Question 

Our family was recently approached by my aunt’s facility to place her on hospice care. It came as quite a surprise to us as we did not know that she was dying. 

We visit our aunt with some regularity and have not noticed that she is going to be leaving us soon. She talks to us and seems quite alert when we visit. Yes, she continues to age and decline, but this came to us out of the blue. 

Does everyone react to the hospice proposal that way, with shock and denial? 

Answer 

I would say that very few of us are ready to hear that it is time for ourselves or a loved one to be signed on to hospice care. 

We all know that our life will end someday, though most of us have a healthy denial that tomorrow will be different than today. It is the same as getting older. We only look forward to getting older until about age 21. After that, we start dreading the effects of getting older and do our best to deny or prevent the effects of aging. 

Some of how we look at life is societal. The citizens of the United States for the most part glorify youth. We do whatever we can to look younger, eliminate wrinkles, maintain our youthful form, or fudge the truth about our real age. We generally do not venerate the elderly. We are also a death denying society. While we intellectually know that our lives will end, we tend to live and act as though they will not. 

Denial can be quite protective in holding out hope and believing that we will live on can give us the strength to fight on when it is very difficult to do so. When the fight is over, the last new pill or trial is done, and the end is coming, it takes a bit of time for most of us to accept that reality. Switching our mindset takes time and rumination. 

The shock or surprise that you are feeling is a typical response to the proposal that your loved one should sign on to hospice care. Many people put it off when the subject is brought up. They need time to process that the end is approaching and time to switch from status quo to a shortened timeline; an acceptance that life will end. They need time to internalize the signs that health care professionals are acutely aware of. The signs that body systems are shutting down and the timeline associated with that. 

What you are feeling is normal. You saw the changes you simply did not translate them to the end of life. So, when a professional suggested hospice, it was a bit of a shock. 

Unless your loved one had a rapid decline and death is imminent, you will have a few days to process the hospice conversation. It is best though to move forward timely, as quality end-of- life care is best established weeks to months before death. Far too often, families and patients put off the decision until the eleventh hour, during a crisis. What that does is create a flurry of activity during the transition to hospice care at a time that would be better spent with family. It can materially decrease satisfaction with the experience of end-of-life care and the final hours of a loved one's life. 

This will be a time of change and loss. It will be difficult for all those who are close to your aunt to accept the new reality. Do your best to support her during this journey.