Necessary end of life care discussions with loved ones.

Something to Seriously Consider.

End-of-Life Care Discussions Should be Initiated Earlier This can help patients reduce suffering, make more informed choices, and attain life closure Discussions about end-of-life issues between patients, their families and health care clinicians are difficult for clinicians to initiate, but by doing so earlier and more systematically than is typical, clinicians can better serve patients and their families, according to an article in the November 15, 2000, issue of The Journal of the American Medical Association, a theme issue on end-of-life care.

Unfortunately, palliative care [making a patient more comfortable by treating a patient's symptoms, rather than curing the patient] is frequently offered late in the dying process, if at all, and as an alternative to usual medical care as opposed to something that can enhance or supplement it. Hospice, a system for providing palliative care, is underused even for patients with advanced cancer.

Physicians are also reluctant or unable to tell patients that they are likely to be approaching the end of their lives. When physicians do talk about prognosis, they tend to be overly optimistic. This inability to relay unfavorable prognostic information results both from medicine's inherent prognostic uncertainty and from clinicians' fears that they will be perceived as 'giving up' if they talk about dying, thereby eliminating hope and depressing patients.

However, studies have found that not only is this not necessarily the case, but failure to provide appropriate information about palliative care and prognosis can contribute to unnecessary pain and suffering." Consensus has evolved among clinicians that meaningful end-of-life options are usually offered too late. Fewer physicians agree as to the clinical markers signaling the time to initiate discussions.

The following situations suggest urgent indications.Patients facing imminent death Patients who talk about wanting to die Patients recently hospitalized for severe progressive illness Patients suffering out of proportion to prognosis Normalizing the discussion allows patients to learn about their right to high-quality pain and symptom management and educates clinicians about patient's values and goals. Asking 'What would be left undone if you were to die sooner than later?' gives a message that time may be short." Indications for routine discussions might be: When discussing prognosis When discussing treatment options with a low probability of success When discussing hopes and fears When the physician would not be surprised if the patient died in the next six to 12 months. Before addressing various types of medical interventions with patients, clinicians should discuss the relative weight placed by the patient on prolonging life as opposed to enhancing the quality of life.

It is important that clinicians review the following with patients:Living wills Health care proxies Do not (attempt) resuscitation (DNR) orders.

Other life-sustaining therapies such as:
Mechanical ventilation
Feeding tubes
Antibiotics
Hemodialysis Palliative careManagement of pain and other symptoms
Relief of psychological, social, spiritual and existential suffering Creating opportunity to address unfinished business

DON'T LET YOUR LOVED ONES SUFFER!

OUR ELDERS

If you love them, and care about their comfort, don't let any of this happen to them, if they must stay in a nursing home, or assisted living facility!

Easyinsurance Helpful Tips suggest you check with your health insurance carrier before you make your final decision when choosing a resident friendly care facility.

Your health insurance carrier may be very helpful, because of their knowledge of which insurance loss prevention programs reputable Nursing home , and assisted living facilities, participate.

Nursing Home Facilities

Abuse and Neglect

Assessing Nursing Home Facilities
overview assessment tips other facilities

It is vital for your family member that you spend a considerable amount of time researching the nursing home before you send them to one. Do not judge the nursing home on the basis of a guided tour or the nice furniture or attractive physical features of the facility.

Visit with residents

You should find at least one resident that you can visit in the facility. This will help you in evaluating the facility without a guided tour. Walk up and down the halls and talk to bedridden residents and those who are wheelchair bound. As you talk to them, check out their grooming, skin quality, nail care and oral care. See if the residents appear upbeat or if they are depressed. If almost everyone you talk to is confused and unable to have a normal conversation, this could be cause for concern.

Assisted living facilities

Assisted living offers a wide range of services with a wide range of monthly fees. If you need assistance getting through the day, but don't require the intensive supervision and medical services of a nursing home, assisted living may be for you or your loved one. Take the time and investigate state agencies which may assist with payment for assisted living facilities.

Services, staffing, and philosophy of this type of housing vary enormously. It is very important that you determine exactly what is offered in each home. Look for a place that encourages residents to be active. People who have been loners all their lives are unlikely to adapt well to congregate living, and a mentally alert person doesn't belong in a small home with cognitively impaired people. Make sure the person is suited to assisted living.

