Challenges in End-of-Life Care: What to Expect and When to Seek Help

Jia Hui

Jia Hui is a content marketer who loves helping others and hopes to make this world a kinder place in any way she can.

Jia Hui

Jia Hui is a content marketer who loves helping others and hopes to make this world a kinder place in any way she can.

Published on

Regardless of how you have prepared for the end of life, it still comes with many challenges. It can be physically, emotionally, and financially draining for the patients and their loved ones.

While end-of-life care can be complex, you must prioritise giving quality of life to someone suffering from a life-limiting illness. Now more than ever, family members must not only learn how to provide relief for the physical symptoms but, more so, give the topmost emotional support to the patient and all the loved ones going through this tough phase of emotional turmoil.

This article will help shed light on healthcare providers, family members, family caregivers, and loved ones of the patient about end-of-life care. Let’s look into your options and what ought to be your purpose when providing palliative care services.

Defining End-of-Life Care

End-of-life care refers to a specialised form of medical and emotional support provided to individuals with life-threatening illnesses, meaning they’ve gotten a prognosis that they don’t have much time to live. The primary objective of end-of-life care is to enhance the quality of life for both patients and their families, ensuring comfort, dignity, and relief from pain and distress.

The end of life can vary based on individual decisions, needs, and preferences. Some would opt to spend their last moments at home, while others may choose to receive medical care in a hospital or an elderly co-living services in Singapore until the end.

Some steps can be taken to encourage a peaceful death for a loved one, respect their end-of-life wishes, and give them dignity while they are dying.

End-of-Life Care vs Palliative Care

You may have heard about palliative care being discussed when talking about end-of-life care in Singapore. This is because end-of-life and palliative care share many similarities, the topmost being ensuring the quality of life of someone with a life-threatening illness despite the circumstances.

However, end-of-life and palliative care also have particular distinctions, which include the following:

Who Is It For?

Palliative care pertains to a specialised approach to dealing with patients with life-threatening illnesses, such as heart disease or cancer, regardless of their age. These patients can have a palliative care team of health professionals or a local palliative care service take care and provide curative treatment even though their lives are not numbered. This means that palliative care can provide end-of-life care in Singapore services but can also deal with symptom management and active treatment of individuals without life-limiting illnesses.

On the other hand, end-of-life care is specifically designed for terminally ill patients receiving treatment for life-limiting illnesses and are only waiting for their final days.

What Is the Purpose?

Palliative care aims to improve the quality of life for patients with life-threatening illnesses by relieving pain, controlling symptoms, and attending to their physical, emotional, and spiritual requirements. The goals of palliative care are to reduce the suffering of the patients and, eventually, improve their health and overall well-being.

Meanwhile, providing comfort, dignity, and respite from pain and misery to those nearing the end of their lives is the main goal of end-of-life care. It emphasises quality of life and addresses the individual and their family’s particular physical, emotional, and spiritual requirements.

Approach, Support, and Treatments

Palliative care focuses on providing a holistic care approach and practical support to patients suffering from life-threatening diseases. It involves the patient’s healthcare team, who work together to manage pain, relieve symptoms, provide counselling, and offer support services. Moreover, palliative care services include facilitating effective communication and assisting with the decision-making of the patient and their loved ones.

End-of-life care strongly emphasises symptom control, pain management, and compassionate support. It seeks to guarantee the person’s physical comfort, emotional stability, and spiritual tranquillity. It involves advance care planning, emotional support for the patient and family members, and service coordination.

Does Palliative Care Mean End of Life?

Palliative care does not imply abandoning therapy or providing care while waiting for a patient’s demise. Palliative care services are done with curative therapies done by healthcare professionals to enhance the person’s quality of life. Palliative care is available at any stage of disease and does not indicate that death is close at hand.

This is their main difference because end-of-life care acknowledges the impending death of a patient. It focuses on ensuring a peaceful and dignified transition during this time by providing support to both the patient and their loved ones.

Other Differences of End of Life and Palliative Care Services

Here are the other differences of end of life and palliative care services:

  • Place

Palliative care can be done at patients’ own homes by getting home palliative care services, in a senior living facility, or select hospitals as an outpatient. End-of-life care can be facilitated in an inpatient hospice facility, assisted living or nursing home, or the patient’s home, provided they are constantly monitored by a live-in caregiver Singapore.

  • Timing

A patient can access palliative care at any stage of a serious disease, unlike end-of-life care, which is given when death is imminent.

  • Healthcare Providers and Healthcare Team

Hospice care is implemented by trained healthcare professionals, medical social workers, spiritual support counsellors, nurses, nurse practitioners, and a board-certified doctor. While these professionals also handle palliative care, the team can also have specialists to provide other treatments and early identification of the roots of the problem.

The Challenges in End-of-Life Care

The journey of those dealing with life-limiting illnesses can be tough for the patients and those around them. Although the emphasis is on comfort, supportive care, and dignity, patients may face particular difficulties at this time, which include the following;

  • Fatigue

Fatigue is a typical problem not only with most of the ageing population but when giving end-of-life care that frequently results from the underlying illness or its side effects. Patients may feel extremely weak, run-down, and less able to participate in activities. By allowing them to rest, helping patients with everyday duties, and maintaining a comfortable and tranquil environment, caregivers can help maximise their energy levels and rest intervals.

