Author Archives: Cindy Moyer

Tomorrow is Too Late

“Yesterday is rarely too early but tomorrow is frequently too late.”

This was the inspirational quote in my inbox this morning.  It made me think of a woman I spoke with recently who shared that she was taking a family member to the beach today because it was the family member’s last wish.  They aren’t waiting for warmer (beach) weather.  They aren’t making elaborate plans and reservations.  They are simply packing warm clothing and blankets, getting in a car, and driving today to honor a last wish.  Waiting would likely reduce the last wish to regret.

Procrastination is a habit we get into in life.  There may be things deemed more important on which we spend time.  Some tasks are too daunting when seen in the whole so we put off starting them.  We typically procrastinate on doing things that are not fun.

Anyone who has children can understand how time flies.  “Yesterday” my son was born.  A few months ago, he turned 30.  Life flies past us more quickly than most of us like.  Tomorrows arrive (and are in the rear-view mirror) more swiftly as we get older.

Procrastination is very strong when it comes to talking about healthcare choices and making decisions.  Facing a medical crisis, traumatic accident or terminal diagnosis doesn’t usually allow for procrastination.  They often demand deliberate, thoughtful but prompt decision-making.  Given the experiences we’ve had and witnessed, waiting until tomorrow is frequently too late (as the inspiration quote states.)  Emotions run high when faced with the immediacy of unprepared decision-making.

Learn how to start important conversations with people you love today so you can reduce the emotional burden of tomorrow.  April 16th is National Healthcare Decisions Day (#NHDD).  Be like the woman taking her loved one to the beach today.  Don’t wait for “beach weather.”

© 2016 Caring Choices

Grief and Gratitude

People frequently say: “I don’t want to be a burden to my family.”  And yet without conversations, planning and guidance, that’s exactly what we may become to them.

A loved one’s involvement through the end of life experience, especially having decision-making responsibilities, can greatly impact how they cope through their grief and bereavement.

  • If they feel guilt and remorse over making decisions, they’re likely to feel guilt, maybe resentment, through their bereavement.
  • If they have the benefit of knowing our values, beliefs and decisions, the emotional burden of decision-making is decreased and bereavement is likely to be less fraught with negative emotions.

Below is our illustration of the general concept of how we experience grief with the actual “closer to the truth” experience of grief.   Some assume that the deepest grief is felt immediately at the loss (as indicated by the darker shade of the line).  As time passes, and we move away from the moment of loss, the shade of the line grows lighter – so does, supposedly, the depth of our grieving feelings.  In reality, grief and bereavement have a less-defined trajectory as illustrated in the second “line”.  Grief is different for each individual, as it is for each situation, whether it be death, divorce, loss of job, loss of independence, etc.  One size does not fit all.

Loss and Grief pic

There is a method of coping with grief that may seem absurd.  Yet, it can be helpful when you’re ready to consider it.  The notion is that of gratitude and creating a Gratitude List.  Not, of course, that you’re grateful for the loss (death, divorce, loss of job, loss of independence, etc.) BUT that you are able to see how the loss transformed your life in a positive way.    I’ve written before about the year I turned 30:  One month after my 30th birthday, my Dad died unexpectedly.  Four months later, I was filing for divorce and leaving my home with my then 8-year-old son to move back in with my Mom.  At that time, I could only focus on the enormity of the losses.

Shortly after Mom died (five years later), I realized that had those things not aligned as they did, I (and my son) would likely not have had those years with Mom so closely in our lives. And there began my Gratitude List of experiences after deep losses:

  • We were able to support each other through the loss of Dad.
  • I was able to be Mom’s primary caregiver through her final years of life.
  • I learned a lot about family caregiving that influences my life and work today.
  • We learned first-hand the benefits of Hospice care.
  • My son had the benefit of living with his Grammie for five years.
  • We had the benefit of being prepared for Mom’s death because we had time together to talk.

