Home-based transitions: a space of grace

Next up in our Green Afterlife series, we have a story by a transition facilitator who works with the dying to ease their journey.

A few years ago I had the enormous privilege of assisting my mother through her transition. She was critically ill, and had expressed a strong desire to die in her familiar environment. We made a decision as a family to respect this wish, and gently supported her through her final days. It was an experience that has stayed with me, and that I would not do any other way if faced with the choice again.

Home-based dying is not something that we are too familiar with in the West. All too often in the past the terminally ill were either taken to hospital for the last part of their earthly journey, or we would enlist the help of professionals. To me, death is not much different from birth. It is a process that is powerful, and simply the moment of transition from one state to another.

Many people have realized the beauty of home-based birth, with those you love close as you welcome a new life. Few people realize the beauty of a home- based transition, where we gently support a loved one as they depart from their body. We have moved away from these natural cycles, yet the opportunity is there to experience this in way that has a profound impact on all involved.

I have been assisting the dying for many years, and have learnt from my own research as well as my experience that if this is a choice one is going to make, there are things that one should know and take into account in order to make the journey easier for everyone. If handled correctly, without fear, it is possible to create a true space of grace, making this profound process a shared experience between ourselves and those we love. It is inclusive and natural, and the greatest gift we can give a loved one is to support them fearlessly at this time.

I will share the most important things that I have learnt:

Facilitate a graceful & enriching experience

Sometimes the choice to die at home is a conscious one made by patients and their families. Sometimes it just happens that way. No matter how it happens, it is possible for the experience to be graceful and enriching for all involved. The following things should be taken into account:

• Which room would be the most suitable?
• Ideally, a hospital bed works best as it can be raised to ease end-stage breathing difficulties.
• Is there enough support? There should be sufficient support for your loved one during both the day and night.
• Who do they want with them during their last moments?
• Do they have specific wishes for pre or post transition?
• Has your loved one got closure on everything that is important to them?
• Are there members of the family that need counseling or other forms of support during this process?
• Do you have enough support, and/or the assistance of an end-care facilitator? This could make a huge difference to your experience.

Recognize the final weeks

It is always difficult to tell exactly when someone is going to transition. There are however some clear signs that the final weeks have arrived.

• Increased exhaustion and weakness
• Decreased appetite
• Loss of interest in external reality
• Increased sleeping, and being ‘within’ themselves.
• Agitation towards the end, attempts to get bedding off them.
• Loss of temperature regulation.
• Decreased bowel activity.
• ‘Seeing’ deceased loved ones.
• Sudden increase in alertness and energy just before transition. They may even request a meal.

These are simply some of the signs, and may or may not be present. Each person’s transition is unique.

Gentle touch & sounds are comforting

Your loved one may not want much food or liquid. The senses are acute, especially touch and hearing, so keep sounds muted, and touch them with great gentleness. Turn the person as often as possible to prevent bed sores. Do not crowd the space during the last days as they very often feel anxious. Keep activity in the room to a minimum, as the patient needs to do internal preparations for transition. Gentle foot and hand massage can be very soothing.

On the day of transition, many patients are pale with a kind of a glow around their faces. They may also develop mottling of the hands and feet as circulation decreases. The extremities are cold, and often the breathing changes with long pauses between the in and the out-breath. They may evacuate just prior or just post transition. This is all the body’s natural way of shutting down. Just gently support all processes as they occur, without being alarmed. It is the natural process occurring.

It is important to know that during the final moments your loved one is mostly not aware of any discomfort. Bodily and neural processes ensure that the experience is often quite calm and even blissful for the departing soul.

Candles and soft light create a soothing passage

During most of the transitions I have facilitated, I have lit candles during the final hours, and kept the lighting very soft. I burn aromatherapy oils, favoring rose and neroli oils, and play quiet piano or classical music. Keep all harsh sounds out, and keep voices quiet. Those transitioning can be very aware of everything being said, even if they seem comatose.

You can add anything that you wish, and that creates the environment that supports all involved.

Encourage and support the departure

Very often people transition when they are alone, and the caring family member has stepped out for a moment. If you are there when your loved one departs, it is important that you try and encourage them on their journey. They are in an inevitable process, and may be aware of you on some level, and concerned about leaving. As difficult as it may be, try to support this moment for them, gently telling them that they should go. This is often just what the departing soul needs, and moments later they quietly slip away.

In many cultures, and in ancient times, the women would do the cleansing of the loved one’s body. This is a sacred ritual and something that you could consider. Nothing needs to be rushed as it takes a few hours for the body to stiffen. Take your time and feel the sacredness of the process. Remove all medical devices and clothing. Place a folded towel under the chin as this allows the mouth to remain closed. Close the eyes, by holding shut for a minute or so.

It is easier if there are two or more people doing this ritual. You simply wipe your loved one down with warm soapy water and a cloth, taking care to support each part that you are working with. Dry the body and dress in chosen clothing. Remove the towel, and place the hands on the abdomen or chest. It is also beautiful to drape the body in soft scarves or cloth. Otherwise a sheet can be used to cover the body after cleansing. This is a good time for family members to come and say their farewell, each saying what they need to, or reciting a poem or prayer.

It is a privilege for all involved to have a home-based transition, where natural processes are supported and the cycle of life revered. It is a time of great intimacy, and allows us to fill ourselves with love for the departing soul – a fullness for which we can ultimately only be profoundly grateful.

By Elizabeth Masson