  • Temperature sensitivity

Patients receiving end-of-life care may be sensitive to temperature and prefer warmer or cooler environments. Comfort can be achieved by maintaining a cosy room temperature, offering blankets or fans as required, and modifying the bedding. Determine the patient’s unique needs and preferences concerning temperature via constant communication.

  • Digestive issues

In the last stages of life, digestive issues, including nausea, vomiting, constipation, or loss of appetite, can substantially negatively influence a patient’s wellness and comfort. Relief from symptoms and support for good nutrition can be obtained through symptom management medications, dietary changes, and the aid of a nutritionist or dietician. To improve the quality of life, a loved one must provide regular meals according to the patient’s preferences and health requirements.

  • Skin problems

Patients may experience discomfort due to skin-related problems such as dryness, irritation, or itching. The skin can be soothed and hydrated with the help of proper skin care, which includes routine moisturising and the use of soft products. It’s also crucial to address underlying reasons like allergies or the negative effects of prescription drugs. Open communication and cooperation with the patient’s end-of-life care team can direct the most effective approaches to ease skin-related problems.

  • Breathing problems

Conditions like severe lung disease or congestive heart failure may cause breathing difficulties or shortness of breath. Treatment options for respiratory problems include medications, oxygen therapy, breathing drills, and positional strategies. To lessen the related worry and fear, emotional support and anxiety management are also essential.

  • Pain

Pain is quite common to people nearing the dawn of their lives. The levels of pain depend on the gravity of their illness. For example, cancer patients may experience more intense pain, especially as the symptoms worsen, than patients with chronic illnesses or advanced dementia.

Acupuncture, massage, and relaxation methods are examples of complementary therapies that can be used in conjunction with prescription drugs, such as opioids, to manage pain effectively. Customising pain management strategies to the patient’s needs require ongoing assessment and dialogue with the healthcare team.

The Different Needs of End of Life Care

End-of-life care encompasses more than physical comfort and symptom management. It requires a comprehensive approach that recognises and addresses the diverse needs of individuals and their families during this sensitive phase.

Here’s a look at the different needs of a patient undergoing end-of-life and palliative care:

Mental and emotional needs

A wide range of emotional states, such as dread, worry, grief, and existential worries, are included in end-of-life and palliative care. It takes empathy, active listening, and creating a safe environment for open dialogue to support patients emotionally. People can negotiate their emotional issues by being given access to mental health professionals, support groups, or counselling programs. Giving people a chance to reflect, tell stories, and discuss difficulties can also help people heal emotionally and find peace.

Spiritual needs

Concern for spiritual needs is crucial in providing end-of-life and palliative care. During this period, people could look for comfort and meaning in life or to examine existential issues. It is essential to respect and encourage various spiritual practices and beliefs. Depending on the person’s religious traditions, chaplains, spiritual advisers, or religious leaders can offer spiritual counselling, prayer, rites, or sacraments. Creating a calm environment that promotes meditation, introspection, or communion with nature can also aid in addressing spiritual needs.

Support for practical tasks

End-of-life care extends beyond emotional and spiritual support to practical assistance with daily tasks. Individuals may require help with personal care, household chores, meal preparation, medication management, or transportation. Engaging caregivers, home health aides, or volunteers can alleviate the burden on patients and their families, allowing them to focus on quality time together. Support for practical tasks ensures that individuals can maintain a sense of normalcy, comfort, and dignity in their daily lives.

The Signs of End-of-Life Deterioration

People experience physical changes as their lives draw to a close, changes that signal the progression of death. Caregivers, medical professionals, and family members who are providing end-of-life care must be able to recognise the following indicators:

Changes in urination

Patients receiving end-of-life care may notice changes in their urination patterns. This could show up as decreased urine production or alterations in odour and colour. In some circumstances, people may become incontinent or lose control of their bladder. The body naturally slows down, and the kidneys work less effectively, which causes these changes. To retain dignity, it is crucial to give comfort measures, including regular toileting chances and good cleanliness.

Decrease in Body Temperature

As a person approaches death, their body may gradually lose the capacity to control temperature. The person may feel cold to the touch or get chills due to a drop in body temperature. Warm blankets, temperature control, and the use of heating pads or hot water bottles can all contribute to their comfort.

Appetite Loss

People could feel less hungry or thirsty as their body processes slow down. Physical discomfort, changes in taste and smell, or a diminished capacity to swallow may all contribute to this. Offering short, readily digestible meals or liquids, as preferred, and ensuring appropriate hydration to prevent discomfort are key to respecting their choices in food and drink.

Social Changes

As people get closer to the end of their lives, they might avoid social situations and favour solitude or little interaction. This withdrawal may be brought on by exhaustion from physical activity, emotional processing, or the need for alone. It is essential to respect their preferences while ensuring that emotional support is there when needed. A sense of comfort can be offered by offering a serene setting during this time.

