Spending the Last Days with your Loved Ones

Spending the Last Days with Your Loved Ones

A Guide for Carers

Making It easier

Caring for someone who is dying is not an easy task. We understand that this is not an easy time for you and your family. This guide has been specially prepared to ensure that your loved one spends the last days of their lives in a warm, comfortable and familiar surrounding.

Specially written for one with no clinical or nursing experience in caring for your loved one at home, this guide contains useful suggestions and instructions on basic caregiving skills to prepare yourself and your home for caregiving. We have also included procedures for death certification and useful contact numbers for your convenience.

Most people prefer to spend the last days of their lives in warm, comfortable and familiar surroundings, and in the presence of their loved ones.

For a person who is at the end of life, dying often occurs slowly, from several days to a week and sometimes it happens in a few hours.

Tips to Keep Your Loved One Comfortable

Here are some tips to keep your loved one comfortable

The Environment

• Maintain a pleasant room atmosphere.

• Avoid using bright lights which may be glaring to the eyes.

• Play soothing music at low volume near the bedside.

• Music can create a sense of calmness and serenity for your loved one.

• Sit and hold your loved one’s hand. Gently massage or stroke the hands and feet. Touch eases suffering and promotes comfort.

Mouth Care

• Clean the mouth with glycerin swabs or moist swabs at least once or twice a day to keep the mouth clean and moist.

• If your loved one wears dentures, they should be removed for cleansing.

• Apply lip balm if the lip is dry.

• If your loved one is conscious, offer ice-chips or sips of water to keep the mouth moist.

Skin Care

• Turn your loved one every 2 to 3 hours to prevent bedsores due to prolonged lying in one position (left-back-right).

• Elevate the head with pillows, gently turn the head to the side to avoid prolonged pressure on the ears.

• Apply normal saline eye drops twice a day to prevent dryness.

Hygiene

• Sponge your loved one in bed to maintain hygiene and to promote comfort.

Bowels & Bladder Care

• Change diapers when soiled to promote comfort, use barrier cream to prevent the skin from contact with excretions.

Nutrition

• Your loved one does not require much calories at this stage. Offer foods in small amounts but do not insist if he/she does not want to eat.

• Small chips of ice or frozen juice may be refreshing in the mouth if he/she can tolerate.

• If your loved one is able to swallow, fluids may be given in small amounts by a syringe.

Spiritual Support

• Spiritual support from an organised religion or through your own spirituality beliefs and values can be helpful.

What to Expect as Death Approaches?

By now, it would be obvious to you that your loved one is very frail and weak. He/She is now spending most of his/her time in bed and is asleep more often than not. He/She also shows no interest in food or drinks and there is hardly any food or fluid intake.

This is expected as the body systems wind down and the need for energy (metabolic rate) slows down as the end draws near.

As death approaches:

• His/her conscious level will further deteriorate and he/ she may subsequently lose consciousness totally.

• The pulse will get weaker and the extremities will become cool to the touch (a result of decreased blood circulation). Keep your loved one warm with a blanket but do not overheat him/her up.

• Breathing also becomes ‘labored’ and he/she may even appear to be gasping. There may be pauses in the breathing that can last up to a minute or so.

• The complexion becomes pale with a yellowish hue.

• Throat secretions may increase. These often collect in the back of the throat and cause a gurgling sound when the person breathes. Turn him/her to the side will help him/her breathe more easily.

• Other signs may include increased confusion, seeing people or things that no one else sees. Reassure your loved one if he/she becomes restless.

Occasionally a loved one may linger on despite signs of impending death. This may happen when he/she is trying to hold on to life, especially when he/she is uncertain if the ones left behind will be able to cope or if there is some unfinished business. This could take place with much discomfort for him/her.

What you could do is to reassure him/her that it is alright to let go of this life. In other words, give him/her your permission to leave this world.

Death occurs when the breathing has stopped completely and the pulses are not felt any more. Other signs of death would include a cessation of the heartbeat, enlarged pupils, fixed position of the eyes, slightly opened eyelids, a relaxed jaw, a partially opened mouth and bowel or bladder soiling.

How to Arrange for Death Certification?

On discharge from hospital, you would have been given a memo stating your loved one’s medical problems and his/her condition(s). The possible diagnosis as the cause of death will also be noted down. This will help the person signing up the Certificate of the Cause of Death (CCOD) even if he/she has not seen your loved one before.

Signing of the CCOD can be arranged by the following ways

• Call your family doctor who may know about your loved one and is willing to make a home visit.

