The Last Chapter - End of Life Decisions

the following is a news and public affairs presentation of West Virginia public broadcasting support for this program is provided by the ECA Foundation learn more about the Foundation's work at Energy Corporation of America com [Music] you [Music] life is an exquisite gift but it's not permanent you got to think about what you want for yourself and what you don't want for yourself [Music] it doesn't mean because she completed advanced directives that you're going to die tomorrow but it's for the future it's for you know you complete it while you're able to make those decisions for yourself for someone to go to the intensive care unit you want to breathing machine and fight for every last moment and others clearly say I want to die at home and I want to be comfortable and the last thing I want to do is be in the hospital at the end of life there's often a time when all of these advances in medicine are no longer our friend they become the enemy when they make a person's life more difficult [Music] you're on your last chapter and majority of people when you ask them they know how they want that last bit of their life to be [Music] [Music] so Amy tell us a little bit about your client today she has lung cancer she is a very independent still I usually just go to have general conversation with her and do her hair she likes her hair done so I wash her hair and curl it and that's about the extent of the care that she gets right now she's still pretty able to do for herself but in just a few weeks that will change on a cloudy autumn afternoon Amy shumake of the hospice of southern West Virginia is on her way to visit 73 year-old Joyce Chesebrough Joyce and her husband Bill have shared their home in Raleigh County for half a century I believe they've been married for 50 or 60 years it's been a long time and I'm sure it'll be hard when you're with someone for that long for them to eventually not be there anymore it is very emotional it is emotional for us although we try our best not that it always happens because there are some patients that we get very close to not to show emotion in the home because you know how can you be there for them if you're discombobulated yourself there's many many many times a lot of us will leave the home you go up the road pull off on the side of the road and just cry and cry and cry and cry but we do the best that we can do to possibly help any way we can we just deal with situations as they make home hello how are you today sir very good thank you where is your beautiful wife at hi darlin how are you doing Joyce cheese brew has decided she will die at home she's completed a medical power of attorney a living will and a do not resuscitate card 120 over 56 yes ma'am hospice workers will visit weekly daily and eventually remain here around the clock to the end with Joyce and her family comes in and does your hair they take pretty good care can you tell me Joyce what it it means to you to be able to stay in your home versus care in an outside facility it's more than you can dream you know cuz people don't want my bill away from home you know they want to be in their home and it's too good to be true almost and so you you find peace staying here and and you're at peace because you're able to stay around and that hospice is taking care of them just hospice take care of the the other members of your family - your husband your children is see my son wanted me to come live us to come live with them but we don't want to leave her home you know but we didn't know what else to do really and then somebody said something about hospice I didn't know I thought it's something he paid for you know we didn't have a lot of money to pay for anything you know so I found out about it and it's amazing yes so God's looking out for me and how do you like to to spend your days now I just I just do little things little cleaner I can't do big cleaner but I just do little cleaning alone I used to quill that I can't do that anymore and you had family coming in to visit you yeah who's coming in my daughter and her husband tonight what Amy's pretty good at the curling iron she's the only practice I get now you tell me I just 30-pin you Amy having conversation with you and spending time with use my tip helps me I think another good thing with Hospice is not only do they want to stay in their home that they yes it may be the end but they're still alive they still in live life and when they're in their home they can do that they can do what they want to do every day is a blessing yeah when your health isn't that good it becomes very costly and one good thing with Hospice is they pay for your medications that are but you know attributed to your diagnosis so you don't you're not looking at spending four or five hundred dollars a month or medication you don't have to pay him to to come into your home and spend time with you you don't have to worry about am I gonna pay this bill how am I gonna pay you know that bill you need the nurses they uptown you know just tell them 24 hours a day were on the call which ICU you have children grandchildren and great-grandchildren that's a lot to be grateful for it certainly is 54 years what else didn't you want we've had our ups and downs Amy honey no matter of fact most of them in good you can go in peace when you you know if we need to get that much [Music] there's perhaps not a more difficult subject to talk about with a loved one than death yours or theirs but health care providers and families who have found themselves in the middle of medical crises will tell you not knowing what medical treatment your