. I think that’s the end goal for everybody and today we wanna talk about it. It’s a tough topic, listeners be aware, but it’s a really important one. And actually on that note, Liz, I just wanted to chat like…
Liz Lewington, LPN (01:04)
Yeah.
Melissa Therrien, RN (01:18)
We mentioned in a meeting, I mentioned in a meeting yesterday about the imposter syndrome and how I worry that no one is listening to these podcasts and we’re just talking for the sake of talking. But what I did realize and some self-reflection is I think it’s really great that we’re talking about these things. Sometimes they’re hard conversations and sometimes they’re conversations that people just don’t want to have. So for us to put it out there in the universe and just openly talk about it, share some of our experiences, my hope is that
know, between these conversations with you and I, someone will hear it and it’ll make a difference or it’ll give them the power to then reach out and ask a question or talk to their loved ones about it. So I just wanted to mention that and chat about that quickly.
Liz Lewington, LPN (01:59)
Yeah,
healthcare and the palliative process and dying process, accessing long-term care, all of these conversations that we’re talking about, nobody, you don’t go to school and get a degree in how to manage my mother’s dying process. These are not educational opportunities that exist in the world unless you are dropped in to the neck at a moment’s notice and it can happen.
Melissa Therrien, RN (02:18)
Yeah.
Liz Lewington, LPN (02:27)
I know that nobody here wants to have this conversation other than you and I, clearly. But it’s a conversation that people need to have access to. Like you say, imposter syndrome, people might not be listening, but when they need us to have that information out there is really a good thing. Yeah, so what should we dive in? What is palliative care, Melissa? What is it? What is it?
Melissa Therrien, RN (02:47)
Let’s do it.
Wow, it’s so big. mean, I don’t, yeah. I mean, yeah, it’s essentially the process of dying and how we care for someone who has made the decision or maybe subconsciously has made the decision that they would no longer like to pursue curative measures for their disease process and would like to pursue comfort measures and make comfort a priority. You know, I think palliative care is so broad in the fact that
Liz Lewington, LPN (03:13)
Yeah.
Melissa Therrien, RN (03:20)
Like you can talk about palliative care at any stage in the disease trajectory from the initial diagnosis where the prognosis may be 20 years or a diagnosis where the prognosis is very short and very life limiting. So, you know, in that sense, I think it’s quite broad because it can take a whole different look and a different perspective depending on where we’re at in that process in end of life care and the palliative care process.
Liz Lewington, LPN (03:46)
Mm-hmm. And
it’s that shifting ideas of, this a condition that we’re treating or can we prolong life? And then when that decision is made to say, you know what, I don’t want to fight anymore or it’s not my, you know, my quality of life is not such that I want to continue this road anymore. And you switch to comfort measures. So you’re instead of looking at how can we assist with making, you know,
Melissa Therrien, RN (03:56)
Okay.
Liz Lewington, LPN (04:14)
helping with longevity of other organs and that sort of thing, we’re now focusing strictly on comfort and controlling symptoms of whatever the condition is that this person is existing with. So making sure that we’re treating the human being, the symptoms, but we’re not gonna move forward with controlling blood pressure necessarily. A lot of the times you have a laundry list of medications that you’re on and when you make that decision, you…
out a lot of medications and you just focus on what’s necessity. yeah, like you said, palliative care can really, it can be a conversation that you start at the beginning of your process when you know, you know, this is a condition that is life limiting. What do I want the end of my life to look like? And having those conversations again, we always talk about this, but tell your family, tell your family what you want in that process. palliative care versus hospice care, what do you…
Melissa Therrien, RN (05:05)
Mm-hmm.
Liz Lewington, LPN (05:11)
What are your thoughts on that? Because I know it can be used interchangeably. Absolutely, can. And I know in different places, it is used completely interchangeably. What are your thoughts on it?
Melissa Therrien, RN (05:18)
Yeah, for sure.
Yeah, and I think in order to qualify
for hospice care, you must have a palliative diagnosis and be within in Alberta and I think in most hospice situations, it is a three month timeline where we’re anticipating that end of life will be within those three months. know, hospice care is very much taking that palliative approach of their comfort measures, know, creating a space where your loved ones can visit.
of at all times of day. It’s very calm. It’s very peaceful. You know, it’s not the hustle and bustle typically that you see in acute care or other like long-term care units. Hospice care is, it’s a very beautiful place. Like you can feel the energy is very calming. The people that work there are very calm, compassionate, understand the dying process and the end of life process very well. The physicians that are there are amazing people who also
very much understand that process. And hospice care often brings in the maid situation, which is a hot topic, you know, across all legislations these days, but medical assistance in dying. And so you can receive the maid procurement through hospice as well, or in your home, but we can talk about that later.
Liz Lewington, LPN (06:42)
Yeah.
