Best West End Hotel Deals, Ontario: Find 100 Hotels In West End

#ottawa motels

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West End Hotels, Ontario Canada

West End Hotels Guide

Foodies of the world flock to West End to sample the cuisine. Known for its multi-cultural palette, it s easy to find anything from traditional French dishes to modern fusions and international fare.

  • Search for over 100 West End hotels in Ottawa
  • Choose a hotel with amenities like a hot tub, cable TV, and a pool
  • Save money when you book with us and spend it indulging in culinary delights

Make sure your stomach is empty and your walking shoes are in good repair; between parks and food, you re in for a full-body workout.

Luckily, this side of town is brimming with trails and parks you can hike through after a big lunch. Head over to local favourites like Hampton Park, Island Park, or Bel-Air Park among others. Some of these parks are pet-friendly, so you may be able to bring Fido with you. The West End is also close to the Riviere des Outaouais, if you d like to enjoy some time by the water. When you work up your appetite again, sample from the available fare; do you feel like African food tonight? What about steak?

When you re done exploring this side of Ottawa, a West End hotel will help you recharge and digest. Take advantage of the in-house fitness centre (to perk up your pecs), complimentary Wi-Fi (to upload all your latest selfies), and in-room refrigerators (to hold all the leftovers from lunch and dinner). Get to know friendly staff members and ask them to recommend their favorite eateries and hiking routes you get to do this all again tomorrow.

Find all the best hotels in Ottawa here on Expedia.ca, and enjoy your vacation with your travel budget intact. Whether you re a foodie looking for your nirvana or are just passing through as you explore greater Ontario, you ll receive our Best Price Guarantee.





Derwentside Hospice Care Foundation – Willow Burn Hospice – Hospice Co Durham

#durham hospice

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Win your Happily Eve. Local hospice, Willow Burn, based in Lanchester are offering one very lucky couple the c. Read More

Consett Shop celebra. On Thursday 5th May the staff in our Consett Shop held a party to celebrate the annivers. Read More

Fantastic Volunteers. Our fantastic volunteers Julia and Beryl, together with the help of their friends, are b. Read More

Willow Burn Wonsie W. On Wednesday 20th April, St. Pius RC Primary School in Consett took part in a Willow Bur. Read More

Consett Shop holds 1. On 5th May Consett Shop will be holding a Birthday Party to celebrate the anniversary of. Read More

Thank you to our Vol. We recently held a bucket collection on the streets of Chester-le-Street raising a fanta. Read More

In Celebration of Qu. South Causey Inn are holding a special event on Thursday 21st April 2016 in celebration. Read More

Spring Fair held Sat. Our Spring Fair was an enormous success this year making a fantastic total of £5,821.92. Read More

Exhibition with a Te. On Thursday, 7th April 7 Willow Burn Hospice held an open day to unveil an exhibition wi. Read More

TEENAGER MAKES SPORT. A champion gymnast, whose dreams were shattered by a devastating injury, is making a spo. Read More

Donate

Make a donation now and support a local charity who provides vital services to the community of Derwentside

Events

Find fundraising events at Willow Burn. Take part in our forthcoming events and help us to continue our vital work

Volunteer

Join us as a Willow Burn volunteer and know that you are making a difference to a local charity in your community

Newsletter

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Website designed by Azure Graphic
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Willow Burn is a registered charity, number 519659
and registered as a company limited by guarantee in the name of
Derwentside Hospice Care Foundation, number 2263960
Willow Burn is VAT registered, number 888918050.





End of life care – Alzheimer – s Society #san #antonio #motels

#end of life palliative care

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End of life care

Background

Dementia is a progressive condition for which there is currently no cure. All people who develop dementia will have dementia at the end of their lives, either as the condition they die from or as a factor which may complicate the care of a different condition. Diminishing capacity means that it is important for the person with dementia to plan for the end of their life at an early stage. Problems with capacity and communication can also contribute to undignified treatment and the under treatment of pain in people with dementia at the end of their lives. Significant, co-ordinated and holistic support is needed to ensure that all people with dementia end their lives with dignity, free from pain and in the place of their choosing.

Alzheimer’s Society calls for:

  • Ensuring a good death for people with dementia. The Department of Health (2008) suggests that, for many, a good death would involve being treated as an individual, with dignity and respect. without pain and other symptoms, in familiar surroundings and in the company of close family and friends. Too often, however, people with dementia receive undignified treatment and are ending their lives in pain (Alzheimer’s Society 2012, Health Service Ombudsman, 2011, Commission on Dignity in Care for Older People, 2012, Royal College of Psychiatrists 2011) and partnership between dementia care and palliative care are undeveloped (NCPC, 2009). People with dementia may not be referred for specialist end of life care or receive inappropriate treatment. Alzheimer’s Society believes that people with dementia have the same right to a good death as people with other health conditions.
  • Advance planning for end of life care. People with dementia should be involved in decisions about end of life care wherever possible. However, as dementia advances, in many cases capacity is lost and decisions need to be made on behalf of the person with dementia. Advanced planning for end of life care is vital. At present, taboos about discussing death and poor understanding of dementia mean that these conversations do not take place between people with dementia, families, friends and health and social care professionals. People with dementia should be supported to use their rights, under the Mental Capacity Act in England and Wales, to identify whom they want to make decisions and any treatments they would not want. In Northern Ireland, the Assembly is developing mental capacity legislation.
  • Improved training for health and social care professionals. Declining ability to communicate characterises the later stages of dementia. Health and social care professionals should be trained to provide high-quality, person-centred care to improve dignity and quality of life even when communication has diminished. People working with someone at the end of their life also need to be able to communicate sensitively themselves, both to families and to the person with dementia, following best practice set out by the Social Care Institute for Excellence (www.scie.org.uk ).
  • Focus on quality of life, rather than length of life, in the final stages of dementia. Withholding or withdrawing treatment is especially ethically complex and emotionally challenging for a person with dementia as they may lack the ability to communicate, the capacity to make decisions and may not have prepared instructions about their wishes. The NICE-SCIE Guideline on dementia states that artificial feeding and hydration should not commence if disinclination to eat or inability to swallow is considered to be part of the progression of the disease and will not change in future (NICE-SCIE, 2007). Alzheimer’s Society believes that when someone with dementia is close to dying the main issue of concern should be quality of life and quality of death, not length of life. However, it is important that there is an honest and open discussion between medical professionals and family, friends and carers about any decisions to withhold or withdraw treatment. The quality of life and comfort of the person with dementia is paramount. Specialist palliative and comfort care should be available to the person at all times and appropriate emotional support should be available for families.
  • Improved emotional and spiritual support. Research has suggested that the emotional and spiritual needs of people with dementia are disproportionately neglected (Sampson et al, 2006). It is still possible for a person with advanced dementia to be depressed, distressed or upset. People with dementia must receive holistic care that recognises and responds to individual wishes and needs.
  • Improved planning and co-ordination of care. Only half of people who express a preference to die at home actually die at home (ONS, 2014). This places pressure on the NHS, causing 52 per cent of unplanned hospital admissions, and adversely impacts on the quality of care received by a person with dementia (ONS, 2014). Alzheimer’s Society supports the government’s goal of ensuring that more people die in a place of their choosing (Department of Health, 2008). To achieve this, the Society calls for the implementation of the Palliative Care Funding Review (Hughes-Hallet et al 2011). This would provide commissioners with funding for palliative care, regardless of setting, in-line with a person with dementia’s wishes.
  • Implement the recommendations of the Leadership Alliance for the Care of Dying People. In July 2014, new best practice guidance from the LACDP replaced the Liverpool Care Pathway. Alzheimer’s Society supports the LACDP’s recommendations that, in the final weeks and days of life, the dying person should be the focus of care. However, Alzheimer’s Society is concerned that the guidance does not have statutory force.
  • Assisted dying. Alzheimer’s Society is not calling for a change in the law on assisted dying or euthanasia, although we monitor changes in legislation to ensure that people with dementia are appropriately safeguarded. We believe that people with dementia are entitled to good end of life care. This includes use of advance care planning and advanced decisions to refuse treatment so that people with dementia can receive the treatment and care that responds to individual needs and wishes.

References

Alzheimer’s Society (2012) My life until the end: dying well with dementia
Baker et al, (2012) Anticipatory care planning and integration: A primary care pilot study aimed at reducing unplanned hospitalisation. British Journal of General Practice, 62(595):e113-20.
Commission on Dignity in Care for Older People (2012) Delivering dignity: Securing dignity in care for older people in hospitals and care homes. A report for consultation. Commission on Dignity in Care for Older People, London.
Cox and Cook, (2002) Caring for people with dementia at the end of life in Hockley J, Clark D, eds. Palliative care for older people in care homes. Open University Press, Buckingham: 86-103.
Department of Health, (2008) End of life care strategy.
Neuberger (2013), More Care, Less Pathway: Independent review of the Liverpool Care Pathway.
General Medical Council (2010). Treatment and care towards the end of life: Good practice in decision making. General Medical Council, London.
Health Service Ombudsman (2011). Care and compassion? Report of the Health Service Ombudsman on ten investigations into NHS care of older people. The Stationery Office, London.
Hughes-Hallet, T, Craft, A, and Davies, C (2011). Funding the right care and support for everyone: Creating a fair and transparent funding system: The final report of the Palliative Care Funding review.
Mitchell et al (2009). The clinical course of advanced dementia. New England Journal of Medicine, 361(16):1529-1588.
NCPC (2009), The Power of Partnership: palliative care in dementia.
NICE-SCIE (2007) Dementia clinical guideline: supporting people with dementia and their carers in health and social care.
Office of National Statistics (ONS) (2011). Deaths registered in England and Wales in 2010, by cause.
Office of National Statistics (ONS) (2014). National Survey of Bereaved People (VOICES), 2013.
Royal College of Psychiatrists (2011). National audit of dementia.
Sampson, E, Gould, V, Lee, D, and Blanchard, M (2006). Differences in care received by patients with and without dementia who died during acute hospital admission: a retrospective case note study. Age and Ageing, 35(2):187-9.

Alzheimer s Society factsheet about the later stages of dementia.

The National Council for Palliative Care is the umbrella organisation for all those providing, commissioning and using palliative care.





Hospice and How It Can Help the COPD Patient AND Caregiver –

#end stage copd hospice

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Hospice and How It Can Help the COPD Patient AND Caregiver

Hospice can be an invaluable resource for people with end-stage COPD and their overworked, overwhelmed caregivers. But before I get into that, let me apologize. I’m writing 3 posts today, and they’re all a bit on the depressing side, because they deal with death.

I don’t mean to remove all hope for people fairly new to COPD as they read these posts. There are many opportunities for hope and a certain quality of life, even after a diagnosis of COPD. But it’s also a fact that COPD is a chronic, progressive illness for which there is no cure. Eventually, death does become a reality. It can take years, but it will happen at some point. So, while it’s important to live life to the fullest as long as you can, it’s also important for both patient and caregiver to prepare for what is coming in the future.

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So, this post is about how hospice can help, and the sooner it is initiated once the end is approaching, the better. Unfortunately, many people do not get referred to hospice (or are not ready to accept it) until far too late. And at that point, there may not be time for hospice staff to do what they are so good at. easing the way to a dignified, peaceful death.

My mom was referred to hospice during a recent hospitalization. and it turned out to be far too late. Although I have said that she was “dying for the last 2 years” more than once, in the end, she deteriorated so rapidly that we weren’t even thinking hospice before she went into the hospital. And then it was too late for her (or us) to reap the benefits, for the most part.

Hospice is a concept of care that provides comfort and support (on several levels) to patients and caregivers when traditional medical care can no longer prevent death from coming on, usually within a few weeks or a few months.

Hospice is a team-oriented approach that neither prolongs life nor hastens death. According to the Hospice Foundation of America, “the goal of hospice care is to improve the quality of a patient’s last days by offering comfort and dignity.”

Hospice care is not just about providing physical care, though that is certainly included. It’s also about the emotional, social, and spiritual impact of the disease and of the dying process.

Hospice does not usually refer to a place. 80 percent of hospice care is provided in the patient’s home. The emphasis is on enhancing comfort and reducing any pain or distress.

When the doctor says that nothing more can be done to improve or even maintain respiratory function, and that death is likely within the next one to six months, then hospice should certainly be considered. Hospice doesn’t mean giving up. it means making a conscious choice to focus on the quality of your life in your last days and then to go out on your own terms!

When you accept hospice, though, you are accepting that you will no longer be accepting life-sustaining or invasive treatments, except in the case of an emergency. It also entails acknowledging “Do Not Resuscitate” (DNR) status. In other words, if your heart or lungs stop working, you do NOT want emergency personnel to initiate treatment that would get things going again.

However, if you were to fall and hit your head or if you broke a bone, then emergency treatment for those would be acceptable, even if you are on hospice.

Once you go on hospice, you are not a prisoner. You CAN change your mind and go off of it. But you can only do that once or twice. So do not take the decision about hospice lightly. Make sure you are ready.

What Does Hospice Offer?

As I’ve already stated, hospice can be beneficial both to the patient and to the caregiver. I have been a COPD caregiver for more than 4 years, and it takes a toll. So, even if patients are willing to “go it alone”, keep in mind how helpful hospice can be to your caregivers.

