It is a difficult and awkward topic for many.

When asked about their elder parents’ wishes for end-of-life, most of our clients reply that they don’t know, they suppose they should, and they just hate to think about it.  Elder clients express discomfort with the thought of “bringing it up” in conversation with their adult children.  “We can’t ruin a family dinner with that stuff!” 

Reframing the conversation into one of family history, elder experiences, lessons learned, and hopes for a different future outcome can soften the talk and lead to important shared information about preferences and desires.  Even if an elder doesn’t seem able to express specific preferences, basic important items of information and guidance can come to light.  This information is a valuable gift for family members who will be left with the responsibility to finish things for parents at the end of their lives.   What a relief to know everyone is prepared with accurate information and clear direction!

Here is a list of important information and documents that should be in a notebook or file where family members can easily locate it.  (Best yet, each sibling might have a copy.)

1. Power of attorney for financial (General Power of Attorney)  preferably durable
2. Durable power of attorney for healthcare or medical needs
3. Living Will or a Five Wishes document
4. CPR Directive (Do Not Resuscitate)
5. Last Will and Testament
6. Burial plan and wishes for final disposition of remains

While many spend time with an elder law or probate attorney for assistance with these documents, all but the Last Will are possible to execute in Colorado without legal assistance.   This varies from state to state.  Information and forms are available through the internet, some local Offices on Aging, elder care advisors, consultants and managers, hospital discharge planning departments. 

The most significant part of this gift of process and planning, though, is the discussion and sharing  that happens within a family. 

In addition to the essential documents listed above, other important and basic items of information that should be easily accessible are:

                1.            Copies of medical insurance cards

                2.            A current list of medications

                3.            Names and phone numbers for treating physicians and

                                other healthcare providers

                4.            A list of all medical conditions being treated or managed

  Nancy Driskill, RN,MS, CMC

Durable Power of Attorney : True or False?

 Mother is 86 years old and has chronic health issues including what the MD has diagnosed as “early stage dementia.”  Mother has difficulty with her activities of daily living, her check book, and her medications.  She is proud and stubborn and refuses to consider a move out of her own home.  I, as her eldest daughter, have a Durable Medical Power of Attorney. 

True or false?

I can announce to Mother and my family that she is moving to an assisted living facility where she will be safe and be well cared for.

I can take over all decisions having to do with her medical care.

I can insist she has help in her home and can arrange for it, paying for it out of Mother’s funds.

I can be held legally responsible if mother suffers injury or illness as a result of her decisions to ignore my pleas or the doctor’s advice.

The answers to the above 4 scenarios are FALSE.

A power of attorney does not give that individual the right, legal or ethical, to subjugate the individual’s preferences or decisions for the POA’s own purposes or convenience.  The document for assigning a POA clearly states that the designated individual shall make decisions based on the principal’s stated desires and preferences and when the principal is unable to express her desires and preferences herself.

It is incumbent upon the individual with the POA to KNOW the principal and to honor as far as possible her preferences when she can’t speak for herself.

The DPOA does not give the individual carte blanche the power to do what she prefers or believes is right.  It does provide the privilege to act on another’s behalf and as her advocate. 

That said, discussions about decisional capacity and competence vs. incompetence needs to happen.

Decisional capacity is the ability to consent to or refuse care.  It is determined by discussion and verbal exchange and is said to be present when an individual can hear, understand, and report accurate interpretation of a set of options or choices and can accurately describe in her own words,  the possible consequences of her choices.

Incompetence is a legal term and , with the support of  specialized examination (as a neuropsyche evaluation) and assessments is determined by a court of law .  Only in that case can an individual’s decisions be made by an appointed individual, a guardian or (in the case of financial management) a conservator.

When a DPOA is assigned and accepted it must be with complete trust on both sides, clear understanding of responsibilities, rights and preferences.  This is not a document to be taken lightly, despite the fact that it is easily obtained and executed and can be done without the assistance of an attorney.