I’ve added to my Gratitude List with other losses over the past 22 years (that’s how long my Dad is gone).  Some might say this is simply finding the silver lining in each cloud but I believe it’s more than that.  It’s not just positive thinking or reflection.  It’s about recognizing and accepting positive changes in your life when really awful things have happened.  There is a research group at UNC Charlotte who works on this topic, which they termed “post-traumatic growth”.  When you’re ready, check them out.

Caring Choices understands that loss is inevitable for most of us.  Falling into the depths of despair because of loss can be lessened.  We have the power to prepare people we love for loss which can allow them to eventually make their own Gratitude List.  It starts with communication. We can help.

© 2015 Caring Choices

More Than a “Right to Die”

So much of today’s press seems to be about the “right to die” or “dying with dignity” movement.  We get caught up in the hyperbole of words like “physician-assisted suicide” or “euthanasia.”  I believe that focus misses some very important points that are beneficial to every person who faces death (their own or that of someone they love).  I prefer to focus more broadly on the right to decide, the right to participate, and the right to be prepared.

Since no one knows when a personal medical crisis, traumatic accident, or terminal diagnosis will happen, it’s imperative that we begin meaningful conversations with people we love while we’re healthy and able to communicate.  It’s important that we speak with our healthcare team (whether that’s our primary care/family doctor or a whole team of specialists) about risks/benefits and options.

Waiting until we’re faced with a never-before-discussed situation is absolutely the wrong time to begin advance care planning or end of life counseling.  At that time, we’re forced to make tough decisions in very limited windows of opportunity — when emotions are chaotic and reason is hindered.

Here are some significant arguments from a growing body of research (and from our experiences) promoting the importance of advance care planning.  I’ve noted some key phrases in bold font:

  • Attending to emotions, understanding their purpose in decision-making, and exploring patient values can help surrogate decision-makers make an “authentic decision … informed by knowledge of the patient’s values and motivated by an intention … that respects the patient as a person”1
  • “We must all realize that if we don’t make these decisions soon enough, someone else, often a family member, sometimes a caregiver, will be forced to carry the terrible weight of making these decisions for us”2
  • Major stressors for surrogate decision-makers: unsure of patient’s preferences, poor communication by clinicians, insufficient time, and uncertainty or guilt over decisions3
  • The better educated family members and surrogate decision-makers are about the needs of the patient, the better they are able to cope with the demands of their decision-making roles4
  • Decision-makers express feelings of guilt, doubt or burden related to making end-of-life decisions
  • Negative emotions are mitigated when patient’s wishes are known.

We believe there are considerations in guiding successful advance care planning/end of life conversations.  Below are 10 such considerations that you might use to begin conversations with people you love:

Conversation Considerations blog pic

Caring Choices proposes everyone should have a “right to decide” what type of care they want and when they want it.  We also believe that decision-makers have a right to be prepared to step in to advocate for a loved one who can no longer communicate their wishes.  Family and friends have a right to participate in planning when a loved one asks them to be a caregiver.  Stating that “my family will know what to do” or “my daughter will take care of me” are bold assumptions if you’ve never had conversations with or commitment from those you want as your decision-makers and caregivers.  Consider the conversation(s).  Then schedule time to have them. It’s your right … and theirs.

Footnotes:
  1. Scheunemann, L.P., Arnold, R.M. & White, D.B. (2012). The facilitated values history: Helping surrogates make authentic decisions for incapacitated patients with advanced illness, American Journal of Respiratory and Critical Care Medicine, 186(6), 480-486.  DOI:  1164/rccm.201204-0710CP
  2. Thompson, J. & Fry, P. (2012). Call to action: What needs to change to improve care and allow sustainability.  In B.J. Jammes (Ed.), Having your own say (c. 16, pp. 231-235)  Washington, DC:  CHT Press
  3. Wendler, D. & Rid, A. (2011). Systematic Review: The Effect on Surrogates of Making Treatment Decisions for Others, Annals of Internal Medicine, 154(5), 336-346, W-100-W104.
  4. Connor, S.R. (2009). Hospice and Palliative Care:  The Essential Guide (2nd Edition).  New York, NY:  Routledge

© 2015 Caring Choices

 

 

 

 

A Line in the Sand

I had the opportunity this week to attend a seminar provided through the Hospice Foundation of America titled The Longest Loss:  Alzheimer’s Disease and Dementia.  One of the presenters, Dr. Kenneth Doka, referred to advance care planning as “drawing a line in the sand.”

