We plan for the best life possible. Yet, all too often in this planning, we put off thinking about our final chapter of life and how to close that chapter as peacefully as possible and without crisis.
Consider this: Research shows that 70 percent of Americans would prefer to be at home with loved ones in their final days, yet only about 25 percent die at home. And, one of the most requested advice from legal aid is how to deal with end-of-life issues amidst a family crisis.
By planning for end-of-life care, many people may be able to avoid dying in unfamiliar institutional settings and can help their families avoid being impoverished by end-of-life care.
An advance health care directive lets your doctor, family and friends know your health care preferences, including the types of special treatment you want or don't want at the end of life and your desire for diagnostic testing, surgical procedures, cardiopulmonary resuscitation and organ donation.
By considering your options early, you can ensure the quality of life that is important to you and avoid having your family guess your wishes or make critical medical care decisions for you under stress or in emotional turmoil.
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Hospice care is designed to comfort and support patients and their families when the patient can no longer benefit from cure-oriented medical treatment. The typical hospice patient has a life expectancy of six months or less. Hospice care typically allows a dying patient to receive care at home surrounded by family and friends.
Hospice services are provided by a team of trained professionals – doctors, nurses, counselors, therapists, social workers, aides and volunteers – who provide medical care and support services not only to the patient, but to the patient's family and loved ones. The care addresses the emotional, social and spiritual impact of the disease on the patient and the patient's family.
Note that hospice physicians are not a substitute for your own personal physician. Hospice physicians primarily prescribe medication for pain management and may have little expertise in other chronic health conditions you may have. They focus on symptoms rather than causes, managing pain after it occurs rather than providing preventive care or treatment. Other medical conditions should continue to be treated by your primary care physician or relevant specialist to maximize your comfort and quality of remaining life (e.g. heart conditions, thyroid conditions, memory issues, diabetes, and cancer if not related to the hospice diagnosis)
There are many hospice programs, which vary in quality. You should ask a knowledgeable person you trust, such as your personal physician, for recommendations and evaluate several options before selecting one.
You should carefully review any hospice plan of care before signing it. There are a wide variety of services that may be available, including physical therapy, but that may not be provided if they are not listed in the plan of care. Hospice programs receive per diem compensation and therefore have a financial incentive to limit services to those specifically negotiated for in the plan of care. You should ask for a complete list of available services, and be sure to request that your plan of care include all services that you and your personal physician feel will be beneficial for you.
As the primary health insurer for people age 65 and older, Medicare offers certain hospice benefits for end-of-life care. Check with the federal Social Security Administration and your health insurance plan for more information.
Modern health care focuses on end-of-life pain through palliative care and pain management.
In California, all hospitals and nursing homes are required to assess a patient's pain condition as a fifth vital sign, along with the patient's pulse, temperature, respiration and blood pressure. California also requires all medical schools in the state to train physicians on pain management and end-of-life care.
Palliative care is given to patients who face serious illness for which there is not a cure. Often called "hospice-type care," palliative care seeks to make the patient's life as comfortable as possible by controlling pain and symptoms, by easing the patient's concerns over daily living needs, and by helping the patient and family address psychological and spiritual needs. Respect for the patient's culture, beliefs and values are essential components of palliative care.