loved one wants and doesn't want at the end of life or not sharing your own wishes can have heartbreaking physically painful and yes costly consequences the good news is West Virginia ranks highest in the nation with 50% of its citizens having completed advanced directives those include a living will a medical power of attorney a do not resuscitate order among other directives available but of course the other side of that statistic is half of West Virginia citizens have not documented their end-of-life wishes with all that you know professionally why haven't you made out your advanced directives that's a good question you know there's no answer for that it's just one of those things that people put off until the last moment and the last moment comes and it's too late to do it do you have a certain peace of mind now that you have made your wishes known yes well when it comes time to go I don't want you know being hooked up to me I don't want to when the doctor says that's it it's in my medical power of attorney my son and my husband both know what I want and they say they will follow my instructions and we often don't think about that in in middle age to make out those decisions we didn't think about it until I lost my mother and father fairly young I was only 33 when my mother passed away and she got cancer and very quickly went to where she didn't know what was going on and we had to have her admitted to a hospice care unit in the hospital and they had to ask us how you know what what her wishes were and we hadn't discussed that with her ever and my dad and my brother both looked at me like I was supposed to and it was a really hard decision to make but I tried to go with what you know what I thought her beliefs were and the way she felt and but without having that written down it's it's you never know if you've made the right choice the discussions themselves are hard to begin dr. Heidi Wareheim is a hospitalist a generalist at Thomas Memorial Hospital in South Charleston do you think that you know on a whole physicians health care providers might might shy away from that uncomfortable conversation yeah who wants to say I can't help you a lot of people are just uncomfortable death in general and to bring up the subject of death related decisions and end-of-life and I always say the last chapter of your book it's you know are we on the first page of last chapter middle page the end it's it's all debatable but it's very uncomfortable and we're not taught that in medical training you're not.you are taught to just push forward to the end and not accept something that's just a truly a natural process you know we're taught how to rejoice at birth but we're not how taught how to make the end of life movie not rejoice for a moment but a peaceful and happy and dignified moment where I'm says that's when she relies on the trust that has developed between her and her patient particularly as a provider another patient well enough that I can say you know I love seeing you I love taking care of you but this isn't the best for you that you are at the end of this disease that we can't cure and present the other options of like long-term hospice care in the home in a nursing home things like that that's an ideal situation when we can there's a relationship with the patient in the family and we can look at where we're at with the disease and make plans from there so they don't have to spend their time in the hospital and getting poked and multiple tests and everybody has a chance to come to grips with it dr. Bruce foster is a family practice physician and chair of ethics and investigational studies at Thomas Memorial where ethics comes into end-of-life care is it's all communication you learn to talk you learn to speak English you kind of jump ahead of what you think they what they need to do you know my dying people and typically wives outlive husbands they know that this process is going to happen they know that there may be this bloody mess they've made that well you know that this is what we kind of expect because you prepared them yeah and and frequently and when they come in and they come to their cancers they're come back from their ecologist I don't say well how was your oncologist I said how was your visit to your cancer doctor okay the the cancer on your x-ray it is not really getting smaller I don't pussyfoot around I used the nasty words okay and the the wives frequent comeuppance it that made me uncomfortable at the time but I'm glad I knew foster agrees there's an important component of medical training still missing when it comes to end-of-life care doctors know medicine they know the science but they don't have to speak English what's mom's test all of the ejection fractions 14% to the doctor that's a fatal number you have to say you your heart's not squishing very well and your mom is dying many doctors don't know how to tell bad news they'll kind of hem and haw you'll see reports all the time patient deteriorating prognosis poor none of the guys dying and by not telling people that they're dying you rob them of a stage of their life that could be exquisite well had met you yes you explain things can I say down the earth uh-huh we don't have to be able to have a dictionary beside us you know I'm saying I'm glad because my daughter went to school and she'd say mom helped me with all the vocabulary of course you know that speaking you know the words of the physician yes but you broke it down you gave us a time my family to voice how they felt what they expected and you clarified and you demonstrated in your kindness that we knew I don't want to use it in the wrong way