Category: Advance Directives

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People who see death and trauma each day ask: WGYLM?

UC San Diego Nurses use a clever guerrilla marketing campaign to get their colleagues thinking about advanced directives.

By Paul Sisson

[O]nly one in four Americans has written down their end-of-life wishes in case they end up in a hospital bed unable to communicate — despite high-profile cases over the years that have plainly shown the emotionally painful, expensive and sometimes lawsuit-ridden consequences of not making those wishes known in advance.

A group of UC San Diego nurses and doctors is engaged in an effort to increase that ratio, building a wide-reaching campaign that started with just five letters and a question mark.

Operating like a guerrilla marketing group, albeit with the approval of two key hospital bosses, they began posting signs at both UC San Diego hospitals and its seven largest clinics. The signs simply asked: “WGYLM?”

At first, they refused to explain to others what those letters meant.

“We considered that a great victory to hear, that we were irritating people with our message. It totally primed them to be on the lookout for the answer,” said Dr. Kyle Edmonds, a palliative care specialist.

In March, the letters expanded from a five-letter bloc into the question, “What Gives Your Life Meaning?” There were small signs spelling it out and seven chalkboard-size whiteboards with the question written in large letters at the top. A bucket full of Post-It notes and pens was attached to each whiteboard display and very quickly, people wrote and pasted up their responses.

God has figured into many of those messages. There also have been plenty of first names, heart outlines and attempts at humor — including a note that said, “cheese biscuits.”

Some have been quite dark. Politics have been mentioned as well, including President Donald Trump and his proposed border wall.

The next step for the project group, after thousands of notes had built up, was to add the kicker question: “Have you told anybody?”

It’s not enough to answer the question for yourself, said Edmonds and colleague Cassia Yi, a lead nurse at UC San Diego. They want people to tell their loved ones — in writing — what matters most to them, including how they want to be treated upon death or a medical emergency.

The campaign’s organizers hope that getting people to think about the best parts of their lives will provide an easier entry point for end-of-life planning.

The National Hospice and Palliative Care Organization recommends that everyone fill out an advance directive to make their wishes known in writing. Also often called “living wills,” these are witnessed legal documents that confer medical power of attorney to the person you designate if two doctors certify you are unable to make medical decisions.

Each state has its own form, and California’s asks people to specify whether they want a doctor to prolong their life if they have an irreversible condition “that will result in … death within a relatively short time or if they “become unconscious and, to a reasonable degree of medical certainty … not regain consciousness.”

This has been fraught territory, with many high-profile cases in the courts of distraught families wrestling over the decision to remove life support without any knowledge of the patient’s true wishes.

That includes the case of Terri Schiavo, who was left in a persistent vegetative state after a heart attack in 1990 caused severe brain damage. Her parents clashed with her husband, Michael, who asked the court to order her feeding tube removed in 1998 on grounds that she would not have wanted to live in such a state. Because she had no living will, it took years of very public legal wrangling before life support was disconnected on March 18, 2005.

Yi said she and other nurses feel this type of gut-wrenching stress every time a “Code Blue” page sends them scrambling for a patient who needs immediate resuscitation. Most of those patients don’t have wills or other written indications of their wishes in place, even though every patient is asked if they have an advance directive upon admission to the hospital.

“Advanced care planning wasn’t happening until people were coding out. There is nothing advanced about that,” Yi said.

Even before the current awareness campaign, Yi and her colleagues had worked with computer experts to add special categories to UC San Diego’s electronic medical records system that provide a single collection point for this kind of information. Previously, such details could be entered in dozens of different places, depending on the whims of whoever was taking notes at any given moment.

The project team also got the computer programmers to add a shortcut that allows caregivers to quickly access an advance-directive template.

Since the revamped system went live in February 2015, Edmonds said there has been a 469 percent increase in the number of patient charts that include some sort of information about end-of-life care.

But the project was not reaching every patient — or enough of the university’s medical staff.

Yi recalled a trip that some UC San Diego nurses took to the CSU Institute for Palliative Care at Cal State San Marcos. There, they saw “WGYLM?” signs and learned what the acronym meant. At the time, Cal State San Marcos was in the early stages of creating the “What Gives Your Life Meaning?” project.

