Category: Advance Directives

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Holidays a time to talk plainly about end-of-life care wishes

By Mary Thelen

Let’s talk turkey. And, no, I don’t mean gobbling like that festive holiday bird. I mean use the holidays, when family members are gathered, to go beyond the “How ’bout them Packers?” discussion. Use that precious time to speak honestly and openly about your end-of-life wishes. For example:

– Would I want a feeding tube?

– Would I want to be put on a breathing machine?

– Would I want CPR if my heart or breathing stops?

– What would be important to me if my days were numbered?

“Depressing,” some people groan. “I’ll make those big decisions when the time comes.” It’s human to want to put off thoughts of death and dying. Unfortunately, a health care crisis can happen at any time, at any age. When the unthinkable strikes – a debilitating illness, a devastating accident – families who haven’t had these discussions often are left agonizing over “what would my loved one want?”Accidental-Turkey-Death (1)

So, turn down the volume on the game, and tell your family you want to “talk turkey,” a phrase to describe serious conversation. Give yourself and your loved ones the gift of preparation:

– Talk about your wishes with those close to you.

– Seek guidance, if desired, from your religious leader.

– Fill out an advance directive to make your wishes known.

WHAT IS AN ADVANCE DIRECTIVE?

An advance directive is a legal form that tells your doctors what kind care you want if you are too ill to express yourself. One type of advance directive, Power of Attorney for Health Care, is preferred because it makes your care wishes known and also designates a person to make decisions for you if you are unable to speak for yourself.

WHERE DO I FIND A POWER OF ATTORNEY FOR HEALTH CARE FORM?

Power of Attorney Health Care is a free form, and you don’t need an attorney to fill it out. It’s readily available at your local library or online.

HOW DO I FILL OUT THE FORM?

If you don’t know where to get started, don’t worry. There are plenty of resources to help you. If you find the language intimidating, don’t be afraid to ask for help from:

– Your local hospital. Spiritual care, palliative care, social services and hospice workers all can help you.

– Your county’s Aging and Disability Resource Center.

WHEN DOES AN ADVANCE DIRECTIVE GET USED?

These forms relate to end-of-life wishes. Personal care preferences are put in motion when doctors believe a patient will not recover and the person isn’t able to express his wishes at the time.

A Power of Attorney for Health Care form gives a designated decision maker the right to make decisions. Without the form, even a spouse may need to attain legal guardianship to make health care decisions for a loved one. Going through the legal system adds time and money to an already stressful situation.

IT CREEPS ME OUT, BUT …

Tell your family: “I know this is hard to discuss.” Emphasize why it’s important: “I want to make it easier on you during a medical crisis.”

Better yet, depending on their ages, have your kids and grandkids complete an advance directive too. Anyone 18 and older needs an advance directive.

So, pass the gravy and the Power of Attorney for Health Care form.

Don’t forget the turkey. Talking about what’s important at the end of life is one of the most meaningful gifts we can give each other.

Complete Article HERE!

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What working in a nursing home taught me about life, death, and America’s cultural values

by Valery Hazanov

nursing home

 

The first thing I noticed when I began working in a nursing home was the smell. It’s everywhere. A mix of detergent and hospital smell and, well, people in nursing homes wear diapers. It’s one of those smells that takes over everything — if you’re not used to it, it’s hard to think about anything else.

Being in the nursing home is tough. People weep and smell and drool. Sometimes you can go on the floor and hear a woman in her 90s scream, “I want Mommy.”

But it’s also ordinary — just people living together: gossiping, daydreaming, reading, watching TV, scratching their back when it itches.

People at the nursing home like to watch TV. It’s always on. How strange, then, that there are no old people on TV.

For the past eight months I have been working as a psychotherapist with dying patients in nursing homes in New York City. It’s an unusual job for a psychotherapist — and the first one I took after graduating with a PhD in clinical psychology. My colleagues were surprised. “Why not a hospital? Or an outpatient clinic? Do the patients even have a psychiatric diagnosis?”

