Mom was fortunate that she received the care she wanted during her death. It made her transition less painful, more peaceful and more meaningful for all of us. But, what of others facing the end of life; do they get the care they want?
Most elderly people say they want to die at home but 55 percent die in a hospital. They frequently do not want aggressive, invasive treatment at the end of life but are placed in an ICU. Routinely, they endure the pain of repeated trips between home, nursing facility, and a hospital in their final months.
Evidence from the Robert Wood Johnson Foundation indicates that patients prefer more conservative, home-centered end of life care; but, often do not receive it. Aggressive treatments preferred by providers are the norm.
This practice pattern stresses patients, families, and is very costly. Thirty-two percent of Medicare dollars are spent in the final two years of life mostly for hospital and physician charges on patients with nine chronic conditions.
So, why did my mother get her wishes? What can you do to get yours?
We talked as a family about what medical care each of us preferred when our time is up. Neither of my parents wanted end of life treatment that would be of no benefit, primarily prolonging death. Specific aggressive treatments such as antibiotics, blood transfusions, feeding tubes, ventilators and resuscitation were ruled out in their cases.
They told my sister and me their wishes directly; it was included in their Living Wills and Healthcare Power of Attorney, which gave my sister legal status to make medical decisions when my parents were incapacitated. The family meeting and the Living Will eliminate uncertainty about the patient’s end of life wishes. It assures that medical treatment at end of life will be patient-centered, not muddled by charged family dynamics. Julie and I were free to concentrate on our mother because we were prepared.
In my mother’s final weeks, she stayed in her home receiving palliative care that kept her as pain-free as possible. She enjoyed her three kitties and visits from Julie and me; she got to know one of her aides, who is studying to be a nurse. When she no longer wanted food, I gave her sips of water.
When the end came, it was after a peaceful time at home with her family rather than fruitless trips to the hospital, painful tubes and wires and unconsciousness.
You may want a different death; but I encourage the family talk and securing a Living Will and Healthcare Power of Attorney to ensure your wishes are fulfilled.