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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