October 23, 2017
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How to ensure the compassionate End-of-Life moment

By: Julie Ann Soukoulis
August 11, 2017

Imagine you are 94, frail, clear-thinking and you are admitted into the hospital because you fell. Now imagine that you didn’t break a single bone, and the doctor ordered a huge array of tests. Suddenly you are told you need to stay. In the hospital, you are not allowed to even stand without a nurse arriving to monitor every movement.

 I arrived to set up in-home care to help this elder go home. She was almost in tears saying; “I feel like I am in prison here! How am I going to pay my bills?” Now this little red haired woman is crying. “They won’t let me go home without having in-home care already in place! How can I afford that?” My heart moved as she sobbed into her tissue.

I have yet to meet an elder who wants to go into the hospital or emergency room. These places have become fear-points as dying in an intense machine-dominated environment of intervention by well-intentioned strangers takes many of our elders by storm. This also often carries them into a rehab center that they may never emerge from again. Suddenly it seems they have been sentenced to die in a hospital setting with the occasional visit from whomever remembers where they are. Finally, I realized; this could be me! 

A “palliative care” plan can help prevent these profoundly expensive and unwanted hospital stays. Having a directive that calls hospice into your elder’s home in the event of a health crisis can prevent countless hospital visits and potential rehab stays. Having a registered in-home nurse who can make a determination about when it is time to go into the doctor’s office for x-rays and at-home follow-up plans is the safest way to ensure your elder does not become part of the admissions-by-default because no one knew to put directives in place to prevent these traumatic events.

‘Traumatic event’ can be an understatement when you are 94, extremely vulnerable, and both physically and mentally exhausted. Physical therapy, occupational therapy and other in-home medical supervision are the kindest, easiest and safest ways to keep an elder in the safety and security of their own home – especially if they are so frail that being exposed to, say, a Noro virus (that is so common to skilled nursing and rehabilitation facilities these days), suddenly decides to make the rounds – and happens to be virulent enough to cause death.

 When an elder is under the weight and extreme stress of having advanced Alzheimer’s or Dementia – trauma is the fastest way to cause a harrowing and significant decline in mental function and capacity. This decline has no rebound.

I was able to help our little red haired lady. We explored her insurance details, and found an in-home care schedule that met with both the hospital need for release as well as her own budget perimeters. Her son stepped up to help with a portion of it, and we supported her in applying for the federally funded IHSS (in home support services) – with an added Home Instead fully-qualified care team leader to make sure the other largely unsupervised, mostly untrained care providers were properly supervised and trained by our staff. We were able to provide this at a low monthly cost for two monthly supervisory shifts that overlapped with the IHSS worker schedules.

This affordable approach provided everyone with the safety, financial viability and in-home care support required. We contacted a hospice program and did the intake process to make sure that she could quickly arrange for in-home nursing when the time came. Her palliative, non-invasive care program was committed to writing, and posted in the home for all to obey if an emergency came up. Care givers were instructed to call in-home nursing before taking anyone into the hospital emergency room. We discovered that to qualify for In Home Support Services (IHSS) you must have medical insurance with no co-pay. To qualify for hospice support – you simply need to be in the early stages of significant, trackable health decline.

When you reach the place where your elder has become a fall risk and in-home supervision seems mandatory since the last stove-burner-left-on accidentally incident has sobered you to the nuances and responsibilities of supervising an elder in significant decline – here are the numbers you need to set up the wrap-around palliative care plan that will protect hearts, set minds at ease – and deliver the quality end-of-life care that will usher your loved one calmly and safely into the beautiful heaven they have been so patiently waiting for.


Sutter Home Health:



Hospice of Petaluma:



St. Joseph’s Home Health: 



Legal Support: Redwood Caregiver Services:



Legacy Concierge Services (connection to needed services/financial management/needs assessment)



Federal In Home Support Services:



Free Medical Equipment and Supplies:


(walker’s, portable bed-side commodes, canes, adult diapers, etc.)


Home Instead Senior Care: 



Julie Ann Soukoulis is the owner of Home Instead Senior care office in Rohnert Park, mother of two and passionate about healthy living at all ages. Having cared for her own two parents, she understands your struggles and aims, through her website, to educate and encourage seniors & caregivers. Have a caregiving or aging concern? She’s love to hear from you at 586-1516 anytime.