And although there’s like the hospice society as well, when you’re talking about hospice society, they’re non-medical. you go, that’s where the name I think gets kind of confused is, hospice care is bedside companionship operated with volunteers. And it depends on what area that you live in as to the functionality of whether they can actually come and do bedside care. I’ve been in really remote living situations where there will be
Melissa Therrien, RN (06:47)
you
Liz Lewington, LPN (07:11)
there was one woman that was hospice. she, so you would phone her and she would say, yes, I have availability. And she would come and sit at the bedside as much as she could so that that person would not die alone. She did not do any of the medical side of it, but yes, she was there for that spiritual, emotional support. She was an ex-nurse because we’re all deranged and really can’t give it up. Once you care, you can’t stop. It’s really a medical condition for us. So if there’s any cure for that, just let me know, holler.
heavily in tag us if you have anything. But yeah, it’s the hospice care, like you say, it isn’t just about the hustle and bustle and getting you up and getting you going. It’s you can sleep when you want to sleep. You can have loved ones there with you around the clock. There’s no visiting hour restrictions. There’s usually some pretty decent snacks kicking around if you’re going that route. Yeah, so knowing that if somebody that you love
Melissa Therrien, RN (07:44)
Hehehehe.
Okay.
Liz Lewington, LPN (08:09)
you know, they make a decision where they want to pass. hopefully, if you’ve had that conversation, you want to pass at home, they can still have that palliative team look after them at the home. Or you can move into that hospice care in in a facility that is 24 hour nursing care that has that sort of gentle touch that isn’t, you know, trying to get them up. They’re just nourishing their soul there and their body as much as they’re able to and supporting the family. And like you say, the staff that work there are
Melissa Therrien, RN (08:36)
Yeah.
Liz Lewington, LPN (08:39)
cut from a different cloth. just, the feeling, like you said, that energy when you walk into a hospice wing or facility, it’s just down to earth. I don’t know what kind of crystals and voodoo magic there is going on around there, but it is such a beautiful place. The experience is a beautiful thing. Yeah.
Melissa Therrien, RN (08:59)
Yeah. Yeah.
And I mean, hospice can be a pediatric hospice, you know, which I spent some really incredible time at a pediatric hospice in my early years of nursing, right through to, you know, seniors and they’re, you know, I think the way that we treat and it’s not treating, that’s a terrible word for this. I think the way that we work together with families and patients that are, you know, going through that palliative process is very similar across all age groups where
We are, yeah, nurturing and really spending some quality time and allowing families to spend quality time with their loved ones, taking away that care burden and just, you know, making the environment really conducive to quality, you know, loving time.
Liz Lewington, LPN (09:46)
Yeah, yeah, it is. It’s the highest quality care you can get in the healthcare field. Honestly, you can go to an ICU where you have one-on-one nursing care, but if you’re looking for an actual quality, beautiful moment, it is always on that palliative care wing. Yeah, yeah. So, I mean, when you’re talking about palliative care and your experience, where have you…
Melissa Therrien, RN (09:55)
Yeah.
Liz Lewington, LPN (10:13)
Have you you practiced in the home? Have you practiced in acute care? Like what does that look like for you? What’s the difference?
Melissa Therrien, RN (10:16)
yeah, I
mean, I’ve had the privilege of working in many different environments where palliative care was part of our job description, I suppose, which is terrible because it’s a privilege to be a part of it. know, from, like I said, pediatric hospice I’ve worked in, I worked in trauma for many years and even in trauma where, you know, typically we’re very much in a life saving, like everything we need to save and
Liz Lewington, LPN (10:45)
Yeah.
Melissa Therrien, RN (10:46)
know, families are faced with such a crisis. There is that aspect of palliative care where, you know, you kind of shift gears and you go back and you talk, you know, bigger picture. What is this going to look like long-term for you? And some of the most difficult conversations that I have had and been a part of are with families through that trauma experience and where their loved one has, you know, had some sort of trauma and they’re now facing.
you know, very life limiting trajectory and palliative care has become a process. But some of the most beautiful conversations too, you know, it seems like when palliative care gets involved, we start looking at the patient as a whole again, you know, it’s not systemic where it’s like, you know, respiratory or GI or neuro or anything like that, like palliative team, when they come in, they tend to really get everybody working in the same direction and start thinking as
holistically as possible about what is best for this patient. And that’s a pretty incredible approach. I love when I get to work with the palliative care team because they are a phenomenal group of people.
Liz Lewington, LPN (11:52)
Yeah, they are. Yeah. And it is that holistic approach. You know, you go in and it’s more about what was the treat that they really loved and how do get it here? yeah, and is there a dog? You know, let’s get that dog in here. And did they love music? they want some music playing in the background to help ease them? Because, you know, they can still hear. You know, we always hear, you know.
Melissa Therrien, RN (12:01)
Yes.
Yeah. Yeah.
Mm-hmm.
Liz Lewington, LPN (12:18)
The last sense to go is hearing. So always talk to these
people that are going through the process of dying. And if they can’t respond, they can still hear you. So that’s what we always say to our folks is just keep talking to them. Keep talking to them. Yeah. Yeah.
Melissa Therrien, RN (12:28)
Yeah. Yeah.
talk. Yeah.
And that thinking outside the box too, right? Like, is it music? Is it a dog? How do we get this loved one from Africa, which I’ve had, into Canada? How do we expedite this visa? How do we expedite this plane ticket, this passport? What does that all look like? Because that’s important and people will go out of their way to try and make that work. Pretty incredible.
Liz Lewington, LPN (12:52)
Yeah. Yeah.
Yeah. And it’s amazing
that the strength of the human spirit, I know it sounds very woo woo, but I really do believe that people will wait. They wait for somebody. They wait. And it doesn’t have to be a person. It can be a dog. I had a woman that was, you know, she was actively dying. you know, as a nurse, you’re always asked that same question. Well, how long do we have? How long do you think we have? And you can give a ballpark, but I’ve had people that are breathing, you know, four times a minute and it goes on for days.
