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A Guide for Seniors and Caregivers
by Steven Lipson, MD
Dying is the final portion of the life cycle for
all of us. Providing humane care to persons near the end of life
is an essential part of medicine. The American Geriatrics Society
recognizes that 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.
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Q. Will
I have to go to the hospital or can I end my days at home?
A. Dying
at home is usually possible, provided you have family and/or
other caregivers who will take care of you. Advance planning-discussing
such issues while you are still healthy-is always a good idea.
Be sure your family and other caregivers know your plan.
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Q. Does pain and suffering
have to be a part of dying?
A. Pain can
almost always be effectively managed, and without the use of needles
or tubes.
Q. If I cannot eat
or drink by mouth, will I have to be fed by a needle or a feeding
tube?
A. Many people
at the end of life do not feel hunger or thirst. Artificial feeding
is rarely needed to provide comfort to the dying person. Ice chips
appear to cool the mouth and provide hydration.
Q. I have heard about
hospices. What are they?
A. A hospice
is a program for caring for dying persons. Inpatient and home
hospice services are generally short term to control pain, or
when a caregiver needs a break.
Q. I don't want to
be alone. Who can be with me when my family has to go to work?
A. A variety
of community programs, including hospices, train volunteers to
help as companions, visitors, drivers, etc. Programs in your community
may be operated or sponsored by churches, hospitals, and municipal
agencies.
Q. Who will help me
find volunteers, arrange for my care, help me get a hospital bed
and other items I will need?
A. 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 so 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 which 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.
Q. If I can't stay
in the hospital or at home, where else can I live and get the care
I need?
A. Depending
on your medical condition and your finances, places such as nursing
homes, assisted living facilities and group homes may meet your
needs. Your doctor or hospital social worker can refer you to
a case manager to help you find the right place.
Q. 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?
A. The key
is to plan early, prior to need, so you are actively participating
in your care plan. There are several documents to consider to
make sure your wishes are met:
- An Advance Directive, a document that expresses
your health care wishes and preferences, is a practical
idea for all older adults, not just those nearing the end of
life. Advance directives allow you to give specific information
about your wishes (whether you want feeding tubes,
respirators, etc.).
- A Living Will describes your care decisions
if you are dying with little or no hope of recovery.
- The Durable Power of Attorney for Health
Affairs names the person(s) you wish to make decisions
for you when you cannot.
You do not need to pay anyone to help you complete
these documents. Forms approved for the state you live in are
available from many health care organizations and institutions,
and can sometimes even be purchased at stationary stores. Always
discuss your wishes with your doctor and the person who will exercise
your durable power, and be sure to provide them with copies of
these documents. You and your doctor may also wish to complete
a special form that ensures that your wishes are followed if you
are transported by a rescue squad. Make extra copies of all documents,
and be sure that you (and a caregiver) take a copy with you if
you may be hospitalized.
Q. Where do I go for
more information?
A.More detailed information can be obtained through organizations such as the National Hospice Organization (800-658-8898); National Association for Home Care (202-547-7424); Choices in Dying (800-989-9455; website: http://www.choices.org); Legal Services for the Elderly (212-391-0120); and the Visiting Nurse Association of America (800-426-2547). 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.
*Please see the following AGS position statements:
Perform a MEDLINE
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