Mental Confusion

Mental confusion, often known as delirium, can happen when a person is on the verge of passing away. They could display symptoms of confusion, agitation, restlessness, or hallucinations. Both the individual and their loved ones may find this upsetting. Their discomfort can be reduced by giving reassurance, upholding a regular and comfortable setting, and seeking medical advice on managing symptoms.

Too Much Sleep

People nearing the end of their lives may become overly sleepy or go through periods of profound sleep. The body may have a natural reaction like this to conserve energy. It’s crucial to make sure they are comfortable, move them around frequently to avoid pressure sores, and keep them clean while awake.

Significant Decline in Physical Activity

As people get closer to the end of their lives, their physical activity declines noticeably. They might become less active, spend more time sitting or in bed, and have less energy. Ensuring their comfort by placing them correctly, protecting their skin, and helping them with personal care requirements is crucial.

End-of-Life Care – When Does It Begin?

Although the idea of end-of-life care may conjure images of the dying process, it’s crucial to realise that the journey starts much earlier.

  • Early Dialogue and Planning

Long before a person reaches the end of their illness, talks and planning are frequently the first steps in providing end-of-life care. Patients must discuss their values, preferences, and care objectives with their loved ones, medical professionals, and maybe a palliative care team. Advance care planning, which involves designating a healthcare proxy and putting wishes in writing through advance directives, helps guarantee that the person’s preferences are respected and carried out when they can no longer convey them.

  • Life-Limiting Diagnosis or Terminal Prognosis

When a person is given a terminal prognosis or identified as having a life-limiting illness, end-of-life care is more important. Healthcare professionals and caregivers can now start a conversation about the prognosis, available treatments, and care objectives. The emphasis turns to supplying comprehensive support, controlling symptoms, and preserving the highest quality of life possible. Palliative care may be required to meet the demands in terms of the physical, emotional, and spiritual well-being of the patient.

  • Transition to Hospice Care

When curative treatments are no longer desirable or effective, hospice care, a specialised end-of-life care, is usually introduced. To ensure that patient’s physical, emotional, and spiritual needs are satisfied during their terminal illness, hospice care strongly emphasises offering comfort and support to patients and their families. This transition often occurs when the life expectancy is six months or less, although it might vary depending on the situation.

  • Continuity of Care and Support

A multidisciplinary team of healthcare professionals work together to satisfy the individual requirements of the patient and their family. They include physicians, nurses, social workers, chaplains, and other specialists. Regular assessments, talks, and revisions to the care plan are made to address changing needs, give comfort and dignity throughout the trip, and address evolving needs.

  • Providing Emotional and Grief Assistance to the Patient’s Loved Ones After They Have Passed Away

Family members can navigate the mourning process and discover peace and healing in their loss through grief counselling, support groups, and other services.

The Steps of End-of-Life Planning

End-of-life planning is a thorough and proactive approach that enables people to prioritise their values and preferences, keep control over their financial situation, and ensure their healthcare decisions. People can lessen the stress on their loved ones and ensure their end-of-life desires are respected by making advance plans.

Here are the steps to get this done:

  1. Start Early Planning

It is important to start end-of-life planning before it is necessary. Starting early enables people to communicate their values, beliefs, and preferences for end-of-life care to their loved ones openly and honestly. These conversations can assist in establishing priorities, reducing emotional stress, and ensuring everyone is aware of the person’s intentions.

  1. Create Financial and Legal Papers

It is crucial to create and organise crucial financial and legal papers to guarantee financial stability and the effective management of assets. This can entail drafting or revising a will, appointing a person to manage your finances and healthcare, and naming beneficiaries for your life insurance and retirement accounts. A lawyer or estate planner can offer assistance in navigating these complex issues.

  1. Think About Your Healthcare Preferences

Making decisions regarding the kind of medical treatment a person wants entails end-of-life planning. This involves taking choices for resuscitation techniques, life-sustaining therapies, and the choice of a healthcare proxy or durable power of attorney for healthcare into account. Advanced healthcare directives, like a living will or Medical Orders for Life-Sustaining Treatment (MOLST), can make sure that medical staff are aware of and respectful of the patient’s intentions.

  1. Get Palliative Care or End-of-Life Care

Individuals with life-threatening illnesses receive comfort, symptom management, and emotional support from end-of-life or palliative care professionals. Early involvement with a palliative care team can help address the person’s physical, mental, and spiritual needs and ensure their quality of life is maximised. Along with curative therapies, palliative care can be given and aid in facilitating discussions regarding end-of-life desires.

  1. Obtain Caregiving Assistance

End-of-life planning includes taking caregiving assistance needs into account. Finding family members, close friends, or professional carers who can help with personal care, housework, and emotional support during the end-of-life journey may be one of these things. The strain on loved ones might be lessened by looking into hospice programs, support groups, and local community resources.


End-of-life planning is a humane and powerful process that enables people to take control of their care, lessen the stress on loved ones, and guarantee that their end-of-life desires are honoured. People can navigate this difficult phase with peace of mind, dignity, and a focus on their physical and emotional well-being. Making end-of-life plans gives one a sense of control and gives oneself and those left behind a priceless gift, enabling a more peaceful and kind transition when approaching death.

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