Melissa Therrien, RN (13:06)
yeah.
Liz Lewington, LPN (13:26)
And all you can think is what are they waiting for? And then in that case, was a son that came from across Canada. And when he got there, as he left, she took her last breath and that was her. was gone. She was waiting to say goodbye. And you can have, I had a woman who passed away, but she was waiting for her dog. We ended up taking her to hospice. And again,
Melissa Therrien, RN (13:39)
Mm-hmm. Mm-hmm.
Liz Lewington, LPN (13:49)
nurses and we all think she’s going to be if this is a normal trajectory we can predict about yay to hey somewhere in there really can’t give you a ballpark other than that and then the dog came and she knew she was there even though she couldn’t verbalize it and and those are those beautiful moments of being able to be present with somebody that is in the the final moments of their life is to be able to just yeah holistic it is just such a yeah nurturing holistic place to be.
Melissa Therrien, RN (13:56)
Mm-hmm.
Mm-hmm.
Mm-hmm.
Liz Lewington, LPN (14:18)
a part of. Yeah, yeah. I know as a new nurse, you know, you came into it and you were like, someone’s dying and it was terrifying. you know, as you’re like you want if you’re going for a palliative care, you know, you want that nurse that’s seen it all because they want to approach it, you know, in that soft, gentle manner. So experience goes a long way when it comes to palliative.
Melissa Therrien, RN (14:18)
and a privilege. my goodness, what a privilege. Yeah. Yeah.
Mm-hmm. Yes.
Yeah.
Yeah, for sure. Yeah, I
remember taking students through a clinical and, you know, many of them were experiencing their first death. And they’re like, what is it going to look like? I’m so nervous. Like, what is? my goodness. And I was like, if it’s anything but uneventful, then we’ve done something wrong. We want it to be uneventful and beautiful and calm and comfortable for all people involved. You know, it’s devastating, of course.
But the more uneventful that we can make that dying process, better, truthfully. And many of my students thought that was really odd that I would say that, but I think it’s important to think of it that way. Like, it doesn’t need to be chaotic and stressful. And I think that’s where palliative care really brings that calm and that preparation into the picture for all people involved. Yeah. Yeah.
Liz Lewington, LPN (15:33)
Yeah, and it’s the planning, like you say, it’s the planning and nobody,
nobody can plan on when we’re going to pass. But creating that conversation early so that when your family is in that position where they feel like they have to make these decisions, like do we, you know, you’re not capable of making a decision on your own. Where do you want to be? Do you want to continue to fight this illness? Would you prefer to, you know, have that palliative approach where we’re treating the symptoms and not the disease any longer?
Melissa Therrien, RN (15:44)
Okay.
Liz Lewington, LPN (16:03)
Yeah.
Melissa Therrien, RN (16:03)
Yeah. And
I think that’s pretty scary too for people to acknowledge, right? Like, you know, I know so many people that just don’t even want to hear the palliative word, like, absolutely not. I’m not giving up. But it doesn’t have to be giving up, you know, it’s, it’s weighing that quality over quantity, right? And making that decision to understand like, what is a priority for you? Is it time? And, and that may be yes, you may get more time or you may not.
Or is that quality and how like changing the way that you are, you you and your family are perceiving this process and how you’re going to spend your time. Yeah.
Liz Lewington, LPN (16:38)
Yeah, yeah, yeah. And that’s where that conversation
is so hard because, know, people, time, time always feels like a more important value to consider. But, you know, we’re at a place on that journey where time really does not equal quality. Yeah, yeah. And conversations and connectedness like that, it deteriorates and then nobody wants their last moments with their loved one being something of a trauma. So knowing that
Melissa Therrien, RN (16:49)
Mm-hmm.
Yeah. Yeah.
I’m sorry.
Liz Lewington, LPN (17:07)
Yeah, having that early conversation and getting connected with the palliative team in your area and, you know, investigating all the options that exist and knowing where you’d like to pass as well. any having a backup plan, you know, it’s just like any other other, you know, place in life where you need to have that backup plan. I’d like to die in my home, but if this becomes too difficult, I’d like to, I’d like to go to the hospice. If my family is not able to continue doing what they’re doing. yeah.
Melissa Therrien, RN (17:20)
Mm-hmm.
Mm hmm.
So for you, like when as a nurse, it’s so challenging because often we’re the first to broach the topic, right? We’re the first to start that conversation with our clients or patients. So what are some signs that you look for in order to initiate that conversation? How do you initiate that conversation with families?
Liz Lewington, LPN (17:45)
Mm-hmm.
Well, I often start by asking them what they know about their medical condition. You know, has the doctor ever mentioned this word to you? Because you’ll go in and you’ll notice that there has been a lot of weight loss often comes with that sort of approaching the end of your life. You see rapid weight loss or consistent hospitalizations or, you know, you find out that there’s been a diagnosis that you know may have potentially a life ending prognosis. So those conversations
Melissa Therrien, RN (18:02)
Mm-hmm.
Liz Lewington, LPN (18:28)
are sort of where I jump in. just say, hey, if this is the diagnosis, let’s say there’s a cancer diagnosis, are you pursuing treatment? And then they’ll let me know, well, yeah, I’ve gone through X, Y, Z and it didn’t agree with me and so I’m gonna stop doing that. So you know that that’s now a decision that sometimes people make that decision not really openly saying to their family, look, I’m done fighting this condition. I’m happy to move on.