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Most people who have hospice have Medicare health insurance, but both Medicaid and private insurance also often will cover hospice care in qualified people. Here are the hospice services typically covered by Medicare:

  • Nursing care and case management
  • Physician oversight sometimes home visits
  • Home health aide bath services
  • Medical appliances, medication, and supplies
  • Spiritual, dietary, and other counseling
  • Trained volunteers for patient companionship caregiver respite
  • Social work services
  • 24/7 on-call availability

Most people think of hospice in relation to cancer patients, but it can also be helpful to a respiratory patient. As death approaches in someone with COPD, breathing gets harder and harder and air hunger, fear and stress can develop.

Hospice nurses can help tweak oxygen levels and delivery methods, along with morphine and other medicines to control this air hunger and emotional stress. How much will that contribute to a more peaceful, gentler COPD death?

How to Learn More About Hospice

The Hospice Foundation of America website has lots of information about hospice, such as their Myths and Facts About Hospice page and their Hospice Stories section.

You can also talk with your doctor about hospice, and/or talk with the staff at one of the local hospices in your area. You should be able to find them listed on the Web or in the yellow pages of a phone book. Local hospitals may have their own hospices or be able to refer you to one as well.

My Personal Hospice Experience

My mom was diagnosed with COPD back in December 2005. Although she went on oxygen, for a couple of years, she still seemed pretty healthy. Then, in February of 2007, she developed pneumonia and was hospitalized. At that time, her doctor suddenly referred her to hospice, telling us it was not just for dying patients (which is not really true).

At that point in time, neither mom or I was prepared to think of her as imminently terminal, but we accepted hospice and they initiated services that seemed more like traditional homecare than anything else. Unfortunately, about 6 weeks later, mom’s femur broke and hospice was cancelled so she could have the leg surgically repaired.

2007 was a rough year, with 5 hospitalizations in total. On the 4th one, we thought we were going to lose Mom, but by 2008, she was on the mend and over the next year got better and better, often not really even needing her oxygen. Hospice was a distant memory.

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Towards the end of 2009, Mom’s breathing started to gradually worsen and I started wondering how much longer she could go on. But she soldiered on, adapting to every little change. Her current doctor talked about hospice when Mom started to ask questions about what the end would be like, but it still didn’t seem like time.

Then, in early November of 2011, Mom just suddenly decompensated, breathing-wise, and had to be hospitalized. Within a week, the doctors decided her lung deterioration was so far advanced, there was nothing more to be done, and started to prepare her to come home to die, which is what Mom wanted so badly.

A hospice referral was initiated, and they helped us with the whirlwind of preparation to bring Mom home on 12 LPM of oxygen (2 concentrators!), a CPAP machine, and kinds of other equipment and medication. It felt like we were setting up an at-home hospital room.

Mom came home on her birthday, and it was a joyful day for her, though also exhausting and with a few scary moments for both her and me. The hospice nurse spent 4 hours with us, getting us situated and setting up support services for the future. I was grabbing that lifeline, as the thought of being chained to my home 24/7 (Mom couldn’t be left alone) was pretty overwhelming and terrifying.

We thought we had at least 3 months to prepare and deal with the dying process. But Mom had other ideas. She passed away early the next morning. In the end, all that the hospice team was able to do for us was set things up and then to come out and pronounce her so that we didn’t have to call the police or coroner. Those things were great, but there is so much more hospice could have done for us, had there been more time.

So, our experience was that first we got hospice way too early and then in the end, way too late.

If you are starting to sense that your life is coming to a close, at least start thinking about hospice and what it can do for you and yours. Don’t wait until the end is right there before you take action!

Published On: December 08, 2011





End of Life Journal – BMJ Journals #footbridge #beach #motel

#end of life care issues

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End of Life Journal is a free, peer-reviewed journal for nurses and others working in health and social care. It promotes an integrated approach to practice and is aimed at those caring for dying people and their family/friends at home, in hospital and in care homes. It publishes articles from a range of professionals on all aspects of care relating to the end of life. The journal is keen to publish end-of-life care assignments, including master’s degrees, and will provide students with advice in relation to how best to adapt their course work into articles.

About End of Life Journal

Read the introductory editorial about the End of Life Journal and BMJ partnership to find out more.
Editorial

All content free

End of Life Journal is free to read. Simply register via this link

Communication Skills

Discover our special series of free papers that will help you conduct difficult conversations

St Christopher’s Hospice

St Christopher’s — exists to promote and provide skilled and compassionate palliative care of the highest quality

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Submissions





SCIE: End of life care #book #a #hotel #online

#what is end of life care

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End of life care

Information and links for professionals who support people and their families at the end of life

This resource is for people who work with adults who are approaching the end of life. Some 500,000 people die each year and, because of the ageing population, that number is predicted to rise over the next few years. It’s important that social care and health professionals who work with people at the end of life and their families have access to high quality resources and information so they can give the best care possible.

This guide is about enabling people who want to die at home to do so and improving the quality of care they receive.

Specific needs of people with dementia at the end of their lives.

Eight films that explore different aspects of end of life care. These films can be used in group training or for professional self-development.

SCIE’s resources support the professional development of health and social care staff who work with people at the end of their lives and their families.

Evidence-based information describing high quality end of life care from the National Institute for Health and Clinical Excellence (NICE).

Find out about the innovative end of life care practice of other organisations and share your own ideas with others working in the sector.





Hospice palliative and end of life care #roosevelt #hotel

#hospice end of life care

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Hospice, Palliative and End-of-life Care

What is hospice care?

Hospice care aims to improve the lives of people whose illness is no longer curable. It helps them to live as fully as possible to the end. It seeks to relieve the physical symptoms of illness while equally addressing the patient’s emotional and spiritual needs. Hospice care also provides support to families and those who are important to the patient, and extends its reach into bereavement.

Hospice care can be provided in various care settings, such as a hospice, people s homes, a hospital or a nursing home.

What is palliative care?

The terms hospice care and palliative care are sometimes used interchangeably. Palliative care is the term generally used by those working in the health service.

Palliative Medicine is a recognised medical specialty in Ireland. A doctor specialising in this area is known as a Consultant Physician in Palliative Medicine or Palliative Care Consultant. Specially trained nurses working in hospices or as part of a specialist palliative care team in a hospital or in the community are Clinical Nurse Specialists (CNS) in Palliative Care.

Click here for the World Health Organisation s definition of palliative care.

What is end-of-life care?

Understanding of the term ‘end-of-life care’ is not universal. In the Irish Hospice Foundation we use this term to refer to all aspects of the care provided to a person with a life-limiting illness, from the time of diagnosis through the last months of life, up to and including the final hours. We consider end of life to be a continuum rather than a point of time.

For more detailed information on these and other terms as used by the Irish Hospice Foundation, see Definitions.





End-of-Life Decisions – End of Life Issues – California Medical Association #kansas

#end of life issues

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End-of-Life Decisions

California law provides individuals the ability to ensure that their health care wishes are known and considered if they become unable to make these decisions themselves.

The California Medical Association (CMA) encourages Californians to think and talk with loved ones about their wishes for end-of-life medical care before a serious illness or injury occurs. CMA has developed a number of guidelines, forms, and other resources to assist providers, patients, and loved ones with making important end-of-life decisions.

NEW! California s End Of Life Option Act

On October 5, 2015, California became the fifth state in the nation to allow physicians to prescribe terminally ill patients medication to end their lives. ABX2-15, the “End of Life Option Act,” permits terminally ill adult patients with capacity to make medical decisions to be prescribed an aid-in-dying medication if certain conditions are met. The following document discusses the requirements under the End of Life Option Act, which went into effect June 9, 2016:

  • CMA On-Call #3459: The California End of Life Option Act
  • On-demand webinar: The California End of Life Option Act: An Overview

Advance Health Care Directive

In California, advance directives are the legally recognized format for living wills. An advance directive enables individuals to make sure that their health care wishes are known in advance and considered if for any reason they are unable to speak for themselves. Advance directives also allow patients to appoint a health care “agent” who will have legal authority to make health care decisions in the event that the patient is incapacitated, or immediately upon appointment if the patient expressly grants such authority.

See below for more information about advance directives, or to purchase CMA’s Advance Health Care Directive Toolkit, available in English and Spanish:

  • CMA Advance Health Care Directive Kit in English (rev. 3/14)
  • CMA Advance Health Care Directive Kit in Spanish (rev. 9/14)
  • CMA On-Call #3451. Decisions Regarding Life-Sustaining Treatment – Advance Directives and POLST (2015)
  • CMA On-Call #3450. Decisions Regarding Life-Sustaining Treatment for Patients Without Advance Directive or POLST (2015)

Physician Orders for Life-Sustaining Treatment

Physician Orders for Life Sustaining Treatment (POLST) in 2009 became a legally recognized document, similar to the widely used do not resuscitate (DNR) orders. The POLST form, used for patients with a serious illness or whose life expectancy is a year or less, outlines a plan of care reflecting the patient s wishes concerning medical treatment and interventions at life s end. The POLST form complements an advance directive by turning a patient s treatment preferences into actionable medical orders.

See below for more information about POLST, or to purchase CMA’s POLST toolkit, available in English and Spanish:

  • 2016 POLST form (effective January 1, 2016)
  • CMA POLST Kit in English (rev. 12/15)
  • CMA POLST Kit in Spanish (rev. 10/14)
  • CMA On-Call #3451. Decisions Regarding Life-Sustaining Treatment – Advance Directives and POLST (2015)
  • CMA On-Call #3450. Decisions Regarding Life-Sustaining Treatment for Patients Without Advance Directive or POLST (2015)

Do Not Resuscitate (DNR) Form

The Pre-Hospital DNR form, developed by the California Emergency Medical Services in conjunction with the California Medical Association, instructs EMS personnel to forgo resuscitation attempts in the event of a patient’s cardiopulmonary arrest. Below you will find CMA resources that include additional details about DNR requests and purchasing information for the DNR form in English and Spanish.

  • Do Not Resuscitate Form in English
  • Do Not Resuscitate Form in Spanish
  • CMA On-Call #3453. Decisions Regarding Resuscitative Measures DNR Requests Orders and Cardiopulmonary Resuscitation (2015)

Other Resources

CMA’s Health Law Library
Updated annually, CMA’s online health law library contains nearly 5000 pages of valuable information for physicians and their staff. The CMA Center for Legal Affairs has developed several On-Call documents on important end-of-life issues in the medical practice. Access to the library is FREE to members. Nonmembers can purchase documents for $2 per page.

  • On-Call #3452. Documenting Decisions Regarding Life-Sustaining Treatment
  • On-Call #3454. Decisions Regarding Life-Sustaining Treatment and the Patient Self-Determination Act and Joint Commission
  • On-Call #3455. Physician-Assisted Suicide
  • On-Call #3456. Responding to Request for Non-Beneficial Treatment
  • On-Call #3458. CMA Model Policy: Responding to Requests for Non-Beneficial Treatment
  • On-Call #3400. Autopsies
  • On-Call #3401. Organ and Tissue Donation
  • On-Call #3402. Pronouncement of Death and Death Certificates
  • On-Call #3403. Pronouncement of Death Diagnosis of Death by Neurologic Criteria

For Patients
For more information about end-of-life medical decisions, visit the Coalition for Compassionate Care of California (CCCC) website, www.coalitionccc.org.

The booklet Finding Your Way was written by the Center for Healthcare Decisions as a useful guide to thinking about and discussing end-of-life issues. To order a copy, visit the CCCC website or call the organization at (916) 489-2222.

If you have a serious medical condition or have been diagnosed with a terminal illness, CMA encourages you to talk to your doctor about POLST. Before initiating that conversation, you may wish to visit www.capolst.org or the California Coalition for Compassionate Care website for more information.

For Providers
End-of-life resources for health care providers are available at the Coalition for Compassionate Care of California website. CCCC also provides decision guides. palliative care tools and resources for physicians.





Terminal Illness – End of Life Fasting, Prayopavesa, Santhara #hospice #of #broward

#what is a terminal illness

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Life Beyond Death

The purpose of death
The nature of life after death
How we can prepare for death
How we can assist the dying

Terminal Illness – End of Life Fasting

Most people would consider terminal illness to be the worst misfortune that can happen in life. And yet, from a spiritual perspective, terminal illness offers certain opportunities that are not available in the case of sudden death. During a terminal illness, we have time to settle our personal affairs, prepare ourselves and our loved ones and address any unfinished business. Also, we have an opportunity to apologize to people we’ve hurt and to forgive those who’ve hurt us. These simple acts can resolve deeply held psychic impressions, which otherwise we would have to carry with us into the next world. If we take advantage of these opportunities, we can pave the way for a smooth transition after death. For this reason, ancient sages considered terminal illness to be preferable to sudden death.

During terminal illness, people will sometimes turn to suicide in an effort to avoid the onslaught of physical and emotional pain. But even in this case, suicide is not a good idea, for reasons outlined in the previous chapter (see Suicide ). However, certain ancient traditions offer an alternative in this situation – a voluntary ritual fasting reserved for the terminally ill, called Prayopavesa (Hindu) or Santhara (Jain). Below is a brief explanation of Prayopavesa by Satguru Subramuniyaswami, abbot of the Saivite Hindu monastery on Kauai, Hawaii. Subramuniyaswami himself observed Prayopavesa after he was diagnosed with terminal cancer in 2001. During his fast, he continued many of his daily duties and passed away peacefully on the 32nd day.

