Resources for Family Caregivers of Older Adults
End of Life Decisions — Don’t Let Senior Loved Ones Wait Until the End of Life to Make Them

End of Life Decisions — Don’t Let Senior Loved Ones Wait Until the End of Life to Make Them

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We love life and want it to last forever, but the reality is that our time on earth is finite.

No one knows when the end of life will come for themselves or the ones they love, so being prepared to face it as we want and with dignity requires us to plan for the eventuality.

Facing the multitude of decisions that accompany the end of a loved one’s life can be overwhelming and heart wrenching for family caregivers and their senior loved ones.

Everyone has the right to create their own end of life plan, to withdraw or refuse medical treatment or to choose pets, visitors, or music to surround them near the end.

Everyone has the right to make his or her own decisions until such time when they are no longer capable and need someone to step in for them.

But how do we as family caregivers approach our seniors to make these decisions?

How can we learn what decisions for the end of life our senior’s may have already made?

This is one of the toughest conversations families will have but one of the most important for them to begin.

Legal Aspects at the End of Life

(Please keep in mind we are not attorneys and not providing legal advice. If unsure about laws or legal process where your seniors live, you should contact an elder law attorney or other legal expert.)

In addition to the straightforward tasks of planning for the end of life such as funeral arrangements, absolution of your senior’s personal possessions or finances or saying goodbye, it is important to ensure your senior’s medical directives are executed according to their wishes.

Here are a few documents that should be created and may require advice of experts like elder law attorneys to be sure they are done in accordance with the laws of the state where your senior resides. They will dictate whether specific treatment is used, withdrawn or withheld based on the wishes of your senior loved one.

These advance directive documents will be used when your senior is unable to speak for themselves.

Durable power of attorney for healthcare and/or finances

Who will be named proxy to control the decisions made for your senior when he/she can no longer make them? Who will pay your senior’s bills if they can’t? Who will make medical decisions in your senior’s place when he can no longer to express himself? Who will protect their rights for them? Who can be trusted?

These are questions for your senior to answer through the creation of durable powers of attorney for their healthcare and financial decisions.

DNR

Creation of a DNR or Do Not Resuscitate advance directive is important to be done before a crisis occurs. It requires a doctor’s signature instructing other healthcare providers.

Does your senior wish to have CPR if their heart stops or to have artificial means to remain alive? Are they well enough to survive chest compressions? Do you know their opinions on this?

A DNR only orders what will happen in the event their heart stops beating. It doesn’t decide if antibiotics or IV fluids will be given or if the healthcare team will give up on them.

Living will

This is an advance directive that will express your senior loved one’s desire about what medical interventions will be used to keep him alive. It can detail his or her wishes for the use of mechanical ventilation for breathing, if a tube feeding will be used to keep them alive (artificial nutrition or hydration), or if other (or any) heroic measures should be used.

These documents are witnessed by one or more individuals according to state regulations so check with a professional to be sure they are completed correctly.

Five Wishes 

Five Wishes is a document that is specific to a variety of different items that you and your senior may not have yet considered. They include decisions such as those contained in a living will but also other more personal things to be done at the end of life.

Considerations such as if they wish to die at home, if they want their pet on their bed, who should and shouldn’t be asked to visit, what music they want in the room to soothe them, what types of personal items they want nearby such as pictures of deceased spouse or certain flowers, and a host of other items.

This document will help them transition with dignity and guide caregivers to making their end more comfortable.

Don’t Just Put Advance Directives in a Drawer

None of these documents are written in cement and can be changed at any time, as long as your senior loved one is still of sound mind under the law. As a matter of fact, they should be reviewed regularly to be sure nothing has changed including the designated proxy.

Copies should be given to family caregivers and healthcare providers so that your senior’s wishes will be followed when the time comes.

Learning Senior Loved Ones’ Wishes

Older adults have probably already thought about what their end of life desires will be. They likely have dealt with family members and friends who have faced end of life.

Death with dignity is the goal for most of us, including our senior loved ones.

It is important, therefore, that family caregivers take the opportunity to learn what their senior’s wishes are and how you can advocate for them in the future.

Start the conversation with them to see if they have documents created, where they are kept and if you can read them for the purpose of understanding not changing their minds.

If they don’t have these documents executed, can you help them do that?

Completing Advance Directives

Each state has its own unique forms for advance directives. You can request a copy of your state’s forms using this locator from AARP.

Here are some questions to ask your senior when considering what to document in their advanced directives:

  • Do they want nature to take its course or have healthcare professionals perform heroic measures that can lengthen their life even if it could be considered futile?
  • Do they want their heart to be restarted or a tube down their throat breathing for them?
  • Do they want a tube placed in their stomach providing them with nutrition and fluids when they can no longer eat or drink for themselves?
  • Do they want to die peacefully and with dignity?
  • Where do they want to spend their final days — at home, hospital or hospice facility?
  • Would they prefer to receive comfort or palliative care at the end of their life instead of aggressive care?

Remember, while you may help them, it is important the answers be theirs to the advance directive reflect their wishes.

In the Event of An Emergency…

If your loved one has not made these wishes clear in a legal document, you may be asked to make some hard choices for them when the time is all too quickly upon you. That is why it is so important to learn as much as you can about their wishes now.

Talking with family members, including siblings, spouses, and other close relatives, who may have had conversations with your loved one along the way about what they might want done for them even if it was never put in writing can help you decide what is the best choice if you are called upon to decide without prior knowledge of your own.

Ask yourself-is this what he/she would want? Would they want to live this way?

If you don’t make some of these decisions quickly or if you are not prepared to respond, healthcare professionals will have to make them for you in the interest of life saving. Oftentimes, this is the very moment you need support and understanding to deal with your own emotions in the event of an emergency.

Before the Time Comes

Talking openly with all your loved ones about what their wishes are before the time comes, creating a document to record these wishes, and honoring their wishes when the time does come will not make the pain go away, but hopefully make it easier to deal with at that time.

Keep your senior’s advance directives, will and other financial documents like insurance information and burial arrangements in an easy to access place or supply a designee with copies so that they are where they can be reviewed as quickly as possible when needed.

You can prevent having to make tough choices by keeping the line of communication open with all your loved ones. Don’t be afraid to talk about death and dying, it is a natural part of life and unavoidable.

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