Melissa Therrien, RN (18:36)
Mm-hmm.
Liz Lewington, LPN (18:57)
counterintuitive as a human being can think that giving up, it’s moving on. These are people that are moving on from this life and it’s their decision and it’s so hard to give up loving somebody and let them move on.
not that you give up loving them, you know, giving giving them the power to make their own decision as to as to when they want to leave because we all want to hold on to people that we love forever and ever amen. So that’s where I come in is, what’s the diagnosis? What are we looking at? If this is the case, has anyone talked to you about these options? And then and that’s when I will start the process of just educating folks on
you know, making sure that there’s representation agreements and powers of attorney in place and, you know, that they have done the extensive planning that really is required for making sure that everybody feels safe with the decisions being made and legally, of course, I not that we want to go down that road, you know, making sure that legally everything’s covered because you don’t want to sit there in limbo while they’re in a tough condition, not being able to make any decisions.
Melissa Therrien, RN (20:10)
No, and it’s
good to have that legal stuff in place too to better understand the thought process before this became an issue. You know, what of not of sound mind, but what pre diagnosis was your thoughts on how you would like your life to end and you know, those sorts of things. It’s always good to look back on what those ideas were and maybe revisit them. Maybe they’ve changed as a result of the diagnosis, but
Liz Lewington, LPN (20:36)
Mm-mm.
Melissa Therrien, RN (20:39)
Yeah, always important to kind of look back and like, okay, why did I choose this one way or the other? And why did I want, you know, all life-saving measures? because I did it when I was 18 years old. That makes total sense. And now I’m 45, right? Or 80. I don’t know, right? You know, things change. So you always want to revisit those legal documents. And yeah, I mean, it’s a great place to start to open that conversation amongst your family members too, because that’s pretty black and white, right?
Liz Lewington, LPN (20:45)
Well.
there’s the Canadian government released the My Voice book. I’m sure you’ve come across it. Yeah. And it is a wealth of, mean, agonizing to read. Legally, but it is there’s a lot of documents in there that can be completed with really no additional expense, just witnesses and you can get your representation agreements in there. can get
Melissa Therrien, RN (21:12)
Yes.
Yes.
huh.
Liz Lewington, LPN (21:28)
So I don’t know if they I don’t think the enduring power of attorney is in there but there’s a lot of a lot of documents in there that can really help with that process and and not necessarily just palliative but you know planning or incapacity that That really does need to be made Doesn’t matter what age you are Start planning today. Yeah
Melissa Therrien, RN (21:40)
Mm-hmm.
No. It’s true. Yeah, it’s true.
Tough conversations, but the more we talk about them, the easier they get, really. So it’s good to talk about them early. Yeah, so we talked about the signs that might lead someone to think about a palliative conversation. But all of my conversations with the palliative care team have been either
Liz Lewington, LPN (21:57)
Exactly.
Mm-hmm.
Melissa Therrien, RN (22:15)
I wish that we were involved sooner because we have the ability to support this family in a way that they’re not currently feeling those supports. Or they’re saying earlier the better, keep us involved. As soon as there’s maybe this diagnosis or as soon as that diagnosis comes and they’re open to those discussions, whether it be with social work or specifically the palliative care team, they want to be involved as early as possible.
Liz Lewington, LPN (22:25)
Mm-hmm.
Mm-hmm.
Melissa Therrien, RN (22:44)
And what’s
your opinion behind that? Why do you think that is and what can they bring to the table even in those early days?
Liz Lewington, LPN (22:51)
I think that, I mean, again, education, I can blabber on about getting that in early, absolutely, but connecting with the other social, like you said, connecting with the team, knowing what’s out there so that you can be fully aware of where your journey is headed. So what symptoms are you potentially managing? What happens if the…
If your blood pressure drops, what happens if there’s maybe a bleed, what do we do? Is there a protocol in place? So yeah, connecting with a nurse or a social worker or whoever it is on that team and asking those scary questions. And then when you’re in there early, I’ve been the nurse, I’m sure you have in home care where you have what we call a stable palliative. So palliative, when we’re talking about it in home and community care, it’s six months is sort of the…
where we get that Plan P, which is the name of the government program that pays for medications and palliative supplies, things like briefs and soaker pads and wound care, dressing supplies, skin care, that sort of thing. So that exists, so keep that in mind. But you have access to that Plan P. It cuts down the cost. It also allows home and community care to support you with additional hours.
through the government. So government subsidies come in and you don’t have to pay a penny towards any personal care. have faster, fast track access to those hospice beds when the time does come and you get to know your case manager. So you may, if you’re coming in late in the game, you know, that relationship that you really can create with your case manager or the home care nurse that’s been managing wound care.
They phone, they check in, hey, how’s this going? And help to manage mild symptoms, things like your bowels aren’t functioning as well or they are functioning way too well. Managing symptoms that have cropped up that may not necessarily be a major concern for you or your family member on that day, but if extrapolated out will end up causing a hospitalization in the future. So getting in early.
creating that connection, getting your education. And again, I’m so sorry I keep saying that, creating your net is really important, I think. And then getting to know, even going for a tour, I know it sounds weird, but going for a tour of the hospice building so that maybe you can say, it would be great if we could have a room with a view or whatever comes up available, I’d really like to be able to come in.
Melissa Therrien, RN (25:12)
Mm-hmm.