that to face in other words you was you laid it down honestly and openly she expressed much and she that my children voice how they felt and then they gave me understanding about the CPR yes and it took around after they expressed mom this how we feel this is what we can expect and I got calm and I said okay Lord and I let them take it off that you will letting go peacefully it's the best way good all right well I'm glad that the conversation was helpful that Oh teaching healthcare providers how to talk to patients and Families about death end-of-life medical options and the importance of advanced directives is an ongoing effort at the West Virginia Center for end-of-life care in Morgantown dr. Alvin Moss is an internist a nephrologist and the center's project director do you want to go to the hospital at the end of life or do you want to try and be kept comfortable at home would you want to be put on a breathing machine in the intensive care unit or would you prefer less aggressive medical treatment do you want intravenous fluids do you want antibiotics do you want a feeding tube what is it you want what is it you don't want now of course for patients to be able to answer those questions and for families to be able to answer those questions they need to understand well what are the options and what are the well a feeding tube help or not help you know will will a breathing machine help or not helping so there's our challenge to educate not only doctors but the public Moss says these are the questions that need to be considered and answered in advanced directives by all adults the Center for end-of-life care distributes 50,000 of these forms a year as well as providing information through its phone line and website we in West Virginia have a living will form and we have a medical power of attorney forum and we have a combined form which includes both and the form that's completed the most in our state is the combined form and and once somebody's 18 years old they can do a combined advanced directive that basically says I want this person to be my decision-maker if I'm too sick to make decisions for myself and if that person is unavailable for some reason I want this person to be my successor or my backup representative to make decisions for me and then the living will says if I'm terminally ill or if I'm permanently unconscious these are the treatments I would want are the treatments I wouldn't want and so what we find is most people I was talking to you earlier and we were saying three-quarters of West Virginians say really at the end of life I don't want to die on machines I want to be kept comfortable you know and preferably die at home and so somebody who has those values would want to do a combined living will and medical of attorney these directives are also available in hospitals and physicians offices they do need to be notarized but attorney services are not needed and they can be changed or updated as often as the individual wants when directives have not been documented and wishes are unknown a medical emergency can tear a family apart something traumatic happens or a catastrophic illness end up in the intensive care unit on a ventilator can't speak for themselves multiple family members and it doesn't matter if this person is 20 a year if this person is 90 it's the same thing and we don't know who makes the decisions you know they haven't talked about which of the siblings is going to make the decisions they have no idea what mom or dad or grandma would want and then a lot of times you'll see internal disagreements within families what do you do and that's you maybe eight I can't my job is to mediate to give information of where that person is physically and then mediate decisions let's sit with them and let them talk and it's not easy and that's not the time to be making the decisions this is something that should have been made sitting at the dinner table with your family members when life is good and happy and you don't have the fear of the loss of someone whenever I see a new patient I bring up advanced directives at the very first visit so it's just it's it's a continuing conversation now that we've actually finished your exam ok I understand you were really sick and Louisiana mo Stephanie I was getting a respirator for about 37 days in a coma in ICU on a respirator yeah well once you really understand is that I don't want you doing what I tell you okay I wanted to make sense to you okay you I'm not the one in charge you have the right to say yes you have the right to say no you have the right to say I want to do it and I don't want to do okay sure how can we empower the patient and family to get the information it is not that difficult it's really actually very easy all you have to do is have five questions answered and in words that you understand not medical jargon what's wrong with me what are you offering me what are the risks and benefits what are the alternatives and what if I do nothing if I know those five things I can make a good decision that's essentially the elements of informed consent problem that we've got is there might be a time when you can't tell people do you have a medical power of attorney at the present time I do but I didn't you didn't didn't back then back to Louisiana yeah I should have but I didn't have it the medical power of attorney form is the most important thing that you need okay so you have somebody that you trust just speak your voice if you if you didn't wake up and you had to go through all that again yes but I really recommend the sons and daughters wives relatives is whatever question you feel uncomfortable