What you can do to care

How you approach the care you give will depend on your relationship with the person who is ill. Every illness is different, and we would encourage you to try to maintain the relationship you have as much as possible.

Asking the person what they want is the easiest way to understand how to start caring. Communication is very important at this time. The two-way process of communication will always depend on your original relationship with the person you are caring for. Sometimes we don’t have the answers or the ability to fix the situation for the person who is ill, but we can listen to their worries or requests.

This link is designed to help the person who is living with a life-limiting illness and can be useful: Talking to people about your condition

Below is a list of practical things you can do to care. Please find further information via this link: End-of-Life Toolkit

Practical things you can do to provide care (without medicine)

Mouth care – Regular mouth care can be hugely soothing and comforting. Use ice-chips, or ice lollies at home help to relieve dry mouth. Brushing the person’s teeth regularly, and keeping the persons mouth moist are very helpful. Try to have the person as upright as possible when delivering mouth care.

Bowel and Bladder Problems – Seek advice with continence care from community nurses. Being offered regular toileting can relieve distress and discomfort for someone who is very ill. In the case of severe weakness and / or being unable to get to the toilet the Bladder and Bowel UK website has also has helpful advice. We also suggest:

• Ask for incontinence pads to absorb urine (avoid sanitary towels as they don’t absorb as well as incontinence pads) and for absorbent sheets to put on the bottom sheet to soak up any leaks. It may be that a catheter will be advised by the district nurse to collect urine.
• If nothing is available, men can pee into a large empty jar such as a coffee jar. Women find it difficult to pee in a bucket, so a large towel folded between her legs that can go straight in the washing machine may be easier.
• For stool (poo), if nothing is available, a few sheets of newspaper can catch stool and be immediately put into a binbag and tied off. If possible, drop the stool off the newspaper into the toilet first, but beware – newspaper may block your drain.
• If you can’t get disposable gloves, ordinary household gloves are fine and can be washed in the way you wash your hands under running hot water with liquid soap. Disposable gloves can be recycled by doing this too. Then hang them on the line to dry in the sun – sunlight helps sterilise.
• If you cannot get washable or disposable bed pads you can improvise as follows: Lay any form of plastic sheeting you have available at home, or large opened large plastic bags (e.g. large bin liners) over the mattress, sticking joins with Sellotape or similar. Cover them with large bath-towels in a couple of layers, then put the sheet on top.
• To change the sheet, if the person is too weak to get out of bed, lay the clean sheet longways along the side of the bed and roll it longways. Then roll up the dirty sheet as you unroll the clean one to replace it. (Finlay,2020)

Washing – Washing face and hands daily can provide comfort. If showering or bathing is not an option due to mobility or accessibility, then keep it simple if possible.

Being present – doing nothing except sitting/lying next to your someone is a huge comfort and will allow some peace for you both.

Self-care – Look after yourself to ensure you can look after your someone else.

Movement – Lift each limb gently, and flex the joints in the natural position

Relaxation – Sitting together watching the world outside, reading passages of a book – whatever you both find relaxing.

Meditation / mindfulness

Touch / gentle massage – feet and hands

Positioning for Comfort – Sometimes discomfort can be relieved by moving someone on their side, or sitting them more upright (using pillows, or rolled up blankets). For people with breathlessness please look at this link, which has really helpful tips.

Soothing music – YouTube has lots of resources for appropriate soothing music

Comforting environment – This is whatever the person being cared for wants it to be. Have a conversation, if possible, to determine what can make their environment more comforting (pictures, memories, TV, radio, flowers etc)

Bodily contact – Being close to your loved one might be the most comforting thing for both of you. It might be as simple as holding hands or hugs.

Remember to be aware that you are doing your best at this time with what you have, and there is support out there.

Providing comfort without medicines for people with COVID-19

The information below provides further guidance in providing comfort without medicines for people with COVID–19

Breathlessness

• Positioning – sitting / propped up in an upright position
• Temperature – cool room and face (damp flannel / paper towel) with a slight air movement if possible
• Relaxation – reassurance and calm approach by carer, rectangular breathing and various general relaxation techniques (music, imaging / visualisation etc)

Cough

• Relieve dryness – maintain oral fluid intake, regular mouthcare if unable to swallow. Humidification of room air with humidifier or bowl of steaming hot water
• Positioning – elevate head when sleeping
• Cough Remedy – boiled sweets, honey and lemon drink etc.

Anxiety or Distress

• Reassurance – carers’ approach is vital to minimise anxiety – try not to mirror.

Agitated Delirium

• Exclude Contributors – eg bowels, bladder, pressure area pain, flat hearing aid batteries.
• Communication – calm, quiet, single voice at a time, Reorientation to place and time.
• Noise - reduce extraneous noise to a minimum.
• Lighting – ensure good lighting in individual’s room.

Thin Respiratory Secretions

• Positioning – keep as upright in bed as possible. if consciousness lost then position flat on one side with the foot of the bed elevated a few inches, if possible, allowing secretions to drain from the mouth onto an absorbent pad
• Reassurance of other Carers – noisy thin retained secretions are usually more distressing to the carer than the patient

(Keen, 2020)