Mm-hmm.
Liz Lewington, LPN (25:35)
at night so that people don’t see me leaving my home or something along those lines. Just having conversations like that, knowing that the team is there to support you through the whole process. So that’s why I would say jump in early, get everything you can out of the situation as well. So you’re not destitute. You know, your family doesn’t feel the need to sell the car to pay for your medications that you may need during that process.
Melissa Therrien, RN (25:42)
the
Mm-hmm.
Yeah, in Alberta,
we definitely have a palliative team and it falls under, you know, the home care. So the fully funded option, which is phenomenal for us in Alberta. And it’s you access it through that same community care intake or, you know, your community case manager currently can connect you with that palliative care team. Many people feel like that has to come from a doctor.
It’s not necessary. I think once we’ve determined those goals of care and deemed that we’re no longer going that curative direction and you’ve made those wishes very clear to your entire care team, I think anyone is privy to that palliative care team and I recommend everyone make use of it for sure. And families too, right?
Liz Lewington, LPN (26:49)
Mm-hmm.
Melissa Therrien, RN (26:51)
the earlier that that team is involved or the earlier we start talking about palliative care and what that looks like, everyone grieves in their own time and in their own way. And that may start happening long before someone has even passed, you know. Many times we see, you know, loved ones who are caring for someone with dementia and then they pass away. And it’s almost like a, like that’s okay. And
I have been grieving this for 14 years and today I’m okay. Thank you for your well wishes and your condolences, but today I’m okay. And so again, everyone’s journey is very different and I think the more people we have on that team, the better.
Liz Lewington, LPN (27:37)
Yeah, yeah. I mean, we could go into the grieving process and how it looks so different and that journey of a dementia diagnosis, like you said, you’re grieving the whole time because you’re losing little pieces. if it’s somebody that is younger, you’re going to be grieving in a huge way than allowing people to grieve in their own way. Being in a hospice environment, you see everybody at their best and at their worst.
and knowing that you have that support team as well. There’s hospice support groups that meet afterwards if you have somebody that has passed away that can help with counseling. And it’s really important to not shut yourself off to the world. I know it sounds easy, because that’s totally the way that I would go is to just get into a closet and close the door, but to reach out to other people to keep communication open with other people that have been through it or
can help you through it is really important. Yeah.
Melissa Therrien, RN (28:37)
And from different perspectives too. Maybe you don’t want to hear from another wife whose husband died from the same cancer diagnosis. Like maybe that’s too close to home, but you do want to talk to a nurse who has seen many beautiful deaths. And that’s the perspective that you want to see by pooling those resources through the palliative care team or through the extended care team. think you can…
Liz Lewington, LPN (28:53)
Mm-hmm.
Melissa Therrien, RN (29:04)
You can get the resource that’s really in tune with what you’re needing.
Liz Lewington, LPN (29:07)
I know that when you’re on that journey, if you’re caring for somebody at home, I mean, that’s where we come in with Ohana to supply that additional support because it is a 24-hour process because folks near the end of their life, they may not know it’s day or night. Depending again where they’re at, they are going to need continuous repositioning to make sure that their body
Melissa Therrien, RN (29:14)
Mm-hmm.
Okay.
Liz Lewington, LPN (29:36)
isn’t breaking down in different areas on their skin. They’re going to need small amounts of hydration. They’re going to need consistent pain medication and management potentially, anti-nausea. Those sorts of medications are around the clock. And that’s where a barrier can really present itself when you’re at home doing in-home palliation. So having support of a nurse in the home.
having support of your entire net of friends and family if they’re comfortable with being there for that process. And again, have a chat. What do you wanna do? Are you capable or willing or creating a sort of rotation where, you know what, I could do two hours on a Wednesday if that’ll help. But knowing that you really will be suffering right along with that person and you do need to reach out.
or you’re going to be really, really suffering at the end of the day. It takes a village like you’ve said so many times when it comes to home and community care, we’re the village. We are part of that process of making sure that it’s comfort and everyone’s supported, not just the person that is palliative or that is passing away. It’s the whole family. We need to make sure that everyone’s eating and drinking. That’s what I always say.
Melissa Therrien, RN (30:48)
Hmm.
Liz Lewington, LPN (30:55)
You know, when you check in with somebody who is the caregiver, say, did you sleep last night? And if they say no, then they say, well, what’s the plan for tonight? Because you can’t keep doing this. Or have you had anything to drink today other than a cold coffee that you made six hours ago? And if they say, well, no, I haven’t, go get a drink right now while I’m on the phone with you. I need you to have something to drink. And so they’ll go and I won’t get off the phone until they do. Or did you have anything to eat today? Yeah.
Melissa Therrien, RN (30:59)
Yeah.
Stubborn.
Liz Lewington, LPN (31:20)
Well, yeah, I had
a burger yesterday and I ate some cold hash browns today and I’m good. No, you’re not. You need to eat something because you are going to be suffering here. So make sure you look after yourself so you can look after your loved one as well. Yeah. Yeah.
