These are the dreaded words millions of people hear in hospitals across the world. The families and loved ones of many elderly people are not prepared for this day. Families sometimes believe death will just happen and are not aware that decisions need to be made when their loved ones are in between Critical illness and death. A misunderstanding of what life support means, mixed emotions and not knowing what a loved wants causes patients to linger on hospital units unnecessarily. Part 3, the last section of my series, Growing Old in a Culture of Busy People and Broken Families will discuss Advance Directives and the legal implications for elderly care.
Advance directives, also known as living wills, durable or medical power of attorney and DNR (do not resuscitate) are documents that express to your physicians, family and friends your wishes regarding health care. For example, an 80 year old woman, living at an assisted living facility comes into the emergency room because she is having difficulty breathing. The woman has an advance directive on file and the assisted living facility forwards this document to the hospital. En-route to the hospital the woman needs additional help breathing, and the ambulance crew intubates her (breathing through a tube). Upon arrival at the ER the doctors and nurses stabilize her with additional medications to help her blood pressure. After working on the patient the doctors discover the patient did not want to be resuscitated and approach the family.
This scenario happens more often than you think. I'm not a doctor or nurse and I can not explain the technical and medical causes or reasons for the body's behavior. I can not even give you medical advice or guidance. I'm a chaplain and I am speaking with the voices of families I support almost daily. They do not have a complete understanding of life support and struggle with the decisions involved in a DNR. Educating yourself on the different forms of life support available and what they do is important. Being informed helps you make better decisions for your elderly loved ones. The first thing I want you to know, you are not killing your loved one by removing life support. Their bodies are already sick and beyond the point of recovery. Life support merely sustains a dying body, life support does not repair or heal. The next thing I want you to know is when doctors are approaching you and ask "what do you want us to do (in regards to life support)?" They have already done everything to 'cure' the patient, they want to know to what degree do you want us to keep the body living. You have to remember living does not mean your loved one is going to return to their former activities and life. The expectation usually is your loved one will spend the rest of their life in bed and/or on a breathing machine. Their quality of life is gone and your loved one is no longer 'your loved one' they are a body laying in the bed. The last thing I want you to know before we move forward is people die on life support. Removing life support gives comfort during the last season of your loved one's life.
Talking with your loved one before they are unable to make their own medical choices is invaluable. In part 2 of this series I discussed having difficult conversations, please review for further information. A good place to start with these conversations is quality of life. Ask your loved one how they define quality of life. Knowing how they feel about physical independence, the level of mental capacity that is acceptable to them and how aggressive they want their treatment to be reduces stress if you are confronted with these decisions. Respecting your loved one's wishes allows them to have dignity when they are vulnerable. Putting your own desire aside and respecting the wishes of your loved one, is the most selfless and loving action a family member can do.
FORMS OF LIFE SUPPORT
Life support is used to support failing or failed organ systems because they can not function alone. The human systems that are helped with life support and some of the support forms used are:
Respiratory System- usually supported with a ventilator
Cardiovascular System- usually supported with medications
Renal System- usually supported with dialysis
Gastrointestinal System- usually supported with tube feedings
If your loved one does not have an advanced directive the physicians will consult with the family. The spouse normally becomes the decision maker. If the person is single or widowed the children are usually the next people to make the medical decisions. There is normally one sibling designated for this task and a social worker is usually involved in establishing the decision maker. A person can be appointed a surrogate decision maker through the courts if the family doesn't agree or the patient does not have any family or friends.
Sometimes families decide not to remove support, then their loved ones must be transferred out of the hospital. They are normally placed in long-term care facilities, which specialize in caring for patients on life support. Please be aware of your loved ones healthcare insurance. They can be transferred out of state, you should be aware of their long-term care benefits.
CONCLUSION
To get further information on advanced directives you can contact an attorney. They will be able to answer your questions and give you additional information according to your state or country. I would also recommend families to sit down with their loved ones and doctor to discuss different forms of life support.
This concludes my series, I hope you enjoyed it and learned empowering information to give you spiritual well-being and peace.
This concludes my series, I hope you enjoyed it and learned empowering information to give you spiritual well-being and peace.
ADDITIONAL RESOURCES
Medicare.gov (This link will help you discover your loved ones Medicare benefits)
My 5 Wishes, Aging with Dignity (This is a great tool for discussing and planning end-of-life medical care)
The Merck Manuals Online Medical Manuals (Everything you want to know about healthcare is here)
Nolo Long-Term Care Kit (Planning long-term care with guidance)
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