• Call the home hospice support team if your loved one is under their care.

• Call a casket company who may be able to arrange for a doctor to sign the CCOD.

What to Do after Obtaining the CCOD?

• You or your relatives have to bring your loved one’s CCOD and NRIC to any police station or neighbourhood police post to report the death.

• The person reporting the death has to bring along his/her NRIC together with information as to whether your loved one will be buried or cremated.

• The police will then issue the Certificate of Registration of Death & Permit for Burial or Cremation. Both documents are required for funeral arrangements and for putting up obituary in the newspapers.

• You can contact one of the casket companies listed in the Singapore Telephone Directory to arrange for the funeral.

Losing Somebody Close - How It Affects You ‘One’s journey end... another’s beginning’

We know how much your loved one means to you. Unfortunately losing people who are dear to us is part of the human experience. Our lives are meaningful only because we have built close and nurturing relationships with others. In doing so, we always stand the risk of being hurt when we lose these special people. This parting of ways, which is inevitable, can be the most painful experience that anyone can face.

Every individual will experience this at some point in his or her life. Despite this, the experience of grief and bereavement is unique to each individual and each will have his or her own unique ways of coping.

You’re Not Alone Right at this moment, as you read this, there are many others experiencing the loss of a loved one from various causes. Still many others have trodden down this path before you.

Just like you, they will be asking or have asked many questions. Why did this have to happen? Why did it have to be him/her? Why has it got to be now? What will I ever do without him/her? Questions for which there may be no answers at all.

There will be a whole range of emotions too that will well up in your innermost being, each playing separately, occasionally together. Shock, sadness, loneliness, frustration, guilt, anger, fear, denial, anxiety, hopelessness, aimlessness, despair are but some of the feelings that you may have felt earlier, be feeling now or will feel at some point later.

Remember, you are not alone in this journey. Many others are taking a similar path and there are some others who would like to accompany you along the way, who wish to support you when the burden seems unbearable.

Grief is Natural

In the initial stages, you may find it hard to believe that this person has left for good. You may be shocked or even ‘numbed’. There may be periods when there is a strong yearning for this person and the need to cry out becomes intense. Rapid welling of tears and uncontrollable crying will usually follow. This may be interspersed with periods of anxiety and tension.

You may lose your appetite, have difficulty sleeping and experience various physical symptoms such as abdominal cramps, tiredness, lethargy, headaches, chest pain, dizziness, etc. There may also be panic attacks and you may feel breathless or feel the need to catch your breath to the extent that you overbreathe (hyperventilate).

As time goes on and you begin to sense the impact of your loved one’s death, there will be a profound sense of loss where you feel that you have lost something that is irretrievable. You may be overwhelmed with feelings of loss of control, helplessness and powerlessness. There will be feelings of longing, yearning, pining and even searching for your loved one.

Some people may sense the presence of their loved ones as they go about their daily activities. Others may even have visions or dreams of their loved ones. Periods of despair, loneliness and withdrawal from social involvement may follow. There may even be loss of weight.

With the passage of time, as the storm clouds clear and as a new day dawns, the sun starts throwing its rays of hope and allow Mother Nature to begin its healing process, the journey to recovery will take place, slowly but surely.

Your appetite will return followed by your energy. Hope begins to shine through and you will begin to reorganise and rebuild your life which has now changed. You will never ever forget the loss but you will be able to accommodate it into your new life. You will not forget your loved one as a new relationship that transcends space and time now emerges. The sense of yearning may give way to the pleasure of remembering or recalling the good times that you had with the person in the past.

“Grief has a quality of healing in it that is very deep because we are forced to a depth of emotion that is usually below the threshold of our awareness.”

- Stephen Levine

Your grief is personal and unique

Although you may have been told or have read that there are clear-cut stages/phases in the grief process, yours is as unique as your own person. Your pain and grief is unique to yourself and nobody can tell you to “get over it!” or “get on with your life” because it is not so simple.

There is no fixed time frame for the resolution of your grief and the intensity of grief that you experience is not a measure of your affection or love for this person. You will grieve in your own unique way and in your own time, not according to somebody else’s dictate.

Be Kind to Yourself

By now, it is clear that grief affects your whole person. Your experience is physical (breathlessness, chest tightness, stomach upsets, headaches, dizziness, poor appetite, weight loss, insomnia, tired, etc.), psychological (absentmindedness, poor concentration, short attention span, confusion, etc.) and emotional (sadness, loneliness, anger, etc).