The short answer is that I wanted to see what death looks and feels like — to learn from it. I hope that I can also help someone feel a little less lonely, a little more (is there a measure to it?) reconciled.

I haven’t gotten used to the smell yet. But I have been thinking a lot about the nursing home and the people who live and die there, and wanted to share what I learned.

1) At the end, only the important things remain

“This is all I have left,” a patient recently told me, pointing to a photograph of himself and his wife.

It made me notice the things people bring to the nursing home. The rooms are usually small, so what people bring is important to them. If they have a family, there will be photos of them (most popular are the photos of grandchildren). There might also be a few cherished books, a get-well-soon card, a painting by a grandchild or a nephew, some clothes, maybe flowers. And that’s about it. The world shrinks in the nursing home, and only a few things remain: things that feel important — like they’re worth fighting for, while we still can.

2) Having a routine is key to happiness

‘m a little lazy. My ideal vacation is doing nothing, maybe on a deserted beach somewhere. I look in terror upon very scheduled, very planned people. Yet I have been noticing that doing nothing rarely fills me with joy, while doing something sometimes does. Hence, the conflict: Should I push myself to do things, or should I go with the flow and do things only when I feel like doing them? Being in a nursing home changed my perspective somewhat: I noticed that all the patients who do well follow a routine. Their routines are different but always involve some structure and internal discipline.

I am working with a 94-year-old woman. She wakes up at 6:30 am every day, makes her bed, goes for a stroll with a walker, eats breakfast, exercises in the “rehabilitation room,” reads, eats lunch, naps, goes for another walk, drinks tea with a friend, eats dinner, and goes to bed. She has a well-defined routine. She pushes herself to do things, some of which are very difficult for her, without asking herself why it is important to do them. And, I think, this is what keeps her alive — her movement, her pushing, is her life.

Observing her, I have been coming to the conclusion that it might be true for all of us. And I often think about her when I am debating whether to go for a run or not, whether to write for a couple more hours or not, whether to finally get up from the couch and clean my apartment or not — she would do it, I know, so maybe I should, too.

3) Old people have the same range of emotions as everyone else

“You are so handsome. Are you married?” is something I hear only in extended-family gatherings and in nursing homes. People flirt with me there all the time. This has nothing to do with their age or health — but rather with whether they are shy. When we see someone who is in his 90s and is all bent and wrinkled and sits in a wheelchair, we might think he doesn’t feel anything except physical pain — especially not any sexual urges. That’s not true.

As long as people live, they feel everything. They feel lust and regret and sadness and joy. And denying that, because of our own discomfort, is one of the worst things we can do to old people.

Patients in nursing home gossip (“Did you know that this nurse is married to the social worker?”), flirt, make jokes, cry, feel helpless, complain of boredom. “What does someone in her 80s talk about?” a colleague asked me. “About the same things,” I replied, “only with more urgency.”

Some people don’t get that, and talk to old people as if they were children. “How are we today, Mr. Goldstein?” I heard someone ask in a high-pitched voice of a former history professor in his 80s, and then without waiting for a response added, “Did we poopie this morning?” Yes, we did poopie this morning. But we also remembered a funny story from last night and thought about death and about our grandchildren and about whether we could sleep with you because your neck looks nice.

4) Old people are invisible in American culture

People at the nursing home like to watch TV. It’s always on. How strange, then, that there are no old people on TV.

Here’s a picture I see every day: It’s the middle of the day and there is a cooking show or a talk show on, and the host is in her 50s, let’s say, but obviously looks much younger, and her guest is in his 30s or 50s and also looks younger, and they talk in this hyper-enthusiastic voice about how “great!” their dish or their new movie is, or how “sad!” the story they just heard was. Watching them is a room full of pensive people in their 80s and 90s who are not quite sure what all the fuss is about. They don’t see themselves there. They don’t belong there.

