Recognize pain, even when a person cannot tell you, offer comfort the care plan allows, and give caring support near the end of life.
ForNursing home, Home health, Hospice staff
TimeAbout 76 minutes
Lessons9, each with a quick check
FinishA quiz (80% to pass) and a printable certificate of completion
What you will learn
Know that pain is not something older adults just have to live with.
Ask simple questions about pain and listen to the answers.
Recognize signs of pain in people who cannot say they hurt.
Use comfort measures that are in the care plan.
Explain palliative care and hospice care in plain words.
Know that eating and drinking less is normal near the end of life.
Recognize common physical changes as death nears.
Support a dying person's emotional and spiritual needs.
If someone is not breathing, get the nurse and follow your emergency steps right away.
Written by Pact Compliance from federal rules and CDC, CMS, OSHA and NIH guidance (sources under each lesson), checked October 2026. Where your facility's policy is different, follow your facility's policy.
Lesson 1: Pain Is Not a Normal Part of Aging
In this lesson you will:
Know that pain is not something older adults just have to live with.
Explain how pain can affect sleep, mood and daily life.
Know your role: notice, ask, comfort and report.
Not normal aging
Help exists
Many older people live with pain from health problems like arthritis, diabetes, shingles, or cancer. Some people put off getting help. They think pain is just part of getting old, and that nothing can help. NIA says this is not true. NIA also says that while not all pain can be cured, most pain can be managed. So never brush pain off as 'just old age.'
What pain does
Sleep, mood, life
Pain does more than hurt. NIA says pain can get in the way of daily activities. It can upset sleep and eating. It can be linked to depression or worry. It can keep people away from friends and family. CMS says nursing home residents are at high risk for pain. That pain can make it hard to move, lower mood, upset sleep, and take away quality of life.
Everyone is different
Believe them
MedlinePlus says each person feels pain differently, even when the cause is the same. Pain may be sharp or dull, mild or severe. It may come and go, or stay all the time. MedlinePlus says the person is the only one who knows how their pain feels. You are not the judge of how much someone hurts. So believe what people tell you about their pain.
Show the answer
Pain is not a normal part of aging, and most pain can be managed. Tell the nurse. NIA says the idea that pain is just part of aging and nothing can help is not true.
The rules
Pain care required
Federal rules protect people from living with pain that is not treated. A nursing home must make sure residents who need pain care get it. That care must follow professional standards, the care plan, and the resident's own goals and choices. Hospice patients have the right to good pain care and symptom control. And every hospice plan of care must include ways to manage pain and symptoms.
You notice first
Report changes
CMS says nursing assistants may be the first to notice a resident's symptoms. So you need to spot a change and report it to a nurse. Home health and hospice aides must also report changes in a patient's condition to a registered nurse. You see people during bathing, dressing, turning, and meals. Those are the times when pain often shows.
Your role
Notice, ask, comfort, report
Your job has four parts. Notice signs of pain. Ask the person about it. Comfort them, using the steps in their care plan. Then report to your nurse what you saw, what they said, and what helped. Pain medicine is ordered by a doctor or other provider. Do not give, skip, or change it on your own. Help with medicine only if your care plan, your training, and state law allow it. NIA tells patients that if a medicine is not working, they should not change it, but talk to the doctor or nurse. The same goes for you.
On your shift
Just old age?
Mr. Allen is 88. He winces each time he stands up. He says, 'My hip always hurts. That's what happens when you get old.' A coworker nods. You say, 'I'm sorry it hurts. Let me tell the nurse, so we can try to help.' Then you tell your nurse what you saw, what he said, and when it happens.
Quick review
Pain matters
Let's review. Pain is not a normal part of aging, and most pain can be managed. Pain can harm sleep, mood, eating, and daily life. Each person feels pain in their own way, so believe them. Nursing homes and hospices must give pain care. You are often the first to notice. Notice, ask, comfort, and report. Leave pain medicine choices to the nurse and the doctor.
Ask simple questions about pain and listen to the answers.
Know the many words people use for pain.
Report new, severe or unrelieved pain to the nurse right away.
Ask
Don't wait
Many people will not tell you they hurt unless you ask. NIA says some people feel they should be brave and not complain. Others think nothing can help. So ask. Ask during care, and ask when something seems different. A simple question works: 'Are you having any pain or discomfort right now?'
Other words
Listen closely
CMS says a person may not use the word 'pain' at all. The words people use can differ by culture, language, and region. Listen for words like aching, sore, pressure, heavy, burning, throbbing, stabbing, cramping, tingling, or pins and needles. Some say they feel 'rough,' or just 'uncomfortable.' Treat these words as pain, and report them.
Simple questions
Where, when, what
NIA and MedlinePlus list questions that help describe pain. Where does it hurt? When did it start? Does it come and go? What does it feel like? What makes it better or worse? You do not need to ask them all. Ask what the person can answer. Write down their words.
Show the answer
Treat it as pain and tell your nurse her exact words. CMS says people may avoid the word 'pain' and use other words like heavy or aching.
How bad?
Use your scale
NIA says nurses may ask a person to rate pain from 0 to 10. Zero is no pain. Ten is the worst pain they can imagine. Some use pictures of faces, or ask if pain is mild, moderate, or severe. Use the pain scale your workplace uses. Report the number or face the person picks, and their own words.
During care
Watch and ask
CMS says everyday care, like moving, turning, bathing, and dressing, can hurt. Watching a person at rest and while they move can show pain. Pain during meals or mouth care may point to mouth or tooth pain. So go slowly. Tell the person what you will do before you do it. If they wince or say it hurts, stop, comfort them, and tell your nurse.
Right away
Don't wait
Some pain must be reported right away, not at the end of your shift. NCI lists times to call the nurse. They include pain that the prescribed medicine does not relieve, new symptoms, and symptoms that come back. They also include grimacing or moaning, trouble breathing with distress, and a fall. Report any new, sudden, or severe pain right away too. CMS says pain should be found and treated promptly.
Medicine
Nurse decides
Pain medicine is not your call. Do not give extra, skip, or change a dose. If a person says their medicine is not working, tell the nurse. NIA says that when pain is not controlled, medicines can be raised or changed. But that only happens if the nurse knows.
Give the facts
Words, place, time
A good pain report is short and clear. Say who, where it hurts, how bad, and when it started. Say what makes it worse and what helped. For example: 'Mr. Reed in room 4 says his back pain is a 7. It started after lunch. It is worse when he turns. A pillow helped a little.' Then write it down where your workplace says to.
Quick review
Ask, listen, report
Let's review. Ask about pain. Many people won't bring it up. Listen for other words, like aching, pressure, or sore. Ask where, when, what it feels like, and how bad, using your workplace's scale. Watch during care. Report new, severe, or unrelieved pain right away. Leave pain medicine to the nurse. Give clear facts.
Your facility's policy (ask your supervisor):
The pain scale your workplace uses (number scale, faces, or a scale for people who cannot speak)
Where and how aides document pain reports
How to reach the nurse or the hospice 24-hour on-call line right away
Lesson 3: Signs of Pain When a Person Cannot Tell You
In this lesson you will:
Recognize signs of pain in people who cannot say they hurt.
Learn each person's usual behavior so you can spot changes.
Report what you see to the nurse.
Hidden pain
Harder to see
Some people cannot tell you they hurt. This includes many people with dementia, people after a stroke, and people who are very sick or near death. CMS says pain is harder to recognize when a resident has moderate to severe problems with memory and thinking. NIA says people with Alzheimer's may not be able to tell you when they are in pain. So you have to watch for clues.
Face and sounds
Clues
Start with the face and the voice. CMS lists facial signs like grimacing, frowning, looking scared, or clenching the jaw. It also lists sounds like groaning, crying, whimpering, or screaming. NIA adds moaning and sighing. NIA says a person with late-stage Alzheimer's may grimace when they are touched.
The body
Guarding, rubbing
Watch the body. CMS lists rubbing one spot, or guarding an arm, a leg, or another body part. NIA says a person may sit in an unusual position to protect the part that hurts. NIA also says they may keep changing position. CMS lists limping, sweating, changes in skin color, and faster breathing or heart rate.
Show the answer
Possible pain. Tell your nurse what you saw. Resisting care and rubbing one spot are possible signs of pain.
Behavior
Changes
Pain often shows up as behavior. CMS lists resisting care, pacing in distress, being cranky, a low mood, and pulling back from usual activities. NIA says the person may become upset, aggressive, or more agitated. NIA lists pain as a common cause of behavior changes in dementia. So when behavior changes, think about pain.
