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End of Life Decisionmaking

In the 11 years that I have been writing this blog it has been a rare week that I have missed posting anything.  For 25 years I have focused my practice on the field of elder law – helping to guide families through life’s transitions – as our tag line says.  Aging and dying has for many Americans and their families become a long drawn out process.  During these years we have helped our clients navigate that process.

In the last several weeks I navigated that process on a personal level as my father, who has had several years of declining physical and mental health finally passed away last week.  15+ years ago both my grandmothers died a few years apart.  I assisted my parents but more as an attorney would a client.  I wasn’t the decision maker but there to provide advice.  This time, with my dad, was different.  I was the health care representative and the agent under power of attorney, consulting with my mother and sister, but responsible to make, communicate and carry out those decisions. In today’s post I want to share some of my observations.

Obviously, doing what I do for a living, the legal documents were in place and detailed enough to allow me to speak with medical personnel and make medical decisions.  This allowed for a much smoother process and I again can’t stress enough how important that is.

 The isolation caused by the Covid pandemic, I believe, hastened by dad’s decline, something that many of our clients have experienced in the past 4 months.  Several weeks ago Dad suffered a stroke.  Trying to get a complete picture of his prognosis was not easy.  Fore example, the neurologist focused on prescribing medication that would reduce the risk of future strokes by preventing blood clots.  That same medication, however, was a problem for someone who was a fall risk, having had several falls in the past 2 months.

Rehabilitation also was problematic because of the isolation.  Most facilities still strictly limit visitors which is understandable, however, being alone in a strange place for many dementia patients causes agitation.  This would certainly hamper any rehabilitation efforts. Conversations with Dad’s hospitalist, cardiologist, dietician and nurses each provided important information but also made it difficult for me to get a clear picture of where he was headed and what was realistic to expect.

 A conversation with my dad’s internist who specializes in geriatric medicine was ultimately what enabled me to pull everything together.  Having someone look at the entire picture and sort out the multiple medical issues and pros and cons of various options I found to be most helpful, especially as someone who does not have any medical background or training. 

Ultimately, we decided that bringing Dad to our home on hospice was the right choice for our family.  I learned nearly 20 years ago with my mother in law that a conversation about hospice often happens too late.  The limited choices caused by the pandemic made our decision easier. While we have for years recommended hospice to families, I had no previous personal experience with the process of palliative care.  The focus on making Dad as comfortable as possible and having him surrounded by family in his last days made a difficult time a little bit easier for him and for us.