I live in Brooklyn, and I rarely see old people around. I rarely see them in Manhattan, either. When I entered the nursing home for the first time I remember thinking that it feels like a prison or a psychiatric institution: full of people who are outside of society, rarely seen on the street. In other cultures, old people are esteemed and valued, and you see them around. In this manic, death-denying culture we live in, there seems to be little place for a melancholic outlook from someone that doesn’t look “young!” and “great!” but might know something about life that we don’t.

There isn’t one Big Truth about life that the patients in the nursing home told me that I can report back; it’s a certain perspective, a combination of all the small things. Things like this, which a patient in her 80s told me while we were looking outside: “Valery, one day you will be my age, God willing, and you will sit here, where I sit now, and you will look out of the window, as I do now. And you want to do that without regret and envy; you want to just look out at the world outside and be okay with not being a part of it anymore.”

5) The only distraction from pain is spiritual

Some people in the nursing home talk about their physical pain all the time; others don’t. They talk about other things instead, and it’s rarely a sign of whether they are in pain or not.

Here’s my theory: If for most of your life you are concerned with the mundane (which, think about it, always involves personal comfort) then when you get old and feel a lot of pain, that’s going to be the only thing you’re going to think about. It’s like a muscle — you developed the mundane muscle and not the other one.

The saddest people I see in the nursing home are childless

And you can’t start developing the spiritual muscle when you’re old. If you didn’t reallycare about anything outside of yourself (like books, or sports, or your brother, or what is a moral life), you’re not going to start when you’re old and in terrible pain. Your terrible pain will be the only thing on your mind.

But if you have developed the spiritual muscle — not me, not my immediate comfort — you’ll be fine; it will work. I have a couple of patients in their 90s who really care about baseball — they worried whether the Mets were going to make the playoffs this year, so they rarely talked about anything else; or a patient who is concerned about the future of the Jewish diaspora and talks about it most of our sessions; or a patient who was worried that not going to a Thanksgiving dinner because of her anxieties about her “inappropriately old” appearance was actually a selfish act that was not fair to her sister. Concerns like these make physical pain more bearable, maybe because they make it less important.

6) If you don’t have kids, getting old is tough

The decision to have kids is personal, and consists of so many factors: financial, medical, moral, and so on. There are no rights or wrongs here, obviously. But when we are really old and drooling and wearing a diaper, and it’s physically unpleasant to look at our wounds or to smell us, the only people who might be there consistently, when we need them, are going to be either paid to do so (which is okay but not ideal) or our children. A dedicated nephew might come from time to time. An old friend will visit.

But chances are that our siblings will be very old by then, and our parents will be dead, which leaves only children to be there when we need it. Think about it when you are considering whether to have children. The saddest people I see in the nursing home are childless.

7) Think about how you want to die

José Arcadio Buendía in One Hundred Years of Solitude dies under a tree in his own backyard. That’s a pretty great death.

People die in different ways in the nursing home. Some with regrets; others in peace. Some cling to the last drops of life; others give way. Some planned their deaths and prepared for them — making their deaths meaningful, not random. A woman in her 90s recently told me, “Trees die standing tall.” This is how she wants to go: standing, not crawling.

I think of death as a tour guide to my life — “Look here; pay attention to this!” the guide tells me. Maybe not the most cheerful one, slightly overweight and irritated, but certainly one who knows a lot and can point to the important things while avoiding the popular, touristy stuff. He can tell me that if I want to die under a tree in my backyard, for example, it might make sense to live in a house with a backyard and a tree. To you, he will say that if you don’t want any extra procedures done to you at the end, it might make sense to talk about it with the people who will eventually make this decision. That if you want to die while hang-gliding over an ocean, then, who knows, maybe that’s also possible.

I think of death as a tour guide to my life — “Look here; pay attention to this!”

My father, who has spent the past 30 years working in an ICU as a cardiologist and has seen many deaths, once told me that if he had to choose, he would choose dying well over living well — the misery of a terrible, regretful death feels worse to him than a misery of a terrible life, but a peaceful death feels like the ultimate reward. I think I am beginning to see his point.

I am 33. Sometimes it feels like a lot — close to the end; sometimes, it doesn’t. Depends on the day, I guess. And like all of us, including the people in the nursing home, I am figuring things out, trying to do my best with the time I have. To not waste it.