Prayopavesa. by Satguru Sivaya Subramuniyaswami

In cases of terminal disease or great disability, religious self-willed death through fasting – Prayopavesa – is permitted. The person making such a decision declares it publicly, which allows for community regulation and distinguishes the act from suicide, performed privately in traumatic, emotional states of anguish and despair.

Ancient lawgivers cite various stipulations: 1) The inability to perform normal bodily purification. 2) Death appears imminent, or the condition is so bad that life’s pleasures are reduced to nil. 3) The action must be subject to community regulation.

The gradual nature of Prayopavesa is a key factor distinguishing it from sudden suicide, for it allows time for the individual to settle all differences with others, to ponder life and draw close to God, as well as for loved ones to oversee the person’s gradual exit from the physical world. In the ideal practice, one begins by obtaining forgiveness and giving forgiveness. Next, a full discussion of all karmas of this life and confessing one’s wrongdoings. Thereafter, attention is to be focused on scripture and the guru’s noble teachings. Meditation on the innermost, immortal Self becomes the full focus as one gradually abstains from food.

In the event of terminal illness, Prayopavesa offers us the opportunity to arrange our own death, if and when the time is right. If this idea appeals to you, discuss it with your family and decide whether it’s an appropriate option for you. If so, then ask an attorney to clarify your intentions by means of a Living Will and Health Care Directive to Physicians. according to the laws of your state and country of domicile.





GBM – end stage question – Brain Tumors Forum – Cancer Forums

#brain hospice

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Thread: GBM – end stage question

Re: GBM – end stage question

Dear Imli, sorry to know what you are going through. As I understand, that is the way this disease progresses. The patient switches to coma later and then passes away in sleep. When death is close, breathing pattern changes and the color of urine goes darker due to lack of sufficient oxygen in the body. Death is usually painless.

My mother is in the end stages of GBM. She is currently completely bedridden, cannot talk or comprehend and sleeps all the time. When she does open her eyes, her gaze is unfocussed and glazed. Her vitals are strong, and she is being fed via a tube. Has a catheter- Urine and stools normal. I know this is progression of the disease, but I am still at a loss and its hard to see a loved one deteriorate. We were told that the symptoms in her case were due to edema and swelling post Gamma knife, may not be the tumor. This has been going on for 5 weeks now.How long can this go on? I know a lot of you have lost loved ones to the disease, and am hoping your collective response can give me a better picture on how much more time she has. She is diisplaying symptoms ( of the timeline chart on brain hospice) of 1-2 weeks for over 1 month now.

New User Join Date Jan 2010 Posts 14

An update on the situation and a little confused. Mom had been sleeping and opening her eyes for a few minutes at most, occasionally-when she was physically moved. This has been the situation for approx 6 weeks. No response to any other stimuli, no recognition or cognition. Last week she had low grade temperature for a few days and still feels warm occasionaly. Since the last 3 days however, her eyes are open and gazing at the ceiling for hours. Her breathing sounds like she is snoring lightly.Her last MRI was in Nov ’09 which showed lots of Edema, post Cyber knife ( Aug 2009). CT in Dec ’09-showed heavy midline shift, when she became paralysed. bedridden and non-cognizant after which she was given steroids that only marginally helped her.
I’m not sure what to make of this, in that she has gone from sleeping continuosly, to opening her eyes and gazing for hours. Is this a sign of improvement? Should I push for another MRI?

Administrator Top User Join Date Oct 2005 Location Tennessee Posts 7,967 Blog Entries 5

Hi Imli. I don’t know what it means that your mother now has her eye open for a long time but still not responding to others. Does she track? That is, if you put your finger in front of her eyes and move it, do her eyes follow your finger? If not, she is probably not really seeing anything just sleeping with her eyes opened. She needs to blink her eyes or they will dry. In hospitals, some times they go so far as to tap eyes closed when someone sleeps with their eyes open so that they do not dry.

In terms of getting an MRI. for sure you need to make her doctor aware of this change and let him/her advise you on what needs to be done.

New User Join Date Jan 2010 Posts 14

Brainman- No, she does not track. Keeps Gazing and but does blink on her own though. She has been off steroids for approx a month now as well.

Regular User Join Date Oct 2009 Posts 18

response to your queries

Sorry imli, as far as my experience with this disease goes, it appears that the disease is spreading within the brain and is taking away your mom slowly. I am not sure if scans can reveal anything since growth and spreading could be at microscopic level. A doctor would be able to advise you better. Sorry again, it is painful to observe the patient at this stage.

Regular User Join Date Oct 2009 Posts 18

Re: response to your queries

signs of increasing body temperature are also common, as I understand. I am not sure how that connects with the disease.

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End of life care for adults #private #hospice

#end of life care

#

End of life care for adults

This NICE quality standard defines clinical best practice within this topic area. It provides specific, concise quality statements, measures and audience descriptors to provide the public, health and social care professionals, commissioners and service providers with definitions of high-quality care.

This quality standard covers all settings and services in which care is provided by health and social care staff to all adults approaching the end of life. This includes adults who die suddenly or after a very brief illness. The quality standard does not cover condition-specific management and care, clinical management of specific physical symptoms or emergency planning and mass casualty incidents.

This quality standard was previously called the quality standard for end of life care for adults.

31 October 2013: Following the independent review of the use of the Liverpool Care Pathway (LCP) for the Dying Patient and the subsequent announcement of the phasing out of the LCP, interim amendments have been made to this quality standard. These amendments, which relate to the removal of direct and indirect references to the LCP, reflect the gradual phasing out of the LCP and ensure that the quality standard remains current.

Supporting organisations





NIHSeniorHealth: End of Life – Preparing For The End of Life #hotel

#end of life care

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End of Life

Preparing For The End of Life

Few of us are comfortable talking about death, whether our own or a loved one’s. It is a scary, even taboo, subject for many. The end of a life, no matter how long and well lived, can bring with it a sense of loss and sadness. It can also be a reminder of our own mortality, so we may avoid even thinking about death.

This is normal — but death is normal, too. All of us will face it at some point.

Defining the End of Life

The end of life and how people die has changed a great deal in the past century. Thanks in large part to advances in public health, medicine, and health care, most Americans no longer die suddenly from injury or infection. Instead, we live longer and, more often than not, die after a period of chronic illness.

As a result, it is hard to know when the dying process begins. Some people pass quickly, while others recover from severe illness several times before death. Even people who are the same age and sex, with the same disease and state of health, are unlikely to reach the end of life at the same time.

We often rely on health care providers to tell us when the end of life is near. But even the most experienced health care provider may find it hard to predict when someone will die. An expert may say the end is within weeks or months, but the dying person slips away much sooner or survives for a year or more.

Preferences for the End of Life

Because the end of life is hard to predict, it is best to plan ahead. You might want to start by asking yourself or a loved one, “What is the best way to plan for the end of life?”

The answer will differ from person to person. Some people want to spend their final days at home, surrounded by family and friends. Others may prefer to be alone, or to be in a hospital receiving treatments for an illness until the very end.

The answer may also change over time — the person who wanted everything possible done to prolong life may decide to change focus to comfort. Someone else who originally declined treatment may agree to an experimental therapy that may benefit future patients with the same condition.

No matter how a person chooses to approach the end of their life, there are some common hopes — nearly everyone says they do not want to die in pain or to lose their dignity. Planning for end-of-life care, also known as advance care planning, can help ensure such hopes are fulfilled. To learn more about advance care planning, see Planning for Care.

What Is End-of-Life Care?

End-of-life care is the broad term used to describe the special support and attention given during the period leading up to death, when the goals of care focus on comfort and quality of life.

Hospice Care

One of the ways end-of-life care is provided is through hospice. Hospice, as defined by the Center for Medicare and Medicaid Services, is a program of care and support for a dying person whose doctor and a hospice medical director certify has less than six months to live.

The focus of hospice is on comfort, not cure. Currently, patients must be willing to give up curative treatments to receive Medicare coverage for hospice care. (Medicare continues to pay for any covered health problems that are unrelated to the dying person’s terminal illness.)

Palliative Care

Unlike hospice care, you do not have to be dying or give up curative treatments to receive palliative care. The term “palliative care” is sometimes mistakenly used to mean end-of-life care, but palliative care is a treatment available to anyone of any age who is suffering from the discomforts, symptoms, and stress of a serious illness.

Palliative care is used effectively to provide relief from many chronic conditions and their treatments, too. Older persons who are living with one or more chronic illnesses may benefit from palliative care long before they need end-of-life or hospice care. Unlike hospice care, palliative care may be used for as long as necessary.

To learn more about hospice care, palliative care, and other types of end-of-life care, see Types of Care.

Questions To Ask As the End of Life Approaches

Regardless of a person’s choices for treatment and care at the end of life, it is important to maintain the quality of a dying person’s life. To better understand the care options available for someone who is approaching death, you may wish to ask the dying person’s health care provider the following questions.

  1. Since the illness is worsening, what will happen next?
  2. Why are you suggesting this test or treatment?
  3. Will the treatment bring physical comfort?
  4. Will the treatment speed up or slow down the dying process?
  5. What can we expect to happen in the coming days or weeks?
  6. If I or my loved one take this treatment or participate in this clinical trial, will it benefit others in the future?

Additional Care Needs

People at the end of life usually need additional care in several areas, including for physical symptoms, emotional and spiritual issues, and practical concerns. Other sections of this health care topic address how to help make sure these needs are met.





Palliative Care Services – no end to caring #hospice #medicare

#hospice south africa

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Palliative care is an approach that improves the quality of life of patients and their families facing problems associated with life threatening illness, through the prevention and relief of suffering, the early identification and impeccable assessment and treatment of pain and other problems, psychosocial and spiritual. (World Health Organisation’s definition of palliative care.)

Home based care: Our palliative trained nursing sisters visit patients in their own homes. The nursing sister co-ordinates the care and liases with other hospice team members such as the doctor, social worker, community care workers, volunteer caregivers and other professionals who may be involved in treating the patient.

Care consists of:

Regular visits by the Hospice Sister as is appropriate to the patient’s condition

Pain and symptom control

Nursing management such as how to deal with incontinence, wound dressing, prevention of bed sores, colostomy care

Advice regarding nutrition and feeding

Equipment such as commodes, wheelchairs, mattresses, sheepskins and walkers may be loaned by hospice patients at no charge.

Our ten Nursing Sisters visit patients residing in the Ekurhuleni Metropolitan region (Nigel, Springs, Benoni, Boksburg, Brakpan, Kempton Park, Germiston, Edenvale, Bedfordview and the township areas in these regions). Currently, on average, 425 patients per month receive our care.
Hospice Sisters are available telephonically 24 hours for emergencies.

In Patient Unit: Hospice East Rand has a 5 bedded facility situated at 218 Kemston Ave, Benoni. The Unit offers short term stay and provides 24 hour specialised care for patients who cannot be treated at home. This may be due to deterioration in the patient’s condition or the need for medical intervention for unmanageable symptoms. Patients can also be admitted to the Unit to allow family members a short period of respite.

Frail Care Centre: We are in the unique position of having a long term Care Centre attached to our In Patient Unit. It is a 5 single room facility and provides comprehensive nursing care to the residents in our care. A fixed monthly tariff is charged and this is payable in advance. Residents are encouraged to add a few personal belongings to the fully furnished rooms to create a familiar and comforting feeling.

Doctors: Hospice East Rand has three part-time doctors.

Day Care: We offer a Day Care Programme (in Benoni) and a Drop In Care Centre (in Vosloorus). These services are invaluable to patients providing an outing with a programme of interesting activities, a tasty meal and the company of other people. Hospice (Benoni) runs a day care facility each Wednesday and in Vosloorus twice weekly on Tuesday and Wednesday.

Emotional support: The changing dynamics of family life, which are brought about by terminal illness, can impair communication and cause anguish and fear. Caregivers are volunteers who have specialised training, and have the necessary counselling skills to discuss problems. This can make a meaningful difference to patients and families enabling them to be more effectively involved in all aspects of their care.

Bereavement Care: Our Hospice offers bereavement counselling to anyone who has suffered the loss of a loved one. Regular social get-togethers are organised by trained caregivers for those whose dear ones have died. Events such as bring and braais are held at our centre on a regular basis and provide a social outlet for the bereaved.

How to access hospice care and place a patient on the hospice programme. Patients needing hospice care are required to contact hospice themselves, by telephone to the Intake Officer at 011 422 1531. Alternatively contact can be made by a family member, the patient’s doctor, social worker or other appropriate person. It is a stipulation that the patient must want hospice care and be aware that we have been approached.

Once the intake documentation has been completed, and a medical report from the patient’s doctor has been received, a Nursing Sister from hospice will do an assessment visit to determine if the patient should be placed in the hospice programme.





What are palliative care and end of life care? #motel #santa #barbara

#palliative care

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What are palliative care and end of life care?

What is palliative care?

If you’ve been told you may not get better, you might also have heard about palliative care. Palliative care is for people living with a terminal illness where a cure is no longer possible. It’s also for people who have a complex illness and need their symptoms controlled. Although these people usually have an advanced, progressive condition, this isn’t always the case.

Palliative care aims to treat or manage pain and other physical symptoms. It will also help with any psychological, social or spiritual needs. Palliative care includes caring for people who are nearing the end of life. This is called end of life care.

The goal of palliative care is to help you and everyone affected by your illness to achieve the best quality of life. You might receive palliative care alongside particular treatments, such as chemotherapy or radiotherapy.