Eating and sleep
Watch too
CMS lists trouble eating, a poor appetite, and trouble sleeping as possible signs of pain. NIA says refusing to eat may be a sign of tooth pain or other mouth problems. CMS says watching a person eat, or during mouth care, can show mouth, tooth, or face pain. So pay close attention at meals and during mouth care.
Know their normal
Spot changes
CMS says staff who know a resident well are better at telling pain behavior from other behavior. That is you. Learn each person's usual face, sounds, sleep, and mood. Family and friends can help. CMS says they may notice pain and share what helped before. CMS also says these signs can have other causes, so they must be looked at as a whole. That is the nurse's job. Your job is to notice and report.
On your shift
Pulling away
Mrs. Grant has advanced dementia. She is usually calm. Today she pushes your hands away when you turn her, and she groans. Her face tightens when you touch her right arm. You stop, speak softly, and help her get comfortable. Then you tell your nurse: 'Mrs. Grant groans and pulls away when I touch her right arm. It started today.'
Quick review
Watch and report
Let's review. Some people cannot tell you they hurt, so watch for clues. Look at the face: grimacing, frowning, a clenched jaw. Listen for groans, moans, or crying. Watch the body: guarding, rubbing, or odd positions. Notice behavior changes, like resisting care or agitation, and changes in eating or sleep. Know each person's normal, and report what you see.
Your facility's policy (ask your supervisor):
The pain tool your workplace uses for people who cannot speak (if any)
Where to record each person's usual behavior and pain signs in the care plan
Lesson 4: Comfort Without Medicine: Follow the Care Plan and Report Results
In this lesson you will:
Use comfort measures that are in the care plan.
Know that some comfort measures need an order.
Report how the person responded.
More than pills
Comfort measures
Medicine is only one way to ease pain. CMS says pain care can use both medicine and non-medicine approaches. Non-medicine means comfort measures, like positioning, warmth, quiet, and touch. CMS says some can be given by staff during routine care. Others need an order from a provider. So follow the care plan.
The room
Small changes
CMS lists changing the room for comfort. That includes setting the room temperature, smoothing and tightening sheets so there are no wrinkles, and a comfortable seat. NIA says some people prefer quiet moments with fewer people, and soft lighting. Turn down the TV if the person wants. Small changes can make a big difference.
Show the answer
Smoothing and tightening the sheets. CMS lists smoothing linens as a way to change the room for comfort.
Positioning
Gentle moves
CMS lists good body alignment and changing position as comfort measures. NIA says turning a person in bed every few hours may help prevent bed sores and stiffness. NIA also suggests a foam pad under a heel or elbow to raise it off the bed. Use the pillows and devices in the care plan. Tell the person before you move them, and move slowly and gently.
Touch and sound
Calm the mind
NIA suggests holding hands or a gentle massage. NIA says music at a low volume can help a person relax and can lessen pain. CMS lists relaxation, reminiscing, distraction, activities, music, and spiritual comfort. Talk about a happy memory. Play their favorite songs. And ask the person what helps. If they can tell you, they are the expert.
Heat and cold
Only if ordered
CMS lists ice packs and mild heat as comfort measures. But heat and cold can hurt skin if they are used the wrong way. Use them only if the care plan says so, and only the way you were taught. NCI says to avoid electric blankets and heating pads for people near death, because they can cause burns. If you are not sure, ask your nurse first.
Did it help?
Report results
CMS says pain care must be checked to see if it is working, and changed as needed. You help with that. After a comfort measure, look and ask. Did the person relax? Did the moaning stop? Did they sleep? Or did nothing change? Tell your nurse what you did and how the person responded. The hospice team reviews the plan of care at least every 15 days, and more often when needed.
On your shift
A useful report
Mr. Owens is in hospice at home. He is restless and frowning. His care plan says to reposition him and play his gospel music. You turn him, with pillows behind his back, and start the music softly. After ten minutes, his face relaxes and he dozes. You tell the nurse what you did and that it helped. On your next visit, he is restless again, and nothing helps. So you call the nurse right away.
