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An Important Conversation: End-of-Life Decision Making

It’s never easy to say goodbye to someone we love, no matter if it’s expected or not. It can be doubly difficult if you find yourself having to make end-of-life decisions for a loved one who can no longer make their own decisions. This is a position that many caregivers ultimately find themselves in, and there’s no easy way to approach it.

“In a perfect world, you and your loved one would have a frank conversation well in advance of the situation and write down specific instructions to various scenarios,” says Phil Noto, Executive Director of Bridges® by EPOCH at Trumbull, a memory care assisted living community in Trumbull, CT. “However, even though upwards of 90 percent of seniors think it’s important to have end-of-life conversations with their loved ones, less than 30 percent actually end up doing it. Planning for the end isn’t easy, but it’s a priceless gift to your loved ones and peace of mind for you.”

There’s a lot to consider when it comes to end-of-life care and decisions, but talking through as much as possible – from healthcare proxies to when treatment should be stopped to where you would like hospice to take place – can help seniors make thoughtful decisions instead of rushing due to a crisis.

Beginning the Conversation

There are many resources available on the internet for helping you begin the conversation with your loved ones. Here are some approaches and suggestions from The Conversation Project, a nonprofit dedicated to helping people talk about their wishes for end-of-life care.

Prepare yourself before you begin the conversation. 

Instead of simply leaping into the conversation, prepare yourself by sitting down and thinking about what’s important to you. Are there any particular topics that need special consideration? What do you need to think or do in order to feel ready to have the conversation? Remember, you don’t have to (and probably won’t be able to) make all the decisions in one sitting. Like any good conversation, this will be a starting point – the first in a series of discussions between you and your loved ones.

Decide who you wish to speak to. 

You can choose to discuss with as many or as few people as you wish. You can also begin the conversation with one group and then bring others in as conversations progress. While close family members are most often the ones involved, you can also include medical professionals, faith leaders or counselors to help you through this discussion.

Cover important topics.

An important topic can mean different things to each individual. While there is no one master list of questions and topics to discuss, here are some ideas to help you think about what’s important to you:

  • When you think about end-of-life, how would you like it to look?
  • Are there any particular concerns about health or other issues?
  • What items and affairs do you need to talk to loved ones about and get in order?
  • Who would you like to be in charge of decisions on your behalf? Who would you NOT want?
  • Are there others you would like to be involved in your care? Would you prefer to have doctors decide what’s best?
  • Are there any family issues that you’re worried about?
  • What important milestones would you like to be there for, if possible?
  • Where do you want to receive care? Where do you NOT want to receive care?
  • What types of treatments would you like? What would you consider to be “extreme measures?”
  • What would cause you to want to switch treatment to comfort care (palliative or hospice) from a curative approach?

Understand that it may take time. 

It’s possible you may need to have a conversation more than once or simply come back to it at another time. Remember that the other parties will need time to absorb what you’re saying and deal with their own emotions, too. If the conversation is becoming too difficult, try again at a later time. You will also need to have follow-up conversations throughout the process in order to make sure everything you need and desire is laid out.

Making Decisions For Your Loved One

If you are the caregiver of a loved one and have already discussed end-of-life decisions, congratulations – hopefully, it will help make a difficult situation a little less challenging. However, it’s also common that caregivers and other family members may need to make decisions on behalf of the senior, without having discussed their wishes. There are two approaches that are suggested to try and honor your loved one while making the best decisions for them.

The first approach is called substituted judgment. This just means that you put yourself in the place of your senior loved one and attempt to decide as they would. Some experts believe that decisions should be based on substituted judgment whenever possible. The second approach is called best interests. In this approach, the caregiver or decision-maker makes a judgment call based on what is best for the individual. Oftentimes, these two approaches end up being combined.

If you or another person you care about are in a situation where you are making decisions for someone at end of life, here are some questions to help guide you:

  • Has your loved one ever discussed what they want for their end of life?
  • Have they given opinions in the past based on how someone else was treated?
  • What were your loved one’s values? What gave them the most meaning?
  • What options are available? What are the results if you were to move forward with one option over another?

“End of life is a delicate time that should be treated with the utmost respect and dignity,” says Phil. “As a caregiver or decision maker for a loved one, we understand that this can be a difficult situation. Bridges® by EPOCH at Trumbull strives to provide support and assistance for our residents and families at any point during the process – before, during and after – to help respect wishes and provide the very best care possible. It is our honor to serve.”

Personalized Lifestyle

Bridges® by EPOCH at Trumbull’s highly specialized, resident-centered Bridges® program is a positive, uplifting approach to memory care and wellness that focuses on a resident’s current skills and abilities, not on those that have been lost to dementia.

Each programming plan is as unique as the resident it serves, requiring all Bridges® team members to take an active interest in getting to know each resident on a personal level. Then, accounting for a particular resident’s preferences, interests, needs and abilities, we customize the most efficient blend of expert-recommended care, exercises, activities and communication techniques in order to connect with the individual, encourage their involvement in daily life and create happy, meaningful moments.

Intimate Environment

Bridges® by EPOCH at Trumbull features four distinct households, each with its own spacious common areas, along with 14 private and two companion suites. Suites feature private bathrooms and walk-in showers.

Each household has a home-like look and feel, creating an atmosphere of warmth, security and comfort for our residents and their families. While furnishings are provided, we encourage families to furnish their loved ones’ suites with favorite possessions from home to help them feel at home.

Featuring stunning residential design that complements the surrounding community, every inch of the interior is designed to benefit those with Alzheimer’s disease and memory loss. Attributes such as soft colors, directional cues, aromatherapy and interactive life stations create a soothing and secure environment where residents feel comfortable and safe.

Contact us today to learn more.

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