Meeting the Moment with Gentle Eyes: PTSD and Hospice Care

At the end of life, peace is possible. But only if we know what stands in its way.

When we think of post-traumatic stress disorder (PTSD), we often picture veterans, survivors of abuse, those who have experienced systemic violence, been in an accident, or are experiencing profound loss. What we don’t often consider is how PTSD can emerge in the final stages of life—when dying itself can reawaken long-buried trauma.

1. The Overlooked Struggle of Dying with PTSD

PTSD in medical patients is frequently misunderstood or missed altogether. Many are dismissed as “difficult” or “uncooperative,” when they are overwhelmed by a reactivated nervous system.

For those with a terminal diagnosis, the stressors of dying—loss of control, unfamiliar settings, new providers coming to and from their bedside, pain, and dependency—can mimic or amplify original trauma. This can lead to:

Distress during life review, as trauma-related memories surface
Avoidance and distrust, making medical care and communication harder
Emotional isolation, especially for those without caregivers
Physical symptoms like pain, insomnia, and tension

Even the most routine aspects of care—oxygen masks, restricted mobility, hospital beds—can feel threatening for someone carrying invisible wounds (and particular sensations involved in that care can also be problematic, especially for veterans experiencing PTSD).

2. Why Trauma-Informed Care Matters at the End of Life

To truly serve patients facing death, we must recognize the deep prevalence of trauma in those we care for. Older adults are especially at risk, having had more time to experience trauma, and are also more vulnerable to delayed-onset PTSD.

Medical care itself can unintentionally retraumatize. The impersonal nature of modern healthcare, invasive technologies, and urgent decisions can strip away a patient’s sense of agency.

What’s worse: untreated PTSD can block patients from achieving resolution, connection, or spiritual peace at the end of life. The very symptoms of PTSD—hypervigilance, avoidance, re-experiencing—often oppose the goals of hospice: comfort, closure, and meaning.

3. Holding Space for Pain for Every Patient

For some patients, hospice may be the first—and last—time anyone has acknowledged their emotional pain and/or trauma.

While we cannot undo the trauma they’ve endured, we can create a safe place to hold that trauma with a patient, practicing active listening when they share what they share in whatever way is comfortable.

4. Hospice of Orange & Sullivan Counties Commitment to Trauma-Informed Care:

There’s a growing consensus in the medical community: hospice and palliative care must be trauma-informed. Trauma-informed care shifts the focus from “what’s wrong with you” to “what happened to you?”; and then, to “what’s strong with you?” Using a person-centered framework, such care is grounded in an understanding of and responsiveness to the impact of trauma and how that can manifest in patients.

But, the success of Trauma-Informed care depends on large-scale, agency wide commitment. Every clinician, nurse, aide, administrator, and staff member must understand the basics: how to recognize distress, how to speak gently, how to help a patient feel safe and seen.

Hospice of Orange & Sullivan Counties is committed to creating an environment where every patient is met with dignity, empathy, and understanding. As we further our trauma-informed practices throughout our organization, we renew our promise: to care for the whole person, not just the diagnosis, and to honor and care for the emotional, spiritual, and physical needs of each person we serve.

Source Material:

American Academy of Pediatrics. (n.d.). What is trauma-informed care? National Center for Relational Health and Trauma-Informed Care. https://www.aap.org/en/patient-care/national-center-for-relational-health-and-trauma-informed-care/what-is-trauma-informed-care/

Janssen, S. (n.d.). Trauma-informed care at the end of life. International Society for Traumatic Stress Studies. https://istss.org/member-reflections-trauma-informed-care-at-the-end-of-life-scott-janssen-lcsw/