Whatever they may be, be kind to yourself. Accept that they are a natural reaction to your grief. In fact this is essential for the healing process to take place. They should not be suppressed. Cry if you have to. This acts as a good release for the pain and hurt that you are bearing deep inside.

You cannot just ‘snap’ out of this and you should avoid trying to behave as normal as possible as if nothing had happened. It will be very difficult to take on new tasks and would be extremely difficult to bounce back quickly and return to your old way of life. Pay attention to your body’s need for nutrition, exercise and rest during this trying period. Try not to expect too much of yourself.

There are People Who Care about You

You may feel lonely in your grief or you might prefer to be left alone and withdraw yourself from the world. This is understandable. Periods of solitude and personal reflection are important but do take time to use an important resource available to you, that of close friends, colleagues and relatives. Most of them would be willing to lend an ear or be a shoulder for you to cry on. Many of them have had similar experiences and would be willing to share with you their valuable experiences.

This is also a time to renew old friendships and build new ones. If you belong to any organisation or group, it would be helpful if you do not withdraw completely as it is important to widen your social support network. If you belong to a religion, tap on the resources of your religion. If you really feel that you need someone to talk to and there is nobody available, there are several hotlines that you can call (listed at the end of this booklet).

Build a Hopeful Future & the Memory of Your

Loved One is Yours Forever

Time heals a wound. Your sadness and grief will melt away as you reenter a new world without the physical presence of your loved one. But the memory of him or her will live on forever. Your world has changed irreversibly but you would, in time, be able to accommodate the absence of your loved one.

You must look to the future with hope. You must get about rebuilding a new life and reinvesting in new relationships with others. Yourloved one would have wanted this for you. There should not be any sense of guilt or fear of abandoning the memory of your loved one. You can create a memorial in honour of him/her. It is not necessary to build something or even preserve your loved one’s belongings or clothing in their original state at the time of death.

You could, however, collect a scrapbook of old photographs, letters, drawings or momento to remind you of your loved one. Some people would commemorate the anniversary of their loved one’s death by publishing in the local newspapers.

In the initial years, the anniversaries may bring back painful memories but these too should resolve with time. The happy memories together, places visited together, things done together will remain. In this sense, your loved one lives on in your memories forever. And his/her legacy lives on forever in many others who have fond memories of him/her.