Melissa Therrien, RN (31:28)
and
Yeah, for sure. Yeah,
what you brought up there was actually really interesting, you know, the hydration, the medication to help someone who is dealing with their bowels. You know, despite the fact that we have said we’re no longer doing curative measures, I think it’s misleading to say, you know, that it’s giving up or that we’re not doing anything anymore, because it’s very much an active process to support someone in palliative care, you know, we’re
constantly evaluating how to better support them in their symptoms, whether it be, you know, a bowel protocol or pain management or, you know, a terminal delirium. It’s a very active and constantly revisited process that, you know, I think that that gets missed amongst many people. You know, we don’t want to create any undue suffering. It’s not giving up on our end at all. It’s actually creating
Liz Lewington, LPN (32:30)
no, no.
You shift into a different, yeah, yeah. You go from, yeah, you go from trying to figure it out to knowing what you’re doing. Like honestly, in a palliative diagnosis, you’re like, okay, palliative hat’s on. I’m gonna move forward with monitoring your skin and making sure that there’s no reddened areas on your body. We’re gonna be doing consistent, constant repositioning, hydration.
Melissa Therrien, RN (32:32)
a completely different plan. Yeah. It’s a very active process.
Yes.
Yes.
Liz Lewington, LPN (32:57)
You’re going to make sure that their oral membranes are moistened, that they’re getting oxygen if it is something that’s going to help with comfort. It’s not like you think. It’s not like we just go, okay, good luck, walk away. Yeah, no. If anything, it is very much more involved. 100%. Yeah. Usually. Yeah.
Melissa Therrien, RN (33:06)
Mm-hmm.
Walk away. No.
Yes, it’s less poking and prodding, potentially. But it’s, it’s still very involved. Like, yeah,
I mean, some of our palliative clients where you’re doing hourly pain medication are some of the most involved clients. You know, whereas someone who’s not in that palliative trajectory is maybe a little every four hours, I’m doing vitals or whatever that looks like, right?
Liz Lewington, LPN (33:31)
Mm-hmm.
Yeah.
Melissa Therrien, RN (33:41)
So I think that’s something that is so key for people to understand is like, we aren’t stopping anything. You know, like we’re gonna nitpick the vitamins and the big pills that you don’t wanna take anymore and pull those out. Absolutely. Calcium, let’s get it out of there. Yeah, but for us, it’s very much an involved and active process. yeah, I mean, I think, like you said, you just put the hat on and you know exactly what you’re gonna do.
Liz Lewington, LPN (33:53)
And they can go immediately out the door. Omega, no. No.
Melissa Therrien, RN (34:11)
and you know what’s available to you, which is wonderful as well, which is almost endless.
Liz Lewington, LPN (34:18)
it is. I know. That’s why I love palliative doctors so much. They come in and they’re like, what do you need, sister? And you’re like, I need all of this. And then maybe all of that too. So I love the palliative team. Like you say, it’s just, it’s stunning the way that it works. And it’s so compassion-based, so compassion-based. I love it. And then when we’re there, let’s say, you you’re in the home, you’re providing that sort of more medical side of the support, managing the symptoms, et cetera.
Melissa Therrien, RN (34:22)
Yes.
Yeah.
Yes.
Liz Lewington, LPN (34:47)
And then you move in to a place where the client’s family are no longer in that role. And that’s lovely because they get to breathe and you can say, you know what? I’m here. Go take a step back. It’s OK. I’ve got it from here. If you need to nap, like go have a rest because you know this is not often it can be weeks in a row where you’re in this 24 hour care model where it’s always
Melissa Therrien, RN (34:53)
Mm-hmm. yeah
Mm-hmm. Yeah.
Liz Lewington, LPN (35:14)
somebody’s up doing something or eating or you know family gets up at 3 a.m because they couldn’t sleep and they pop in to check on their loved one and there’s somebody at their bedside that’s making sure that they are hydrated that they are you know they have everything that they’re comfortable and that and that you know they have what they need so supporting the family to have that quality time where they can walk away and they can all you know you’ll walk out of the out of the space where you’re looking after their loved one and they’ll be a room full of people
Melissa Therrien, RN (35:36)
huge.
Liz Lewington, LPN (35:44)
and they’re all looking rough. man, know, we’re not the time anything to look at, but you know, they’re hungry when they’re tired, but they’re together. And you have people that can very much be leaning on each other. And again, family dynamics come into it. So that doesn’t disappear because we’re palliating, but being able to take that nursing component off of their plate and the personal care component off of their plate so they can go back to being a loved one.
Melissa Therrien, RN (35:44)
Mm-hmm.
Starving.
Liz Lewington, LPN (36:13)
with that quality time that they can spend together talking to their loved one and giving them privacy so they can have those moments when they’re when you’re no longer needed in that in that space.
Melissa Therrien, RN (36:23)
the peace of mind that someone is there to say, okay, like now is maybe a good time for us to come together. Let’s, you know, sit at the bedside. I’m going to give you this space. Because, you know, people think they’re going to miss out, right? They’re going, they’re going to wake up from that nap and mom or dad is going to be gone. And that, that’s that sense of loss or that regret, you know, that doesn’t sit well. So having someone at the bedside, but that’s professional that can say like,
Okay, things are moving in a quicker direction now. Um, and, and so now is a good time and that, you know, tap on the shoulder, like, do you want to get up and maybe sit with mom for a few minutes? And, you know, we’re not going to go and be like, you got five minutes. Let’s go kind of thing. It’s, it’s that progressive, like, you know, I think maybe it’s a good time for us to call your daughter and ask her if she’d like to come over. And it means everyone doesn’t have to be there and everyone can take that rest in that space that they need to.
Liz Lewington, LPN (37:09)
Yeah.