Quick review
Comfort and report
Let's review. Comfort measures can ease pain along with medicine. Try room changes, smooth sheets, gentle positioning, touch, quiet, and music. Some measures, like heat or cold, need an order. Avoid heating pads. Follow the care plan. Then check and report: what you did and how the person responded.
Your facility's policy (ask your supervisor):
Which comfort measures aides may use during routine care, and which need an order
Lesson 5: Hospice and Palliative Care: The Team and Your Role
In this lesson you will:
Explain palliative care and hospice care in plain words.
Name the members of the hospice team.
Know your role: follow the plan of care and report changes.
Palliative care
Comfort, any stage
Palliative care is care for comfort and quality of life when a person has a serious illness. The federal hospice rule says it works to prevent and treat suffering. It cares for the body, mind, feelings, social needs, and spirit. NIA says palliative care can start when a person first learns they are sick. It can go on at the same time as treatment meant to cure the illness.
Hospice
Comfort near the end
NIA says hospice is a type of palliative care for the last weeks or months of life. In hospice, trying to cure the illness stops. Comfort becomes the goal. A doctor believes the person has six months or less to live if the illness runs its normal course. Other care can go on. For example, NIA says a person may still take medicine for high blood pressure.
Where
Home or facility
NIA says hospice is a way of caring, not a place. It can happen at home, in a nursing home, in a hospital, or in a hospice center. Someone from the hospice is usually available by phone 24 hours a day, 7 days a week. NIA says people in hospice are more likely to have their pain controlled.
Show the answer
Comfort and quality of life for a person near the end of life. NIA says hospice focuses on care, comfort, and quality of life.
The team
Many roles
The hospice rule requires a team. It must include a doctor, a registered nurse, a social worker or counselor, and a pastoral or other counselor. NIA says trained volunteers help too. The team works together on the physical, emotional, and spiritual needs of the patient and family. A registered nurse on the team assigns each hospice aide and writes the aide's care instructions.
Plan of care
Follow it
All hospice care must follow a written plan of care. The plan must include ways to manage pain and symptoms. Hospice aides give care that the team ordered, that is in the plan of care, that state law allows, and that matches their training. Aide duties include hands-on personal care and help with walking and exercises. If you are asked to do something that is not in your instructions, call the nurse.
Report changes
To the nurse
Hospice aides must report changes in a patient's needs to a registered nurse. Home health aides must report changes to a nurse or other skilled professional. The hospice team updates the plan of care as often as needed, and at least every 15 days. Your report is how the team learns about new pain, new symptoms, or new worries.
In a nursing home
Two teams
Many nursing home residents get hospice care. The hospice plan of care must say which provider does each task. The nursing home must tell the hospice right away about a big change in the resident's condition, or when the resident dies. If you work in a nursing home, check the care plan to see what hospice does and what you do. Tell your nurse about any change, so the nurse can call hospice.
Quick review
One team
Let's review. Palliative care is comfort care for serious illness, at any stage. Hospice is comfort care near the end of life, when cure is no longer the goal. It can be given at home or in a facility. The team includes a doctor, a nurse, a social worker, a counselor, aides, and volunteers. Follow the plan of care, and report changes to the nurse.
Your facility's policy (ask your supervisor):
Hospice provider names and the 24-hour on-call number
Nursing home: the staff member who coordinates care with each hospice
Where the hospice plan of care and aide instructions are kept
Lesson 6: Eating, Drinking and Mouth Care Near the End of Life
In this lesson you will:
Know that eating and drinking less is normal near the end of life.
Never force food or fluid; offer small amounts only if the person wants them and the care plan allows.
Keep the mouth and lips moist and clean, and report swallowing problems right away.
Less hunger
Normal
As death nears, people often want less food and drink. NIA says losing appetite is a common and normal part of dying. NCI says the body needs less food as it slows down, and it cannot use food and fluids as well. NIA says going without food or water is generally not painful. Eating and drinking can even add to a dying person's discomfort.
Never force
Choking risk
NIA says do not force a dying person to eat. NCI says food and fluids should not be forced, because it can cause discomfort or choking. Never push a spoon into a person's mouth. Never keep holding a cup to the lips of someone who turns away. NCI says the person should be allowed to choose whether and when to eat or drink.
Show the answer
Stop, offer again later if she wants, and tell the nurse. Food should not be forced. The person chooses whether to eat.