The nurses thought: Why not adopt that program for UC San Diego as well? They liked that the operation could be rolled out in a provocative way and that it didn’t simply ask people to fill out advanced directives.

“It just makes an introduction in a more positive, intriguing light,” Yi said.

So far, nearly 1,300 employees in the UC San Diego Health system have taken the pledge to prepare their end-of-life documents and talk with their loved ones about these issues.

Sharon Hamill, faculty director of the palliative care institute at Cal State San Marcos, said the “WGYLM?” campaign has been held on that campus for three years in a row and has spread to sister campuses in Fresno and Long Beach.

She said the signature question was created by Helen McNeil, who direct’s the California State University system’s multi-campus palliative care institute, which is also housed on the San Marcos campus.

Hamill also said the message resonates strongly with people of multiple generations, including college students taking care of ailing grandparents or even parents.

“I love it when one of them stops me somewhere and tells me they saw one of the signs and were thinking about it all the way to class,” she added.

For more information about advance directives, go to nhdd.org.

Complete Article HERE!

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Planning for death: Still not easy to talk about ‘taboo’ issue

Almost 10,000 have completed end-of-life arrangements through Advance Care Planning

Madam Amiron Jee

By Foo Jie Ying

[A] former nurse, she has seen her fair share of patients dragging out their final days on life support.

She is also a cancer patient. When she felt her body “going downhill” in late 2014, the Singapore General Hospital (SGH) volunteer, who had heard of Advance Care Planning (ACP) decided to find out more about about it.

She later completed her ACP with the SGH social service department.

The mother of three told The New Paper: “When I fell quite ill then, I was thinking, good thing I had this thing done. I informed my children (about my ACP).”

ACP is a series of conversations about one’s wish for care and treatment in the event of difficult medical situations, when one becomes too ill and is unable to make decisions for oneself.

It can be conducted informally between individuals and their loved ones at home using a workbook by the Agency for Integrated Care (AIC), or formally with trained facilitators present.

Close to 10,000 people have completed formal ACPs to date, since AIC rolled it out in 2011.

The Ministry of Health will reach out to 25,000 Singaporeans over the next four years, said Minister of State Chee Hong Tatlast month.

ACP will also be expanded to different care settings, like specialist outpatient clinics and in primary care, he said.

There is reluctance to talk about death because most people think a medical crisis will not happen to them, said Mr Mark Lin, who started the Good Death project to encourage early end-of-life planning.

The deputy director of Special Projects (Eldercare) at charity Montfort Care told TNP: “The idea of talking about planning for situations if anything happens to yourself can be quite a taboo.”

Madam Jee’s husband is one such example.

The couple had approached SGH’s social service department together, but unlike her, he refused to do an ACP because it is “pantang” (Malay for taboo).

But for Madam Jee, who battled breast cancer in 1998 and lung cancer in 2015, and was diagnosed with Stage 4 brain cancer last year, conversations about death are a matter of pragmatism.

“For me, I’m doing this partly for the sake of my children. I’m a cancer patient. For cancer patients in the terminal stage, it’s very hard to recover because the cancer cells are eating the body up.

“I don’t want my children to feel guilty for suggesting to let me go in peace instead of putting me on artificial nutrition to survive. It may sometimes stay with them, with them thinking ‘I shouldn’t have done that’,” she told TNP.

With her funeral arrangements made, the Muslim also does not have to worry about her three US-based children being unable to rush back in time for her burial, which must be done as soon as possible..

While it is still not easy to talk about end-of-life issues, AIC deputy chief executive Wong Kirk Chuan told TNP he hopes to overcome this by working with partners like the Singapore Hospice Council to raise awareness on these issues.

Instead of waiting for a medical crisis, Dr Wong encouraged early ACP conversations, which offer peace of mind.

Mr Lin, whose youngest clients include a 38-year-old couple, agreed. He said: “The whole point of the ACP is not what you put on the document, although it is a formal record of your wishes. It’s about the process of talking about such things.