  • improves quality of life
  • provides relief from pain and other distressing symptoms
  • supports life and regards dying as a normal process
  • doesn’t quicken or postpone death
  • combines psychological and spiritual aspects of care
  • offers a support system to help people live as actively as possible until death
  • offers a support system to help the family cope during a person’s illness and in bereavement
  • uses a team approach to address the needs of the person who is ill and their families
  • also applies to the earlier stages of illness, alongside other therapies that are aimed at prolonging life

More information on how we can help you or a loved one living with a terminal illness .

What is end of life care?

End of life care is an important part of palliative care for people who are nearing the end of life. End of life care is for people who are considered to be in the last year of life, but this timeframe can be difficult to predict.

End of life care aims to help people live as well as possible and to die with dignity. It also refers to care during this time and can include additional support, such as help with legal matters. End of life care continues for as long as you need it.

Who provides palliative care?

The professionals who provide palliative care fall into two main groups:

1. General care

Those who provide day-to-day care to people with advanced illness and their family and friends, such as your GP, community nurses or Marie Curie Nurses.

2. Specialist care

Experts in palliative care, such as consultants in palliative medicine or clinical nurse specialists.

You’re likely to need both general and specialist care as your needs change. Palliative care can be provided in different places including in your home, in hospital, at a care home or a hospice .

General care

Providing general palliative care is part of many health and social care professionals’ jobs. You might see these people regularly as part of your care:

  • your GP
  • community nurses
  • social workers
  • care workers
  • spiritual care professionals

These professionals should be able to assess your care needs, and those of your family and friends. They should meet those needs where possible and know when to seek specialist advice. The aim of general palliative care is to provide:

  • information for you and your family or friends, and signposting to other services
  • accurate and all-round assessment of your needs
  • coordination of care teams in and out of hours
  • basic levels of symptom control
  • psychological, social, spiritual and practical support
  • good communication with you, your family or friends and the professionals supporting you

Specialist care

Specialist palliative care services manage more complex patient care problems that cannot be dealt with by generalist services. Palliative care specialists usually work in teams to provide joined-up care and you might see one or more specialists when you’re referred. Specialist teams include:

  • doctors and nurses
  • counsellors
  • specialist allied health professionals, such as physiotherapists, occupational therapists, dieticians and social workers

Specialist palliative care services may be provided by the NHS (local health and social care trust in Northern Ireland), local councils and voluntary organisations. These could include inpatient and outpatient facilities and bereavement support services.

Common myths about palliative care

Palliative care is often misunderstood and some people believe things about it that aren’t true.

MYTH: If I need palliative care it means I’ll have to go to a hospice
You can receive palliative care in a range of settings including in your home, in hospital, in a care home or a hospice.

MYTH: If I have palliative care it means my doctors have given up and I’ll no longer receive active treatment for my illness
You can receive palliative care alongside active treatments for your illness, such as chemotherapy and radiotherapy.

MYTH: If I have palliative care I’ll no longer be seen by other specialists who know about my particular illness
You can receive palliative care support alongside care from the specialists who have been treating your particular illness.

MYTH: Palliative care is just about treating pain and other physical symptoms
Palliative care aims to provide a holistic approach to give you the best quality of life possible. This means caring for all your physical, emotional, psychological, social and other needs.

MYTH: Only people who are ill can benefit from palliative care
Palliative care teams are very aware that caring for someone with an advanced illness can have a big impact on family members and friends. Palliative care teams do what they can to help people cope.

I want for nothing at this hospice. The staff give me all the medication I need and plenty of emotional support. They shower me because I get too breathless to do it myself. And they re always throwing tea and biscuits at me not literally, mind! Sylvia, person with a terminal illness

External websites

Carers UK – support and resources for carers

NHS Inform – palliative care zone

NHS Scotland – palliative care guidelines





What Are The Signs Of End Stage COPD – Symptoms #cheap #hotel

#end stage copd hospice

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Brenda Case

MY Husband Has Been Told By His Dr. At Hospice That He Is IN The End Stage Of COPD. I Would Like To Know If There Are Signs For Me To Look For. I Care For Him At Home. We Have Been Married 43 YRS I JUST WANT SOME ANSWERS ANSWERS THAT Will Help Me .CAN ANY ONE DR ETC GIVE ME SOME ANSWERS ON THIS ONE QUESTION PLEASE.

FROM OUR EXPERTS

Hi Brenda. It’s so hard to get news like that and yet be left mostly in the dark about what it means. However, being labeled as end-stage COPD does not necessarily mean death is just around the corner. People can go on to live with that label for months or even years. The body is highly adaptable, especially as related to breathing capabilities, and the human will also plays a part. So no one can say exactly how long a COPD patient has once he or she enters the “end stage.” So you may want to go back to the hospice staff or doctor and ask for more specific answers about what they meant. It’s always OK to ask questions!

My mom is dealing with some of these same issues. She sees herself going downhill daily, although she has not yet reached the hospice stage like your husband. She recently asked her doctor how she would know when the end was coming, and the doctor’s answer was that she would be able to tell. Not much of an answer, but it did seem to calm my mom’s fears.

However, I thought this was an important issue, so I wrote a post about it yesterday, which has not yet been published by the HealthCentral editors. Should be soon, though. Meanwhile, you may want to read an article Dr. David Kaufman did here back at the beginning of March:

That article will help you understand what’s going on inside your husband’s body and some of the signs to look for as he deteriorates.

I also found some descriptions from caregivers of the final days and hours with their loved ones before death which were helpful. It seemed that their loved ones became less and less mobile, remaining in bed more and more, eating and drinking less and struggling to breathe pretty much constantly. Most found that hospice was useful, especially in administering frequent morphine to control the air hunger, or gasping for breath, that was so common. Many saw their loved ones either lose consciousness or get foggier mentally in the final days/hours.

I hope some of that helps you. You have a tough road ahead of you. No matter how prepared you are, it’s going to be hard to lose your mate of 43 years. So take care of yourself during this difficult time and don’t be afraid to reach out to others for support.

My thoughts and prayers are with you. Kathi

FROM OUR COMMUNITY





SCIE: End of life care #mcnevins #logan #park #motel

#what is end of life care

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End of life care

Information and links for professionals who support people and their families at the end of life

This resource is for people who work with adults who are approaching the end of life. Some 500,000 people die each year and, because of the ageing population, that number is predicted to rise over the next few years. It’s important that social care and health professionals who work with people at the end of life and their families have access to high quality resources and information so they can give the best care possible.

This guide is about enabling people who want to die at home to do so and improving the quality of care they receive.

Specific needs of people with dementia at the end of their lives.

Eight films that explore different aspects of end of life care. These films can be used in group training or for professional self-development.

SCIE’s resources support the professional development of health and social care staff who work with people at the end of their lives and their families.

Evidence-based information describing high quality end of life care from the National Institute for Health and Clinical Excellence (NICE).

Find out about the innovative end of life care practice of other organisations and share your own ideas with others working in the sector.





End-of-Life Decisions – End of Life Issues – California Medical Association #eurodisney

#end of life issues

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End-of-Life Decisions

California law provides individuals the ability to ensure that their health care wishes are known and considered if they become unable to make these decisions themselves.

The California Medical Association (CMA) encourages Californians to think and talk with loved ones about their wishes for end-of-life medical care before a serious illness or injury occurs. CMA has developed a number of guidelines, forms, and other resources to assist providers, patients, and loved ones with making important end-of-life decisions.

NEW! California s End Of Life Option Act

On October 5, 2015, California became the fifth state in the nation to allow physicians to prescribe terminally ill patients medication to end their lives. ABX2-15, the “End of Life Option Act,” permits terminally ill adult patients with capacity to make medical decisions to be prescribed an aid-in-dying medication if certain conditions are met. The following document discusses the requirements under the End of Life Option Act, which went into effect June 9, 2016:

  • CMA On-Call #3459: The California End of Life Option Act
  • On-demand webinar: The California End of Life Option Act: An Overview

Advance Health Care Directive

In California, advance directives are the legally recognized format for living wills. An advance directive enables individuals to make sure that their health care wishes are known in advance and considered if for any reason they are unable to speak for themselves. Advance directives also allow patients to appoint a health care “agent” who will have legal authority to make health care decisions in the event that the patient is incapacitated, or immediately upon appointment if the patient expressly grants such authority.

See below for more information about advance directives, or to purchase CMA’s Advance Health Care Directive Toolkit, available in English and Spanish:

  • CMA Advance Health Care Directive Kit in English (rev. 3/14)
  • CMA Advance Health Care Directive Kit in Spanish (rev. 9/14)
  • CMA On-Call #3451. Decisions Regarding Life-Sustaining Treatment – Advance Directives and POLST (2015)
  • CMA On-Call #3450. Decisions Regarding Life-Sustaining Treatment for Patients Without Advance Directive or POLST (2015)

Physician Orders for Life-Sustaining Treatment

Physician Orders for Life Sustaining Treatment (POLST) in 2009 became a legally recognized document, similar to the widely used do not resuscitate (DNR) orders. The POLST form, used for patients with a serious illness or whose life expectancy is a year or less, outlines a plan of care reflecting the patient s wishes concerning medical treatment and interventions at life s end. The POLST form complements an advance directive by turning a patient s treatment preferences into actionable medical orders.

See below for more information about POLST, or to purchase CMA’s POLST toolkit, available in English and Spanish:

  • 2016 POLST form (effective January 1, 2016)
  • CMA POLST Kit in English (rev. 12/15)
  • CMA POLST Kit in Spanish (rev. 10/14)
  • CMA On-Call #3451. Decisions Regarding Life-Sustaining Treatment – Advance Directives and POLST (2015)
  • CMA On-Call #3450. Decisions Regarding Life-Sustaining Treatment for Patients Without Advance Directive or POLST (2015)

Do Not Resuscitate (DNR) Form

The Pre-Hospital DNR form, developed by the California Emergency Medical Services in conjunction with the California Medical Association, instructs EMS personnel to forgo resuscitation attempts in the event of a patient’s cardiopulmonary arrest. Below you will find CMA resources that include additional details about DNR requests and purchasing information for the DNR form in English and Spanish.

  • Do Not Resuscitate Form in English
  • Do Not Resuscitate Form in Spanish
  • CMA On-Call #3453. Decisions Regarding Resuscitative Measures DNR Requests Orders and Cardiopulmonary Resuscitation (2015)

Other Resources

CMA’s Health Law Library
Updated annually, CMA’s online health law library contains nearly 5000 pages of valuable information for physicians and their staff. The CMA Center for Legal Affairs has developed several On-Call documents on important end-of-life issues in the medical practice. Access to the library is FREE to members. Nonmembers can purchase documents for $2 per page.

  • On-Call #3452. Documenting Decisions Regarding Life-Sustaining Treatment
  • On-Call #3454. Decisions Regarding Life-Sustaining Treatment and the Patient Self-Determination Act and Joint Commission
  • On-Call #3455. Physician-Assisted Suicide
  • On-Call #3456. Responding to Request for Non-Beneficial Treatment
  • On-Call #3458. CMA Model Policy: Responding to Requests for Non-Beneficial Treatment
  • On-Call #3400. Autopsies
  • On-Call #3401. Organ and Tissue Donation
  • On-Call #3402. Pronouncement of Death and Death Certificates
  • On-Call #3403. Pronouncement of Death Diagnosis of Death by Neurologic Criteria

For Patients
For more information about end-of-life medical decisions, visit the Coalition for Compassionate Care of California (CCCC) website, www.coalitionccc.org.

The booklet Finding Your Way was written by the Center for Healthcare Decisions as a useful guide to thinking about and discussing end-of-life issues. To order a copy, visit the CCCC website or call the organization at (916) 489-2222.

If you have a serious medical condition or have been diagnosed with a terminal illness, CMA encourages you to talk to your doctor about POLST. Before initiating that conversation, you may wish to visit www.capolst.org or the California Coalition for Compassionate Care website for more information.

For Providers
End-of-life resources for health care providers are available at the Coalition for Compassionate Care of California website. CCCC also provides decision guides. palliative care tools and resources for physicians.





Hospice Buffalo – End of Life Dreams and Visions: The Patient’s #hospice

#hospice buffalo

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End of Life Dreams and Visions: The Patient s Perspective

By: Sarah Kuszczak, Clinical Research Coordinator

People have been recording accounts of dreams and visions experienced toward the end of life for centuries. Family members and staff here at the Center for Hospice and Palliative Care (CHPC) have long noted that these dreams and visions are often deeply comforting and profoundly meaningful for patients and their families alike. The CHPC research team is conducting a project to examine hospice homecare patients dreams and visions from their perspective and most importantly, to further explore their social and spiritual impact. This project could not be carried out without the Dream Team , a group of nurses, social workers, chaplains, and expressive therapists who ask the patients about their dreams and visions each week during their routine visits. Here are some of their reflections about why they have joined the Dream Team and how it has helped them to improve patient care:

I am passionate about research that will further bolster what we as clinicians do here at Hospice Buffalo. This research study has not only given me an excellent opportunity to advance the field of hospice and palliative care, but also to better get to know the use of sleep and dream assessment in my daily patient care. Kevin McKenzie, Nursing Home team social worker

My favorite aspect of being on the Dream Team is learning about how important dreams are to patient s health. Dreams are an integral part of their approach to sickness and suffering. Ken Keenan, Team 7 11 Nursing Home team chaplain

It is my intention to deepen my understanding of the dying process, while providing support, comfort, and awareness of the process itself. I hope to be able to convey to patients just how normal and natural their dying process is. Annie Allen, expressive therapies

It s another way of connecting with and serving our patients and families Jessica Gallman, Team 9 social worker

I joined the Dream Team to obtain a greater understanding of end of life dreams/visions and their impact on the patient This helps me to educate and assist patients to process their dreams and visions. Amy Whelan, Team 9 nurse

The CHPC research team would like to thank Philip Hubbell, whose generous donation has made this study possible. This study is a follow-up to one that was conducted in the Hospice Inpatient Unit, which you can read about here:
HospiceBuffalo.com/Journeys

About

The official blog for Hospice Buffalo. Stay up-to-date with research findings, Life Transitions Center grief & wellness posts, Hospice Foundation event updates, family and volunteer stories and daily happenings at Hospice Buffalo.