Initially, a line in the sand is drawn to signify a point at which no one will cross.  But once water flows over the sand (change!), the line blurs or outright disappears. Then, it becomes time to re-evaluate and draw a new line.

An interesting fact about effective advance care planning (ACP) is that it’s never a once-and-done act.  It demands multiple conversations, oodles of information, shared decision-making, and the ability to plan for, and evaluate, changes as they occur.  Hence, the line in the sand metaphor.

Your initial line in the sand may be a broad decision in your forties to “never have a feeding tube” or “never put me in a nursing home.”  Here’s an example of how a line might change:

Let’s say you’re a healthy 60-year-old man involved in a motor vehicle accident who now requires a feeding tube for a brief period until you’re able to eat normally again.  And maybe you also had your hip replaced because it was broken in the accident.  So, now you also need a short term rehab stay in a nursing home for therapy with your new hip.  In this case, you might change your “nevers” to allow your family to insert the feeding tube for this (expectedly) brief time and you’re okay with a nursing home rehab stay.  So, you move your line in the sand. Lines in the Sand

Advance 20 years and you’re now an 80-year-old man with Parkinson’s Disease and fast-advancing dementia.  You live in your 2-story home with your wife of 50 years and she’s been your primary caregiver.  You are dependent on your wife for all of your care but she’s frail herself now and unable to move/lift you as she once did.  And now you can no longer safely swallow food or drink. 

Where is your line in the sand now about a feeding tube or nursing home placement?

In order to obtain CEUs for this course, I was required to take an online exam.  One of the exam statements addressed the impact of early advance care planning and conversations on grief (specific to dementia, but it is fitting for all scenarios).  Early ACP is important because:

  • The person with dementia [added by Cindy: end-stage heart failure, end-stage lung disease, cancer, aphasia, fill-in-the-blank disease] cannot participate.
  • Families already burdened by caregiving may disagree about care options.
  • Despite the nature of the disease, death may occur suddenly and without warning.
  • All of the above.

I’ll let you decide the correct response.

People may believe this line-in-the-sand approach to conversations about healthcare options indicates that we should wait until we reach a certain age or health condition and THEN decide where to draw our line.  Perhaps some believe that deciding at age 30, 40 or 50 what I want when I’m 70, 80, or 90 is impractical.  Things change rapidly in today’s medical arena so maybe in another 20-30 years I won’t have to worry about a feeding tube or nursing home placement because they’ll be able to fix whatever is wrong with me and I’ll be good as new.

Except we know that the aging process changes our bodies in ways that are not always readily apparent and changes in health can be swift and unrelenting.  We know that heredity gives us increased risk factors and predisposition to certain diseases that we are likely unable to change.  We know that chronic illnesses (including cancers) take their toll eventually on all those who live with these diseases.  We know that illnesses like ALS, Parkinson’s, and Dementia are progressive and irreversible. We know that every person alive will die.

Talking about how our health will change as we age and as diseases occur will not make either of them happen faster than nature occurs.  Talking about the types of care we don’t want will not diminish the types of care we choose.  Talking about dying and death will not hasten death’s approach at our doorstep.

Talking earlier however, WILL prepare you and the people around you (loved ones, caregivers, healthcare providers, employers, co-workers, etc.).  It will prepare you to draw lines in the sand and then re-draw them as conditions/ideals/values change.  It will prepare you to say and do things that are important to you now.  It will give you the opportunity to help prepare those who will grieve your death.  It will prepare those who survive you to embrace their grief as a natural part of life, wrapped in the knowledge that you loved them, you’ll miss them and that you expect them to go on with their lives (and that it’s okay to do so).