Recently, I had a session with a woman in her 90s who has not been feeling well.

“It’s going in a very clear direction,” she told me. “Toward the end.”

“It’s true for all of us,” I replied.

“No, sweetheart. There is a big difference: You have much more time.”

Complete Article HERE!

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Passwords and Powers of Attorney: Your Digital Estate Planning Options

With digital estate planning sites, you can upload wills, trusts, health care directives and even appraisals of your valuable items.

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Digital planning
Digital planning sites encourage you to discuss end-of-life issues with your family, record your wishes and then make it easy for family members to find them when necessary.

We don’t like to talk about the end of our lives, but it’s something that is important to plan for, both for ourselves and for those we leave behind.

These days, estate planning includes not only who will inherit our worldly goods when we die, but also what will happen to our digital legacies. While the digital passwords of our lives may be needed by our heirs after our deaths, it’s not exactly practical to update our wills every time we add a new password.

New companies are springing up to help us make plans and gather all the information our heirs will need in one place. Not only do the services provide a digital value, they provide prompts to encourage us to think about issues we haven’t put in writing, such as what music we would like playing in our final hours.

“I can’t tell you how important it is to have all this information in one place,” says Abby Schneiderman, co-founder of Everplans.com, which started out as a content site and then grew into a planning platform after her brother’s death in a car crash in 2012. “It helps people get together all of the important information and documents the family needs in the event of an emergency or, even worse, a death.”

Everplans is one of several companies that allow you to create a digital repository of your wills, health care directives, funeral wishes, plans for your pet, desires for your Facebook page, what you’d like to see in your obituary, family photos and even your grandpa’s cherished spaghetti recipe. You can enter information during your life that you want your family to find when you die or share information with family now.

Steve Byrne, co-founder of FinalRoadmap.com, says many of his clients are baby boomers who are struggling to figure out what their parents want. They don’t want to put their children into the same position. The sites drill down into much more detail than you would typically include in a will or an advance health care directive, down to what interventions you want and who you want in the room while you’re dying.

If you’re in an accident, for example, who has the power to make decisions for you? If you’ve given your sister that responsibility, how will your doctors know, and does she have a copy of the document?

“People say I don’t want to be a vegetable, but what does a vegetable mean?” Byrne says. “Our mission is to encourage people to think about, to document and share end-of-life wishes.”

Everplans and Final Roadmap are two among a number of sites that provide this type of service, including The DigitalBeyond.com, PlannedDeparture.com, AfterSteps.com and PrincipledHeart.com.

All sites encourage you to discuss end-of-life issues with your family, record your wishes and then make it easy for family members to find them when they’re needed. “What we try to do is not only have a place for everything, but guide them through those questions,” Byrne says. “There are people still years after they’ve made decisions wondering if they did the right thing because it was just a guess.”

You can designate whom you wish to see specific information and whether you want to share it now or not until after you’ve passed.

“I try to make this as easy as possible for people to have this all in one place,” says Byrne, who founded the site with his wife, Kerry Shannon, a health care consultant. “We want people to do this while they’re healthy, while they still have the faculties. … We try to tell people this is not about dying, this is about planning ahead.”

The sites provide places to upload wills, trusts, health care directives, powers of attorney and even appraisals of valuable items you may own. You may also be asked to record the location of notarized and signed copies of documents and the contact information for your estate planning attorney.

Users can add all kinds of details, from records of their pets’ health, to family genealogy, to password for online accounts to instructions on how elements in the house work. “I guess you could call it a smart vault,” Schneiderman says.

Everplans charges $75 a year, while Final Roadmap charges a one-time fee of $249, with discounts for multiple users. The services also have options for sharing all the aspects of your digital life, from passwords to bank accounts to the message you want sent to your Twitter followers after you’re gone.

“I consider [digital estate planning] in this day and age traditional estate planning,” says Wendy Goffe, an estate lawyer who is a partner at Stoel Rives in Seattle. “Your digital life is a big part of your life. For some people, that’s the biggest part of your life.”