“ACP is like a health booklet that follows you as you age. It’s something you have to keep updating.”

Complete Article HERE!

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Sharing One’s End of Life Choices – via a Mobile Device

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[P]atients can now use their smartphones to share their wishes for end of life care — whether or not they want to be intubated or have CPR, for example — with ambulance crews, loved ones, emergency-room doctors and hospitals.

No more fumbling for a piece of paper, signed by the doctor, to show health-care providers when a terminally ill loved one is rushed to the hospital. Patients in New Jersey can have their wishes become part of their electronic medical record and shared on mobile devices.

The online version of the “Practitioner Orders for Life-Sustaining Treatment” was launched Friday, almost five years after New Jersey authorized the use of a paper form for frail and severely ill patients. The online version will be part of a registry maintained by the New Jersey Hospital Association, with strict safeguards for patient privacy.

“We’re moving beyond having a green paper hanging on the refrigerator,” said Health Commissioner Cathleen D. Bennett, speaking of the paper version of the POLST forms. When patients articulate their preferences, it helps them to live on their own terms at the end of life, she said.

They can also express their goals for care, ranging from a full attack on their disease to palliative or comfort care. The form is signed by both the patient and the doctor or advanced-practice nurse, and is considered a medical order. Emergency personnel can follow it whenever the patient can’t speak for himself.

Joseph Carr, NJ Hospital Association Chief Information Officer, demonstrates how the emPOLST can be accessed electronically and how it can help inform care.

“Through this tool, more health-care providers will have immediate access to critical information they need to treat the patient according to the patient’s health-care preference,” Bennett said. “Patients with smart phones also will be able to share their electronic POLST form with a new physician, specialist or emergency-room doctor.”

In New Jersey, about 11,000 patients a year created POLST forms at each of the hospitals that participated in a study of it, said Joseph A. Carr, chief information officer for the New Jersey Hospital Association, who demonstrated the electronic version.

At a ceremony at the Villa Marie Claire Hospice in Saddle River, Bennett and Betsy Ryan, president of the association, signed an agreement for the association to become the online repository for the POLST forms. The villa, a former convent, is an inpatient hospice for 20 patients that is part of Holy Name Medical Center.

Talking about the end-of-life is one of the most important conversations a family can have, said Michael Maron, president of the medical center. The hospice’s decade of work has taught him that patients feel comforted and empowered when they are able to communicate their choices clearly and effectively, and they are understood by caregivers and loved ones.

The POLST form is available from the Department of Health or the New Jersey Hospital Association. For more information, also see National POLST Paradigm.

Complete Article HERE!

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We’re dying more at home. That’s good

[F]or many years now, pollsters have asked Americans where they would rather die, in home or in a hospital.

Once the initial shock of the question wears off (“Who said I was going to die in the first place? How dare you!”), most of us answer that we would prefer to die at home, in familiar settings, surrounded by loved ones. It makes sense.

Then, of course, most Americans go off and die in the hospital, in large part because they haven’t made their end-of-life wishes known to people who might have to make those decisions. (Or, in the alternative, because they haven’t thought that much about their end-of-life decisions in the first place.)

Oregon is an exception. And that’s a good thing.

recent article in The New England Journal of Medicine noted that nearly two-thirds of Oregonians who died in 2013 did so at home, as opposed to 39.6 percent of Americans. (The article relied on statistics from Medicare and defined “home” as wherever the person was living at the time of death.)

The article, by Dr. Susan W. Tolle, head of the Center for Ethics at Oregon Health & Science University, and Dr. Joan M. Teno of the University of Washington, had other good news for Oregon residents who might die someday:

  • The rate of intensive care unit use in the last 30 days of life in Oregon was 18.2 percent, as compared with 23 percent in Washington state and 28.5 percent in the rest of the United States.
  • Patients who were hospitalized in the last month of life were more likely to be discharged to their homes in Oregon (73.5 percent) than in Washington (63.5 percent) or in the rest of the United States (54.2 percent).