It is  an essential document that, along with a Living Will, Five Wishes document or other description of one’s desires, needs, and preferences for end of life, should be distributed to key members of one’s support system.  These individuals would likely include spouse, children, or adult grandchildren, physician, attorney.

Thoughtful planning before a crisis is the key to a smooth transition.

 Thank you to Amy Rosenberg, Esq. for her professional guidance and editing .

The time has come for each one of us to intentionally take charge of our lives , our health, and our happiness.  The medical community is essential to our general well-being and is an excellent resource for us to use in our quest for best quality life.  The human body is, indeed, fallible and no matter how well and intricately made, it does break down with use and abuse.   It was created such that it will not last forever. 

When minor sorts of mishaps occur we have choice about how to approach their management.  Just as when a car or bike has a malfunction and the owner decides whether he has the wherewithall to repair it,  it is something to merely tolerate or  if consulting  a trained specialist is the best answer, so it is with our bodies.

Obviously, one needs to have all the information available about the “machine,” the nature of the malfunction, the importance of the broken piece to the successful operation of the machine, and the ramifications of NOT fixing it.  It is the owner’s choice to ignore, mend/temporarily juryrig a fix, or go all out and invest the time and money in a professional repair.  Even then, the machine will not last forever.  Something else is likely to go wrong and the decision process will need to be revisited. 

Life is finite.  It is an individual decision about what is most important about one’s life and how it is lived. It is also an individual decision about how one will FEEL about that, how he approaches the changes and choices.  I don’t have the right to judge another’s decision about how he or she makes decisions with regard to his own life.

A professional health advocate acts as a guide, support, and buffer to honor an individual’s efforts to manage his own health decisions.  The advocate ensures that the individual has as much information possible on all sides of the issue.  The advocate facilitates effective communication between the patient and the health care provider.  The PHA is an extra set of eyes and ears at appointments and consultations where information may be complicated or confusing and when emotion or apprehension may tend to cloud understanding or accurate recall.  Professional care managers frequently act as health care advocates for their clients.  Sometimes that is the GCM’s primary function for that person;  yet another example of two being stronger than one.

What IS End of Life Care?

End of life.  What does that mean, really?  If one thinks about it, it becomes obvious that the definitions are as many as there are people considering it!  It could be final minutes, days, months, OR years in a “normal” lifespan.  It could be the final moments before a traumatic injury or intrusive illness renders the body unable to continue to function. 

For my purposes as a human developmentalist and a professional care manager, the last months of a lifespan in a body that is becoming more and more tired and painful and a mind and heart that are calm in the certainty that life has been lived as it was meant to be constitutes the end of life. 

End of life care includes comfort care, relief of pain and anxiety, the means to savor everything that is most pleasant and treasured.  Loving relationships of friends and families, opportunity to make amends and embrace in understanding are more important and significant, somehow, at end of life.  To some it may include hosting one last big bash, going on that fishing trip or cruise, or being involved in preparing one more Christmas dinner.  

Hospice care, palliative care, comfort care, and the “slow medicine” philosophy are all intended to enhance one’s end of life experience.  To finish a life well lived with dignity, love, and comfort is our wish for our clients and their families.  It is also our wish in the world beyond our personal knowledge that seems to value length over quality; a society that takes pride in the ability to take control over the natural consequences of aging and dying in order to make them more palatable and attractive.  In so doing, we rob individuals of the opportunity to really LIVE during the last months and years of life.

When you hear the word “Hospice” I hope you will reconsider what is intended;  NOT the suggestion that one should “give up,” NOT the insinuation that there is no hope for anything more, NOT the prediction of imminent passing.  Instead, Hospice means the promise of best possible, realized potential, freedom to be real and genuine and experience the essence of the best of life on earth.  A gift.     Please don’t be fearful.

Nancy McCambridge Driskill, RN, CMC