Caring Choices helps you draw that first broad line in the sand and then define or move the line as age increases and health declines.  We can give you and your family tools to start the conversations to share decisions that will help survivors after you’re gone.  Don’t deprive your loved ones of peace after your death.  Draw a line in the sand now, knowing that you have the option to move it as often as needed.  Talk.  Now and often – until you can no longer do so.

© 2015 Caring Choices

End of Life is More Than Death

Too often the phrase “end of life” is synonymous with DEATH.  When Jim and I talk about end of life, we focus more on the final year of life.  The moment of death is just that … one moment.  One minute you’re alive, breathing on your own (or assisted with machines); the next minute, you’re not.

Sounds harsh, right?  But yet each of us will face that final year of life, as will those who share life with us.  It’s difficult to comprehend, isn’t it?  Many final years will only be examined in retrospect by those left behind, as I’ve done below about my parents.

My Dad’s final year (August 15, 1992 to August 15, 1993) was spent building my house, working on my brother’s store, and fixing things up around his and Mom’s house.  He went to church every Sunday as he did his entire life.  He enjoyed holidays with big family gatherings. He watched his grandson play baseball and soccer.  He volunteered as a Fire Policeman for Tuckahoe Fire Company.  He helped people with their carpentry projects.  He read his Bible.  He enjoyed Mom’s home cooked meals.  He loved and ate a lot of ice cream.  He lived life.  He also had high blood pressure and was taking medication (for several years).  He had high triglycerides (and also took medication).  He was overweight by probably 30-40 pounds.   He had arthritic knees and required replacement.  He replaced one in November 1992.  He had a painful recovery that lasted for six months.  Then, he got shingles which he suffered with — they were intensely painful — for a couple more months.  He saw his kids turn 35 and 30.  He celebrated his oldest brother’s 50th wedding anniversary (that’s the last picture I have of Dad and Mom together).  On August 11, 1993, he had his first heart attack which sent him to the hospital.  During the next four days, we all assumed Dad would be coming back home soon. On the morning of August 15, 1993, he had his second (and would-be-fatal) heart attack.  He died 14 days before his and Mom’s 45th wedding anniversary.

My Mom’s final year (May 17, 1997 to May 17, 1998) was not as “busy” as Dad’s but then Mom had a chronic illness since she was a little girl, which limited her functional level each year as her age and disease progressed.  But she still lived life on her terms, taking care of my son while I was at work, cooking and baking as much as she could, enjoying her soap operas on TV, and having family holidays one last time.  Mom’s lung disease – Chronic Obstructive Pulmonary Disease (COPD) – was much more “predictable” than Dad’s heart attacks.

Trying to wrap our brains around the fact that some period of 12 months will be our final year of life is daunting.  The real challenge is in knowing when we begin our final year.

COPD and heart disease (not acute heart attacks), like many chronic illnesses, have baseline trajectories that physicians can use to better project disease progression and prognosis.  There are a lot of fancy disease trajectory images on the internet but I drew the two below to illustrate that even in the “final year,” there are points of interest not only in living our lives but also in planning for the future … typically a future without us in it.  Like my previous blog on Recognizing the Signs, these trajectory graphs illustrate the importance of knowing how to recognize and react to the signs that our bodies are giving us.

Dads Final Year

Moms Final Year

 

 

 

 

 

 

 

 

 

 

 

The signs are more readily apparent for people like my Mom than people like my Dad.   Understanding that diseases have trajectories can help us better prepare for that final year – the end of life – and not just focus on the moment of death.  When patients and their families understand what’s ahead, and they’re given tools to prepare for anticipated scenarios, they will have better outcomes.  They won’t cheat death, but they may savor more of their final 365 days knowing that they’ve made a plan that will help them and their loved ones when that final moment arrives.

Caring Choices focuses on living through the end of our lives, not merely planning for the final days/hours leading up to death.  It’s not easy to talk about, but ignoring it won’t make death go away.  We can help you talk.  We can help you plan.  We can help.