If you disagree with certain provisions in the admission contract, see if you can modify or eliminate them. Contracts should allow for a minimum of 30 days notice if the facility desires to end the agreement. You should know who makes the decision regarding transfers when a resident's health declines. Remember, assisted living facilities are not immune from the same problems facing nursing homes, particularly the difficulty of keeping a stable staff.

Medical Issues in Nursing Homes
Overview

Nursing home patients may find themselves subject to dozens of adverse conditions through no fault of their own - bed injuries, pressure ulcers, falls, fractures, malnutrition and dehydration are some of the more prominent injuries.

Debilitating conditions that can occur in nursing homes.

Bed injuries

Between 1993 and 1996, there were 74 reports of death from strangulation or suffocation involving hospital beds. The federal General Accounting Office has concluded that many deaths go unreported.

Some siderails extend the full length of the bed; others, called half rails, are about 2-1/2 feet long. Some are metal, others plastic. Most can be raised or lowered.
Siderails are divided, either vertically or horizontally, with slats spaced about six or more inches apart. This space can trap an elderly person's head, causing him or her to strangle; or, to allow a thin, frail person to squeeze between the rails and fall to the floor.

Often mattresses fit loosely in the frame, leaving gaps large enough to trap the resident between the mattress and siderail, also leading to suffocation.

Falls and fractures

Falls are the most frequent causes of fractures in the elderly. Nursing home residents are at increased risk for falls primarily due to advanced age of the population. There are many other factors which place individuals at risk for falls. Nursing home personnel are regularly required to assess patients to determine their risk for falling, and provide safety devices and services to minimize the risk of injury to the resident. Some of the risk factors for falls include:

Previous falls
Cardiac arrhythmias
Stroke
Central nervous system disorders such as Alzheimer's disease,
Parkinson's disease, dementia and others

Problems with mobility and gait
Low blood pressure (orthostatic hypotension) on standing up
Bowel or bladder incontinence
Dizziness
Dehydration
Visual impairment
Use of restraints
Medications

Dehydration

Dehydration should be managed through an individualized daily plan to promote adequate hydration based upon identifying the risk factors which include at least the following: Alzheimer's, or other dementia Major psychiatric disorders Depression Stroke Repeated infections Diabetes Malnutrition Urinary incontinence History of dehydration 4 or more chronic conditions Use of diuretics, antidepressants, psychotropics, or anti-anxiety medications, laxatives, or steroids Chronic cognitive impairment Inadequate nutritional status Acute situations: vomiting, diarrhea and/or fevers

Malnutrition

Many things can cause malnutrition in nursing home residents. The following are factors that may prevent a resident from receiving adequate amounts of the vitamins, minerals, protein, and calories the resident needs:

Physical Causes: Illness Adverse drug effects such as nausea, vomiting, diarrhea, cognitive disturbances, or sleepiness Food and drug interactions which decrease the ability of the body to absorb vitamins and minerals Depression Swallowing disorders Mouth problems such as tooth loss, dentures that do not fit properly, mouth sores, and mouth pain Tremors, which affect the residents' ability to feed themselves

Environmental Causes: Inadequate attention from staff for residents who need assistance eating Staff who are uneducated about malnutrition and proper ways to feed residents who need help Reliance on liquid supplements Special diets

Signs That A Resident is Malnourished:Ask the following questions to determine whether your loved one is demonstrating signs of malnutrition: Do clothes fit more loosely than usual? Are there cracks around the mouth? Do lips and mouth look pale? Has the resident complained that his/her dentures no longer fit? Has the resident's hair been thinning or growing more sparse? Do wounds seem to take longer to heal? Does the resident appear confused (not as a result of a disease such as Alzheimer's)? Is the resident's skin breaking down? Does the resident's eyes look sunken? Does the resident appear to be losing weight?

If the answer is yes to two or more of these questions, the following may help pinpoint specific problems: Can the resident feed him/herself? What is the resident's favorite meal of the day? When and where does the resident prefer to have meals served? Does it take a long time for the resident to eat? Is the resident rushed through meals? Is the resident unable to finish meals?

Does the resident seem to eat more when someone is there to help with the meal? Does the resident seem uninterested in food? Has the resident lost his/her appetite? Does the resident like the food at the facility? Can the resident choose from a menu? Are snacks readily available to the resident? Is the resident on a special diet? Has the resident started taking any new medications? Has the resident's weight routinely been monitored? Has the staff informed family members of weight loss? Has staff asked family members for assistance?

Do Your Homework, when choosing, or considering a Nursing Home, or a assisted living facility, for a loved one.