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Hospice has social workers to help families talk out practical matters of death
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Published: February 19, 2009
Talking about death can be uncomfortable. But if you want to die as you wish, it's essential that you talk about what you want with your loved ones and back up those wishes with the appropriate documentation.
That is something the people with hospice can help with.
When someone starts working with Hospice & Palliative CareCenter of Winston-Salem, a social worker goes out to talk about practical matters: the person's financial situation and the importance of making funeral arrangements, naming someone to make health-care decisions for you when you cannot speak for yourself, deciding what sort of medical interventions you may or may not want.
The idea is to see that people aren't blindsided by issues that they didn't know about, and to help them and their families make important decisions sooner rather than later in what may be highly stressful circumstances.
There are two basic advanced directives -- a living will and a health-care power-of-attorney -- that every adult should have whether they are ill or not.
The living will sets out what you want to happen should you not be able to speak for yourself. The health-care power of attorney designates someone to act as your agent.
In some respects, the power-of-attorney document is the more important document, said Dee Leahman, the director of hospice's Community Partnership for End of Life Care.
"If you don't have a person to speak for you, often that piece of paper (living will) can be ignored," he said.
Before setting up a living will and health-care power-of-attorney, people should talk everything through with loved ones.
"It's not about the paper," Leahman said. "It's about the conversation."
Many people are unaware of how important a health-care power-of-attorney can be.
"It can get very sticky," said Lisa Meadows, hospice's vice president of human services, who supervises the social workers and chaplains.
She cited the example of a man who wanted his ex-wife to make the decisions about his health care. Because they were no longer married, the man's children were the ones with the legal authority.
Leahman cited the example of an older couple who chose not to marry because it would have meant a reduction in benefits. On the other hand, because they weren't married, a relative had the authority to trump the partner's wishes.
A health-care power-of-attorney can prevent such problems.
There is a relatively new document that Leahman also recommends for people with a life-threatening illness. Printed on a neon-pink sheet, the Medical Orders for Scope of Treatment lists point-by-point what sort of treatment to give or withhold in specific situations. The document, known as MOST, covers such topics as cardiopulmonary resuscitation, mechanical ventilation, pain treatments, antibiotics and IVs.
MOST, which North Carolina has been using since October 2007, is a more powerful document than a do-not-resuscitate directive. For one, it is more comprehensive and nuanced. And it is signed not only by a doctor -- as the do not resuscitate is -- but also by the person it pertains to, or by that person's agent.
Going over it can help people clarify just what they do and do not want, Leahman said.
"It is a wonderful discussion guide," she said.
Hospice can also fill in family members on what to expect as an illness progresses. Booklets on that, making funeral arrangements and other topics are available to anyone.
Serious illnesses can have a devastating effect on personal finances.
"A lot of our patients were working prior to being diagnosed," Meadows said. "Maybe the spouse has to quit work as well to take care of them."
In such cases, hospice will make people aware of organizations that can help, such as Crisis Control, the Salvation Army and community churches.
"What we are seeing is a greater need for the basics -- for keeping the lights on and for having food in the home," Meadows said.
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