Goffe cautions that everyone’s situation is different and no online service can replace the advice of an experienced attorney who understands your situation. “You don’t know what you’re not getting,” she says. “A program only gives you what you ask for, and you’re not always asking the right things.” Your digital life may include valuable intellectual property, for example, which requires more planning than what to do with your Facebook status updates.

The other issues people need to be aware of with online repositories, she says, are security and what will happen to your documents if the company goes under. One option for customers might be to print out copies of everything they place online and let a family member know the location of those paper documents.

Here are seven factors to consider when doing your end-of-life planning:

Legal documents. Most people need a will and some would benefit from a trust. You probably also want to designate a health care surrogate and leave an advance health care directive. Exactly which documents you need may vary by state and situation, so consulting with an estate planning lawyer is advisable.

Digital legacy. What do you want to happen with your online accounts when you pass on, and how will your heirs find all the passwords? If you own intellectual property such as e-books, photos or other copyrighted material, you may want to consult an attorney.

Business future. If you own a business, what will happen to it when you die or are unable to run it? Would someone be able to find everything they need to run your business temporarily if you were in an accident? Once you die, does someone inherit the business or will it be shut down?

End-of-life wishes. A health care surrogate and an advance directive will cover your legal bases, but you may want to give your family, especially the person who will make decisions for you, more details about when you would like heroic measures taken and when you would prefer no interventions. Do you have specific ideas on who you would prefer to be with you and what you want the atmosphere to be when you’re dying?

Funeral plans. Do you want burial or cremation? Are there specific readings or songs you want at your service or people you would like to have speak? What do you want included in your obituary? How will your family know whom to contact with the information that you have passed?

Assets. If you died tomorrow, would your heirs be able to find all your assets? Is all your beneficiary information current on your retirement accounts and life insurance? Do you need to leave passwords to access accounts?

Day-to-day details. Will you heirs know how to pay the water bill, the mortgage and other home chores? If you rent, will they know how to contact your landlord? These items will need to be handled while your home is waiting to be sold or occupied by another family member.

Complete Article HERE!

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How to get what we need at the end of life

By Diane E. Meier

MY PATIENT – I’ll call her Mrs. Stein — had been crystal clear for the 12 years I took care of her. “I never want to end up in a nursing home — make sure you help me stay in my own home. I want to die in my own bed!”what we need at the end of life

A few years later, she had a stroke and her only option was a nursing home. She didn’t have enough money to pay out of pocket for 24-hour personal care at home, and neither Medicare nor Medicaid would cover it. Angry and depressed, she left for a neighborhood nursing home, where she lived another five years. I knew her wishes, but our society provided no means of honoring them.

In order to know what our patients prize most, we need to ask them, and then we must be able to act on what we learn. This requires three key elements.

First, we have to help clinicians and their patients get off the 10-minute office visit treadmill, by compensating providers for conducting meaningful conversations with patients about their priorities and treatment options. Recent government effort to provide payments to clinicians for having conversations about what matters most to our patients if they can no longer decide or care for themselves (referred to as advance care planning) is an important step in wrestling our health care system back to one that places patient needs and priorities first.

Second, these are not easy conversations to have. Clinicians are not born knowing how to have them, and just like our patients, we avoid discussions about uncomfortable topics. Meanwhile, talking about future medical priorities is not taught in medical schools. Until this kind of training is routine and universal, it does not matter whether or how much we pay for these conversations; clinicians will continue to avoid them. The good news is that a bill in Congress, the Palliative Care and Hospice Education and Training Act, addresses these issues.

But third, it is not enough to know what patients want. We must also be able to act on those wishes by covering the care and support people need in order to remain as independent as possible in their own homes. While the Care Choices Act represents some progress, as it allows people to get hospice care at home focused on comfort and quality of life at the same time as continued disease treatment, it does not cover the personal care and support. But there is hope here, too — the Affordable Care Act creates new incentives for our health systems to help us avoid unnecessary, risky, and costly hospitalization, incentives that will drive greater willingness on the part of both public and private insurers to meet people’s needs in their own homes. That’s a lot cheaper than having people end up in hospitals and nursing homes. It is also what most of us — including Mrs. Stein — would want.