Small amounts
If they want
If the person wants to eat, offer small amounts of favorite foods. NIA suggests small meals more often, instead of three large ones. NIA says to help with feeding if the person wants to eat but is too tired or weak. Follow the diet and food texture in the care plan. NIA says the person should be sitting upright to eat, and stay upright for at least 20 minutes after.
Swallowing
Watch closely
Swallowing often gets harder near the end of life. NCI says both food and fluids may become hard to swallow. NIA says trouble swallowing raises the risk of choking. Food that goes into the lungs can cause pneumonia. NIA says do not feed a person who is drowsy or lying down. Give time to swallow each bite. If the person coughs or chokes, stop, and get your nurse right away.
Mouth care
Moist and clean
A dry mouth and dry lips can be very uncomfortable. NIA suggests lip balm for the lips, and a soft, damp cloth to keep the mouth clean. If the inside of the mouth seems dry, NIA says ice chips may help if the person is awake. Or wipe the inside of the mouth with a damp cloth, cotton ball, or special swab. Follow the mouth care steps in the care plan.
Families worry
Explain gently
Families often worry that their loved one is starving or thirsty. You can kindly share what NIA says: losing appetite is a normal part of dying, and going without food is generally not painful. NIA says a person may choose to stop eating as part of accepting that death is near. Invite the family to help with mouth care, like putting on lip balm. If they ask about feeding tubes or fluids, get the nurse.
On your shift
A worried son
Mrs. Bell is in hospice and sleeps most of the day. Her son asks you to wake her and make her eat lunch. You explain kindly that it is normal for her to want less food now, and that forcing food can cause choking. You show him how to put lip balm on her lips. Then you tell the nurse about his worry, so she can talk with him.
Quick review
Comfort, not force
Let's review. Eating and drinking less is normal near the end of life, and it is generally not painful. Never force food or fluid. It can cause discomfort or choking. If the person wants to eat, offer small amounts while they sit upright, as the care plan allows. Watch for swallowing problems and report them right away. Keep the mouth and lips moist and clean.
Your facility's policy (ask your supervisor):
Your feeding and swallowing policy, including food textures and who may help with feeding
Choking emergency steps
Mouth care supplies and steps for people near the end of life
Lesson 7: Breathing, Skin and Other Changes as Death Nears
In this lesson you will:
Recognize common physical changes as death nears.
Give comfort for each change, following the care plan.
Report changes, and avoid things that can cause harm, like heating pads.
Changes
Each person differs
NCI says several body changes are common when a person is near death. But not everyone has them, and having one does not always mean death is near. Knowing what to expect helps you give comfort and support the family. Tell your nurse about the changes you see. NIA says hospice staff can help tell what is part of normal dying and what needs care.
Sleep, weakness
Save energy
NCI says people feel more tired and weak, and sleep more and more. They may answer slowly, or not at all. NIA suggests keeping things simple, like a bedside commode or a sponge bath in bed. NCI says most people can still hear after they can no longer speak. So keep talking to them. NIA says to say who you are when you come in, and to talk to the person, not about them.
Breathing changes
Raise the head
Breathing often changes. NCI says it may become uneven, with shallow breaths, pauses, or deep, fast breaths. For a person who feels short of breath, NIA suggests raising the head of the bed, opening a window, or using a fan to move the air. NCI suggests aiming a cool fan toward the face. Follow the care plan. Tell the nurse right away if the person seems short of breath or upset.
Show the answer
Turn her to her side or raise her head, and tell the nurse. NIA and NCI say turning to the side or raising the head can help rattle.
Noisy breathing
Turn to side
Near death, saliva can collect in the throat. It can make a rattling or gurgling sound. NCI says it does not seem to be painful for the person, but it can upset family. NIA and NCI say turning the person to the side or raising the head can help. NCI says this rattle can be a sign that death may come in hours or days. Tell the nurse when you hear it.
Cool skin
Light blanket
As blood flow slows, hands and feet may become cool, blotchy, or bluish. NCI says this is not painful. Keep the person covered with a light blanket. Do not use electric blankets or heating pads. NCI and NIA say they can get too hot and can cause burns. Watch for signs the person is too warm, like pushing off the covers. NIA says you can remove the blanket and put a cool cloth on the head.
