I recently had a conversation with a small group of close friends and former colleagues who also happen to be PTAs. As we're all kindred spirits at this point, having worked closely together in a SNF setting for years -- we laughed and commiserated over our shared experiences. One of my friends posed the question to us all regarding our opinions on working with a patient who is "end of life."
She explained how conflicted she felt as a therapist when having to approach a patient for therapy who is ready to "let go." She mentioned in one particular case, the patient was in her 90s, had lived a full life (with her spouse and peers already passed), and was ready to stop fighting so she could move on herself. This PTA was expected to "work" with this patient for 65 minutes -- as she lay supine in bed.
In the long-term care facility where I work, if a patient has medically declined to the point of "end-of-life," her doctor and nursing staff will recommend hospice services or "comfort measures," which essentially places this person on therapy-hold. Rightly so, but this isn't always the case.
I and each of my colleagues discussed having had a session with patients who were not on hospice -- yet passed on the next day or even later that evening after their therapy session. Typically, these are extremely ill patients and in severe pain/discomfort, so it comes as no surprise when we hear the news the following day. As my friend pointed out, this is cold comfort knowing we had them performing PT during their last hours left on earth.
My personal opinion is that if a patient is agreeable to therapy, my job is to provide this service and I certainly adjust accordingly depending on the patient's endurance and tolerance level. If a patient declines therapy and displays signs of increased fatigue, lethargy and pain, the nursing staff is notified and the refusal is thoroughly documented. As well, I'll notify the primary PT and in some cases my director of rehab.
All of my PTA friends did agree that sometimes, just the opportunity to spend a few minutes with patients as they enter this last phase of life can offer them support and comfort -- whether therapeutically billable or not. In the end, I trust that utilizing my clinical skills and a dose of compassion will lead me to make the appropriate therapy (or non-therapy) choices for these patients.