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Dying is the final portion of the life cycle for all
of us. Providing humane care near the end of life is an essential part
of medicine. People near the end of life deserve to be treated with dignity
and compassion. Every effort must be made to ensure that a patient's last
days are spent in as much comfort as possible and according to the patient's
wishes.
Will I have to go to the hospital or can I end my
days at home?
Dying at home is usually possible, provided
you have family and/or other caregivers to help you. Advanced planning
and discussion of such issues while you are still healthy is always a
good idea. Be sure your family and other caregivers know your wishes and
are able and willing to implement them.
Does pain and suffering have to be a part of dying?
Pain can almost always be controlled. Other suffering
that may occur at the end of life include worries about financial concerns,
guilt feelings, regret, unfinished family business, etc. These feelings
can all be helped.
If I cannot eat or drink by mouth, will I have to
be fed by a needle or a feeding tube?
Most people at the end of life do not feel
hunger or thirst. Artificial feeding does not help most dying persons-it
can even make them feel worse. Good mouth care gives comfort and ice chips
(which can be flavored) cool the mouth and provide hydration.
I have heard about hospice. What is this?
Hospice is a program that cares for dying
persons. Inpatient and home hospice services are generally short term
to control pain and to provide other comfort. Hospice professionals are
experienced in controlling pain and other symptoms, and can help when
caregivers need a break.
I don't want to be alone. Who can be with me when
my family has to go to work?
A variety of community programs, including
hospices, train volunteers to help as companions, visitors, drivers, etc.
Programs in your community may also be operated or sponsored by churches,
hospitals, and municipal agencies.
Who will help me find volunteers, arrange for my
care, help me get a hospital bed and other items I will need?
Your health insurance usually requires that
your physician authorize equipment and treatment by professionals at home.
Depending on your insurance coverage (e.g., Medicare), this may include
visiting nurses and therapists and someone to help with your personal
needs, such as eating and bathing. Since many older patients rely on Medicare
for their health care insurance, it is a good idea for you and your caregiver
to discuss which services Medicare covers. Many organizations that provide
these services (nursing, therapy, etc.) also have social workers or other
case managers who can help identify available resources and programs.
Community service organizations and churches are often available to assist
you.
If I can't stay in the hospital or at home, where
else can I live and get the care I need?
Depending on your medical condition and your
finances, places such as nursing homes, assisted living facilities and
group homes might meet your needs. Your doctor, a social worker or a case
manager may be able to help you find the right place.
How can I make sure that my doctor and my family
know what care I want when I am no longer able to speak for myself?
The key is to plan early, in case you can't
speak for yourself later, so you can participate actively in your care
plan (This is a practical idea for all older adults, not just those nearing
the end of life.). "Advance directive" is a general term that
describes the type of legal documents that "speak" for you in
the event you are too ill to speak for yourself in the future. These advance
directives are the "living will," and the medical power of attorney.
- A living will describes your care decisions concerning medical treatment
at the end of your life.
- A medical power of attorney (or health care proxy) allows
you to appoint the person(s) you trust to make health decisions for
you if you cannot, and clearly states your wishes for resuscitation,
feeding tubes, antibiotics, transfers to hospitals, respirators, etc.
Advance directives are legally valid throughout the United States. The
laws governing them vary from state to state, so sign advance directives
that comply with your state's law. Also, advance directives can have different
titles in different states. Forms approved for the state you live in are
available from many different health care organizations and institutions,
and can sometimes even be purchased at stationery stores. You do not need
to pay anyone to help you complete these documents. Discuss your wishes
with your doctor and the person(s) appointed to carry out your treatment
wishes and be sure to provide them with copies of these documents. Your
doctor and you may also wish to complete a special form that ensures your
wishes are followed if a rescue squad is called to your home. Make copies
of all such documents and be sure that you (and a caregiver) take a copy
if you are hospitalized.
Where do I go for more information?
More detailed information can be obtained through organizations such
as:
Other good sources are local affiliates of organizations such as the
American Cancer Society, the American Heart Association and the Alzheimer's
Disease Association. Also, local agencies on aging and home health agencies
are valuable sources of information.
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