Skin care
Clean and dry
NIA says to keep the skin clean and moist. Gently use lotion without alcohol for itching and dryness. Lying in one place can cause painful bed sores. Watch for skin that looks discolored or darker, on the heels, hips, lower back, and back of the head. NCI says urine may lessen and turn dark, and the person may lose control of bladder or bowels. Keep the bed clean and dry, and give gentle care.
Confusion
Stay calm
NCI says people near death may be confused about time, place, or who is with them. Gently remind them where they are and who is there. Stay calm. NCI says do not restrain a person who is agitated. Tell the health care team. NIA says a dying person may seem to see or talk to someone who is not there. Do not argue or correct them. Report agitation to your nurse.
Quick review
Comfort each change
Let's review. Body changes near death are common, but each person is different. Keep talking; hearing may last. For breathing changes, raise the head or turn to the side, and tell the nurse. Use a light blanket. Never use heating pads or electric blankets. Keep skin clean and dry. Stay calm with confusion, and report changes to your nurse.
Your facility's policy (ask your supervisor):
Steps when a person near death has breathing distress (who to call, oxygen policy)
Lesson 8: Emotional, Spiritual and Cultural Needs, and Respecting Wishes
In this lesson you will:
Support a dying person's emotional and spiritual needs.
Respect cultural and religious customs.
Follow advance directives and the care plan, and bring questions to the nurse.
Four areas
Whole person
NIA says people who are dying need care in four areas. They are physical comfort, mental and emotional needs, spiritual needs, and practical tasks. The hospice rule says the hospice assessment must look at physical, emotional, social, and spiritual needs. The goal is comfort and dignity all through the dying process.
Fears
Be present
A dying person may fear the unknown, fear being alone, or worry about the people they leave behind. NCI says two common worries are being left alone and being a burden. NIA says your presence may be the greatest gift you can give. Sit with them. Listen without planning what to say next. Hold a hand if they want. Talk or read to them, even if they can't talk back.
Dignity
Choices
NCI says dying people often worry about losing dignity and control. Give choices whenever you can. Respect their need for privacy. NIA says always talk to the person, not about them, when you are in the room. People have the right to refuse care. Hospice patients have the right to help plan their care. If someone refuses care, respect it, and tell your nurse.
Show the answer
Tell the nurse, so the team can help arrange a visit. Hospices must make reasonable efforts to arrange visits from clergy.
Spiritual needs
Meaning, faith
NIA says spiritual needs may be as important as physical ones. They may include finding meaning in life, ending old fights, or making peace. Many people find comfort in faith. Others struggle with it. Prayer, religious readings, or religious music may help. The hospice must offer spiritual counseling and help arrange visits from clergy, if the person wants. Tell the nurse if someone asks for a chaplain or faith leader.
Culture
Ask, respect
NIA says a person's culture and religion can shape their end-of-life choices. That includes comfort care and pain care, who can be present at death, who makes decisions, and where the person wants to die. Don't assume. Ask the person, the family, or the nurse what matters to them. Follow the customs noted in the care plan.
Advance directives
Written wishes
An advance directive is a legal paper with instructions for medical care. It is used if a person cannot speak for themselves. NIA says the two most common are a living will, and a durable power of attorney for health care. That names a health care proxy. A do not resuscitate order, or DNR, tells staff not to try CPR if the heart and breathing stop. Nursing home residents have the right to make an advance directive. Hospices must follow federal advance directive rules.
Your role
Know the plan
You do not decide what a person's wishes mean. The nurse and the team do. Your job is to know where to find the person's code status and care plan, and to follow them. In home health, the plan of care must include information about any advance directives. If a person or family tells you about new wishes, or hands you a paper, tell your nurse right away.
Quick review
Whole-person care
Let's review. Dying people have physical, emotional, spiritual, and practical needs. Be present and listen. Protect dignity, privacy, and choice. Support faith and help connect people with clergy through the team. Respect culture and customs. Know where to find advance directives and code status, and bring new wishes to the nurse right away.
Your facility's policy (ask your supervisor):
Where code status and advance directives are kept and how aides check them
Lesson 9: After a Death: Dignity, Policy, Family and Your Own Grief
In this lesson you will:
If someone is not breathing, get the nurse and follow your emergency steps right away.
Treat the person's body and family with dignity, and follow your workplace's policy after a death.
Know that grief is normal, and take care of yourself.