 

Dr. Diane E. Meier is a palliative medicine physician and director of the Center To Advance Palliative Care at the Icahn School of Medicine at Mount Sinai in New York City.

Complete Article HERE!

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Families urged to discuss end-of-life plans in A Good Death film

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A Pangbourne GP has made a film about the experiences of a family dealing with the death of a loved-one to help others in the same situation

Judy
Judy, whose mother Molly died in June, helped Pangbourne GP Dr Barbara Barrie make a film about the experience

A tearful new film shows how one Berkshire daughter was able to ensure her mother could die at home and with minimum pain.

The film is called A Good Death and features a daughter Judy speaking of the death of her mother Molly who lived for many years in Pangbourne and died in June in her own home.

Health service commissioners in Berkshire West are now asking families to ask their loved ones about their wishes and not to be afraid to discuss end-of-life plans with their doctor.

Pangbourne GP and Thames Valley Strategic Clinical Network End of Life lead Dr Barbara Barrie said: “Our job isn’t just about health and survival.

“This new film is a great example of what can be achieved through good end-of-life care.”

What is your view on end-of-life plans? Tell us in the comments section below.

Factors most important to people at the end of their life often include having pain and other symptoms managed effectively, being surrounded by loved ones and being treated with dignity.

Dying in a preferred place is important too. In a recent survey only three per cent of respondents said that they wanted to die in hospital yet, nationally, 52 per cent of deaths among those between 75 and 84 take place in hospital.

Dr Barrie said: “The proportion of people dying at home or in care homes continues to increase, but there’s more to be done.

“Early conversations with patients and their carers is vital.”

Local health commissioners are working to ensure patients’ wishes are respected.

Electronic palliative care record

Alongside encouraging early discussions, doctors in the area are using an ‘electronic palliative care record’.

This means that vital information about carer’s details, patient’s wishes on resuscitation and preferred location for death is available to every professional caring for someone at the end of their life.

The new film, available on YouTube, tells the story of Molly and the care team that surrounded her towards the end of her life.

Dr Barrie said: “Molly got to die at home, her dignity preserved and with no unnecessary medical interventions. All families in Berkshire should expect the same level and quality of care shown in this film.”


 
Complete Article HERE!

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Grieving to death: the animals left behind

By Michelle Mitchell

Ezma
Ezma, a 13-year-old female cat, was brought to the Shenandoah Valley Animal Services Center after her owner passed.

When a cat or dog gets lucky, they can spend over a decade in a home with abundant affection. They are accustomed to unconditional love; they’re used to getting their belly rubbed and love to snuggle on their favorite part of the couch. Until one day, everything changes, and these animals are ripped out of their home and dumped at the shelter.

If a pet’s owner dies and nobody planned ahead, this could lead to problems. Animals are often dumped at the shelter or just thrown out. The Shenandoah Valley Animal Services Center said this is a problem; they’ve recently saw more animals come in because their elderly owner died, in situations where none of the children could or would take care of them. Often, these animals do not survive at the shelter.

“Once they come here, the chance of them making it out is slim,” SVASC Assistant Director Tracey Meadows said. “When they come into a shelter environment, it’s very stressful for them. Sometimes they can’t overcome. They grieve themselves to death.”

Sometimes animals at the shelter miss their human so much, they won’t eat or drink. It is an entirely different lifestyle for them that they cannot get used to.

“I think they’re heartbroken. They’ve been with their family their whole lives and all of a sudden their routines changed, it’s not the same,” SVASC worker Hope West said. “They give up. They feel like they have nothing else to live for.”

They can develop medical issues and even die as a result of being depressed. Dr. Leti Hansen, a veterinarian at Greenbrier Emergency Clinic in Charlottesville, explained.