These numbers likely will not surprise anyone who’s followed Oregon’s efforts to lead the way in the tricky issue of end-of-life care. In their article, Tolle and Teno argue that one big step forward came in 1995, when Oregon created a POLST program.

POLST is an acronym for Physicans Orders for Life-Sustaining Treatment; the program essentially allows patients to document their preferences regarding the use of life-sustaining treatment. Ideally, medical providers have access to a patient’s POLST documents and abide by their instructions.

But just having a POLST program in place is not enough, the article notes: After all, Washington state has a similar program, but it trails Oregon in some of the metrics that Tolle and Teno were tracking.

The difference between the two states? At the risk of oversimplifying, a lot of it comes down to execution and follow-through.

In the decades since Oregon adopted the POLST program, the state has developed educational materials about it, organized conferences to spread the word, researched the issue and (perhaps most importantly) maintained a statewide registry of POLST participants. That electronic registry allows medical providers throughout the state to access it to check on a patient’s wishes at the end of life; that’s important because those patients may not always be able to speak for themselves.

Washington had a registry in place, but abandoned it because it wasn’t widely used.

Oregon’s POLST system isn’t perfect: For example, Tolle and Teno note that one-click access to the POLST form from a patient’s electronic medical records is not yet available in most hospitals. We need to keep measuring our progress and improving our systems.

Perhaps the best part of filling out the POLST forms is that it provides a starting point for conversations that are easy to put off. No one likes talking about death. But talking about it now might help ensure that we can die on our own terms.

Complete Article HERE!

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Many end-of-life talks end in confusion, study shows

By Dennis Thompson

You’ve filled out a living will, and designated a surrogate to make medical decisions if you’re incapacitated.

But, your end-of-life planning may not be done yet.

That’s because, according to a new study, your surrogate may still not have a clear idea about what you really want done in a crisis situation — even after you’ve discussed your wishes with them.

In the study, seven out of every 10 surrogates didn’t have an accurate understanding of their loved one’s wishes regarding potentially life-altering medical treatment, even though both believed they had adequately discussed the topic.

“There were a lot of surrogates in those pairs where they both said, ‘yes, we’ve had this communication,’ who didn’t have a good understanding of the patient’s goals of care,” said lead researcher Dr. Terri Fried. She is a professor of geriatrics with the Yale School of Medicine.

The surrogates couldn’t accurately say whether their loved one would want treatment even if afterward they would have to live in extreme chronic pain or with severe mental or physical impairments, Fried said.

“Those are the kinds of things that make people say, ‘Oh, maybe I don’t want to get life-sustaining treatment if that’s the way it’s going to leave me,’” she explained.

These results show health-care professionals need to take a more active role in helping patients make end-of-life preparations, and that includes facilitating in-depth conversations between them and their chosen surrogates about their preferences, Fried said.

“It’s becoming more a part of the responsibility of primary care to make sure this happens as part of health maintenance, the same as flu shots or cancer screening,” Fried said. “We need to do a more thorough assessment of what patients have done and haven’t done, so we know what they still need to do.”

For their study, Fried and her colleagues interviewed 350 veterans, all aged 55 or older. The researchers also separately interviewed their end-of-life surrogates.

Just over half of the surrogates were spouses. Another 27 percent were children. The rest had other relationships with the veterans, according to the study.

About two of every five veterans hadn’t bothered to complete a living will or officially designate someone as their surrogate (health care proxy), or talked about the quality of life they’d like to maintain near the end, the findings showed.

And often, surrogates remained in the dark about the loved one’s wishes even if both agreed that they had discussed the matter.

Only 30 percent of surrogates who thought they’d talked it over could display an accurate knowledge of their loved one’s desires regarding quality versus quantity of life, the researchers found.

That’s better than the performance of surrogates who hadn’t had the conversation (21 percent) or pairs that disagreed whether they’d discussed the matter (15 percent), Fried noted.

But that still leaves a majority of people in a position of thinking that their surrogate knows their wishes when the person really doesn’t, the study authors pointed out.

“Part of it is that patients and surrogates don’t really know what the things are that they ought to be talking about,” Fried said.

