What can I say to a friend who is dying?

booch1It’s normal to feel anxious about visiting someone who is dying. Our society discourages talk about death, dying and illness, and few of us have much experience with it. It’s important to remember that even though your friend is dying, she’s still the same person you’ve always known. She’d likely prefer that you treat her as you always have.

First, you may have to overcome reluctance to discuss the illness. Each of you may want to spare the other any discomfort. Yet avoiding the subject creates its own awkwardness. Do acknowledge her illness, and even ask questions about it if you want.

This lets your friend know you can handle the subject, and it lets her feel at ease talking about it, if that’s what she wants. It’s good though to talk about other things besides the illness.

The best approach generally is to take your cues from your friend. Listen and watch for
verbal and visual signs to what makes her booch6comfortable or uncomfortable. It’s okay to ask your friend what’s on her mind, or what she wants to talk about. She may want to share feelings, or memories, or the interests you’ve shared throughout your friendship.

It’s okay to be emotional. This is a difficult time, and it’s likely to be easier for both of you if you acknowledge it, and even show it. Emotions may remain high throughout this booch3time, and that’s normal. Be willing to share them with your friend. Again, try to treat her as you always have.

Often, people who have a terminal illness say friends don’t call or visit. This is usually
because friends don’t know what to say or do, so they avoid the whole situation. Yet,
people most need their friends and friendship when they’re facing death. Be aware of
how you can help your friend deal with what she’s going through.

booch2Listening often helps the most. Offering assistance can also be helpful. If this is
something you can offer, let her know it. Many people don’t want to be a burden when
they’re ill, and are reluctant to ask for help. So it’s better to offer help rather than wait to
be asked. In every conversation, you may want to ask in a genuine way if there’s
anything you can do for her, or you may want to offer something specific.

If your friend is a colleague, you may want to let people at work know that you’re going
to visit her. They may have greetings, or a card they want you to take along. Presenting
these can be a good way to start your visit, especially if you’re nervous about what to say.

The first conversation with someone who has a terminal illness is often the hardest. It
does get easier. You’ll become more comfortable as you continue to visit and talk.

booch5

Suggested Reading:

I Don’t Know What to Say: How to Help and Support Someone Who is Dying
by Dr. Robert Buckman

Remembering Shane

ShanesBoardThis is a memory board of my son, Shane.  He died in a car accident, at the age of 23, on July 4th of 2017.  He was a good son, sweet and kind with a great smile.  His death left a permanent scar on my heart.  To help me with the grieving process, I met a wonderful counselor, Dina.  She suggested making a memory board of Shane. I love pictures and I had lots. I couldn’t wait. I collected pictures and personal items of his.  Our session began, with supplies in hand, and Kimberley’s guidance, and Dina’s encouragement, the board began to take shape.  It was a very emotional process. The memories were almost unbearable. Everything about the board tells a story. His passions in life. Hockey, drumming, skateboarding, the outdoors and people.  It shows his peaceful nature, his acceptance of all that is life.  His ever present smile, that beautiful bright smile!  Kimberley gave me the opportunity to create a lasting memory of my son.  This experience was very rewarding and therapeutic . The memory board is one of my most treasured items. I look at it everyday, just reminding myself of the life he had and how much he was loved and how much he is missed. From the bottom of my heart, thank you Kimberley!

– Sandra Bernard

When Death Is Near

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In the final phase of progressive life-limiting illness, patients and families face changes, challenges and choices that are unfamiliar and can seem overwhelming. This article offers information about what might be expected as death nears.

When a death is expected to occur within hours or days, the focus of care is usually on maintaining the person’s comfort rather than pursuing tests and treatments. At this time, families may want to consider if there are important cultural, spiritual or religious rituals that should happen just prior to death or at the time of death. If so, it is helpful to inform those who will participate and notify the health care team as required.

A Common Concern: Will Pain Worsen As Death Nears?

Pain is often experienced by those with serious illness, leading to concerns that pain will steadily worsen and be poorly controlled as death nears. They may think: “If I have this pain now, and I’m not near dying, how bad will it be when I am closer to dying?”

Death as depicted on television and in the movies contributes to this perception. In reality, however, pain tends to behave consistently for a person throughout an illness. If pain hasn’t been present, it’s unlikely to develop near end-of-life. If pain has been present but manageable, it will likely continue to be manageable rather than escalate out of control as death nears.