Looking for posts from our Research team? Search key word: RESEARCH.

Want posts on the Foundation? Search key words: EVENTS and FOUNDATION.

Looking for Life Transitions Center? Search key words: LTC, GRIEF, WELLNESS, CAREGIVING or SUPPORT.

Looking for more?
Check out www.hospicebuffalo.com

Me, Elsewhere





HospiceCare of the Piedmont – Enhancing life at the end of life

#hospice of the piedmont

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Interested in becoming a volunteer? HospiceCare of the Piedmont is seeking volunteers. Volunteers are needed in many areas: patient sitting, working in the Hospice House, running errands, selling and sorting donations, repair work, clerical, fundraising and many other exciting opportunities that provide services to patients and families of the terminally ill. Becoming a hospice volunteer is similar to helping a neighbor in need. Volunteer Training will be held: September 20th, 21st and 22nd from 9am 3pm at the Volunteer read more

HospiceCare of the Piedmont presents the 25th annual Festival of Trees as the premier holiday event in Greenwood. Stroll along and enjoy the greenery and lavishly decorated trees and be filled with the holiday spirit! The sounds of Christmas are here for you to enjoy, as well as the delicious treats and wonderful entertainment. Saturday, December 3rd 10am 5pm Sunday, December 4th 1pm 5pm First Baptist Church 722 Grace Street, Greenwood Holiday Sweets Reception begins at 4:30pm Sunday. read more

This years Santa Stroll will be on Saturday, December 3rd. Registration will be at 8am with the 5K starting at 9am. Our 5K walk (3.1 miles) takes you from First Baptist Church through surrounding scenic residential areas…or try the one-mile fun walk. Keep the care going, walk to raise money for HospiceCare of the Piedmont’s Hospice Fund. Remember loved ones no longer with us, and honor all Hospice patients. Contact us for more information, 227.9393.

HospiceCare of the Piedmont is hosting four educational workshops for people who have experienced a significant loss in their lives or for those who wish to learn more about the grief process. The workshops will offer an in-depth look at how loss and grief affect us emotionally, physically, and spiritually. The workshop series will be held on Tuesdays in September 2016 from 5:30 p.m. until 6:30 p.m. at the Volunteer Community Center, Hospice Store, 217 North Creek Blvd. Greenwood. If you have read more

HospiceCare will host its 20th annual children’s grief camp at Camp Fellowship on Lake Greenwood. The camp is open to children ages 6-14 who have experienced the death of a family member or a significant person in their lives. The overnight camp will begin early Saturday morning, September 10th, and end midday Sunday, September 11th. At Camp Celebrate Hope, participants learn about their grief and are encouraged to speak openly about issues of death and their grieving experiences within a read more





End of Life Care #hotel #website

#hospice end of life signs

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General Pet Care

End of Life Care

Coping with the impending loss of a pet is one of the most difficult experiences a pet parent will face. Whether your furry friend is approaching his golden years or has been diagnosed with a terminal illness, it’s important to calmly guide the end-of-life experience and minimize any discomfort or distress. As your pet’s health declines, you may elect to care for your pet at home—with the supervision of a veterinarian—or you may decide to end his suffering with euthanasia.

Read on to find out how to help make your pet’s final days peaceful and dignified.

Is Your Pet In Pain?

When cats and dogs are suffering, they may not show outward signs that we normally associate with pain like whimpering or crying. Sometimes an animal will continue to eat or drink in spite of pain or disorientation. Some physiological and behavioral signs that your pet might be experiencing pain include excessive panting or gasping for breath, reclusiveness, reluctance to move and food pickiness.

Caring for an Elderly Pet

The most important thing you can do for your elderly pet is to minimize any pain or distress she’s experiencing.

  • Consult with your veterinarian and treat any health problems, since undiagnosed issues can cause discomfort and rapid deterioration.
  • Surround her with her favorite things, like a warm blanket or special squeaky toy.
  • Since pressure sores can develop in pets with limited mobility, it’s also essential to provide a warm sleeping spot with plenty of cushioning.
  • Some older pets may develop incontinence, or the loss of bladder control, so be sure to check your furry friend regularly for any wetness or soiling. If your pet needs help getting up to urinate or defecate, you can purchase a sling or use a large towel to wrap under her body and assist her.

Pet hospice care, also known as palliative care, is an option if your pet is suffering from a terminal illness and a cure is not possible. The goal is to make a pet’s final days or weeks more pleasant with the proper use of pain medications, dietary strategies and human interaction. Pet hospice is not a place, but a personal choice and philosophy based on the principle that death is a part of life and can be dignified. When considering hospice care, pet parents should very careful not to prolong the suffering of pets who are in pain or experiencing poor quality of life.

A participating veterinarian will teach pet parents how to provide intensive home care to keep an ill pet as comfortable as possible. Hospice care requires an active commitment and constant supervision from pet parents, who work with their veterinary team to make sure their pet’s life ends comfortably. If you decide hospice care is the right course for you and your pet, you will become your pet’s primary nurse and caregiver, as well as the link between your pet and the veterinary team. Consult with your primary veterinarian and see if she recommends hospice care for your pet based on his specific needs.

Euthanasia provides a painless, peaceful end for a pet who would otherwise continue to suffer. Your veterinarian has special training to provide your pet with a humane and gentle death. During the procedure, your vet will inject your pet with a sedative followed by a special medication. The animal experiences no awareness of the end of life—the process is akin to undergoing general anesthesia for a surgical procedure and takes about 10 to 20 seconds.

Your veterinarian is the best person to advise you on when the time is right to euthanize—information from medical tests is often more accurate than what a pet owner can observe, and pet owners often delay the moment of euthanasia in anticipation of grief. Observing and keeping an accurate record of your pet in his daily activities can help you to decide. If you observe that moments of discomfort outweigh his capacity to enjoy life, it is time to euthanize, even if your pet still experiences pleasure in eating or socializing. If your pet is in pain, your main goal should be to minimize his suffering.

What to Do If Your Pet Has Died at Home

If your pet is under the care of a veterinarian at the time of his or her passing, he or she can guide you through next steps. However, if your pet dies in your home, there are options to consider. Whether you simply want the body to be removed from your home, or you wish to permanently memorialize your pet in some special way, the choice is yours.

  • Depending on your decision, you may have to keep the body in your home for a short period of time. A well-cooled body can be held for up to 24 hours, but the sooner it can be taken somewhere else, the better.
  • Placing the wrapped animal in a refrigerator or freezer is recommended, with one exception—if you plan to have a necropsy (autopsy) performed to determine cause of death, the body should not be frozen (refrigeration is still okay). It is essential that you contact a veterinarian as soon as possible if you would like a necropsy.
  • If the animal is too big to be put into a refrigerator or freezer, the body should be placed on a cement floor or concrete slab, which is the best way to draw heat away from the carcass. Do not cover or wrap the body in this instance. Doing so will trap in heat and not allow the body temperature to cool.
  • As a last resort, you may keep the body in the coldest area of your home, out of the sun, packed with bags of ice. In this case, the body should be placed in a plastic bag to prevent it from getting wet.

Pet Cremation and Burial

It is very common for pet owners to have their deceased pets cremated. You need to decide if you wish to keep your pet’s ashes as a remembrance. If so, you will want to arrange an individual (or private) cremation, meaning that your pet will be cremated alone. Businesses that offer individual cremation commonly offer home pick-up/delivery of remains as part of their service packages.

Depending on local laws, it may be legal to bury an animal on your own property. It is typically illegal to bury an animal on public lands such as parks. If you desire burial for your pet but do not have land of your own, check to see if there is a pet cemetery or memorial park in your area.

If you wish to simply have your pet’s body removed from your home, consult your local government to find out if your sanitation department picks up animal remains.

Dealing with Pet Loss

There are many forms of grief that are completely normal in the wake of the loss of a beloved pet. For support dealing with the loss of a pet, call our Pet Loss Hotline at (877) GRIEF-10.





Best West End Hotel Deals, Ontario: Find 100 Hotels In West End

#ottawa motels

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West End Hotels, Ontario Canada

West End Hotels Guide

Foodies of the world flock to West End to sample the cuisine. Known for its multi-cultural palette, it s easy to find anything from traditional French dishes to modern fusions and international fare.

  • Search for over 100 West End hotels in Ottawa
  • Choose a hotel with amenities like a hot tub, cable TV, and a pool
  • Save money when you book with us and spend it indulging in culinary delights

Make sure your stomach is empty and your walking shoes are in good repair; between parks and food, you re in for a full-body workout.

Luckily, this side of town is brimming with trails and parks you can hike through after a big lunch. Head over to local favourites like Hampton Park, Island Park, or Bel-Air Park among others. Some of these parks are pet-friendly, so you may be able to bring Fido with you. The West End is also close to the Riviere des Outaouais, if you d like to enjoy some time by the water. When you work up your appetite again, sample from the available fare; do you feel like African food tonight? What about steak?

When you re done exploring this side of Ottawa, a West End hotel will help you recharge and digest. Take advantage of the in-house fitness centre (to perk up your pecs), complimentary Wi-Fi (to upload all your latest selfies), and in-room refrigerators (to hold all the leftovers from lunch and dinner). Get to know friendly staff members and ask them to recommend their favorite eateries and hiking routes you get to do this all again tomorrow.

Find all the best hotels in Ottawa here on Expedia.ca, and enjoy your vacation with your travel budget intact. Whether you re a foodie looking for your nirvana or are just passing through as you explore greater Ontario, you ll receive our Best Price Guarantee.





Christian Life Resources – End of Life Issues #motel #clothing #uk

#end of life issues

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End of Life Issues

Featured Article:
Look at What is Coming

In 2011 Mariette Buntjens was a patient suffering from metastatic cancer at a Roman Catholic nursing home in Diest, Belgium. Buntjens requested euthanasia but the nursing home refused on obvious religious grounds. Her family brought her home where she said her good-byes and she was then given a lethal cocktail of drugs to end her life. In January of this year her daughter filed a lawsuit against the nursing home for failing to permit the killing at the facility.

Earlier this month a judgment was reached. The nursing home was ordered to pay 1,000 euros (about $1,100) to each of the three children and 3,000 euros as a fine for failing to permit the killing.

Since the earliest efforts to legalize euthanasia in America we have expressed concern that Christians will be forced to participate in these killings. Advocates for the legalization of assisted suicide have dismissed those concerns as exaggerations. Really?

Take a look just in America at what has been happening with the binding of religious consciences for pharmacists and some forms of birth control or businesses and medical professionals and the performance of abortions, and participation in gay marriages.

Despite the surface logic for autonomy we must realize that the tentacles that permit sin run deep and are pervasive. It is simplistic to think a my body, my choice mentality stops there.

Society is in full rebellion against the Biblical truth that some things are wrong, or in religious parlance, sin. In a post-modern society nobody likes to talk about right and wrong but muting the reality does not change the reality. Surrendering to some sin surrenders to sin s ultimate agenda total rebellion against God. It is a slippery slope, indeed.

More End of Life Issues Articles

Look at What is Coming
In 2011 Mariette Buntjens was a patient suffering from metastatic cancer at a Roman Catholic nursing home in Diest, Belgium. Buntjens requested euthanasia but the nursing home refused. July 27th, 2016

Q Position Statement on Abortion: Click Here Christian Life Resources Position Statement on Euthanasia: Click Here June 26th, 2014

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All graphics and content are the property of Christian Life Resources unless stated otherwise.
Christian Life Resources reserves and maintains the following websites: ChristianLifeResources.com. ClearlyCaring.com. ClearlyKids.com. CLREvents.com. CLRLifeTribute.com. ACompassionateVoice.com. GuiaParaVivir.com. HomeForMothers.com. LifeWitness.com. and SectionQ.com.
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UKCEN: Ethical Issues -End of Life Decisions #low #price #hotels

#end of life issues

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Ethical Issues – End of life decisions

Ethical Considerations

A number of ethical theories and principles are relevant when considering treatment decisions at the end of life.

Sanctity of Life Doctrine

The argument underpinning this doctrine is that all human life has worth and therefore it is wrong to take steps to end a person s life, directly or indirectly, no matter what the quality of that life. This is in keeping with both traditional codes of medical ethics and a general perception of what doctors and other health professionals should do, that is save and preserve life. One challenge to this principle in the context of health care is to ask should life be preserved at all costs. Is there no place for consideration of quality of life? One of the problems with considering quality of life is the question of how this is defined and by whom. An objective view of someone s life may be very different to the view of the person who is living that life. However, this problem does not remove the challenge to the sanctity of life doctrine. There may be some circumstances where a person s quality of life, however defined, is so poor that it should not be maintained even if it is possible to do so. Some ethical arguments have been developed to address this challenge.