asking that's the one you probably what I asked okay oh I don't want to get mom upset mom's dying she is already upset she needs to have someone to talk to okay oh but I don't want to get my children upset know that the truth is what people need yeah so talk early talk often talk frequently if I was king of the world what I'd have happened they say you're at a family reunion and anyway hey Tom are you still going down to Myrtle Beach of that condo in September hey grandma you still don't want that respirator if you can't be fixed just put it out there and make it part of the conference it was help to miss the fire okay end of life things are scary we don't know what it is all about and that's okay that's okay I don't know if you know what your wishes are this time if you don't the main thing is that we have the medical power of attorney and the person that you named would be able to make that decision then we can right refer to medical power of attorney and they can make that decision for you but I would suggest that you talk to them and let them know what your wishes are Brenda Yuen is patient advocate at Thomas Memorial Hospital and routinely discusses advanced directives with patients you know nobody's gonna be mad at you if you you know refuse treatment or you accept treatment and you know it's your body you know you take charge of it or if you're the medical power of attorney that's why you were appointed medical power of attorney to represent you're the person who that has appointed you the hot-pink form that yung reviews with a patient is the physicians order for the scope of treatment known as the post form an innovation among advanced directives we're in the you know top three states in terms of having developed this form and it's clearly working very well if the doctor says to him or herself I wouldn't be surprised if this patient died in the next year then a post form should be completed because that then is the doctor sitting down with the patient or if the patient can't make decisions with the family and saying are we doing CPR or not and the doctor should inform them about the likelihood of benefit of CPR are we doing breathing machines in the intensive care unit or are we gonna do something that's not quite so traumatic or we're just gonna admit them to the hospital and do heart monitoring and oxygen and antibiotics keep them comfortable but not you know not put a tube down their throat and put them on a breathing machine and tie them down because they're gonna not like that tube in the throat and try and pull it out so they're in restraints which is typical unfortunately for an intensive care unit setting so the post form is very helpful for patients who are clearly nor the doctors think in the last year flight mas says the do not resuscitate card is still in use but it's not as comprehensive as the new post form in fact twice as many post forms are now being filled out compared to the DNR cards the last tool physicians comes from the West Virginia health care decisions Act of 2002 it allows the doctor to appoint a family member as a health care surrogate if the patient has no medical power of attorney and did not complete other advance directives when it comes to making those end-of-life decisions medical providers save society often has unrealistic expectations of heroic measures like CPR breathing machines and feeding tubes we love medical shows I mean just this nation we think they are great and they were so super interesting and they're often sold far from the truth I wish dr. house was at every hospital and I wish that ER situations went as well as they did when ER was on but I think we do get a false sense that if my doctor does the CPR and does the chest compressions and give me all this medicine it puts a tube down my throat I come out of it and I'm gonna be a hundred percent normal and everything's gonna be okay and that's not the case we probably have more research on CPR and when it works and when it doesn't work than probably any other health care procedure treatment we know for example when somebody's having a heart attack they're having their first heart attack and they'd previously been healthy that that person has a 50-50 chance of benefiting from CPR and leaving the hospital and doing pretty well or if somebody has a drug overdose they've overdosed on a drug and they're in the emergency department they stopped breathing they have a 25 to 50 percent chance of being fully recovered and you know receiving further treatment but CPR is likely to work in that situation or if somebody has their heart stops in the operating room again 70 80 percent chance that they're going to do well with the CPR and that they're going to be able to carry on with their life on the other hand if you take all people who have their heart stops in the hospital and they receive CPR only one in six survived to leave the hospital the majority of people who arrest have an underlying or multiple underlying issues that because of the lack of oxygen because of a lack of blood flow because of the breaking of the bones you know it just compounds an issue a lot of the time and you know the general public were not exposed to what happens during a resist or effort and it's a very difficult thing for a person's body to go through and especially when you are an elderly and frail and you don't have a lot of muscle mass you have thin bones you already don't have a lot of blood flow to your brain you know the sequelae or what comes afterwards is just sometimes worse than what we started with if there's nothing in writing that says don't do the heroic things such as CPR life support