Having a conversation with loved ones about death and dying is never easy. There are a numerous reasons not to have the conversation but even more reasons to have it. The value of being prepared and having one’s wishes known is crucial. 60% of people surveyed say that making sure their family is not burdened by tough decisions is “extremely important” but 56% have not communicated their end of life wishes (California Healthcare Foundation, 2012). 70% of people say that they prefer to die at home, while 70% die in a facility (Centers for Disease Control, 2005). 80% of people say that if seriously ill, they would want to talk to their doctor about end-of-life care but only 7% report having an end-of-life conversation with their doctor (California Healthcare Foundation, 2012). 82% of people say it’s important to put their wishes in writing and only 23% have actually done it (California Healthcare Foundation, 2012).
Even though you and your loved ones may have numerous disagreements in the beginning, at least the seed has been planted to begin to formulate end-of-life care wishes before a medical crisis occurs. Perhaps the most important question one needs to answer is, “What is important to me?” Do you want to be totally in charge of all medical decisions or do you want your doctors to do what they think best? Do you want to be informed of all the details or is ignorance bliss?
How long do you want to receive medical care? Where do you want to die, in a facility or at home? Do you want to receive hospice care? If so, do you understand what hospice care is? How involved do you want your family and loved ones to be? These are just several of the many questions which surround the process of effective end-of-life care planning.
Choosing the right moment to have the conversation is important. Who do you want to include in the conversation? When would be a good time to talk? Where would you feel comfortable talking? What do you want to be sure to say? How do you break the ice to initiate the conversation? What specific issues do you want to include in the discussion? Patience is important during this conversation as some people need more time to digest what is being said. Remember that nothing is set in stone and plans can be changed as circumstances change. It may take several conversations to accomplish all that needs to be covered, so don’t be discouraged if things don’t go well the first time. End-of-life planning is not a sprint but a marathon.
Other things to consider in end-of-life planning are the legal and medical documents that need to be in place. Advance Directives, Durable Power of Attorney (POA), Living Will, and a POST form all serve a specific purpose to help you record your death and dying wishes.
- Advance Directives are legal documents that allow you to spell out your decisions about care ahead of time. They give you a way to tell your wishes to family, friends, and health care professionals and to avoid confusion later on.
- A Durable Power of Attorney (POA) for health care is a document that names your health care proxy. Your proxy is someone you trust to make health decisions for you if you are unable to do so.
- Living Will tells which treatments you want if you are dying or permanently unconscious.
The POST form is a relatively new document in the state of Indiana. It was signed into law and became effective on July 1, 2013. POST stands for Physician’s Orders for Scope of Treatment. A POST:
- Is not intended to replace a Living Will or a Durable POA
- Is strictly voluntary
- Addresses an individual’s preference for CPR, medical interventions, antibiotic use, and artificially administered nutrition
- A physician’s order that needs to be signed by the physician to be valid
- Is suitable only for those who meet the qualifications
- Replaces an Out-of-Hospital DNR
Having “the conversation” while difficult is a huge step toward proactive planning for seniors and their families. It gives all involved peace of mind and assurance that the end-of-life wishes for their loved one will be honored. It also lets family enjoy quality time and unburdens them of the countless decisions and plans during the last days of their loved one’s life.
By Nancy Hanley, RN
Geriatric Care Manager