Acts /omissions distinction

This distinction argues that there is a difference between actively killing someone and refraining from an action that may save or preserve that person s life. Thus it is morally wrong to push someone into a river to their death but we may not have a moral duty to leap into the river to save someone who is drowning. In a medical context this distinction would mean that a doctor could not give a patient a lethal injection to end his/her life, whatever the circumstances, but could, withhold treatment that may sustain it. Withholding treatment would only be permissible if the patient s quality of life was so poor, and the burden of treatment so great, that it would not to be in the patient s best interests to continue treatment. For example, it might be permissible not to ventilate a patient if he/she was in chronic respiratory failure, or not to use tube feeding if he/she was in a permanent vegetative state.

Doctrine of Double Effect

The doctrine of double effect argues that there is a moral distinction between acting with the intention to bring about a person s death and performing an act where death is a foreseen but unintended consequence.

The doctrine of double effect allows that performing an act that brings about a good consequence may be morally right even though the good consequence can only be achieved at the risk of a harmful side effect. Prescribing pain relieving drugs which in large doses shorten the life of a terminally ill patient is often used as an example of double effect. The intention is to relieve pain and the foreseen but unintended consequence is that the patient’s life will be shortened. Current practice in palliative medicine and the range of drugs available may reduce the appropriateness of this doctrine.

Respect for autonomy

The principle for respect for autonomy acknowledges the right of a patient to have control over his or her own life, including decisions about how his/her life should end. Thus a competent person should be able to refuse life saving treatment in both current situations and future foreseeable situations. Should respect for autonomy mean that a person can request assistance in ending his/her life? Some would argue that this is the case but as assisted suicide is currently illegal in the UK this is not an issue that a clinical ethics committee should need to consider. Does respect for autonomy mean that a patient can request treatment that the clinician does not think is in his/her best interests, or treatment that is futile? In these situations the principle of respect for autonomy comes into conflict with other ethical considerations, such as preventing or avoiding harm, or distributive justice.

A duty to act in the patient s best interest (Beneficence)

The duty of beneficence, that is to act in a way that benefits the patient, is an important ethical principle in health care. In treatment decisions at the end of life the dilemma often revolves around what course of action will be in the patient’s best interests. It is difficult to see how death can be a benefit or in the patient’s interests, but in some circumstances, if existing quality of life is so poor, or treatment is very burdensome, then the balance of harms and benefits may suggest that continuing treatment is not a benefit to the patient.

A duty not to harm (Nonmaleficence)

The concept of nonmaleficence – an obligation not to inflict harm intentionally, is distinct from that of beneficence – an obligation to help others. In codes of medical practice the principle of nonmaleficence (primum non nocere) has been a fundamental tenet. However, in the context of health care it can sometimes be difficult to comply with this principle depending on the definition of harm. Many medical treatments may have harmful side effects but save or improve lives. In end of life decisions the question of how much harm is caused by the treatment needs to be considered, as does the question of whether death itself is always a harm.

Page created: May 26, 2011





End-of-Life Decisions – End of Life Issues – California Medical Association #roach

#end of life issues

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End-of-Life Decisions

California law provides individuals the ability to ensure that their health care wishes are known and considered if they become unable to make these decisions themselves.

The California Medical Association (CMA) encourages Californians to think and talk with loved ones about their wishes for end-of-life medical care before a serious illness or injury occurs. CMA has developed a number of guidelines, forms, and other resources to assist providers, patients, and loved ones with making important end-of-life decisions.

NEW! California s End Of Life Option Act

On October 5, 2015, California became the fifth state in the nation to allow physicians to prescribe terminally ill patients medication to end their lives. ABX2-15, the “End of Life Option Act,” permits terminally ill adult patients with capacity to make medical decisions to be prescribed an aid-in-dying medication if certain conditions are met. The following document discusses the requirements under the End of Life Option Act, which went into effect June 9, 2016:

  • CMA On-Call #3459: The California End of Life Option Act
  • On-demand webinar: The California End of Life Option Act: An Overview

Advance Health Care Directive

In California, advance directives are the legally recognized format for living wills. An advance directive enables individuals to make sure that their health care wishes are known in advance and considered if for any reason they are unable to speak for themselves. Advance directives also allow patients to appoint a health care “agent” who will have legal authority to make health care decisions in the event that the patient is incapacitated, or immediately upon appointment if the patient expressly grants such authority.

See below for more information about advance directives, or to purchase CMA’s Advance Health Care Directive Toolkit, available in English and Spanish:

  • CMA Advance Health Care Directive Kit in English (rev. 3/14)
  • CMA Advance Health Care Directive Kit in Spanish (rev. 9/14)
  • CMA On-Call #3451. Decisions Regarding Life-Sustaining Treatment – Advance Directives and POLST (2015)
  • CMA On-Call #3450. Decisions Regarding Life-Sustaining Treatment for Patients Without Advance Directive or POLST (2015)

Physician Orders for Life-Sustaining Treatment

Physician Orders for Life Sustaining Treatment (POLST) in 2009 became a legally recognized document, similar to the widely used do not resuscitate (DNR) orders. The POLST form, used for patients with a serious illness or whose life expectancy is a year or less, outlines a plan of care reflecting the patient s wishes concerning medical treatment and interventions at life s end. The POLST form complements an advance directive by turning a patient s treatment preferences into actionable medical orders.

See below for more information about POLST, or to purchase CMA’s POLST toolkit, available in English and Spanish:

  • 2016 POLST form (effective January 1, 2016)
  • CMA POLST Kit in English (rev. 12/15)
  • CMA POLST Kit in Spanish (rev. 10/14)
  • CMA On-Call #3451. Decisions Regarding Life-Sustaining Treatment – Advance Directives and POLST (2015)
  • CMA On-Call #3450. Decisions Regarding Life-Sustaining Treatment for Patients Without Advance Directive or POLST (2015)

Do Not Resuscitate (DNR) Form

The Pre-Hospital DNR form, developed by the California Emergency Medical Services in conjunction with the California Medical Association, instructs EMS personnel to forgo resuscitation attempts in the event of a patient’s cardiopulmonary arrest. Below you will find CMA resources that include additional details about DNR requests and purchasing information for the DNR form in English and Spanish.

  • Do Not Resuscitate Form in English
  • Do Not Resuscitate Form in Spanish
  • CMA On-Call #3453. Decisions Regarding Resuscitative Measures DNR Requests Orders and Cardiopulmonary Resuscitation (2015)

Other Resources

CMA’s Health Law Library
Updated annually, CMA’s online health law library contains nearly 5000 pages of valuable information for physicians and their staff. The CMA Center for Legal Affairs has developed several On-Call documents on important end-of-life issues in the medical practice. Access to the library is FREE to members. Nonmembers can purchase documents for $2 per page.

  • On-Call #3452. Documenting Decisions Regarding Life-Sustaining Treatment
  • On-Call #3454. Decisions Regarding Life-Sustaining Treatment and the Patient Self-Determination Act and Joint Commission
  • On-Call #3455. Physician-Assisted Suicide
  • On-Call #3456. Responding to Request for Non-Beneficial Treatment
  • On-Call #3458. CMA Model Policy: Responding to Requests for Non-Beneficial Treatment
  • On-Call #3400. Autopsies
  • On-Call #3401. Organ and Tissue Donation
  • On-Call #3402. Pronouncement of Death and Death Certificates
  • On-Call #3403. Pronouncement of Death Diagnosis of Death by Neurologic Criteria

For Patients
For more information about end-of-life medical decisions, visit the Coalition for Compassionate Care of California (CCCC) website, www.coalitionccc.org.

The booklet Finding Your Way was written by the Center for Healthcare Decisions as a useful guide to thinking about and discussing end-of-life issues. To order a copy, visit the CCCC website or call the organization at (916) 489-2222.

If you have a serious medical condition or have been diagnosed with a terminal illness, CMA encourages you to talk to your doctor about POLST. Before initiating that conversation, you may wish to visit www.capolst.org or the California Coalition for Compassionate Care website for more information.

For Providers
End-of-life resources for health care providers are available at the Coalition for Compassionate Care of California website. CCCC also provides decision guides. palliative care tools and resources for physicians.





End of Life Doula Program #key #colony #beach #motel

#hospice end of life

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End of Life Doula Program

Hospice of San Luis Obispo County’s Volunteers are Putting Their Hearts in Service to People at the End of Life

Hospice of San Luis Obispo County (Hospice SLO County) offers an End-of-Life Doula (EOL Doula) Program for in-home clients provided by Doulas trained through the International End of Life Doula Association (INELDA). Just as a Birth Doula brings greater comfort and deeper meaning to the process of labor and the beginning of a life, EOL Doulas offer the same during the process of dying. The EOL Doulas serve people and families going through the end stages of a terminal illness when caregivers experience many losses in the patient’s function and role as well as an increase in physical symptoms. This is correspondent with greater demands for their time, energy and fatigue in the face of knowing the end is coming. As with all Hospice SLO County programs, EOL Doula services are provided without charge.

In-Home End-of-Life Doula Services

The EOL Doula program offers a well-rounded approach that supports both a non-medical and medical model by helping the patient and family deal with questions about the dying process, meaning and to help plan for how they want the last days to unfold when their loved one dies at home. The EOL Doulas offer compassionate presence, knowing support, caring touch, and respite for caregivers. They provide simple physical support and utilize guided visualization created with/for the patient to assist in pain and anxiety control. They assist families in creating spiritual and emotional legacies and rituals that honor and recognize the uniqueness of their loved one. EOL Doulas provide guidance and assistance around the clock when the patient is actively dying. And, assist the family to reprocess the dying experience after the death to help guide and support them into the early days of their grief. End-of-Life Doulas help a dying person and their loved ones plan for what they envision as a “good death,” and then assist in facilitating the individual’s planned vigil in their final days.

End-of-Life Doula Services for Hospitals and Long Term Care Facilities

Many hospitals and long term care facilities make substantial efforts to address the physical, emotional and spiritual needs of their dying patients and families. Often, the needs or expectations of the families far exceed what can be provided within the standard medical treatment model. To address and support this, the EOL Doula program offers a well-rounded approach that supports the medical model by helping the patient and family deal with questions, provides a constant presence insuring someone is with the patient around the clock when they are actively dying.

The purpose of the EOL Doula service is to bring a dying person and their family the kind of intimate and personal care they deserve during the end of a life. Added care to make the last days and hours comfortable, peaceful, and richly meaningful.

“Helping to guide and companion a dying person and those around them through the final days of life has been the most rewarding volunteer activity I’ve ever done—it has changed my life.”

-End of Life Doula





Signs of the End of Life in the Elderly (with Pictures) #holiday

#end of life stages

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Signs of the End of Life in the Elderly

It can be difficult to assess when your elderly parent is nearing death, and you may feel unprepared. Before your elderly parent passes, his body will develop phases of dying. Some signs of the end of life can include increased agitation, withdrawal from family and your parent discussing that he’s dying — which will alert you that death is approaching. While this may not provide you with any comfort, you can at least give palliative care to make the transition as peaceful as possible.

Your loved one may decrease food intake. This may trouble you to witness, as you may feel that eating can somehow renew your loved one’s strength. However, as one becomes closer to death, the body no longer needs nourishment. Repeatedly encouraging someone to eat, or even forcing food can cause nausea and abdominal pain, according to Rhode Island Hospital. However, you can provide comfort by applying lip balm or moistening the lips of your loved one with ice chips, recommends the Mayo Clinic.

The elderly can experience disorientation as they near death. Between 28 to 83 percent of individuals will experience some form of delirium as they come closer to death, as stated by Charlotte A. Paolini, DO for the Journal of the American Osteopathic Association. Symptoms can include hallucinations, memory loss, talking to previously passed away loved ones and confusion. You can confer with your loved one’s physician to provide a non-stressful environment if an increase in agitation becomes noticed.

Circulation of blood will begin to relocate to the organs, making the extremities cold to the touch. The body can fluctuate between cold and hot, and you may notice your loved one perspiring or feeling clammy to the touch.The color of skin can also change, becoming bluish or a blotchy purple. You can provide your loved one with a blanket to keep her warm. Yet, don’t feel hurt if she decides that she doesn’t want a blanket. Your loved one may not even feel cold.

Your loved one can spend copious amounts of time sleeping. During this phase, he may awaken, but be incapable of communicating to you. In other moments, it may be difficult to rouse your love one from his slumber. Don’t be afraid to talk with him during this time. Although he is unresponsive, he can still hear you. William Lamers, M.D. former consultant for the Hospice Foundation of America, asserts that hearing is the last sense lost prior to death.

Breathing patterns change upon nearing death. Breathing can become rapid, followed by a duration of stopped breathing in a process known as Cheyne-Stokes, notes William Lamers, M.D. The breathing will resume and become more labored as death advances. Congestion and coughing can accompany Cheyne-Stokes breathing. You may also notice a rattling sound within your loved one’s lungs. You can provide your loved one with a vaporizer in his room to help alleviate fluid accumulation in his lungs.