and if say a mother has a terminal illness such as pancreatic cancer maybe it's spread to the liver a feeding tube it's not going to change the outcome a life support it's not going to change that outcome or if it's lung cancer and there is no further treatment you place someone on life support does it change the fact that they have the terminal illness you know a lot of times it's the terminal illness that causes them not to be able to breathe or not to be able to eat so you have to look at you know is this what what they would want I mean you know we can offer a lot of things and we can do a lot of things to people but are we really doing it for them we're supposed to be a benefit and do no harm that's part of the Hippocratic oath and when we have this patient who's very sick with widespread cancer who's not responding to chemotherapy who's in the intensive care unit because their disease has gotten worse and worse and nobody's had a discussion about well if it got that bad would you want to be on life support and so we we end up coming in and we can say you know the oncologists have told us they don't have anything else to offer that's going to stop the cancer and the cancer has now caused your lungs to fail your you know or we'll say this is the family and your loved one is in shock on a breathing machine because of the cancer we can be fairly certain that keeping the patient comfortable is the best course of action at that point let him make a decision what he wants to go through okay all right so did you hear that certainly you know how the buck stops here yes so she's gonna let you decide if you want to try more chemotherapy or not when you took it in 2003 it worked well yes but you're not quite as good as you were in 2003 are you not quite as strong you've had what some heart attacks and some heart trouble along the way right and some strokes okay you had said that if he goes to the skilled nursing unit and he was not you know they he wasn't you know doing well with physical therapy and those things if he was declining rather than getting stronger you still thought about taking him home with Hospice at that yeah okay the work at the Center for end-of-life care is based on the medical specialty of palliative care mas says that's appropriate when a cure is no longer likely we're not giving up on the patient at all we're being very aggressive if you will intentional in our treatment it's just that the goal of our treatment has changed from doing as much as we can to cure the patient to doing as much as we can to be sure that the patient is comfortable okay and has has as good a quality of life as we can provide for the patient so palliative care is working with the patient and the family to identify their wishes to treat their pain to treat their symptoms and to try and ensure that the patient has the type of treatment that the patient wants so it's a very positive thing sometimes doctors think oh we won't consult palliative care that's giving up well it's not giving up it's it's getting good communication to try and figure out what would the patient want at this stage in their life with their condition [Music] [Music] dr. Foster's director of palliative care at Thomas Memorial one of about 10 palliative care teams located in hospitals throughout the state his entry into palliative care followed his father's diagnosis of cancer in my medical training I had zero zero amount of what to do with a dying patient I was taught that the death of my patient was my failure so my daddy was kind of a pragmatic type of fellow he's sitting on the side of his bed and he goes okay what's wrong with me I can't tell my dad he's gonna die I don't know how to do this so I said daddy you're about as sick as you ever gonna be and he goes what and the heck does that mean I said you're eating up with pancreas cancer it's gonna kill you he watched his back arch I said I gotta come up with a different approach very simply what I decided to do it was tell him the truth and words he understands put my feelings aside because he's alone with the problem and support him so with palliative care what we're trying to do is improve quality and let the person kind of direct how much quantity and just because you get a palliative care consult doesn't mean that you're stopping everything oftentimes sometimes will determine no no the patient would want to continue or we may put in place a time-limited trial of treatment so we meet keep on going for a while and then if the patient benefits that's great we have cases that we sign off of all the time where we sat down with the family we said let's try it let's give it a period of time but if it's not working then we'll stop and it worked and that's great and we're all happy but then there many cases where we try it and clearly moms getting worse and suffering and everybody can see it and then we say let's let's just make our main goal now keeping our comfortable the goal is to get the patient where they want to be I always say one minute is a lifetime for somebody that's done or an hour you know we take it for granted but if you if it's your last moments of life you know you want to be where you want to be and we honor that it gives you an opportunity to recognize that I'm dying I'm preparing for death the majority of us want to be happy and the majority of people when you ask them they know how they want that last bit of their life to be and that's all part of palliative care and then helping support their wishes so at this point we're sort of trying to figure out where do we go from here what would what would he want okay he wants to go home okay now I