Planning for end-of-life care is important. End-of-life planning often is associated with cancer or Alzheimer’s. It also is often thought of as something you do after you find out that a loved one has only a few months to live. But it’s appropriate to do at any time. In fact, it is best done prior to actually facing end of life.
Planning for end-of-life is a difficult and uncomfortable process. The earlier the planning, the better. This is true for the individual, loved ones, and the caretaker. End-of-life care includes planning financially and managing pain. Also, it involves selecting care professionals, discussing funeral wishes, and maintaining the best quality of life possible.
Certain physical symptoms can indicate the end is near:
- Loss of control of urinary and/or bowel functions.
- Decrease in food and liquid consumption.
- Decrease in urine output and tea-colored urine.
- Increase in time spent sleeping.
- Confusion about the time, place, and identity of close family or friends.
- Irregular breathing patterns.
- Visual and hearing impairment, including hallucinations.
- Feeling very cold or running a high temperature.
- Pulmonary congestion.
The goal is to always provide comfort and dignity to a dying person.
Path to improved well being
Planning helps ensure that the care you receive is consistent with your wishes. This is important if you are unable to speak or make those decisions. Important steps include:
- Communicating your end-of-life wishes. Few people talk to loved ones about their end-of-life wishes. The organization, The Conversation Project, provides a starter kit to guide patients through end-of-life decisions. This helps patients talk with family members, doctors, and caregivers.
- Choosing the type of care. Palliative care can be another end-of-life step. You can use this type of care to manage pain and for illness symptom relief. Palliative care also focuses on improving emotional, spiritual, and mental well being. This helps everyone coordinate medical care and make medical decisions. Hospice care is for people whose illness can’t be cured or who choose not to move forward with treatment for their illness. Hospice provides comfort care and family support. It is similar to palliative care. The biggest difference is that with Hospice, there is no attempt to cure the person’s illness. Hospice care can take place in the home, a hospital, or a senior living facility.
- Preparing documents stating your health care preferences. Few people put their end-of-life wishes in writing. An advance directive is a written document. It tells your doctor the kinds of care you would like to have if you are unable to make medical decisions. Advance directives take many forms. Laws differ by state. A living will is a legal document. It describes the kind of medical treatments or life-sustaining treatments you would want if you were seriously or terminally ill. A medical power of attorney (also called a durable power of attorney) is a legal document. It appoints a person to make those decisions for you when you are unable to communicate them.
Things to consider
Planning for death is emotionally tough. It’s best to try to start the conversation early. You or your loved one may be hesitant to discuss it. These are important questions to ask yourself or a loved one:
- Are my affairs in order (financial, personal, legal, etc.)? Do I have family or loved ones to handle those when I cannot?
- Are there any family or friends I want to see?
- Where do I want to spend the final days or my life?
- What is most important in the final days of my life?
- Who do I want involved in decision-making?
- What effect will a treatment have on prolonging my life? How will it impact my quality of life?
- Which treatments do I wish to receive?
- What are the best and worst outcomes from a treatment?
- At what point do I want to shift focus from receiving treatment for a cure to maintaining comfort at home?
- Do I want or do I have a do not resuscitate order?
Questions to ask your doctor
- How much time do I have left?
- Will I be in a lot of pain?
- What I can do or take to manage my pain?
- Can you refer me to services or agencies that provide palliative and hospice care?
- Should I be moved to the hospital near the end?
Copyright © American Academy of Family Physicians
This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject.