There are actions you can take to make the person as comfortable as possible, and medications that can be given at home to ease someone’s anxiety and breathlessness.
The guidance below takes you through some of the things you can do yourself to help someone you love who is dying at home from COVID-19.
The person may become much sleepier and may drift in and out of consciousness, or become completely unconscious for a long period of time.
Even when the person appears to be unconscious, they may still be aware of your presence in some sense. It is believed that people can continue to hear and sense those around them and continuing to communicate is important. You might want to speak quietly and calmly to them.
You could also try letting them know you are there in other ways. For instance: holding their hand, reading to them, or playing their favourite music. You might arrange for other people that care about them to be ‘virtually’ in the room with them – through phonecalls or video calls.
Confusion/agitation (often referred to as 'delirium') is a common symptom, and if you know the person you’re looking after you’ll be able to tell if they don’t seem themselves, are agitated, restless or confused.
Certain medications can help to keep people calm and reduce anxiety if someone is showing signs of confusion or agitation. If possible, seek the guidance of your local healthcare team about whether such medication is available, and whether it can be given by a professional, or whether you might be able to do it yourself.
Confusion and agitation can be difficult to witness, but the quiet reassurance and the comfort of someone the person knows can help. Even if you need to sit at a safe physical distance, simply sitting with the person may help to calm them down. Keeping things as normal as possible may help comfort the person.
You can help by:
Shortness of breath or laboured breathing Certain medications can help to keep people comfortable if they are short of breath or having difficulty breathing. If possible, seek the guidance of your local healthcare team about whether such medication is available, and whether it can be given by a professional, or whether you might be able to do it yourself. It is becoming more common for health professionals to provide families with medication and advice on how to deliver breathlessness medication at home, enabling them to alleviate distress. Certain medication may cause someone to appear more drowsy.
You can help by:
Sometimes as someone approaches the end of life, their breathing may sound noisy or 'rattling'. This is likely to be because they are not able to re-absorb or swallow the normal fluids in their chest or throat, which can cause a rattling sound.
The rattling sound may be upsetting to hear, but it does not seem to cause any distress to the person. It can be a bit like snoring – which affects those who hear it more than the person who is making the sound. Although the noise is upsetting for you, it does not cause pain or make the breathlessness worse. Sometimes fairly simple adjustments of posture make a big difference to noisy breathing so it is worth trying an adjustment of pillows and cushions or whatever you are using to support the person.
If someone has a high temperature, you can give them paracetamol. If the person has difficulty swallowing and liquid medicine is unavailable, you could try crushing the tablet in a small amount of ice cream or similar food. Ensure that nightwear is light, and remove any excess bedding. You can also try reducing the room temperature. Using a tepid sponge can also help cool someone down - use a flannel to moisten face, neck, arms and other exposed areas of skin and allow the moisture to evaporate.
If someone is thirsty but unable to drink, you can give them a few teaspoonfuls at a time in a propped-up position of any drinks that the person wants. Liquid-like foods might be helpful, for example yoghurt, ice cream and jelly. A small amount of a low-alcohol drink can be given if that is what the person wants.
Other things that can help if someone's mouth is dry are moistening the mouth with a damp sponge can also help (special kinds of sponge are available for this purpose), placing ice chips in the mouth, and applying lip balm.
Simple menthol lozenges may help soothe an irritant cough. Certain cough medicines can be administered. Ask your local pharmacist, GP or district nurse for more information about what is likely to help and what is available locally.
Pain Pain doesn’t seem to be something that people generally suffer badly from in the later stages of this illness, and in most cases you should be able to relieve any pain experienced with paracetamol (follow the instructions on the packet). If the person remains in pain despite paracetamol then they should be assessed by their GP or other health care professional. They may decide to prescribe stronger painkillers such as morphine.
If the person is so weak as to be unable to get to the toilet, there are things you can do to help them - incontinence pads can be used to absorb urine, or through the provision of a catheter. More information about what you can do to help the person is available here: bladder and bowel control
This page has looked at some changes that might happen when someone with COVID-19 is approaching the end of life. However, you may also find the following resources helpful, which were written before COVID-19, to support people caring for someone dying at home.
Though this is a difficult and distressing time, your presence and care will make a big difference to the person you are looking after. You might feel anxious, unsure, or worry that you will make things worse. However, please remember, that though it might not feel like it, everyone has an innate ability to support the people they care about. Being with the person (either close by or at the end of a digital connection) is one of the most important things you can do.
Forest photo by Casey Horner on Unsplash
Clouds photo by Dewang Gupta on Unsplash
Sea photo by frank mckenna on Unsplash
