Pain control is one of the central pillars of hospice care. From a legal standpoint, federal and state guidelines require that hospice providers make every reasonable effort to ensure the patient’s symptoms are managed.
It’s a goal of hospice interdisciplinary teams and RN case managers to ensure the patient is comfortable as possible. The patient’s attending physician typically determines their medications. However, the hospice medical director also has the authority to provide medical orders and make changes if necessary.
Most hospice care providers use the pain rating scale and the FLACC scale to determine varying levels of pain for patients that are unable to communicate their needs. The FLACC scale assesses five different categories: the face, legs, activity, crying and consolability.
Signs that Might Indicate the Need for Pain Management
While most patients can assess their pain levels, others may believe that admitting discomfort makes them appear weak – which is not at all true. This is one of many reasons why caregivers should observe any symptoms that may indicate their loved one is in pain. Some signs to look for include, but aren’t limited to:
- Increased breathing rate
- Tightly closed eyes or rapid blinking
- An increase in systolic blood pressure
- Rigid body posture or tightened muscles
- Rocking, fidgeting or pacing
- Resisting care or guarding specific areas
- Withdrawal, aggression, crying or confusion
- Vocalizations like moaning or sighing
As mentioned, some patients attempt to hide their pain in order to protect their family from being worried. Some even believe that suffering is normal or helps them appear strong. However, while each patient has the right to accept or refuse treatment, hospice care is centered on the idea of bringing comfort into the picture.
It’s impossible for a patient to completely hide their pain level. When it’s severe, many physical changes also occur which alerts the observing nurse or family member about the pain levels. Even if they don’t speak or moan, it’s likely they’re experiencing pain.
Multiple factors give hospice nurses an accurate picture of the patient’s level of pain. When medications become ineffective, a nurse will contact the attending physician for medication orders to increase dosage or change the medication. As a family member, though, it’s important to encourage clear communication from the patient about their pain level and regularly survey for signs of discomfort.
The Truth About Pain Medications and Hospice Care
There’s a common misconception that a patient must discontinue their present medication when enrolling in hospice care. However, this is completely untrue. As a terminal illness takes its toll, pain levels are likely to increase where over the counter medicine is no longer helpful.
It’s important to keep in mind that pain can respond differently depending on the medicine. Hospice nurses work closely with the patients’ attending physicians in understanding how to treat when symptoms arise. This is where a quality hospice provider can make all the difference.
Other Treatments For Pain
Aside from medication, there are other things that can be done to reduce your loved one’s pain. First and foremost, anything that adds tension or stress should be avoided. It’s important to create a peaceful atmosphere that takes your loved one’s wishes into account. Some helpful activities may include light music, reading or relaxing hobbies.
For patients who prefer silence, we recommend that caregivers respect their wishes by avoiding loud discussions, arguments and stressful topics. It all depends on what your loved one needs. And sometimes, the simple presence of someone who loves the patient can be helpful.
If the patient is unable to communicate their needs on their own, you may need to step in and represent on their behalf. Make sure a medical power of attorney has been established so that you may legally make decisions for your loved one.
Patients receiving the support of both their families and a hospice team typically live longer while their symptoms are being managed. Remember, starting hospice care early in the patient’s terminal illness gives them access to pain control and the full benefits a hospice has to offer.
To learn more about medications and the requirements for hospice care, we encourage you to reach out to us today at (405) 360-2400 in Norman and (580) 332-6900 in Ada.