In joint interviews conducted after the main study, many of the pairs said that “after you asked us those questions, we realized these are the things we need to sit down and talk about,” she added.

Dr. Timothy Farrell is an associate professor of geriatrics with the University of Utah School of Medicine in Salt Lake City. He said that “a visit with a physician is often the first time that such a discrepancy may become apparent.”

Doctors who treat the elderly should consider end-of-life conversations as “anticipatory guidance,” similar to the guidance provided parents during well-child visits, Farrell said.

Either a doctor, a physician assistant, a social worker or some other health-care professional can help lead a facilitated discussion that ensures someone’s wishes have all been communicated to the surrogate, he suggested.

“Being proactive is the key, [as is] regularly coming back to this topic before the crisis occurs,” Farrell concluded.

The study was published March 20 in the Journal of the American Geriatrics Society.

Complete Article HERE!

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How do you want to die? Write it down.

By

[M]ost Americans are unprepared for the worst to happen—an accident or an unexpected illness that leaves them brain dead, but still alive.  That’s what happened to Terri Schiavo, a young woman who became comatose after suffering a heart attack in 1990.  

Schiavo was kept alive by a feeding tube for fifteen years.  During that time, her husband tried to withdraw the feeding tube, but was adamantly opposed by Schiavo’s parents, Congress, and President George W. Bush.  After a highly publicized legal battle, the feeding tube was finally removed and Schiavo died two weeks later.  This protracted battle might have been avoided, if Terri Schiavo had completed a document known as an advance directive.  

Post-Terri Schiavo

81-year old Leah Brueggeman wants her intentions made clear, in the event she is unable to express her wishes for medical treatment.  She and her husband live in La Crosse, Wisconsin and they completed their six-page advance directives in 2009 with the help of an attorney.  “We don’t want to be put on feeding tubes indefinitely,” says Leah. “If there’s no chance of recovery—just let us go!”

The advance directive is a legal document that has two parts.  One specifies the kind of medical care a patient wants if he is no longer competent.  For example, CPR if his heart stops, feeding tubes if he can no longer eat on his own, IV fluids for hydration.  Or he can refuse any or all of these interventions.  The patient also designates someone trusted who can make medical decisions on his behalf if he is unable to.

The Schiavo case brought more public attention to the importance of having an advance directive.  But that interest quickly receded.  Today, only a third of all Americans have completed an advance directive. Dr. Ruma Kumar, a palliative care specialist and regional medical director with Kaiser Permanente of Northern California, says that many patients are too afraid to plan for their future health care and their doctors are often reluctant to bring up planning.  According to Kumar, doctors don’t have the time to engage their patients in extended end-of-life conversations.  “Or if you bring up planning, you might make the patient nervous that you’re giving up hope in their treatment plan,” she says.  

Limits of advance directives

But even if an advance directive is completed, a patient’s stated wishes may not always be carried out.  The document can get overlooked, misplaced, or ignored by medical staff, as Katy Butler found out.  “Hospitals are a world of their own,” says Butler. “It’s like a foreign subculture.  And once you enter into that system, it can be very, very difficult to get your wishes put into practice.”

Butler is a Bay Area journalist who wrote the best-selling memoir “Knocking on Heaven’s Door:  The Path to a Better Way of Death.”  In her book, Butler described her own difficult experiences, trying to get her father’s advance directive enforced.  She recalls going up against a wall of resistance when his physician refused her request to withdraw treatment for her dying father.  

Butler’s father was 79 when he suffered a major stroke in 2002, which caused brain damage and dementia. He had a weak heart and Butler says he probably would have died of natural causes within two years following the stroke.  But his pacemaker kept him alive for the next six years.  In her memoir, Butler says that the extra years of life caused him great misery.  “The tipping point had come,” she writes. “Death would have been a blessing and living was a curse.”

As her father’s designated medical agent, Butler went to his cardiologist and requested that the pacemaker be turned off.  “The doctor not only refused to cooperate—he really treated us as if we were some kind of moral monster,” Butler says. “Technically according to the law, you have the right to refuse any form of medical treatment and you have the right to request the withdrawal of any form of medical treatment.  But you’ve got an advanced device like a pacemaker—you don’t know how to turn it off.  You don’t know where to go to get someone to help you turn it off if your cardiologist is saying no.”

