Skipping the chicken soup and focusing on the soul: food and hospice care
By Terre Mirsch
Much of my career as a hospice nurse was in the South Philadelphia community, where I had the good fortune to witness the hospitality and wonderful traditions that make Philadelphia a melting pot of culture and customs. The smell of gravy (spaghetti sauce for us non-Italians) on the stove, soft pretzels, Philly steak (with or without cheese) venues on street corners, and bakeries where locals gathered to purchase sfogliatelle, cannoli, and Italian cookies marked the beginning and end of each day. While food was not the only claim to fame of the community, it certainly was a focus and a way of life. It was the manner in which family, friends, and neighbors demonstrated love, caring, and community.
As my career continued, I had opportunity to witness the culinary traditions of many other communities within the City of Brotherly Love and its suburbs. Even during a hospice business trip to Alabama, local food favorites (including an incredible peanut butter pie) were provided from the moment we arrived until the moment we left. What I quickly learned was that no matter what community, food carries with it tradition and a demonstration of hospitality. Whether during times of joy or sorrow, or during health or illness, food is often the focal point- the universal language that shows we care for and about one another. Chicken soup nourishes the body, and our soul. It is no wonder, then, that families struggle so when their loved one is no longer interested in food and other sustenance.
Almost always, as illness advances, one loses their appetite. Interest in food that may have once been a defining feature of their life diminishes. Medical explanations about why this occurs help us intellectually understand that the body needs less food because less energy is expended. As body systems that digest and eliminate food and fluid slow down; this decrease in food and fluid improves comfort and symptoms associated with illness—including nausea, vomiting, shortness of breath, edema, and incontinence—subside.
But all of these medical explanations don’t really get to the heart of the matter, as they don’t address the social and emotional void that we feel when our loved one rejects the food we offer them. Often we internalize this- not as a rejection of the food- but as a rejection of our love. And because food has always been the way that we demonstrate our love and caring, we don’t know what else to do. Daily battles ensue as we desperately try to get our loved ones to eat just one more bite.
Understanding why nutritional changes occur may help you to feel more confident in caring for your loved one. Changing the way that we offer food and finding other ways to demonstrate our love and care may make time with your loved one more peaceful and meaningful.
- Let your loved one decide when, what, and how much to eat will provide a sense of control that honors their dignity.
- Offer food favorites (check with your health care team if your loved one has dietary restrictions), understanding that taste and preferences may vary from one day to the next. With that in mind, don’t buy too much of any one food.
- Offer small, frequent food choices served on small plates. Remove the plate once your loved one is no longer interested.
- Choose soft foods that are easily swallowed are typically preferred over foods that require chewing.
- Pay attention to mouth care. Using moisturizing balms will keep mucous membranes from becoming dry and cracked. I recall my daughter moistening the lips of her Pop-Pop—a task that allowed her to participate in care, demonstrate her love, and provide him great comfort.
- Add skin care to your routine. Hydrating skin lotions keep skin moist and may deter skin breakdown. The touch associated with skin care demonstrates care, compassion, and love.
Instead of eating together, watch television or a favorite movie, read to your loved one, listen to music, or just sit quietly together. This is a time when ‘being with’ is much more important than ‘doing for’.