End-of-life issues loom large as Baby Boomers reach the break-over point with their own parents and other elderly family members in their care. The decisions that must be made in this age of advanced medical care weigh heavy because our elders are living far beyond any past generation’s life expectancy. It is no longer unusual for a 60- or 70-year-old “child” to be caring for parents in their 90’s.
As a result, there has been a boom in the offerings available for support. Assisted living—the elderly living in their own apartments or small cottages within a complex that offers 24-hour nursing and medical care as well as assistance with the basic needs of daily life—has become standard where a decade ago it was a rarity. In-home health care networks have grown as well with 24-hour aides available and often covered by Medicare if the network is approved. The nursing home industry has undergone serious scrutiny, and it, too, is growing and offering safer and more comfortable support for those who cannot care for themselves.
In the end, however, there is a need for something more intense in the way of care that family cannot provide. As much as we might want to be the sole caretaker for our loved ones to the end, medically and ethically we often can’t.
An elderly person who has serious medical problems—ongoing battles with cancer, diabetes, heart disease, and other chronic conditions—needs medical care. Hospitals will serve the need in a crisis, but most are not long-term facilities. When the patient’s emergent problem has been resolved, the hospital will release him. That is their job.
The patient goes home or to whatever situation has been prearranged by family, and someone is charged with overseeing and administering daily care including monitoring medications and vital signs. The home nurse, whether supplied by the hospital or arranged privately, is a good hand to have on board since she can legitimately administer medications via IV and injection that non-qualified and non-certified helpers are not permitted to handle. If care needs fall beyond the scope of what can be done in an hour at home by a Visiting Nurse or a private-duty nurse, the nursing home comes into play.
Nursing homes, however, are designed (and covered by long-term care insurance) to be temporary situations for patients whose condition could conceivably, with medical support, improve. The elderly woman suffering from the after-effects of chemotherapy or in need of continued treatment and rehabilitation after a fall or illness such as pneumonia may be the ideal nursing home candidate.
But, sadly, there comes a point where no further treatment will increase the patient’s quality of life or projected improvement in health status. When the patient is declared terminal, hospice care, either at home or in a nursing home setting, is the final option.
Hospice networks require that a doctor declare, in writing, that the patient is beyond cure, is near death, and has no hope of recovery. Family members who are charged with the patient’s health care proxy or durable power of attorney must also sign affidavits ensuring that they understand that no further medical treatment will be administered and that palliative care is both recommended and accepted as the next step. The hospice will send a nurse and a social worker to discuss with the patient (depending on his level of coherent thought) and his family what level of palliative care will be supplied on what schedule and by whom.
It is difficult to watch a beloved parent or family member drift away, but with the kind care that hospice provides, the patient can be kept comfortable and peaceful throughout the process. There will be no cure at the hands of the hospice nurse, but there will be a sense of quiet. The patient may be sedated to ease pain or suffering. As many elderly reach the end, quiet and a cessation of pain and stress are the best possible solution.
Be aware that hospice care is not a death sentence, and within the contract there is usually a statement that should the patient, through natural means, improve to the point where he is declared no longer terminal but capable of being medically treated to resolve his illness, the hospice will withdraw and the family can rejoin the battle to continue to improve the patient’s health. But hospice will always be there, waiting quietly in the wings, like a cushion to soften the end-of-life struggle. Not something to fear, but something for which family and patient can be eternally thankful in those moments that reach into the heart.