“I think the hardest issue that animals face when entering the shelter after leaving a home is depression,” Hansen said. “The shelter is a very stressful place to live. The staff works extremely hard to decrease the stress of its animals but it is impossible to replicate the home environment that these animals have come left. Animals that become depressed when entering a shelter can become immunocompromised, rendering them more susceptible to some of shelters’ more common upper respiratory diseases such as kennel cough or upper respiratory diseases of various causes in cats.”

“Depression can lead to anorexia. Anorexia in cats can cause a condition called hepatic lipidosis. Hepatic lipidosis is a condition where the liver is overwhelmed by the attempt to metabolize the body’s fats in order to create energy for the body. These cats will become systemically ill and risk dying if left untreated,” she added.

Changing behavior

The shelter affects behavior as well. For an older animal, they just can’t take the stress and change of lifestyle and shut down.

“Dogs will often become reclusive when spending time in a shelter. It is very difficult for a potential adopter to understand how this dog will behave outside the shelter,” Hansen said. “This high stress environment often causes behavioral changes in the dogs, such as tail biting, hiding in the back of their run, loud barking, and anorexia.”

Young or old, death does not discriminate. Shelter officials said the most important aspect is to be prepared. If a pet owner is prepared, cases like this will not happen as much. They recommended people write a living will with a special clause for their pets.

“We take care of our kids in our wills, we need to take care of our animals,” West said. “If people aren’t prepared at all, they end up here. A lot of them, this is where they spend their last moments. Some, they get so old and they’re so devastated, this is the last place they see. It’s sad because they’ve been in a home. Somebody loved them.”

When somebody does their will, they should ask which family member is able to take on the responsibility of their animal, SVASC members explained. This way, everything is planned for and there is no fight or confusion. If no family member steps up, they recommended people ask friends or neighbors. Again, if nobody is able, people can search online for local rescue groups that help senior animals.

“Go a little bit above and beyond. Try to rehome them to somebody before just dropping them off at your local shelter. Try to find them a home. Being in this cage is just not fair for them,” West mentioned.

If pets lose their owner, they lose their life, Meadows said. This is why it’s so important to have a plan. Hansen agreed.

“I strongly recommend people talk to their families ahead of time to ensure that their pets will have a safe home in the event of their owner’s death. Adding a clause to your will is also recommended. We see a lot of animals come into the shelter after an owner has passed away because provisions were not made ahead of time. To those family members that step up to take care of their loved ones pets, we extend our gratitude,” she stressed.

People need to be prepared, and expect the unexpected, West said, adding that animals are a commitment for life and beyond. If a pet loses its owner, it doesn’t need to lose its freedom as well and end up in a cage.

“I think people don’t take it seriously. It’s like taking care of an elderly parent. If you’re going to commit you need to commit for life. If not, don’t adopt,” West said.

West said it is up to the owner and children to make sure their furry friends are safe if the unexpected happens. With the right precautions, people can rest assured that everything will be taken care of.

“Take your parents in consideration. If your parents had these cats from the time they were kittens until they’re 13 or 14 years old, apparently they loved them,” she explained. “You parents wouldn’t want to see them in a shelter—nobody wants to see them here. They waste away to nothing a lot of them just grieve themselves. I just don’t think people think it through.”

Complete Article HERE!

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Deficiencies In End-Of-Life Care Extend Across Ethnicities

By Barbara Feder Ostrov

What kind of care do you want at the end of your life?

elderlyStanford University researchers put that question to members of three major ethnic groups in the San Francisco Bay area and found little variation in their responses.

“There is a common humanity – people want to live as long as they have good quality of life. When it is their time, they want to be consulted so they die in a way that they are respected, and they don’t want their families burdened,” said the study’s lead author, Dr. V.J. Periyakoil, director of the Stanford Palliative Care Education and Training Program and associate director of palliative care services at the VA Palo Alto Health Care Center.

Regardless of ethnicity, however, the researchers found that access to high-quality end-of-life care is often hampered by lack of financial means, poor communication with health providers, cultural mores and family conflicts. The study, involving more than 300 white, Asian and African-American seniors, was published Nov. 18 in the Journal of Palliative Medicine.

