Wednesday, March 18, 2015 The Nugget Newspaper, Sisters, Oregon
19
Addressing end-of-life issues in Sisters Country
By diane goble
Correspondent
We’d all like to think we’re
going to live forever, but the
truth is, 100 percent of us are
going to die. Whether from
old age or disease, most of
us would prefer to die while
doing something we love to do
or at home in our own bed in
our sleep. The reality is that 70
percent of us die in hospitals,
nursing homes or long-term
care facilities.
Jennifer Blechman, MD,
of Partners In Care – Hospice,
Home Health & Palliative
Care, provided some key sta-
tistics to The Nugget:
Over 90 percent of people
think it is important to talk
about their end-of-life wishes
with loved ones, but fewer
than 30 percent do; 82 per-
cent think it is important to
put their wishes in writing,
but only 23 percent have done
so. People say they don’t want
to burden their families with
tough decisions, but rarely
do they convey their specific
wishes to family members.
It’s difficult to keep up
with all the changes in the
healthcare system until we
suddenly run up against them
and don’t know where to turn.
Partners in Care Bend and
Hospice of Redmond are good
resources for caregivers and
seniors for explanations of all
the changes, and to meet your
immediate needs.
Palliative care is now
being offered to patients after
discharge from a hospital,
which cuts down on hospital
stays and provides follow-
up through recovery. A team
of palliative doctors, nurses,
social workers, physical thera-
pists and dieticians work with
the patient to cut through the
paperwork and find appropri-
ate after-care services. If a
patient needs to go back into
the hospital or onto dialysis,
it is a more seamless process,
which allows families time
with their loved one instead of
filling out more forms.
When is the right time
during the course of an ill-
ness or advancing age to talk
about hospice? Actually ...
long before it’s needed. Over
dinner tonight, start having
“the conversation” with your
family (there will be many
more) about your values, your
thoughts about end-of-life,
who you want to speak for
you if you are unable to, how
you would hope to die. Your
end-of-life decisions are about
what you want. This treat-
ment, but not that one ... but
only for so long. Do every-
thing. Do not resuscitate.
Families, who haven’t
had The Conversation and
filled out an advance health-
care directive, and are forced
to make life or death deci-
sions, are often traumatized
for years. Did we do the
right thing? Is this what she
wanted? Family arguments
often break out over futile
medical procedures and keep-
ing someone alive or letting
them go peacefully.
“Hospice” is a frightening
word to even consider, much
less say out loud. It’s like say-
ing you’re giving up hope.
But hope is not a plan, and too
many people wait too long to
even ask for the information.
Many doctors wait too long
to bring up the hospice option
because they don’t want their
patients to think they’ve given
up on them. Ironically, people
often live longer than expected
on hospice once relieved of
the stress of more invasive
procedures.
May Fan, M.D. of Bend
Memorial Clinic Sisters told
The Nugget, “I think that the
primary reason providers are
hesitant to bring up the option
of hospice is that it is difficult
to tell when a patient has a
life expectancy of six months
or less. Many patients have a
clinical course that fluctuates
or levels off for long periods
of time, and it only becomes
clear at the very end. Also
patients may not accept a
doctor’s recommendations
for palliative or hospice care
because they do not want to
‘give up.’”
Lori Weber, transition
coordinator with Partners in
Care Bend, holds monthly
educational programs and
offers guest lectures about
advance care planning, falls
and fall prevention, home
healthcare and hospice, and
Medicare benefits. She says,
“hospice isn’t about giving up,
it’s about living your last days
as comfortably as possible and
being able to spend quality
time with your family.”
How does a family care-
giver know when to bring hos-
pice up to the doctor? “When
the patient is eating half as
much as they used to, is los-
ing weight, having multiple
infections and is unable to get
over them, is having increased
falls. Anything that changes
and doesn’t go away,” Weber
says. “It may not be time to
sign up, but you’ll have the
information if you need it.”
Surgeon Atul Gawande,
author of “Being Mortal:
Medicine and What Matters
in the End” lost his (doc-
tor) father recently and found
his experience with hospice
changed the way he thought
about end-of-life.
Dr. Gawande learned that
people have more meaning-
ful priorities than just living
longer, and the most reliable
way to learn what they are, he
says, is to “Ask them. But we
don’t.”
“It turns out,” he says,
“what people need most is
help talking to their families.”
Dr. Blechman notes,
“There are many tools avail-
able to help with these dis-
cussions. One is called ‘The
Conversation Project,’ which
is a campaign in collabora-
tion with the Institute for
Healthcare Improvement,
and aims to be sure people’s
wishes regarding end-of-life
care are expressed and fol-
lowed. Their website, www.
theconversationproject.org,
contains a starter kit to help
you organize your thoughts,
and guides you on ways to
have the discussion with those
close to you.”
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