© 2015 Caring Choices

Release Our Grip

I attended a seminar this week to discuss issues that affect the aging (65+) population.  One of the speakers shared a story about her 90-something-year-old father who died earlier this year.  Being a nurse, she suggested to the doctor during her dad’s final hospitalization that perhaps a particular procedure could help him be more comfortable.  She said the doctor told her that of course they could do that but the risk to her father outweighed any benefit given his age, his condition, and the likelihood of his death in a very short time (which occurred only a few days later).   She also shared that what the doctor told her next made quite an impact on her.  I don’t remember the statement verbatim, but it was something like:  “The angels are pulling him up by his shoulders and you are trying to drag him down by his feet.”  Just hearing her rendition of it impacted me.  So much so that I sat down at the computer with my Publisher program and free clip art and came up with the illustration below. (I’m not an artist, but I think it gets that doctor’s point across pretty well visually.)

Shoulders and Feet

It’s beyond difficult to let go of people we love. It’s downright painful and heart-wrenching.  Even 22 and 17 years after the deaths of my Dad and Mom (respectively), I can still recall the scenes of their deaths and the emotions I felt at that time.  And there are times when the span of those years seems very short, as if I just lost them.  I always remind myself that I was fortunate to have had them for 30 and 35 years (again, respectively); but there are also times when I feel “cheated” as I watch my friends still enjoying time with their parents today.

But now that I know what I know about the desperate attempts to hold on to our loved ones, I have wondered if we did harm to Dad by having him airlifted from one hospital to another in a last ditch effort to keep him with us.  Did the procedures forced upon his ailing body in his last several hours really do him any good?  I’m certain he was not aware of any of it.  And at the time, I didn’t understand what was happening.  He was off in another room with medical professionals doing their life’s work.  I just knew that it wasn’t looking good for him to survive and I didn’t want to lose my Dad.  I wonder, if we’d really understood what was going to be done to him, would we have pursued such aggressive, invasive procedures?

He died that day, in August 1993, despite the “heroic” attempts to keep him with us.  He was 66.  If he had survived until now, he’d be 88.  If what happened to him then were happening to him now, I know what my decision would be.  And as hard as it would be for me, I know it would be better for him if I’d release my grip.

Caring Choices –They’re not easy to make.  But they’re necessary.  We can help you start talking now to avoid guilt and regrets down the road over the choices you may be forced to make.

© 2015 Caring Choices

Competing Agendas

Watching someone waffle between hope and despair is a heart-wrenching spectacle.  Having the benefit (or is it a curse?) of a healthcare education, she can see what’s happening to someone she loves and idolizes.  She is suspicious that the specialist may not be sharing all the options with her family, yet she’s hesitant to question the physician for fear of taking away the glimmer of hope she sees her loved one clinging to.    Of course she doesn’t want her parent to die but she also understands that everyone does … and especially when she sees the signs so blatantly in front of her.  Her agenda is to allow loved ones to cling to their hope while she prays that the doctor will soon address the elephant in the room.

The physician, she says, has never spoken of anything except another round of treatment.  There has never been a compassionate discussion with the patient and family about goals beyond treatment.   There has been no recommendation of a palliative care consult for pain and symptom management.  This specialist’s agenda is to follow the treatment trail until it ends, either peacefully or, more likely, in a hospital as a last ditch effort to count one more day on this earth.

The spouse of the patient knows something is amiss yet she doesn’t question the physician.  She and the patient are of the generation when the doctor knows best and you don’t question authority.  She recognizes her husband’s decline and fears for her own usefulness when he is gone.  He is her primary caregiver and her lifelong partner.  Her agenda is to love him until his final breath and not allow him to know her worry for her future without him.

There are still others involved in this scenario with agendas of their own in the care of this patient and his family.  Some have the best intentions but are restricted by the nature of their position.  Still others may struggle with the moral or ethical question of when to share information with the patient without the physician’s authorization.  (A suggestion of hospice is often overruled by reasoning such as “not appropriate,” “not there yet,” or “too soon for that.”)  Some are friends of the daughter and offer suggestions and guidance based on similar paths they’ve walked.  Some are professional healthcare colleagues, not involved directly with this patient, who are ready to support whatever decisions the family makes.