Periyakoil, whose earlier research focused on how doctors discuss end-of-life care with patients from different cultures, said physicians often believe that talking about end-of-life care with patients of certain ethnic groups is taboo and that patients and their families are reluctant to have these sensitive conversations. The new study, though small and limited in geographic scope, suggests otherwise. The participants may have been more affluent and better-educated than their counterparts nationwide, given the region’s demographics, Periyakoil noted.indian elder

The researchers interviewed 315 people over 50 at senior centers in Fremont, Palo Alto, San Francisco, San Jose and Walnut Creek. The group included 38 African-Americans, 160 Asian-Americans and 117 Caucasians. Interviews, conducted in English, Burmese, Hindi, Mandarin, Tagalog and Vietnamese, examined participants’ attitudes toward end-of-life care and whether they had experienced barriers to getting quality end-of-life care for relatives or others in their community.

Researchers are still collecting data on Latino participants and plan to publish a separate study on their views, Periyakoil said.

While all of the participants in the study said they valued high-quality end-of-life care, about 60 percent said they had experienced barriers to getting it, most notably financial difficulties and a lack of adequate health insurance. Medicare typically covers only short-term nursing home care and offers hospice benefits to patients whose doctors certify they have six months or less to live and who are willing forgo treatment intended to cure their terminal illness.

white eldersThere were no statistically significant differences among ethnic groups in reporting barriers to care. But participants with less education were more likely to report that their biggest barrier to care was financial. Patients with more education were more likely to cite doctor behaviors that hampered end-of-life communication. And women were more likely than men to cite barriers to care overall, perhaps because they were more likely to be direct caregivers and have more experience with end-of-life needs.

Regardless of ethnicity, patients felt that “doctors were just too busy to initiate [end-of-life] conversations, reluctant to listen to their concerns and questions about EOL decision making, and often gave vague responses, making it difficult for the patient to comprehend their choices and make informed decisions,” the researchers wrote.

An estimated 2.6 million Americans die every year, but how the American health care system handles their last days is problematic across ethnic groups, according to “Dying in America,” a landmark report released in 2014 by the Institute of Medicine. Too many people end up having aggressive treatment that is ineffective and expensive and doesn’t contribute to the patient’s quality of life, the report found. Other research examiningracial gaps in attitudes toward hospice care and other studies has found differences among ethnic and religious groups in how they approach end-of-life decisions.

But people want to talk about it regardless of background, says Dr. Steven Pantilat, a University of California, San Francisco professor of medicine and director of UCSF’s palliative care program, who was not involved in the study.

“What this study tells us is that all of our patients want us to have these conversations,” Pantilat said. “They’re waiting for their doctors to bring it up, to not be rushed, to communicate sensitively.”Asian Senior

A new federal policy may make those conversations easier – and more routine. Starting in January, Medicare will reimburse physicians for discussing end-of-life care. That policy infamously – and incorrectly – was derided as promoting “death panels” during the debate over the Affordable Care Act and a version of it was dropped from the legislation. The counseling will cover what kind of medical care patients want to receive as they approach their last days.

Periyakoil urges patients of all backgrounds to prepare for these conversations, and new planning tools are available in different languages to help. Among them is the Stanford Letter Project, which helps patients write a letter to their doctors about the end-of-life care they do and don’t want in languages including English, Spanish, Mandarin, Vietnamese, Hindi, Urdu, Tagalog and Russian.

In one redacted letter provided by Periyakoil, a woman named Patricia writes: “I do not want my longevity to be more important than my comfort.”

Pantilat advises the doctors he trains that they don’t need deep knowledge of the beliefs of every religion and culture they might encounter, because every patient, of whatever ethnicity, has different goals.

“If we come in with true curiosity, respect and openness, we can learn a lot about how to take care of someone in a sensitive way,” he said. We need to ask: “What do I need to know about your culture and your family to take good care of you?”

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