Offering your loved one food and drink
Why is eating and drinking still important?
Generally speaking, your loved one’s appetite for food and drink will decline and you will notice that they eat less and drink less. This is normal but your understanding of what is happening to them will affect how you feel at first, when you come to the Cottage Hospice, and how you will continue to feel as your loved one approaches death.
At this stage of their illness, your loved one’s bodily functions will be steadily slowing down and they will need food and drink less; you may have noticed this slowing down already. But our instincts and habits mean that the smell, sight and taste of food and drink remain a pleasure, so providing it effectively is an act of not only kindness or compassion but also one of affection. You love them, so seeing them enjoy their favourite food is fulfilling.
Be prepared for surprises as it is not uncommon even in someone’s last few days of life to suddenly ask for whatever it is they fancy! Chances are, they will take just a bite or two or not even attempt to eat it once you have gone to the effort of getting it. Although that might feel frustrating and disappointing please don’t be dismayed, your loved one will not starve to death or die of dehydration in the Cottage Hospice.
There will be no definite pattern to appetite or thirst, so please forget scheduled mealtimes and “it’s time for your mid-morning cuppa”. “As and when” your loved one needs is the order of the day but at night this may be outweighed by your need to catch up on sleep. You don’t need to nag them to eat or drink every couple of hours.
How to provide food and drink for your loved one
We have talked about your loved one’s bodily functions slowing down as they approach death and that they will need food and drink less and eventually not at all, when they remain unconscious rather than slipping in and out of consciousness. People in their last days of life vary in their needs and the family caregiver’s challenge is to try to meet those needs in a loving and caring way. The practical tips below are to help you to meet that challenge.
Pleasure in satisfying thirst or enjoying the smell, sight and taste of favourite food is instinctive. Offering them is an act of kindness and caring. “Offering” in this situation is a key word rather than “feeding” your loved one or keeping their water level up. They may choose not to eat or drink at all and you need to learn to respect this and not feel or show feelings of frustration.
At the Cottage Hospice, your room has its own fridge and cupboard, so you can stock up your loved one’s favourite foods – the Cottage Hospice provides cooking facilities and utensils in a separate kitchen and the Café provides snacks and drinks.
What about cooking and serving the food?
When some families first come into Cottage Hospice, the family caregiver may cook proper meals and serve them as they would at home, using cups, saucers, cutlery and plates. Some people enjoy a bit of formality and this can enhance the stimulus of food – a plate seems more normal and less functional than a bowl and similarly a cup and saucer compared to a feeder cup but equally, drinking tea from your favourite mug helps some people.
As your loved one approaches death there will probably be a decline in terms of appetite and ability to take in food and drink. They may start to gag over solids and lose interest in food altogether. While feeding them solids may become impossible, they may still drink liquids in small sips. Even taking sips may cause regurgitation and coughing but this is normal and you just need to take it slowly, at a pace they can handle. Coughing is normal and shows that their reflexes are still working
At this stage, they may find it hard to maintain an upright position and feed themselves, so they will become totally dependent on you. You need to think carefully about this shift in feeding and drinking – do discuss this with one of the Cottage Hospice team.
When and how often do you offer food and drink?
How do you offer food and drink respectfully?
Above all, by not trying to impose a routine. Don’t wake your loved one at 1pm because it’s lunchtime and don’t think, “They haven’t eaten for 5 hours, I must persuade them to eat now” - it’s their choice.
Keep an eye on what’s happening. If your loved one wakes up, particularly if they’re moving in the bed, try to find out what’s going on and whether they want anything. If they say ‘no’ to food or drink or shake their head, just accept that. If they say ‘yes’, ask what they want. Try to have favourite foods available in the room’s fridge or cupboards; the Cottage Hospice provides some meals, and, during the day, you can get snacks, and drinks, from the Café.
There’s water obviously; keep a stock of tea, coffee and squash in the room cupboard, and fruit juice in the fridge.
Top tip: It can be helpful to make ice cubes flavoured with your loved one’s favourite juice or squash. If you break the cubes into chips you can refresh their mouth without them taking in too much liquid. This is just one example of how to process food and drink to make it easier to consume and more appealing
What if your loved one refuses the favourite pudding you’ve spent half an hour preparing?
You need to accept that refusal, frustrating and disappointing as it may be. You can’t make them eat or drink, and it wouldn’t be right for either of you if you tried.
You can make sure the room looks, smells and feels the way they would like, and that the bathroom door is shut. If your loved one wants to eat, you want it to make it as nice an experience as possible and it also makes them feel loved and cared for. For the same reasons, make sure remains are cleared away after they have eaten.
At this point, rather than treating the challenges as an obstacle, you have the opportunity to adapt feeding and drinking to the change in your loved one’s condition and still maintain a positive and respectful experience even though his situation had changed. For example, you can put a sick bowl and tissues discreetly under the bed in case they’re needed.
You can prepare food in small amounts and liquidise it, without turning it into a sludge - different colours, textures and tastes help enjoyment. For example, whereas they may have enjoyed fruit and rice pudding, liquidising the solids will make it easier to swallow and still smell and taste as they did in solid form. Use a teaspoon instead of a dessert spoon.
When your loved one has eaten all they want, try offering a drink with a straw or feeder cup. Allow them to take sips at their own speed and in mouthfuls they can handle. Perhaps later you can do mouth care and offer flavoured ice chips to moisten their mouth.
You may find that as the hours pass, you can discipline yourself not to rush food and drink and (very importantly) can savour these moments together rather than seeing it as an exercise in avoiding hunger and thirst.
Picking up on gradual change
Picking up the point about the gradual change in how your loved one takes in food and drink, you will certainly find that the way you respond to this pattern of change will need to be adapted in order to create the best experience possible, given that they are in their last days before death. Watch for change, discuss and take advice from the Hospice team and experiment so that you keep providing the best possible end-of-life experience for your loved one and their family.
The time will come when your loved one doesn’t slip in and out of consciousness and will neither want food and drink nor need it to avoid starvation. At this time, mouth care alone will keep your loved one comfortable.
This waiting and watching, and taking advice, and experimenting, and offering, and preparing, and serving, and helping your loved one eat and drink may sound like you’ll be working hard, but there will be plenty of advice and practical help for you and your family. We hope that you will have other family members to share the load and the privilege of caring for your loved one. In terms of closure, making loving and positive memories for the future is important too.