La Crosse, Wisconsin—the best place to die in America

One place Katy Butler might have gone for help was La Crosse, a small city on the Mississippi River in Wisconsin.  La Crosse is known for its steamboats, Wisconsin cheese, and its excellent end-of-life care.  La Crosse is the home of the Gundersen health system, ranked in the top one percent of hospitals nationwide. An astounding 96 percent of all La Crosse residents who died last year had completed advance directives. That figure far exceeds the number of people who complete advance directives in the Bay Area and the rest of the country.  

Dr. Bud Hammes, Gundersen medical ethicist

Dr. Bud Hammes, a medical ethicist at Gundersen, led the effort to improve end-of-life care in La Crosse. The key to success, says Hammes, was creating a supportive culture of person-centered care that honors a patient’s goals and values.  “It isn’t just about training a few people to have these conversations with patients,” Hammes says. “It’s actually about changing the culture of the health care system and ultimately of the community.”

To change the culture at Gundersen, Hammes convinced hospital administrators in the late 1980’s that end-of-life care needed to be given higher priority.  An electronic medical record system was created to document patient preferences.  That way, advance directives are easily accessible and can’t get lost.

End-of-life conversations and advance directives are now part of the hospital’s routine practice.  Michael Sigmund is a long-time La Crosse resident and patient at Gundersen.  He explains,“It’s the nurse who asks the question when you first walk in the door.  ‘How are you doing?  You have any pains today?  Do you have an advance directive?’”

Michael Sigmund (far left) at La Crosse Coffee Shop

Others come to Gundersen to complete their advance directives because of peer pressure from friends and family.  Karen (who did not want her last name used) sought out the assistance of Gundersen facilitator Janet Olmstead for help with her advance directive.  Karen put off this visit for many years, but finally overcame her hesitancy after speaking with a friend.  “I don’t want somebody else stuck with making decisions,” she says. “It’s a burden for them to make decisions that they don’t know what I want.  So I just thought, ‘now is the time.’”

Karen and Janet Oldstead, a Gundersen advance care planning facilitator

Karen says she doesn’t want heroic measures or life-prolonging treatments if she’s no longer functional. Like Karen, many of Gundersen’s patients want medical treatments stopped if there’s little or no hope of recovery.  Honoring patient preferences has resulted in fewer tests and expensive procedures.  “We are very successful in outcomes in decreasing the costs at the end of life in comparison to lots of other systems,” says Gundersen CEO Dr. Scott Rathgaber, “I can tell you that’s millions of dollars that are left on the table because of our commitment to the patients.”

The Gundersen program was so successful that Hammes took it city-wide.  In the early 1990’s, Gundersen partnered with the other three local hospitals and formed a coalition called “Respecting Choices”.  It brought churches, social service agencies, and nursing homes together and trained their staff to do community education and outreach.  This concerted 25-year campaign has done much to raise public awareness around end-of-life planning and advance directives.  

The La Crosse model comes to the Bay Area

Inspired by La Crosse’s success, Kaiser Permanente worked with Gundersen and started its own Life Care Planning program in 2012. Among its goals is to increase the number of patients completing advance directives.  Over 600 physicians, nurses, and social workers have now been trained as facilitators.  Kaiser palliative care specialist Ruma Kumar says much of what Kaiser did was modeled after the Gundersen program.  “We’re hoping to do the same thing over the next eight to 10 years,” she says. “To get greater than 90 percent of our patients with planning done.”

But replicating the Gundersen model throughout the entire Bay Area presents huge challenges.  Bringing together all the hospitals and the hundreds of churches, senior facilities, and social service agencies would be extremely difficult and expensive.  In addition, the Bay Area has a much larger, diverse population with multiple languages and cultures.  Without language-proficient facilitators, outreach to all sectors of the Bay Area would be nearly impossible.  