Northern Arizona Healthcare reports that prior to dying, a person may develop a new vigor. You may notice your loved one making requests or statements. This is your loved one’s way of saying goodbye and giving you the opportunity to say your farewells. While during this moment, you may become overwrought with grief, giving your loved one a kiss or saying, I love you can help her realize that you have come to terms with her letting go.





Care at the End of Life-The Dying Process #motels #in #florida

#end of life stages

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50+: Live Better, Longer

If you are dying or are caring for a dying loved one, you may have questions and concerns about what will happen physically and emotionally as death approaches. The following information may help answer some of these questions.

Signs of approaching death

The dying process is as variable as the birthing process. The exact time of death cannot be predicted, nor can the exact manner in which a person will die. But people in advanced stages of a terminal illness experience many similar symptoms as they approach the end of life, regardless of their illness.

Several physical and emotional changes occur as death approaches, including:

  • Excessive sleepiness and weakness as periods of wakefulness become shorter and overall energy declines.
  • Breathing changes. such as periods of rapid breathing alternating with short episodes when breathing stops.
  • Visual and hearing changes. such as seeing people or scenes that others do not (hallucinations ).
  • Decreased appetite as your metabolism slows and you no longer have the same interest in food.
  • Urinary and bowel changes. such as dark or red urine and hard stools that are difficult to pass (constipation ).
  • Temperature changes. such as running a high temperature or feeling very cold.
  • Emotional changes. such as becoming less interested in the outside world and being less socially involved with others.

Dying people may also experience symptoms specific to their illness. Talk to your doctor about what to expect. Also, if you have chosen to receive hospice care. the hospice team is available to answer any questions you may have about the dying process. The more you and your loved ones know, the better prepared you will be to cope with what is happening.

Pain

Palliative care can help you to feel relief from physical symptoms related to your illness, such as nausea or difficulty breathing. Pain control and symptom control are important parts of managing your illness and improving the quality of your life.

Whether a person suffers from physical pain in the days before death often depends on the illness. Some terminal illnesses, such as bone or pancreatic cancer. are more likely to be accompanied by physical pain than others.

In this article




Hospice: Volunteering at the End of Life #formula #one #motel

#hospice volunteering

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Hospice: Volunteering at the End of Life

If I can stop one heart from breaking,
I shall not live in vain;
If I can ease one life the aching,
Or cool one pain,
Or help one fainting robin
Unto his nest again,
I shall not live in vain.
— Emily Dickinson, “Complete Poems”

Hospice volunteer Linda Harris spent many a recent hour typing up poems and, in the process, learning about life and death, love and family, honesty and what it takes to make a difference. Written over time, some in the final months of life, the poems are the legacy of a remarkable 80-something woman Linda calls “The Poetry Madame.”

Linda met the Poetry Madame on Christmas Eve, when she first visited her at home as a hospice volunteer. The following week, New Year’s Eve, Linda began what would become a tradition, helping her new acquaintance “get gussied up” and giving her a haircut — a service she provides regularly to other hospice patients as well. (“I’m the best price in town,” she says of her free service.)

Hospice care is an end-of-life-care model that focuses on enhancing quality of life when time is short. It involves an inter-disciplinary team — including doctors, nurses, social workers, bereavement counselors and nutritionists — working together addressing the medical, physical, social, emotional and spiritual needs of the patient, as well as providing bereavement support to the family. In keeping with hospice’s deeply humane and community-service roots (the word stems from the same root as “hospitality”), the team also includes volunteers like Linda — more than 460,000 other hospice volunteers across the country.

“Volunteers are an integral and valued part of the team,” says Taren Sterry. manager of volunteer services for the Visiting Nurse Service of New York Hospice Care. “They provide that extra level of care and comfort that neighbors used to provide for free, without thinking about it.”

In fact, volunteers are mandated by law. Organizations that receive hospice Medicare benefits from the government must have 5 percent of their direct services come from volunteers. Volunteers provide nonprofessional services but are required to undergo intensive training, including interviews and background checks. Our organization asks volunteers to commit to at least one year of service, visiting with one patient one hour per week in the home. Volunteers who visit patients in a residential facility have a small “caseload” per week.

Volunteer services can be as varied as those of any personal relationship and can include:

• Support for patients





NIHSeniorHealth: End of Life – Preparing For The End of Life #wakefield

#end of life care

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End of Life

Preparing For The End of Life

Few of us are comfortable talking about death, whether our own or a loved one’s. It is a scary, even taboo, subject for many. The end of a life, no matter how long and well lived, can bring with it a sense of loss and sadness. It can also be a reminder of our own mortality, so we may avoid even thinking about death.

This is normal — but death is normal, too. All of us will face it at some point.

Defining the End of Life

The end of life and how people die has changed a great deal in the past century. Thanks in large part to advances in public health, medicine, and health care, most Americans no longer die suddenly from injury or infection. Instead, we live longer and, more often than not, die after a period of chronic illness.

As a result, it is hard to know when the dying process begins. Some people pass quickly, while others recover from severe illness several times before death. Even people who are the same age and sex, with the same disease and state of health, are unlikely to reach the end of life at the same time.

We often rely on health care providers to tell us when the end of life is near. But even the most experienced health care provider may find it hard to predict when someone will die. An expert may say the end is within weeks or months, but the dying person slips away much sooner or survives for a year or more.

Preferences for the End of Life

Because the end of life is hard to predict, it is best to plan ahead. You might want to start by asking yourself or a loved one, “What is the best way to plan for the end of life?”

The answer will differ from person to person. Some people want to spend their final days at home, surrounded by family and friends. Others may prefer to be alone, or to be in a hospital receiving treatments for an illness until the very end.

The answer may also change over time — the person who wanted everything possible done to prolong life may decide to change focus to comfort. Someone else who originally declined treatment may agree to an experimental therapy that may benefit future patients with the same condition.

No matter how a person chooses to approach the end of their life, there are some common hopes — nearly everyone says they do not want to die in pain or to lose their dignity. Planning for end-of-life care, also known as advance care planning, can help ensure such hopes are fulfilled. To learn more about advance care planning, see Planning for Care.

What Is End-of-Life Care?

End-of-life care is the broad term used to describe the special support and attention given during the period leading up to death, when the goals of care focus on comfort and quality of life.

Hospice Care

One of the ways end-of-life care is provided is through hospice. Hospice, as defined by the Center for Medicare and Medicaid Services, is a program of care and support for a dying person whose doctor and a hospice medical director certify has less than six months to live.

The focus of hospice is on comfort, not cure. Currently, patients must be willing to give up curative treatments to receive Medicare coverage for hospice care. (Medicare continues to pay for any covered health problems that are unrelated to the dying person’s terminal illness.)

Palliative Care

Unlike hospice care, you do not have to be dying or give up curative treatments to receive palliative care. The term “palliative care” is sometimes mistakenly used to mean end-of-life care, but palliative care is a treatment available to anyone of any age who is suffering from the discomforts, symptoms, and stress of a serious illness.

Palliative care is used effectively to provide relief from many chronic conditions and their treatments, too. Older persons who are living with one or more chronic illnesses may benefit from palliative care long before they need end-of-life or hospice care. Unlike hospice care, palliative care may be used for as long as necessary.

To learn more about hospice care, palliative care, and other types of end-of-life care, see Types of Care.

Questions To Ask As the End of Life Approaches

Regardless of a person’s choices for treatment and care at the end of life, it is important to maintain the quality of a dying person’s life. To better understand the care options available for someone who is approaching death, you may wish to ask the dying person’s health care provider the following questions.

  1. Since the illness is worsening, what will happen next?
  2. Why are you suggesting this test or treatment?
  3. Will the treatment bring physical comfort?
  4. Will the treatment speed up or slow down the dying process?
  5. What can we expect to happen in the coming days or weeks?
  6. If I or my loved one take this treatment or participate in this clinical trial, will it benefit others in the future?

Additional Care Needs

People at the end of life usually need additional care in several areas, including for physical symptoms, emotional and spiritual issues, and practical concerns. Other sections of this health care topic address how to help make sure these needs are met.





End of Life Care #cheapest #hotel #rates

#hospice end of life signs

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General Pet Care

End of Life Care

Coping with the impending loss of a pet is one of the most difficult experiences a pet parent will face. Whether your furry friend is approaching his golden years or has been diagnosed with a terminal illness, it’s important to calmly guide the end-of-life experience and minimize any discomfort or distress. As your pet’s health declines, you may elect to care for your pet at home—with the supervision of a veterinarian—or you may decide to end his suffering with euthanasia.

Read on to find out how to help make your pet’s final days peaceful and dignified.

Is Your Pet In Pain?

When cats and dogs are suffering, they may not show outward signs that we normally associate with pain like whimpering or crying. Sometimes an animal will continue to eat or drink in spite of pain or disorientation. Some physiological and behavioral signs that your pet might be experiencing pain include excessive panting or gasping for breath, reclusiveness, reluctance to move and food pickiness.

Caring for an Elderly Pet

The most important thing you can do for your elderly pet is to minimize any pain or distress she’s experiencing.

  • Consult with your veterinarian and treat any health problems, since undiagnosed issues can cause discomfort and rapid deterioration.
  • Surround her with her favorite things, like a warm blanket or special squeaky toy.
  • Since pressure sores can develop in pets with limited mobility, it’s also essential to provide a warm sleeping spot with plenty of cushioning.
  • Some older pets may develop incontinence, or the loss of bladder control, so be sure to check your furry friend regularly for any wetness or soiling. If your pet needs help getting up to urinate or defecate, you can purchase a sling or use a large towel to wrap under her body and assist her.

Pet hospice care, also known as palliative care, is an option if your pet is suffering from a terminal illness and a cure is not possible. The goal is to make a pet’s final days or weeks more pleasant with the proper use of pain medications, dietary strategies and human interaction. Pet hospice is not a place, but a personal choice and philosophy based on the principle that death is a part of life and can be dignified. When considering hospice care, pet parents should very careful not to prolong the suffering of pets who are in pain or experiencing poor quality of life.

A participating veterinarian will teach pet parents how to provide intensive home care to keep an ill pet as comfortable as possible. Hospice care requires an active commitment and constant supervision from pet parents, who work with their veterinary team to make sure their pet’s life ends comfortably. If you decide hospice care is the right course for you and your pet, you will become your pet’s primary nurse and caregiver, as well as the link between your pet and the veterinary team. Consult with your primary veterinarian and see if she recommends hospice care for your pet based on his specific needs.

Euthanasia provides a painless, peaceful end for a pet who would otherwise continue to suffer. Your veterinarian has special training to provide your pet with a humane and gentle death. During the procedure, your vet will inject your pet with a sedative followed by a special medication. The animal experiences no awareness of the end of life—the process is akin to undergoing general anesthesia for a surgical procedure and takes about 10 to 20 seconds.

Your veterinarian is the best person to advise you on when the time is right to euthanize—information from medical tests is often more accurate than what a pet owner can observe, and pet owners often delay the moment of euthanasia in anticipation of grief. Observing and keeping an accurate record of your pet in his daily activities can help you to decide. If you observe that moments of discomfort outweigh his capacity to enjoy life, it is time to euthanize, even if your pet still experiences pleasure in eating or socializing. If your pet is in pain, your main goal should be to minimize his suffering.

What to Do If Your Pet Has Died at Home

If your pet is under the care of a veterinarian at the time of his or her passing, he or she can guide you through next steps. However, if your pet dies in your home, there are options to consider. Whether you simply want the body to be removed from your home, or you wish to permanently memorialize your pet in some special way, the choice is yours.

  • Depending on your decision, you may have to keep the body in your home for a short period of time. A well-cooled body can be held for up to 24 hours, but the sooner it can be taken somewhere else, the better.
  • Placing the wrapped animal in a refrigerator or freezer is recommended, with one exception—if you plan to have a necropsy (autopsy) performed to determine cause of death, the body should not be frozen (refrigeration is still okay). It is essential that you contact a veterinarian as soon as possible if you would like a necropsy.
  • If the animal is too big to be put into a refrigerator or freezer, the body should be placed on a cement floor or concrete slab, which is the best way to draw heat away from the carcass. Do not cover or wrap the body in this instance. Doing so will trap in heat and not allow the body temperature to cool.
  • As a last resort, you may keep the body in the coldest area of your home, out of the sun, packed with bags of ice. In this case, the body should be placed in a plastic bag to prevent it from getting wet.

Pet Cremation and Burial

It is very common for pet owners to have their deceased pets cremated. You need to decide if you wish to keep your pet’s ashes as a remembrance. If so, you will want to arrange an individual (or private) cremation, meaning that your pet will be cremated alone. Businesses that offer individual cremation commonly offer home pick-up/delivery of remains as part of their service packages.

Depending on local laws, it may be legal to bury an animal on your own property. It is typically illegal to bury an animal on public lands such as parks. If you desire burial for your pet but do not have land of your own, check to see if there is a pet cemetery or memorial park in your area.

If you wish to simply have your pet’s body removed from your home, consult your local government to find out if your sanitation department picks up animal remains.

Dealing with Pet Loss

There are many forms of grief that are completely normal in the wake of the loss of a beloved pet. For support dealing with the loss of a pet, call our Pet Loss Hotline at (877) GRIEF-10.





Cat hospice and end of life care #about #health #care

#cat hospice

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Cat hospice care and end of life care

For cats that are approaching end of life, cat families have several options. In all cases, the desire is for their beloved companion to spend his or her last days in dignity and free from pain while enjoying simple pleasures with the ones they love.

