Hospice Care Benefits Residents, Caregivers
A new study published in the Journal of Clinical Oncology reports that those who die at a hospice or home setting are more likely to have a higher quality of life during their final days as well as less physical and emotional stress.
According to a Washington Post article about the study in which 333 terminally ill cancer patients participated, hospice and home-care services focus on making the ill person comfortable, whereas hospitals will try to keep the individual alive, even if it means prolonging their pain.
Caregivers also tend to be worse off if their loved ones die in a hospital setting. Of the 333 caregivers studied, those whose loved ones did not die at home dealt with a higher risk of mental issues six months after their loved one’s death – including post-traumatic stress disorder and prolonged grief.
Many assisted living advocates have long supported incorporating hospice as a way to make a resident’s last days more peaceful. Some communities choose to partner with hospice companies, and the organization will train the assisted living communities’ staff. Other providers have gone the route of establishing their own hospice service, such as Silverado Senior Living based in San Juan Capistrano, California.
The National Cancer Institute recommends that end-of-life planning should include decisions about:
■The goals of care (for example, whether to use certain medications during the last days of life).
■Where the individual wants to spend his or her last days.
■Which treatments for end-of-life care the individual wishes to receive.
■What type of palliative care and hospice care the individual wants.
Read the Washington Post story about this study.
A staggering 84% of Pennsylvania adults have not prepared an Advance Directive that would tell physicians, family, and other health care providers their wishes. It is vital for everyone over the age of 18 to consider filling out their Advance Directives. Afterall, you can't predict the future.
The Pennsylvania Directive is your state’s living will. It allows you to express your wishes about the medical care in the event that you develop a terminal condition or enter a state of permanent unconsciousness and can no longer make your own medical decisions. When a doctor receives a copy and determines that you are incompetent or in an end-stage medical condition or state of permanent unconsciousness, the Living Will becomes effective. You can name another person (family, friend, neighbor, etc), called the healthcare agent to make decisions about your medical care when you can no longer speak yourself.
How Can I prepare my advance directive?
You do not need a lawyer to fill out a living will and medical power of attorney form. You can find the forms at your state hospice organization, local hospitals, public health departments, state bar associations or state aging offices. It is very important that you use advance directive forms specifically created for your state so that they are legal. Read the forms carefully and make sure you follow legal requirements determined by your state.
Be sure to give your completed copies to your doctor and your healthcare agent. Keep the original in a safe place. Be sure to have your copy in an accessible place, not locked away in a safe. You'll need to get to it quickly in the event of an emergency.
Whom should I name as my healthcare agent?
Your healthcare agent is the person you appoint to make decisions about your medical care if you become unable to make those decisions yourself. Your healthcare agent should be an adult, and can be a family member or a close friend whom you trust to make serious decisions. The person you name as your healthcare agent should clearly understand your wishes and be willing to accept the responsibility of making medical decisions for you. It's important to note that an idividual who works at the facility where a patient resides cannot be a healthcare agent, unless they are a family member.(A healthcare agent may also be called a “surrogate,” “attorney-in-fact,” or “proxy”.)
Can I add personal instructions to my Directive?
Yes. You can add personal instructions in the part of the document called “Other directions.”
Can I change my mind?
You may revoke your Pennsylvania Directive at any time. Your revocation becomes effective when you, or a witness to your revocation, notify your doctor or other healthcare provider. Once your doctor is notified, he or she must then make the revocation a part of your medical record.
4 Decisions to consider...
1. Whether or not to have artificail nutrician/hydration.
2. Whether or not to be hospitalized from home/nursing home.
3. Whether to change treatment goals from curative to comfort.
4. Whether or not to have CPR or a DNR (Do not resuscitate) order.
How Do I make my Pennsylvania Directive legal?
In order to make your directive legally binding, you must sign and date it, or direct another to sign it, in the presence of two witnesses who must also sign the document to show that you knowingly and voluntarily signed the document. Both of your witnesses must be 18 years or older and, if you are unable to sign your Directive, neither witness can be the person who signed the Directive on your behalf. You do not need to notarize your Pennsylvania Directive.
What other important facts should I know?
Your directive goes into effect when a copy is provided to your physician and your attending physician determines that a healthcare provider has documented that despite being provided appropriate medical information, communication supports and technical assistance, you are unable to understand the potential material benefits, risks and alternatives involved in a specific proposed healthcare decision, you are unable to make that healthcare decision on your own behalf, and you are unable to communicate that healthcare decision to any other person; and you are determined to be in a an end-stage medical condition or permanently unconscious. Your attending physician must promptly certify in writing that you have an end-stage medical condition or are permanently unconscious.
The best gift we can give our family and loved ones can be the gift of making our own wishes known.