think you understand and he understands that at this point we're not gonna get him off the breathing machine he's gonna need to be on in at least a part of the time right that was obvious because last weekend they tried to haven't go all day without the breathing machine and he got got into trouble yeah so you would like to take him home on a breathing machine is that right yeah on a breathing machine and then it's a matter of working with your insurance to see if that can happen right now previously they've not been very receptive to that have a no okay but from what I understand in Heidi maybe you can help us with this you've looked into the possibility of if even maybe Hospice could help him go home on the breathing machine is that right and you understand that Hospice means that somebody on average has about six months to live you know then the prognosis is not good now that doesn't mean you might not get better than that okay 20% of people who go on Hospice come off hospice because they've gotten better okay but what it would do for teresa's that would provide a nurse on call to come into the home to check you somebody you could call if you were concerned about how he's doing plus they provide hospital bed and they provide the supplies and the equipment and you know what I mean so it would make your life much easier yeah we also made the decision that if things got so bad that if despite being on the breathing machine you know your heart were to stop you would want us just to keep you comfortable at that point right right and and we made that decision because we knew if it got that bad CPR wouldn't help shock in his heart I'm gonna already breathing for him right that's that's right okay what questions do you have about where we are right now just the questions is can I handle women home can everything be can he be okay with me sure handling him at home right I thought I don't want to do anything to to hurt him yes so what we're gonna need to do is look and work with your insurance company and work with will try and find a hospice and see what services are available okay that's what we're gonna have to try and do is put a plan in place so it doesn't fall only on your shoulders right okay so Denley is that plan I know you can't talk because you've got that thing you know in your throat but does that sound good to try and get you home yeah okay that's what you want okay good sometimes you know in your journey in life even when you drove to our hospital you took the best possible route you did not walk you did not go through the woods or you know off some roads you probably took the interstate in the best route so sometimes in life it's a destiny it's a journey and it depends on how we get you there you know we can continue to do a lot of things a lot of tests a lot of needle sticks a lot of that if we know the end result we're still going to end at our demise is going to still be the same or the destinies still going to be the same then you know you might not like to go through all these backwards to get there so you know the journey could be a lot smoother the cost of end-of-life care and intensive care units like this one at Ruby Memorial Hospital in Morgantown can be staggering for treatment many health care providers say is often unwarranted painful even inappropriate defensive medicine ordering procedures that may not be strictly necessary but done in fear of medical malpractice suits adds to the skyrocketing health care expenditures providers believe this could be curbed with greater use of advanced directives Medicare alone currently reports paying close to sixty seven billion a year on chronically ill patients in the last 24 months of life something like half of that is spent in the last two months of life we put lots of people on machines and intensive care units at the end of life when if we would have had the conversation that I just described with you three quarters those people most likely wouldn't be there and so we could save millions and millions of dollars like billions probably I like to say it's a win-win type of thing the patient gets the treatment that he or she wants and we don't spend all the money that we can't afford to be spending the baby boomers are coming okay that demographics are against us but yet we need to have the conversations that we can stop using the intensive care unit as a surrogate for providing end-of-life care [Music] I've always read my grandmother told me that theoretically everything that ever wrote by man throw it down somewhere so if you just read and read and read and read everything you can get your hands on theoretically you'll know everything known to man it was an idea I could just never get away from Joe Phillips of Fayetteville chose to come to the Bowers Hospice House in Beckley while battling the final stages of pancreatic cancer I've got an NMR no medication or resuscitation I understand that most of the people that come here already have one it's just something I would advise with me it's a whole quality of life issues if you can't think and and participate then there's there's no real quality of life [Music] it's always a hard decision you'reyou're being faced with something that you're not you're just not geared to think about and that makes it very personal the staff here told me that you were you were eager to talk to us can you tell me a little bit about that this is a really nice place you know I usually wind up saying for what it is because it is a terminal care facility you don't normally come to a place like this expecting to walk out so you know you got to sort of say that it you know for what it