Yeah, I can say when a nurse phones you to say you should really come and visit, you should really come and visit. You really should. I’ve had families that think it’s a request. You need to come. If you’re somebody that wants to be involved at the end of this person’s life, then you need to be there when we call. I know that sounds really selfish, but yeah, I hate to have somebody pass.
Melissa Therrien, RN (37:28)
Yeah. Yeah.
if you want to.
Yeah.
Liz Lewington, LPN (37:49)
when their loved one’s not there if that’s not what they wanted. Yeah and again I mean the human spirit again preachy preachy but people can choose when they go so you can have someone that goes you know what I just went in and I saw mom and she’s doing so well and then they’re gone and that was mom. Mom was like I’m gonna trick you you’re gonna think that I’m gonna be here forever or I smiled I had a sip of water we had a great conversation and then you left and so did I and that was it.
Melissa Therrien, RN (37:52)
Yes, agreed.
Liz Lewington, LPN (38:19)
People really do decide. So I think carrying that grief with you that you weren’t able to be there, mom would have hung on for years if you had stayed. She wanted you to leave so she could leave too. Often people don’t, when they make that decision to pass, they don’t want you to be there if they’ve chosen that. They don’t want you to witness them leaving or they want you to be like there’s…
Melissa Therrien, RN (38:22)
Okay.
Liz Lewington, LPN (38:46)
There’s so many instances in my career where I’ve been able to, and I’m sure you have as well, where you can see that this person has made the decision that as soon as you leave, I’m going to go, or you reposition this person and they’re comfortable and they’ve seen everybody and then it’s this peaceful moment where they’d go, okay, well, I’m good now. Everything is just fine. Thank you. Yeah. Yeah.
Melissa Therrien, RN (39:05)
Yeah. Yeah.
Yeah, and it’s okay to say, I don’t wanna be there. Like wake me after the fact. And that’s totally okay. Like I think the permission to be yourself and to recognize your own limitations and to not be prepared to see that last breath is totally okay. And I think it’s just that conversation. And never will a nurse or a palliative care team member say,
Liz Lewington, LPN (39:13)
Yeah.
Melissa Therrien, RN (39:38)
No, absolutely not. I think you should do this, you know Yeah, no, no one is ever gonna say that you know it I think in having the conversation many people are asking permission of themselves to be okay with that decision and they’re just kind of throwing it off of you to just verbalize it so that someone can appreciate and You know be okay with it like yes, absolutely. You don’t want to be there I’m not gonna wake you and when mom is clean
Liz Lewington, LPN (39:42)
you need to stay here. Yeah.
Yeah.
Yeah. Yeah.
Melissa Therrien, RN (40:08)
and she was ready to go and we can start talking about calling the funeral home, then I’ll bring you in. Absolutely. And you can have that moment with your mom or your dad or whoever that may be, right? But yeah, my goodness, everyone deals with it differently and you’re totally okay to deal with it in your own way.
Liz Lewington, LPN (40:28)
Yeah, I like to think that if somebody is leaving for the last time, you know, they leave the party, it doesn’t necessarily mean that they didn’t love you. You know, they know how you feel about them and you know how you feel about them as well. Just because you didn’t get to say it one last time does not make it any more or less real, those feelings.
Melissa Therrien, RN (40:39)
Yes.
Mm-hmm.
Liz Lewington, LPN (40:52)
Really the upshot is if you didn’t get there on time and you didn’t see your loved one and you really wanted to, they knew. They knew. They knew how you felt and they know. yeah. Yeah, that’s okay. Yeah.
Melissa Therrien, RN (41:00)
Mm-hmm. Mm-hmm.
Yeah, and it’s okay. It’s all okay.
Yeah. Yeah. And it’s okay if you’re a sobbing mess when we do call you. And it’s okay if you’re completely stoic and have no idea what how to react. It’s all okay. Yeah, totally. So how does Ohana, let’s say, tailor their approach to palliative care?
Liz Lewington, LPN (41:19)
Yeah, it looks different for everybody. Yeah.
I mean, we’ve talked about the approach being so different for everybody, of course. But yeah, supplying the type of care that is needed is really important. So for OHANA, we do have, we have registered nurses, LPNs. So if we’re looking at, you know, round the clock medication administration, that’s where we would go. If we’re looking at providing supportive care for personal care, you know, hydration, assistance with meals, we have HCAs that we can bring on for the…
Melissa Therrien, RN (41:38)
Mm-hmm.
Liz Lewington, LPN (42:02)
those kinds of roles. And a lot of other companies as well, have that same system where you can have a nurse or a healthcare aide to assist with that. But really the difference lies in the individual themselves. So reaching out to the palliative care team, we will always do that. We want to connect with the people that are able to give us advice, medication, prescriptions, and then connection to that hospice bed if needed.
I always like to reach out once I have a client under me that is classed as palliative. I reach out to the palliative care team and just let them know that, I’m here, I exist. So if there’s any concerns, palliative care is, a 24 hour job, it really is, but there can be times when you can’t reach the team member that you really need and reaching out to Ohana Care and connecting the two of us with who your individual is that is helping to facilitate the process.
with the health authority and then us on the other end and being a team. So connecting the team, creating our staff member team and talking with the family. And it really is, it’s all about communication when it comes to the end of the day is making sure you’re connecting the dots.