One study of patients with advanced cancer showed their pain prevalence actually decreased from 52% about six weeks before death to 30% in the last week of life. Perhaps this occurs because the dying process is one of shutting down, not escalation. Patients’ energy and alertness decreases and they tend to rest and sleep more.

An individual’s unique circumstances may bring increasing pain in the last weeks of life, however this is unusual. In such situations, it is imperative that the health care team aggressively pursues comfort with all of the urgency and expertise possible.

Difficult choices as death nears

As the changes described in this article progress in the final days or hours of a terminal illness, difficult choices may arise, such as whether to provide food and fluids, receive blood transfusions, or treat infections. Ideally, the person who is ill makes these choices. When this isn’t possible, a family member or person chosen as substitute decision-maker may be asked. It can be difficult to decide tests or treatments for someone else, but usually there is some sense of what the person would say if they could. Ask:  “What would the person want if he/she were able to tell us?” rather than “What do we want done for him/her?” In this way, the decision-maker serves as messenger for the patient’s known values and beliefs, rather than assuming responsibility for care decisions.

It may feel to families as though these decisions could make a difference between life and death, but it’s important to remember that the underlying illness is not survivable; no decision can change that. These choices about health care options won’t determine whether the person will live or die, but how their final days are experienced. The illness itself brings the onset of death, and health care decisions are focused on choosing the path that’s most comfortable for the person who is dying, and that reflects the person’s values.

When loved ones are unable to be there

When family members can’t be present as death nears, they may feel guilty. It may help to remind them that their connection is meaningful through thought and spirit, and not physical proximity… Whether they are just outside the room, in a different city or country, the physical distance between them does not diminish the closeness they feel.

Sometimes it seems as if a person waited for a specific time to die, like the arrival of a loved one, or when no one was at the bedside. Families who diligently held vigil may be upset if the death occurs when they briefly left. While we can’t know whether people can actually wait for a moment of privacy and solitude to die, this possible explanation may provide some comfort to those who briefly left the bedside at the time of death.

Sometimes family members arrive just a few minutes after death occurs – they may have been called to come because changes were happening quickly and couldn’t arrive in time. It is reasonable in such situations to sit at the bedside, perhaps holding the hand of the person who died, and say whatever feels right.

 

Understanding Amended Caregiver Tax Credits

taxIf you care for and support a family member, the former system provides three tax credits: the infirm dependant credit, the caregiver credit, and the family credit, all intended to compensate you for part of the non-discretionary, out-of-pocket expenses.

Infirm dependant credit is a 15% non-refundable tax credit for individuals who support an adult family member (other than your spouse or common-law partner) who is dependent on you by reason of physical or mental infirmity. They do not have to live with you to claim this credit.

Caregiver credit is a 15% non-refundable tax credit available to individuals who provide in-home care to family members who are either parents or grandparents 65 years and older, or adult family members including a brother, sister, niece, nephew, aunt or uncle, who are dependent on you by reason of mental or physical infirmity.

Family caregiver tax credit is 15% of $2,121, and helps caregivers of family members who are dependent on them by reason of infirmity, through a top-up to the other dependency-related credits, which could be the caregiver credit, the infirm dependant credit, the spousal or common-law partner credit, or the eligible dependent credit.

The 2017 budget simplified and consolidated these three non-refundable tax credits into one:  the new Canada Caregiver Credit (CCC), to support those who need it the most and extend tax relief to some caregivers who may not currently qualify due to the income level of their dependant. It provides tax assistance to caregivers for dependants who have an infirmity and are dependent on the caregiver for support by reason of that infirmity.

For 2017, the CCC amount will be $6,883 for infirm dependants who are parents or grandparents, brothers or sisters, aunts or uncles, nieces or nephews, or adult children.

The amount will be $2,150 for an infirm dependent spouse or common-law partners, an infirm dependant for whom the individual claims an eligible dependant credit, or an infirm child under age 18.

The CCC will be reduced dollar-for-dollar by the dependant’s net income above $16,163 (for 2017), and the dependant will not be required to live with the caregiver in order for you to claim the new credit. However, the CCC will no longer be available for non-infirm seniors who live with their adult children.