Decisions.
More decisions.
Agonizing, frightening decisions.
Besides the emotional tsunami of losing a love one, end-of-life contains so many difficult choices. I remember panic rolling through me as I thought, “What do I do? I don’t know what to do.”
This week, we are going to look at these decisions and try to take the mystery out of some of them. If you can think through a few of them ahead of time, you have at least a few coping mechanisms in your arsenal.
Paperwork
Power of Attorney paperwork should be signed years before, assigning the person (or persons) they want to look after their affairs. This involves both decisions about care and finances, and can be the same person.
Long before end-of-life, your elder needs to sign DNR (do not resuscitate) paperwork. In Canada, this instructs medical personnel not to perform CPR if their heart stops or they stop breathing. You may think, “Wait, isn’t that a death sentence?” But the truth is, elderly people don’t do well with CPR. About half die during the procedure, and of those who do survive, only one in six survives to leave the hospital. This number increases with the age of your elder. CPR often leaves frail elderly with painful cracked or broken ribs. Talk about this together and ask your doctor for the form.
Hospice Care
The goal of hospice care is to provide comfort and support to people who 
are at end-of-life, enabling them to live fully and comfortably to the end. They strive to provide dignity and a pain-free, calm end to each client’s life.
This can involve different scenarios. Hospice may be a place your elder chooses to go when their care becomes too much for those who are caring for them now. If this is the case, you should choose and develop a relationship with a place ahead of time.
Hospice care can also be provided in your home, or in the long term care where your elder lives. If you are going this route, you need to look at what options are available and exactly what kind of care you would like. Another important factor is when the care should begin. Talk with the people providing the care and your doctor and discuss options with them. An almost universal characteristic of those who work in hospice is their compassion. They are caring for you, too, and they are wonderful at it.
Medical care
The rules change at end-of-life.The goals are different. It all comes down to one word: comfort. Here are some things to consider:
- 1. Many medications can be stopped. Talk to your doctor about this, and your goal for your elder to be as pain-free as possible.
- 2. New medications which better control pain and secretions can be started.
- 3. Medical procedures such as taking blood pressure, physio and having blood work analyzed are no longer necessary.
4. Food and drink should be offered, but only for comfort. Your elder may not want to eat or drink at all, and that’s okay. Their organs are beginning to shut down and can’t process food any more. However, if something appeals to them, by all means provide it. Even a few bites might be enough to bring pleasure and comfort.- 5. Loose-fitting clothes or an open backed gown are usually preferred.
- 6. A special sheepskin can go on the mattress under the fitted sheet to prevent bedsores. Sheepskin booties protect the heels. Any product which provides comfort is a good idea.
- 7. What would your elder like to hear, as hearing is the last sense to go? Classical music, hymns, the reading of scripture or perhaps a favourite novel? Or would they prefer silence? These are good things to know.
Thinking ahead, asking questions and doing some research can prepare you for this difficult time. It’s your final opportunity to care.
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