Educational outreach efforts largely depend on volunteers organizations like the East Bay Conversation Project, a community-wide coalition working to help people plan their preferences for care at the end of life.  At a recent gathering in Berkeley, Alison Rodman and two other volunteers talked to a group of seniors on how to complete an advance directive.  She tells them that forms are available on-line.  “It’s a pretty simple document that’s legal and you don’t have to go through great expense by using a lawyer or having it notarized,” Rodman explains.

Don’t wait until it’s too late

La Crosse resident Leah Brueggeman is glad her family didn’t wait.  “And of course, we don’t like to think of death and dying but—it happens,” she says.  Several years ago, Leah’s husband Jim made the decision to stop medical treatment for his ailing mother.  But following her death, Jim had second thoughts.  “I came home and my husband—he was just nearly sobbing.  He was just distraught,” Leah recalls, “He said ‘I killed my mother.’  He said ‘We stopped her medication.’  I said ‘That’s what she wanted.'”

Leah Brueggeman

Unbeknownst to Jim, his mother had filled out an advance directive.  Leah went to his mother’s assisted living facility and found a copy of it.  “We got it out.  Her wishes are right here:  no medication blah blah blah,” Leah says. “I took that home and said ‘Honey, take a look at this.  This is what your mother wanted. You’re not killing her.'”

Jim stopped agonizing over his mother’s death, now that he no longer had to guess at what she wanted. Thanks to her advance directive, Jim and Leah were able to avoid the guilt and conflict that had torn apart the family of Terry Schiavo over 20 years ago.  

Complete Article HERE!

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What does my family need to know about end-of-life care?

By Sunrise Senior Living

[T]he loss of a loved one is always a somber experience, but thankfully, due to the continuing advancements in health services, the number of Americans that are able to spend their final days in a comfortable and controlled setting is growing.

End-of-life care allows individuals to experience that final chapter in life with a dignified and calm feeling, as well as offer family members that peace of mind, support and a sense of comfort that can help ease that sorrow during this time. Being informed and conscious of this subject makes taking those steps in coordinating this care much easier and straightforward for everyone involved.

When is it time?
There are many conditions in existence that over time can become increasingly difficult and expensive to treat. This not only can be a burden for the patient, but can also create a painful and challenging experience as well. While deteriorating conditions and intolerable discomfort are two chief concerns when considering hospice care for a loved one, things such as complicated health care needs, sustained pain, and loss of mobility or capacity are also matters that should be taken into account.

It is hard to decipher the “right time” when deciding to make the decision to begin end-of-life care. Each and every family has a different approach and belief that can affect their decision. Ultimately, this choice is one that is deeply personal and involves tough choices for the whole group.

What does end-of-life care look like?
There are several types of end-of-life care available. Hospice care is for individuals that are nearing the end of their lifetime, with a terminal prognosis of six months or fewer. Palliative care is one that is more fitting for older adults living with a chronic condition and are in need of relief from the on-going pain and symptoms. In some cases, families may also choose to provide end-of-life care from home.

In either case, a full team of medical professionals and support staff work around the clock to make sure that patients are as comfortable and well-cared for as possible. Every facility is different, which means that nurses and doctors may be supported by home health aides, spiritual counselors and social workers depending on the circumstance.

With that being said, there are people dedicated to helping family members navigate this new challenge and providing guidance with whatever might come next.

Paying for end-of-life care
The Kaiser Family Foundation reported that hospice care is covered by Medicare for eligible older adults, usually individuals with a terminal diagnosis. This organization makes affording end-of-life care easier for many families.

Other than that, Medicaid, private insurance and other sources of payment such as a pension or retirement fund may be used to pay for these services. Families should discuss different payment models and work with a knowledgeable provider to uncover all available options.

Selecting the right partner
One thing families should understand when facing the possibility of end-of-life care is being aware of all available resources available that offer support and guidance during this difficult time. The care professionals at Sunrise Senior Living can advise and help coordinate care for an older loved one. With the help of Sunrise, the best, most appropriate end-of-life care can be identified and any transition can be made as smooth and as comfortable as possible.

Complete Article HERE!