Neighbourhood Police Centres

1. Ang Mo Kio North NPC

Co-located with Ang Mo Kio

Police Div HQ at No. 51

Ang Mo Kio Ave 9

Singapore 569784

Tel: 6484 9999

2. Ang Mo Kio South NPC

No. 81 Ang Mo Kio Ave 3

Singapore 569929

Tel: 6451 9999

3. Bedok North NPC

Co-located with Bedok

Police Div HQ

30 Bedok North Road

Singapore 469676

Tel: 6244 8999

4. Bedok South NPC

20 Chai Chee Drive

Singapore 469045

Tel: 6244 8999

5. Bishan NPC

20 Bishan St 23

Singapore 579757

Tel: 6552 9999

6. Bukit Batok NPC

21 Bukit Batok East Ave 4

Singapore 659840

Tel: 6665 9999

7. Bukit Merah East NPC

Co-located with Central Police Div HQ at 391 New Bridge Road

Singapore 088762

Tel: 6236 9999

8. Bukit Merah West NPC

Co-located with Henderson C.C at 500 Bukit Merah View #01-01

Singapore 159682

Tel: 6377 9999

9. Bukit Panjang NPC

42 Fajar Road

Singapore 679005

Tel: 6892 9999

10. Bukit Timah NPC 1 Duke’s Road

Singapore 268914

Tel: 6462 9999

11. Changi NPC

9 Simei Street 2

Singapore 529914

Tel: 6587 2999

12. Choa Chu Kang NPC 20 Choa Chu Kang Street 52 #01-01 Singapore 689286

Tel: 6765 9999

13. Clementi NPC

Co-located with Clementi Police Div HQ at 20 Clementi Avenue 5

Singapore 149725

Tel 6872 9999

14. Geylang NPC

132 Paya Lebar Road

Singapore 401094

Tel: 6848 6999

15. Hougang NPC

60 Hougang Avenue 9

Singapore 538775

Tel: 6489 0999

16. Jurong East NPC

Co-located with Yuhua Community Club at 92 Boon Lay Way

Singapore 609962

Tel: 6899 9999

17. Jurong West NPC

700 Corporation Road

Singapore 649818

Tel: 6268 9999

18. Kampong Java NPC

Co-located with Tanglin Police Dic HQ at 21 Kampong Java Road

Singapore 228892

Tel: 6295 9999

19. Marine Parade NPC

300 Marine Parade Road

Singapore 449296

Tel: 6442 8999

20. Nanyang NPC

Co-located with Jurong Police Div HQ at 2 Jurong West Ave 5

Singapore 649482

Tel: 6792 9999

21. Orchard NPC

51 Killiney Road

Singapore 239572

Tel: 6735 9999

22. Pasir Ris NPC 1 Pasir Ris Drive 4 #01-01

Singapore 519457

Tel: 6585 2999

23. Queenstown NPC 15 Commonwealth Ave (former Queenstown Test Centre) Singapore 149725

Tel: 6471 9999

24. Rochor NPC 11 Kampong Kapor Road

Singapore 208678

Tel: 6294 2999

25. Sembawang NPC 4 Sembawang Crescent

Singapore 757633

Tel: 6554 9999

26. Serangoon NPC 50 Serangoon Avenue 2 #01-02

Singapore 556129

Tel: 6488 0999

27. Tampines NPC

6 Tampines Ave 4

Singapore 529682

Tel: 6587 1999

28. Toa Payoh NPC

93 Toa Payoh Central

Toa Payoh Community

Building #01-02

Singapore 319194

Tel: 6251 9999

29. Woodlands NPC

1 Woodlands Drive 63

Singapore 738070

Tel: 6767 9999

30. Yishun North NPC

31 Yishun Central

Singapore 768827

Tel: 6852 9999

31. Yishun South NPC

32 Yishun Street 81

Singapore 768456

Tel: 6852 2999

Grief Support Group

Tel: 9369 6297

Palliative Care Nurse

Tel: 9785 5513

Other Contact Numbers

• Newspaper Obituary

Tel: 6319 6319 (Office Hours) 6319 5192 (After Office Hours)

• Family Service Center

Tel: 1800-839 0100

• SINDA Family Service

Tel: 6294 0155

(Mon - Fri: 9am to 5pm / Sat: 9am to 1pm)

• S.O.S. SAMH Helpline

Tel: 1800-221 4444 / 1800-283 7019

• Institute of Mental Health

Tel: 6389 2200

(Mon - Fri: 8am to 4.30pm / Sat: 8am to 12.30pm)

Burial

In Singapore, burial can only be carried out at Choa Chu Kang (CCK) Cemetery. You are advised to note that since 1 Nov 1998, all burials at the CCK Cemetery are limited to a 15-year bury-in period.

Choa Chu Kang Cemeteries

Ahmadiyya Jama’at, Bahai, Jewish, Muslim & Parsi Cemeteries

All other cemeteries at CCK other than those listed above e.g. Christian, Chinese, Hindu & Lawn Cemeteries

Cremation

Addresses & Contact

910 Choa Chu

Kang Road

Tel: 6793 7428

Fax: 6793 7400

–

Mandai Crematorium (Governmentmanaged)

Kong Meng San Phor Kark

Tse Tho Aun Temple

1 Child under 10 years old

Addresses & Contact

910 Choa Chu

Kang Road

Tel: 6793 7428

Fax: 6793 7400

88 Bright Hill Drive

Tel: 6849 5333

Fax: 6456 2151

601 Sin Ming Drive

Tel: 6454 7666

–

– Sun 9.00am – 3.00pm

Fax: 6458 5672 Mon – Sun 9.00am – 3.00pm

2 Price varies depending on choice of urns and storage location

$420 (cremation only) $4202 (cremation + storage)

$400 (cremation only) $5002 (cremation + storage)

Nos. Booking Hours Burial Fee* Child1 Adult

Mon – Sun 8.30am

4.30pm $140 $315

$420 $940

Crematoria

Nos. Booking Hours Cremation Fee* Child1 Adult

Mon – Sun 8.30am

4.30pm $50 $100

Mon

Yishun Health is a network of medical institutions and health facilities of the National Healthcare Group in the north of Singapore. It comprises Khoo Teck Puat Hospital, Yishun Community Hospital and community extensions such as Admiralty Medical Centre and Wellness Kampung. Khoo Teck Puat Hospital • (65) 6555 8000 • www.ktph.com.sg Yishun Community Hospital • (65) 6807 8800 • www.yishuncommunityhospital.com.sg

The information is correct at the time of printing and subject to revision without further notice.

GRM.IE.02.0624

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