The most important person whose agenda is not addressed in this scenario is the patient himself.  The assumption is that he’s clinging to hope for himself when in reality he may be sharing the same worries of his wife – what will happen to her when he’s gone?  He is likely concerned about his daughter – “Daddy’s Little Girl” – whom he’s always supported through these kinds of losses.  He may very well understand that any more treatments are going to be useless for his condition, yet he doesn’t want to take away the doctor’s hope of curing him.

These competing agendas can (and often do) occur to varying degrees in every end of life Competing Agendas TALKsituation.  The only way to end the competition of different agendas and avoid unspoken concerns, unwanted treatments, and make room for compassionate care is to talk.  Talk with family.  Talk with physicians, including specialists.  Talk with religious advisors.  Talk with friends and colleagues.  Talk to whomever matters to you … but do it before things change so rapidly that the agendas are no longer relevant.

Caring Choices can help you align agendas to eliminate competition and ensure compassionate care when you need it the most.  Talking about what we want as the patient, what we need as the loved ones and what we’re able or not able to do as the healthcare provider is the most valuable gift we can give each other.  Talk is not cheap; it’s priceless.

© 2015 Caring Choices

Recognizing the Signs

It seems everywhere you turn there’s a sign showing us the way, urging caution, providing information, enticing a purchase, warning of danger, or providing some of other kind of assistance/information.  Most signs that command attention are in red or yellow providing warnings or cautions leading us to adjust preparations, choose another path or proceed cautiously.  Most of these signs are blatantly obvious, in our faces and difficult to ignore.  Some are downright unsafe to ignore.  When you’re on the road, a detour sign forces you to change course.  Caution signs alert to an upcoming challenge or danger and one must react accordingly to protect yourself and others. RoadSigns for blog

There are many signs in life, however, whose meanings are not so obviously apparent or easily followed.  There are subtle signs which can be misinterpreted, easily ignored, or dismissed.   The signs most difficult to recognize and follow are the signs our own bodies present when the end is nearing.

Contemplating the death of a loved one is rarely without dread.  Recognizing the signs of the failing health of someone we love is difficult, even to trained eyes, but they are most often present in one subtle way or another.  When my Mom was admitted to Hospice care, I was presented with a booklet written by a long-time nurse.  It provides a “road map” of different signs that may be present when a loved one is within months, weeks, days and hours of death.  It may seem gruesome to some but this book helped me recognize when my Mom’s body was giving me signs that she was about to depart our lives.  This book, called “Gone From My Sight,” provided me with insight to know when it was time to call other family members to Mom’s bedside.  [Caring Choices has given this booklet to several families who have found it just as helpful.]

As I read through the booklet after Mom died, hindsight illuminated other subtle signs that Mom’s body had been showing us for the last year of her life.  Fortunately, Mom knew her body well through the lifelong course of her specific disease.  She recognized the signs each time she had pneumonia before the doctors and hospitals ran the necessary tests to confirm it.  She wasn’t afraid to talk about the changes she felt and where those changes were leading.  She talked about death because she lived with the specter of it all her life; she understood her prognosis and what would likely claim her life.  This doesn’t mean she didn’t LIVE life and enjoy it.  She did.  We did.  And on the day of her death, I knew what she wanted and didn’t want. I could recognize and interpret the signs because that booklet and my Mom had prepared me to accept the signs.  It changed my grief experience because I didn’t feel guilt or remorse for making a “wrong” decision.  I followed the signs.

Caring Choices is available to help you recognize the signs, talk about the signs, and follow the signs.  Blatant or subtle, signs are intended to help us.  Knowing what the signs mean can help us make decisions to benefit the people we love.

© 2015 Caring Choices

Priceless Care

Medicare recently announced that it would implement paying physicians for taking the time to have advance care planning conversations with their patients beginning in January 2016.  This could have happened in 2009 but certain politicos and pundits warped the intention of this into “death panels” which knocked these important conversations off the table.  Now that Medicare will reimburse physicians to have these conversations, I can’t help but wonder about the metrics and outcomes measurements that will also be implemented to track the occurrences of these conversations, as well as their efficacy.

