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Apr 18, 2021
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Hospice in the apartment. How to help a palliative patient at home?

The importance of palliative care today is unlikely to be disputed or questioned by anyone. After all, the number of incurable diseases is quite large, and no one has canceled the negative scenarios for the development of oncological diseases. In any case, the main dogma today is the assertion that a person should not live out his days in pain and suffering. This is exactly what the palliative direction of medicine is aimed at – to make the patient with serious pathologies that lead to his inevitable extinction to feel comfortable. This also applies to the loved ones of such a person – after all, it is on their shoulders that not only care falls, but also other procedures.

Today in Russia, the direction of hospice care is actively developing, but so far they are not physically sufficient for all those in need, even though they often help patients under their care at home. It often happens that a person is discharged from the hospital with a recommendation for palliative treatment, but he cannot get into this. And then the question arises of how you can establish palliative at home.

AiF.ru told about what needs to be considered when organizing home care for an incurable patient, as well as what will have to be purchased and what should be prepared for. Oleg Serebryansky, Ph.D., chief physician of the clinic of expert medicine (center for the treatment of oncological diseases)

Psychological nuances

“To begin with, organizing palliative care at home is a very difficult task. First of all, from a psychological point of view. Not everyone will be able to see how a loved one is fading away before our eyes, how in some cases he is deprived of the opportunity to think sensibly, to serve himself on his own. It’s really hard. Oncologists have extensive experience working with such patients, a huge number of them pass through them, and among the most difficult moments, doctors single out the psychological side, ”says Oleg Serebryansky.

In addition, the doctor notes, constantly seeing a dying person in front of you and realizing that you cannot help him in any way, for many it can be an unbearable burden and a way to drive yourself into deep depression.

“Another very difficult psychologically moment is that a patient’s character, if he is conscious, can very badly deteriorate. Such a patient may be characterized by constant discontent and nagging. If we talk about trained personnel in hospices, they can cope with such situations, and untrained relatives are not always capable of this, ”says Oleg Serebryansky.

Arrange a palliative at home

However, there are many options when a person in this position has to stay at home for follow-up care. And we must try to organize full-fledged care for him in order to take into account all the nuances of his situation, the doctor notes. Moreover, from a purely technical point of view, it is quite possible to organize palliative care at home.

“This should be done together with the doctor of the palliative medicine center. It can be either a public institution or a private one. In order to do everything right, you need to seek advice, so that you will be given recommendations in accordance with your specific case, ”notes Oleg Serebryansky.

Further, the specialist says, it is necessary to determine the room where the patient will be. “It is highly recommended that this is a separate room located in the immediate vicinity of the caregiver’s room. It is highly desirable that both the family and the patient himself have personal space. If it is not possible to place the patient in a separate room, then you can, for example, fence off his bed from another space with a curtain. It would seem that this is a trifle, but in practice it is of great importance for everyone, ”emphasizes Oleg Serebryansky.

Then it is necessary to assess the severity of the condition: whether the patient moves independently, whether he is able to serve himself, whether he is able to adequately assess his actions, whether his consciousness is confused, whether he needs constant help from a nurse, etc. “If the patient needs round-the-clock medical assistance , then you can hardly do without a nurse. It should be borne in mind that the standard change of caregiver no more than 12 hours, so at least 2 people are required to provide round-the-clock care, ”warns Oleg Serebryansky.

Preparing the room

After you have determined the location and severity of the patient, you will need to purchase basic equipment, the doctor says. The list of necessary purchases in such a situation may include:

  • a special medical bed, in which the angle of inclination of the backrest changes, which allows you to easily take a lying, sitting or half-sitting position;
  • if the patient is lying – an anti-decubitus mattress and a medical duck;
  • walker;
  • special table for feeding;
  • 2 sets of special cookware;
  • diapers, urine bag, etc.

“In order to store all this, it is better to purchase a separate bedside table or chest of drawers, which will also contain consumables: syringes, bandages, napkins, plasters, catheters, etc. I also recommend purchasing a special box for storing medicines. If any of them need to be stored in the refrigerator, it is better to select a separate shelf there.

Also, if there is a need for this, you will need to purchase medical devices, such as a ventilator, etc. In principle, even a full-fledged resuscitation box can be equipped at home, ”Oleg Serebryansky emphasizes. At the same time, he warns that the doctor of the palliative service will tell you about which devices to buy, how to use them, how best to care for the patient.

“Regarding the cost – the question is very individual and depends on the capabilities of the patient’s relatives. For example, a medical bed can be bought for 15 thousand rubles, and you can buy it for 100 thousand rubles. In either case, the product will perform its function, but in the first case it will be the simplest option with a mechanical drive, and in the second brand model with electric drive. It is impossible to estimate the cost of home hospice equipment offhand. It won’t be cheap anyway. With regard to the basic equipment, we can only say one thing: inexpensive products will fulfill their function in the same way, ”notes Oleg Serebryansky.

Moreover, the specialist emphasizes, you can save money on beds, walkers, tables, etc., because in most cases expensive goods are designed for use in medical institutions where there is a large flow of patients. But it is unlikely that for home use you will need heavy-duty products.

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