Comfort Care at End of Life
by Debbie Hommel, ACC/MC/EDU, CTRS
One of the primary goals of the activity professional is to focus on living and opportunities to have a meaningful quality of life. Unfortunately, death and dying are unavoidable realities we often do not want to face. The end-of-life process is personal and emotional, requiring acknowledgement and understanding. Activity professionals play a critical—yet often underrecognized—role in supporting residents during their final stage of life. While the medical staff address physical symptoms, activity professionals continue to focus on quality of life, as well as emotional comfort and dignity as the life draws to a close.
Many nursing home residents are living with chronic illness, advanced age, dementia, or terminal conditions. Nursing homes often become the final home for residents, many residing in the home for years. As a result, activity professionals (as well as other staff) develop long-standing relationships with the residents, making the end-of-life period meaningful and emotionally challenging.
Death is often described as a process, often involving a slow physical decline, emotional changes, social withdrawal, and spiritual reflection. The activity professional can recognize these changes and adapt approaches and interactions to meet the resident where they are.
The primary responsibility of the activity professional during death and dying is to provide comfort, be present and respect the person’s individual preferences. Approaches shift from group programming and to individualized, supportive engagement.
Some approaches may include:
- Providing meaningful one-on-one interactions
This may include quiet conversation, reading aloud, music, hand massage, or simply sitting with the resident. Just being present can be profoundly comforting. - Supporting emotional and psychosocial needs
Residents may express a variety of emptions – including fear, sadness, anger, or acceptance. Activity professionals should offer a safe, nonjudgmental space for these expressions. This is not the time to “fix” emotions. - Honoring life history and identity
Reminiscing, legacy projects, memory books, or favorite music may bring comfort and contribute to closure. - Maintaining dignity and choice
As always, respecting the person’s wishes regarding participation, visitors, and spiritual practices is essential. - Supporting family members
Families often experience anticipatory grief. Activity professionals may help families engage meaningfully with their loved one or offer reassurance during visits. Many facilities provide a “comfort cart” of refreshments to the family when they visit.
It is important to note that Activity professionals should maintain professional boundaries while offering compassion. It is not our role to provide medical advice or counseling. We can support emotional well-being and quality of life. Equally important is respecting cultural, and personal beliefs surrounding death and dying. What brings comfort to one resident may be distressing to another.
Supporting dying residents can be emotionally taxing. Activity professionals may experience strong feelings of grief, especially after forming close bonds with residents. Compassion fatigue was common during the Covid pandemic. Seeing so many of our residents pass away without being able to visit family at that time was a devastating experience for all staff. Acknowledging these feelings of grief is important as well as practicing self-care and peer support.
Death and dying are part of the life cycle. In the nursing home setting, activity professionals play a significant role in ensuring that residents do not face the end of life in isolation or discomfort. By being present, showing compassion, and person-centered support, activity professionals help residents live fully until the very end.
Check out the NCCAP Approved Continuing Education Program
Comfort Care at End of Life
NCCAP Approved 4 Hours