Not breathing
Get the nurse
If you find a person who is not breathing or does not respond, get your nurse right away. Follow your emergency steps. Do not decide on your own that the person has died. NIA says that without a DNR order, staff will try everything to restart the heart and breathing. So the nurse must check the person's code status at once. In a home, call your agency or the hospice as your policy says.
Signs of death
Pronounced by others
NCI lists signs that a person has died. There is no breathing and no pulse. The eyes do not move or blink. The jaw relaxes, and the mouth may be slightly open. The person does not respond to touch or voice. NIA says a death must be officially pronounced by someone in authority, like a doctor or a hospice nurse. A nursing home must tell the hospice right away when a hospice resident dies.
Show the answer
Get the nurse right away and follow your emergency steps. Without a DNR, staff try to restart breathing. The nurse checks code status at once.
Dignity
Gentle care
Treat the body with the same respect you gave the living person. Follow your workplace's after-death care policy. NCI says the body can be placed on its back with one pillow under the head, and dentures may be put back in place. NIA says the joints begin to stiffen in the first few hours. Close the curtain or door for privacy. Ask your nurse before you remove any tubes or devices.
Customs
Family time
NCI says there is no need to hurry. Families may want to sit with the body, talk, or pray. NIA says this is the time for religious or cultural customs that are done soon after death. Some families want to stay. Others prefer to leave. Ask what they would like, and give them privacy. Tell your nurse about any customs, like special washing or prayers.
Families
Kind words
Families grieve in different ways. NIA says they may feel sadness, guilt, anger, or even relief. All of these feelings are normal. Offer a kind word, like 'I'm so sorry.' Listen. Don't rush them. Hospices must offer grief support to the family for up to a year after a death. If a family member needs support, let the nurse or social worker know.
Your grief
It's normal
You may grieve too, especially after caring for someone for a long time. NIA says grief can bring sadness, numbness, trouble sleeping, and trouble focusing. There is no right or wrong way to grieve. When a hospice serves a nursing home, their agreement must say who gives grief support to the nursing home staff. Ask what support your workplace offers.
Take care
Ask for help
Talk with coworkers, your supervisor, or someone you trust. MedlinePlus says friends, family, and faith can be sources of support, and grief counseling helps some people. NIA says if sadness makes it hard to get through daily life, help is available. That can come from a support group, a counselor, or loved ones. Take breaks and rest. Remember that you gave comfort when it mattered most.
Quick review
Respect to the end
Let's review. If someone is not breathing, get the nurse and follow your emergency steps. The nurse checks code status. A doctor or nurse pronounces death, not the aide. Care for the body gently, with privacy, by your policy. Give families time for customs. Grief is normal for families and for you. Ask for support.
Your facility's policy (ask your supervisor):
Emergency steps when a person is found not breathing, and how aides learn code status
After-death care policy (who does it, removing devices, belongings, labels)
Who to call after a death and in what order (nurse, hospice, family, funeral home)
Grief support for staff (for example, an employee assistance program or hospice bereavement services)
Answer every question. You need 80% to pass. You can try again as many times as you like.
Your quiz covers the lessons for: Nursing home ( questions). Change your setting
Please read
This free course gives you a certificate of completion from Pact Compliance. It is not continuing education (CE) credit and is not approved by any state.
Your employer decides whether it counts toward required in-service hours. Home health and hospice aide training must be given or supervised by the agency's registered nurse.
California: it does not count toward CNA or HHA renewal hours.
Your name and quiz answers stay in your browser and are never sent to Pact.
Pact Compliance LLC, Cordova, TN
Certificate of Completion
This certifies that
completed the online in-service course
Pain Recognition and End-of-Life Comfort Care
Setting
Completed
Seat time
Quiz score
Certificate ID
This free course gives you a certificate of completion from Pact Compliance. It is not continuing education (CE) credit and is not approved by any state. Your employer decides whether it counts toward required in-service hours. Home health and hospice aide training must be given or supervised by the agency's registered nurse. California: it does not count toward CNA or HHA renewal hours.
Part of this topic needs a hands-on check with your supervisor; this online course does not cover that part.
Pact does not keep a record of this certificate. Print it or save it as a PDF and give a copy to your supervisor. pactcompliance.com/free-training/pain-end-of-life-comfort-care/
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