Your veterinarian at The Cat Practice will provide you with complete information on: 1) Hospice care, 2) Hospice care with euthanasia and 3) Euthanasia

Hospice care
Hospice makes no attempt to prolong life or hasten death.
The goal of hospice care is to keep pets as alert and pain-free as possible,
allowing them to live their remaining days in comfort, in their own homes.

Hospice care with euthanasia
With hospice care, euthanasia is used only as a last resort when it becomes evident that your pet’s illness has progressed and is causing serious chronic pain or distress.

Euthanasia
In some cases, when a cat is suffering with little chance to alleviate pain or discomfort, euthanasia may be the most humane alternative. This would apply to cats that:

  • Have been seriously injured or maimed
  • Have a rapidly progressing illness that hampers breathing, swallowing or normal eating
  • Are unable to stand or move

Hootie was a patient in the Cat Practice’s hospice program. See how his feline companion took care of him in his final days in Farewell to Hootie at http://www.youtube.com/watch?v=eQ3mtuJvuTM

Read more about options for Hospice and
End of Life Care:





SCIE: End of life care #hotell

#what is end of life care

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End of life care

Information and links for professionals who support people and their families at the end of life

This resource is for people who work with adults who are approaching the end of life. Some 500,000 people die each year and, because of the ageing population, that number is predicted to rise over the next few years. It’s important that social care and health professionals who work with people at the end of life and their families have access to high quality resources and information so they can give the best care possible.

This guide is about enabling people who want to die at home to do so and improving the quality of care they receive.

Specific needs of people with dementia at the end of their lives.

Eight films that explore different aspects of end of life care. These films can be used in group training or for professional self-development.

SCIE’s resources support the professional development of health and social care staff who work with people at the end of their lives and their families.

Evidence-based information describing high quality end of life care from the National Institute for Health and Clinical Excellence (NICE).

Find out about the innovative end of life care practice of other organisations and share your own ideas with others working in the sector.





Nursing Care Plan: NCP End of Life #last #minute #travel #deals

#hospice nursing care plans

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Nursing care involves the support of general well-being of our patients, the provision of episodic acute care and rehabilitation, and when a return to health is not possible, a peaceful death. Dying is a profound transition for the individual. As healthcare providers, we become skilled in nursing and medical science, but the care of the dying person encompasses much more. Certain aspects of this care are taking on more importance for patients, families, and healthcare providers. These include pain and other symptom management; psychological, spiritual, and grief/bereavement support.

Recent studies have identified barriers to end-of-life care including patient or family member s avoidance of death, influence of managed care on end-of-life care, and lack of continuity of care across settings. In addition, if the dying patient requires a lengthy period of care or complicated physical care, there is the likelihood of caregiver fatigue (psychological and physical) that can compromise the care provided.

The best opportunity for quality care occurs when patients facing death, and their family, have time to consider the meaning of their lives, make plans, and shape the course of their living while preparing for death.

Much of the care of the dying is still provided by nurses in hospitals, primarily in oncology and critical care areas. However, other care settings are becoming more common, e.g. the home, assisted living/extended care setting, or hospice inpatient unit.

Psychosocial aspects of care

Care Plan(s) reflecting underlying pathology of terminal condition

Patient Assessment Database

Data depend on underlying terminal condition and involvement of other body systems.

May report: Stress related to recent changes in ability to care for self and decision to accept hospice services

Feelings of helplessness/hopelessness, sorrow, anger; choked feelings

Fear of the dying process, loss of physical and/or mental abilities

Concern about impact of death on SO/family

Inner conflict about beliefs, meaning of life/death

Financial concerns; lack of preparation (e.g. will, power of attorney, funeral)

May exhibit: Deep sadness, crying, anxiety, apathy

Altered communication patterns; social isolation; withdrawal

May report: Apprehension about caregiver s ability to provide care

Changes in family roles/usual patterns of responsibility

May exhibit: Difficulty adapting to changes imposed by condition/dying process

2. Prevent/manage complications.

3. Maintain quality of life as possible.

4. Plans in place to meet patient s/family s last wishes (e.g. care setting, Advance Directives, will, funeral).





End-of-Life Decisions – End of Life Issues – California Medical Association #stages

#end of life issues

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End-of-Life Decisions

California law provides individuals the ability to ensure that their health care wishes are known and considered if they become unable to make these decisions themselves.

The California Medical Association (CMA) encourages Californians to think and talk with loved ones about their wishes for end-of-life medical care before a serious illness or injury occurs. CMA has developed a number of guidelines, forms, and other resources to assist providers, patients, and loved ones with making important end-of-life decisions.

NEW! California s End Of Life Option Act

On October 5, 2015, California became the fifth state in the nation to allow physicians to prescribe terminally ill patients medication to end their lives. ABX2-15, the “End of Life Option Act,” permits terminally ill adult patients with capacity to make medical decisions to be prescribed an aid-in-dying medication if certain conditions are met. The following document discusses the requirements under the End of Life Option Act, which went into effect June 9, 2016:

  • CMA On-Call #3459: The California End of Life Option Act
  • On-demand webinar: The California End of Life Option Act: An Overview

Advance Health Care Directive

In California, advance directives are the legally recognized format for living wills. An advance directive enables individuals to make sure that their health care wishes are known in advance and considered if for any reason they are unable to speak for themselves. Advance directives also allow patients to appoint a health care “agent” who will have legal authority to make health care decisions in the event that the patient is incapacitated, or immediately upon appointment if the patient expressly grants such authority.

See below for more information about advance directives, or to purchase CMA’s Advance Health Care Directive Toolkit, available in English and Spanish:

  • CMA Advance Health Care Directive Kit in English (rev. 3/14)
  • CMA Advance Health Care Directive Kit in Spanish (rev. 9/14)
  • CMA On-Call #3451. Decisions Regarding Life-Sustaining Treatment – Advance Directives and POLST (2015)
  • CMA On-Call #3450. Decisions Regarding Life-Sustaining Treatment for Patients Without Advance Directive or POLST (2015)

Physician Orders for Life-Sustaining Treatment

Physician Orders for Life Sustaining Treatment (POLST) in 2009 became a legally recognized document, similar to the widely used do not resuscitate (DNR) orders. The POLST form, used for patients with a serious illness or whose life expectancy is a year or less, outlines a plan of care reflecting the patient s wishes concerning medical treatment and interventions at life s end. The POLST form complements an advance directive by turning a patient s treatment preferences into actionable medical orders.

See below for more information about POLST, or to purchase CMA’s POLST toolkit, available in English and Spanish:

  • 2016 POLST form (effective January 1, 2016)
  • CMA POLST Kit in English (rev. 12/15)
  • CMA POLST Kit in Spanish (rev. 10/14)
  • CMA On-Call #3451. Decisions Regarding Life-Sustaining Treatment – Advance Directives and POLST (2015)
  • CMA On-Call #3450. Decisions Regarding Life-Sustaining Treatment for Patients Without Advance Directive or POLST (2015)

Do Not Resuscitate (DNR) Form

The Pre-Hospital DNR form, developed by the California Emergency Medical Services in conjunction with the California Medical Association, instructs EMS personnel to forgo resuscitation attempts in the event of a patient’s cardiopulmonary arrest. Below you will find CMA resources that include additional details about DNR requests and purchasing information for the DNR form in English and Spanish.

  • Do Not Resuscitate Form in English
  • Do Not Resuscitate Form in Spanish
  • CMA On-Call #3453. Decisions Regarding Resuscitative Measures DNR Requests Orders and Cardiopulmonary Resuscitation (2015)

Other Resources

CMA’s Health Law Library
Updated annually, CMA’s online health law library contains nearly 5000 pages of valuable information for physicians and their staff. The CMA Center for Legal Affairs has developed several On-Call documents on important end-of-life issues in the medical practice. Access to the library is FREE to members. Nonmembers can purchase documents for $2 per page.

  • On-Call #3452. Documenting Decisions Regarding Life-Sustaining Treatment
  • On-Call #3454. Decisions Regarding Life-Sustaining Treatment and the Patient Self-Determination Act and Joint Commission
  • On-Call #3455. Physician-Assisted Suicide
  • On-Call #3456. Responding to Request for Non-Beneficial Treatment
  • On-Call #3458. CMA Model Policy: Responding to Requests for Non-Beneficial Treatment
  • On-Call #3400. Autopsies
  • On-Call #3401. Organ and Tissue Donation
  • On-Call #3402. Pronouncement of Death and Death Certificates
  • On-Call #3403. Pronouncement of Death Diagnosis of Death by Neurologic Criteria

For Patients
For more information about end-of-life medical decisions, visit the Coalition for Compassionate Care of California (CCCC) website, www.coalitionccc.org.

The booklet Finding Your Way was written by the Center for Healthcare Decisions as a useful guide to thinking about and discussing end-of-life issues. To order a copy, visit the CCCC website or call the organization at (916) 489-2222.

If you have a serious medical condition or have been diagnosed with a terminal illness, CMA encourages you to talk to your doctor about POLST. Before initiating that conversation, you may wish to visit www.capolst.org or the California Coalition for Compassionate Care website for more information.

For Providers
End-of-life resources for health care providers are available at the Coalition for Compassionate Care of California website. CCCC also provides decision guides. palliative care tools and resources for physicians.





Caregiving Resource Center: Managing Symptoms at the End of Life, Chan #hospice

#end of life stages

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Managing Symptoms at the End of Life

Fatigue
Chronic fatigue, the kind that affects most people who are dying, can stem from:

  • An illness.
  • Anemia.
  • Depression.
  • Poor nutrition.
  • Deconditioning (becoming out of shape from lack of exercise).
  • Side effects from treatments such as chemotherapy and radiation.

Persistent exhaustion impacts every aspect of a person’s life: psychological, physical and emotional. Ask your loved one’s doctor to adjust medications or try nondrug interventions such as gentle exercise. Even a walk around the block can help. If untreated, fatigue will overwhelm a patient’s quality of life.

Loss of Appetite and Thirst
As the end approaches, the desire to eat and drink ebbs. Because the body either doesn’t need as many nutrients or can’t absorb them, it stops asking. Weight loss follows. Bear in mind that it’s a natural part of the dying process and the patient isn’t suffering. Neither family members nor health providers should force terminally ill patients to eat or drink. If they do ask for food or drink, offer small, frequent meals of high-calorie, high-protein foods, or add nutritional supplements. Keep ice chips handy. They relieve two key symptoms: dehydration and dry mouth.

For those who may consider more aggressive measures, such as feeding tubes or intravenous lines, confer first with the doctor, hospice nurse or primary medical professional about the pros and cons.

Skin Breakdown
Anyone confined to a bed for long periods of time will risk bedsores, also known as decubitus ulcers. They usually occur on the arms, legs, feet and back, places where prolonged body weight creates pressure points against the bed. Lack of circulation causes skin to break down at these points. To protect skin and prevent infection, try the following:

  • Change your loved one’s position every two hours. Ask a medical professional to show you how to do this safely.
  • Be sure that your loved one maintains good nutrition as best as possible.
  • Talk to your doctor about whether a special bed or mattress can help.
  • If your loved one develops bedsores, ask a doctor, home care nurse or other medical professional how to care for them. If you cannot cope with changing the dressing, find someone who can.

Cognitive Changes
Up to 85 percent of terminally ill patients suffer from cognitive changes during their final days. The most common afflictions include confusion, delirium and agitation. These symptoms arise from any number of causes, including the disease itself, infection, medications, and kidney and liver dysfunction. The reassurance of family and friends can play a vital role in helping someone who suffers cognitive problems. Discuss these cognitive changes with your health care team. Some medications long in use, such as haloperidol, can help with agitation and confusion.

Digestive Problems
For those who are terminally ill, digestive issues are a frequent problem. The most common issues are:

  • Constipation: Patients who are bedbound and not eating a regular diet are often affected by constipation. Many medications worsen it, so talk to your loved one’s doctor or nurse about preventions and solutions.
  • Bowel obstructions: A cause of great discomfort, obstructions prevent patients from eliminating stool. An obstruction needs to be diagnosed by a health professional and treated as soon as possible.
  • Nausea/vomiting: Nausea torments 60 percent of terminally ill patients, and episodes of vomiting harass another 30 percent. Again, various medicines complicate it, so talk to the doctor about changing medications or having an anti-nausea drug prescribed.

Shortness of Breath
If shortness of breath occurs, notify your loved one’s health team. There are medications that can relax breathing, and home or portable oxygen can help, too. If medical intervention still leaves your loved one feeling short of breath, try these ideas:

  • Keep him or her sitting up on pillows as much as possible rather than lying flat.
  • Open a window or turn on a fan. This can help psychologically.
  • Give your loved one a hand or foot massage. Relaxation in general can help calm agitated breathing.

Emotional Expectationsof the Caregiver
Care recipients, their caregivers and family members can expect a whirlwind of emotions during the end of life process. Sometimes, these emotions can get in the way of the precious time you have left with the one you love. It’s important to honor your feelings and not to force cheer or happiness, as it can be very alienating to the person who is ill. Showing sadness is okay at times because it will let your loved one know they are cared for and will be missed.

Talk with family members, your medical team, social worker or clergy about how you are feeling. Try resolving lingering issues, and you will discover a sense of closure and peace of mind. Depression and anxiety are common emotions during this time, but don’t have to be inevitable parts of the end of life, for either the patient or the caregiver.