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HOW TO BEGIN PALLIATIVE CARE

AND HOSPICE CARE?

The

FIRST STEP

is to have a conversation with your

loved one about her goals for care.

Encourage your loved one to complete a health care

power of attorney, Maryland Advance Directives, or Five

Wishes. These documents allow her to designate who

will make decisions for her if she is unable and provide

an opportunity to indicate the care she would want if her

death is imminent.

Why is this conversation important?

• It assures that your loved one’s wishes are clearly

articulated so that they can be honored

• It may bring family closer together by talking about

important issues and understanding one another

• It may save money. Families often continue with medical

treatments long past the point where they are helpful

because they do not know their loved one’s wishes. This

is financially – and emotionally – costly for everyone.

• Most importantly, if you are the person making decision

about your loved one’s care, you will feel more confidence

with less guilt and anxiety knowing that you are acting

according to his wishes.

The

SECOND STEP

to begin palliative and hospice care is

to communicate with the physician(s) involved in your loved

one’s care.

Some physicians are reluctant to raise the topic of

palliative or hospice care for fear that patients and families

will feel that they are being abandoned or will lose hope.

However, many physicians support palliative and hospice

care because they see the emotional and physical toll that

repeated and unsuccessful treatments and hospitalizations

have taken on their patients and families. Many physicians

just need to hear from families that they are open to

palliative and hospice care.

• Share the advance directive/power of attorney/Five

Wishes with the physician

• Talk with the physician about your loved one’s idea of

quality of life and the treatment he would want at end

of life

• Ask the physician to complete the MOLST (Medical Orders

for Life Sustaining Treatment) form according to your loved

one’s wishes. This form provides orders about whether or

not to perform CPR if cardiac or respiratory arrest occurs.

• When any treatment is proposed ask the physician:

- Given her current condition, what is the likely outcome

of the treatment you are proposing?

- What will her daily life and functioning look like after

this treatment? How likely is it that she will return to

her current level of functioning or better?

- What care will she need in a week, month, year?

- Will she be able to return to her current living

situation?

- What will happen if we don’t do the treatment you are

proposing?

- What is the option that will honor her wishes and will

allow her to live a quality of life as she has defined it?

- Is hospice care a reasonable alternative?

- May we have a palliative consult to understand all of

our options?

Prepared by Jessica Rowe, LCSW-C, Jessica Rowe ElderCare Consulting, LLC

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