Melissa Therrien, RN (43:20)
Yeah. again, that may be a physician that we can loop in and, you know, in home care, that’s totally a possibility where we can liaise with the palliative physicians on the palliative care team. A lot of times, this is Alberta experience, they won’t support the funded palliative won’t support overnight care. And so it may very much, you know, a private team like Ohana may join your care team for those overnight visits, but the rest of it is covered.
by funded supports.
Liz Lewington, LPN (43:51)
Yeah,
which is bonkers because really the overnight is where people fall apart. You can do the things during the day, but if you don’t get a good night’s sleep, there’s no chance that you’re going to continue to fight that fight. Yeah, yeah. And then companionship, just knowing somebody is there. And then you can actually sleep. If your loved one, you know they have what they need, they’re in the other room, you can get a good quality sleep because you know that they’re being cared for effectively with one of our caregivers.
Melissa Therrien, RN (43:55)
Yeah.
on.
Mm. Yeah.
Yeah, and our caregivers have the experience, excuse me, my goodness, our caregivers have the experience too, right? You know, they’re supported by, dear, are we good? Are we back?
Liz Lewington, LPN (44:21)
yeah.
Yeah. Yeah.
I think you’re frozen.
- Sean, can you clip it?
Melissa Therrien, RN (44:37)
Are we there?
Where did I go? I’m good now?
Liz Lewington, LPN (44:42)
All
right, should we give her the beat? Yeah, you’re good.
Melissa Therrien, RN (44:45)
Am I back?
okay, sorry. Whoa, that was weird. Okay. Okay, back. Yes, so our healthcare aides are also trained in palliative care and have the support of you and I and the rest of our administrative team and our nursing team, you know, to support them if there are questions or concerns or
needing virtual support or needing a medication change, things like that. We were totally available to support that as well, which I think is an asset that we have at OhanaCare to have that much experience to back us and the 24 hour support. But also such a privilege to be a part of that. I love to be a part of that. Yeah. Yeah, okay.
Liz Lewington, LPN (45:31)
Yep. Well, I think
I’ve bent your ear enough, lady.
Melissa Therrien, RN (45:37)
I love listening to you talk Liz. I really do. Yeah, I mean, this is a big topic. This is a heavy topic for sure. I think we could talk for days about our experiences and all the different options available to people. you know, I think as we say in every episode, know, it, we’re the resources are there, you just gotta say one word, some word.
Liz Lewington, LPN (45:38)
Yeah. You poor thing. Hey, you’re a sick woman.
Melissa Therrien, RN (46:05)
You know, we’ve probably heard most of them and can understand what you’re asking without you really asking and provide you with the support.
Liz Lewington, LPN (46:12)
Yeah, kind of like guide the conversation
along where it needs to go. Did you think about this? Yeah. Yeah. And access to support in the home as far as like occupational therapy and transfers and toileting and all of those things that alter as that progresses. You know, we have been there, we have done that. know, you know, I mean, we’ve got the t-shirt, but you know, we can access it even if it’s not with OhanaCare and it’s not, you know, anything
Melissa Therrien, RN (46:17)
Yeah.
Liz Lewington, LPN (46:42)
that’s directly related to myself, I would rather help you. You phone, we can help you. We can get you connected, even if it’s not in my local community, we do have connections outside of that. So yeah, just say the word. Say the word. Yeah, we’re all waking eager.
Melissa Therrien, RN (46:55)
Yeah. And we,
yeah, for sure. And we pool resources too. mean, and I are constantly banging ideas off of each other, banging ideas, throwing ideas off of each other. I’m not sure. Yeah. Risqué there. Yeah. We’re always talking about ideas and, you know, trying to seek support from each other when it comes to different clients. And our team,
Liz Lewington, LPN (47:06)
Let’s go with that. Yeah. I don’t know. That sounds a bit… Hello?
Melissa Therrien, RN (47:24)
you know, our admin team is a phenomenal team as well that has just a plethora of experiences that they can bring to the table. And it really doesn’t matter what their background is. They’ve all been in healthcare long enough that they’ve seen a lot and my goodness, we share just about everything with them. So they’re jaded as well.
Liz Lewington, LPN (47:45)
Yeah, it’s just enough. Just enough.
Yeah.
Melissa Therrien, RN (47:49)
Yeah, so it doesn’t really matter who picks up the phone, you know, we pool our resources to and would love to support you. And it’s not going to be, yeah, just hold on, or we’ll give you a call back, like they’re going to sit and talk to you and hear what you have to say, so that you’re not having to rehash it over and over and over again to, you know, and that continuity of care, I think is really valuable as well.
Liz Lewington, LPN (48:09)
Mm-hmm. Mm-hmm.
absolutely. Yeah. Well, yeah, thank you. Thank you for listening. If you made it through this far, yeah, please like and subscribe. And if you have any requests for where you want us to take the next episode, topics that you want us to cover, even just little specific things, please, you know, you can make a comment below or you can reach out to us anywhere you can find Ohana Care in Canada. It’s us.
Melissa Therrien, RN (48:15)
Yeah. All right. Well, Liz, thank you again for this chat. I really looked forward to it. Yeah, thank you.
Yeah.
Liz Lewington, LPN (48:42)
Yeah.
Melissa Therrien, RN (48:43)
Yeah, for sure.
Thank you again, everybody. Play safe, and we look forward to seeing you guys next week. Take care. Bye-bye.
Liz Lewington, LPN (48:49)
Bye everybody.