It seems like a step in the right direction to reimburse physicians for the time they spend in these conversations with their patients.  These conversations can provide important information for doctors, nurses, social workers, etc. about what their patients want as far as treatment, pain and symptom management, and end of life care.  However, the majority of “care” that patients receive may not be provided by their doctor (oncologist, cardiologist, primary care doctor) or the nurses, social workers and psychologists who work inside the healthcare facility.

Medicare’s decision to reimburse physicians for their time may encourage more physicians to take the time to talk with their patients in more depth than time has so far allowed.  Physicians and other healthcare providers certainly have a role in discussing risk vs. benefit of treatments, rates of survival, efficacy of drugs, places to receive care, etc.  This reimbursement will probably not entice physicians already reluctant to talk about “care vs. cure”.  It will not instill the comfort and confidence needed to have these kinds of conversations with patients in some physicians who have not found that comfort and confidence already in their approach.

A conversation in a healthcare setting is only a beginning of much needed consistent and continuing conversations to help a patient and his/her family through chronic illness management and decisions.  Physician-led conversations will likely not be as frequent (or appropriate) in the midst of a medical crisis, accident or trauma.  Conversations must occur long before these situations happen.  There must be more to these conversations than medical considerations.

I continue to believe that the most important aspect of care conversations is the information shared among family and friends who will be the in-home caregivers providing the majority of care.  Family and friends who will serve in the role of surrogate decision-maker when the patient is no longer able to make decisions or needs known will reap the benefit of these conversations.  There are rare instances where financial reimbursement is available for the time family and friends will spend in caring for a loved one.  But when care choices are discussed and prepared for, those experiences can be priceless.

Caring Choices knows that asking questions about values and beliefs can start deep, loving conversations.  We created Elephant in the Room™ to help individuals and families begin these important conversations.  Start with these three questions from Elephant in the Room™ and see where your conversations lead:0147 GW pic

  • What gives your life purpose or meaning?
  • Where do you want to be cared for at the end of your life?
  • If you were suddenly unable to communicate, would your family know what kinds of care you want (or don’t want)?

© 2015 Caring Choices

Not Always about Dying and Death

I recently had the opportunity to provide a Caring Choices presentation titled “Decision-Making for a Loved One.”  The people in attendance were strong advocates for elder loved ones in fluctuating phases of aging and health.  Some are dealing with varying stages of dementia; others are in end stages of chronic illnesses.  Still others have recently experienced acute illnesses that thrust their family members into decision-making roles sooner than they anticipated.

Since becoming a Certified Dementia Practitioner, I’ve also presented a staff in-service and community seminars on the complex, multi-faceted umbrella of neurocognitive disorders (dementias) that afflict many individuals and their loved ones.

I’ve come to really enjoy teaching these sessions and offering educational opportunities to people who are trying to understand the disease process a loved one is going through as well as coming to grips with their role as caregiver or decision-maker.

Caring Choices offers education and support to individuals and their families in order to prepare for whatever their future health concerns might be.  We’re not solely focused on the “end stage” of diseases, dying process, or the death bed experience.

Our goal is to help people have conversations about what’s important to them in every stage of their lives as age advances and health declines.  Below is one of the slides I presented which seemed to best illustrate the purpose of the conversations we’re promoting.  These are some of the decision-making criteria that are important to me.   As we reviewed this slide, I could see the “lightbulb moment” for some of my presentation attendees.  They started thinking about their own criteria to help their families make decisions if they’re unable due to an acute crisis or other medical emergency.  It’s not always about dying and death … sometimes it’s just about what matters most at a particular moment.

2015 07.04 Blog pic

Caring Choices is available to provide education to your group as well as personal consulting to individuals/families. Conversations are important in determining your decision-making criteria.  The presentations we offer can help you figure that out and help your loved ones have the knowledge and courage to make decisions when they most need it.

Contact us to schedule a presentation to your community group or organization.  570-428-2021

© 2015 Caring Choices