is but it is a really nice place and they take good care of you here you've got the birds and everything out here there's geese it fly over all the time and you've got just the peace and solitude you know to get yourself right make sure you chew ready for what you came here for are you at peace really don't think he gets that tool you know it's just like really thrust on you I'm as close as I could come I think I'll work alright so them every day but this just has to be an incredibly hard thing for for you to see your mom go through this well I'm the one that told her her and Dad you know you have bad to be your parents yeah and you never really think you're gonna bury anybody in your family much less your son or daughter so that is that's hard but mom and dad are real close to the church I'm not so much religious myself as I am spiritually it has helped them and like I said they're coping what do you focus on at this time well one of your guys is telling me it's a beautiful day I said yeah anytime you can get up and see the Sun it's a beautiful day and the knurl it has necessarily have to be Sun out too because you know it's here to begin with it makes it a nice day Hospice of southern West Virginia SERPs Raleigh Wyoming Somers and Fayette counties its in-home program serves 500 families a year and now it can care for up to a dozen individuals and their families at Bauer's house its new inpatient facility when we meet with families who have a loved one that needs our care we tell them that we don't do aggressive curative care but we provide very aggressive comfort care we take that very seriously so we will do any medication regimen that is helpful to a patient we administer oxygen we can administer feedings as it is appropriate to do so but from the palliative care and hospice approach we feel we do a lot what fine Angell responsibility just an individual have as they enter the hospice well for the hospice service essentially there is none we accept Medicare and West Virginia Medicaid payments and then we also accept indigent patients we're a nonprofit hospice so we take into account that there will be people who have no means to pay and we still provide care for them as well so related to their end-of-life care there will be no cost what about emotional psychological care right well it can be very stressful for a person to come to terms with facing the end of their life and so we provide some emotional support we have a staff of social workers who can meet with patients and families and basically what we do is just help them speak to each other help them talk about things that maybe are a little difficult to talk about if they if they choose to go that route we have pastoral care as well because at the end of life a lot of people review and they look at spiritual matters and so we make sure that they have access to a pastor we have several pastors in the community who volunteer to go out into the homes and to come here to this facility to meet with people so we're providing an emotional spiritual support we're helping caregivers vent some of their concerns and fears and facing losing a loved one and then we'll also provide bereavement support for 13 months after a patient passes away we'll follow their family for 13 months with bereavement support through phone calls some literature that we mail to them regarding grief and what they may be experiencing so once someone passes away we don't forget about those people that cared about them the most my father was born in Rolla Cali my mom was born in Mingo County but they met in college and were married and both for schoolteachers for I think dad 38 years and mom 37 years Bob you've told me that it wasn't too long ago that you lost your father yeah so returning here has to be with your mother really very bittersweet I would think bittersweet is a very good way of putting it yeah because the first time we weren't sure of what to expect but the second time I knew all the people I knew just what the process is going to be and it makes it easier in a sense but it's still still a great loss they make it very clear to us what's gonna happen next and next and next and the direction they've given us and the care is just been absolutely awesome so it kind of takes the burden off the family knowing that you have that much support and people who know what they're doing in making it the best they can make it for your loved one it's comforting to know that their services are available there are things that we couldn't do at home no matter how hard we tried we could not care for the people like they do here the medical power of attorney the living will any of those were those decisions that had been made and and talked about yes all of our families talked about that and and all of us are opted have opted for you know no special measures or no resuscitation and organ donors but that that I think that's a important our critical decision for a family because there would be a great deal of uncertainty if you had to make some certain choices if you had to decide whether to give transfusions or feeding tubes other choices if you didn't have that directive I guess one thing I would like to let people know is you can't take care of these things too soon I mean people can become disabled and in a coma at 24 you know you've got to study this you got to sign the papers let people know what you want and do it soon because then then the burden is taken off the family [Music] now I have one cancer stage for it spread to my level my bones I am terrible and I got a few minutes later might not too long but human side of me man I'm blessed to be here Kevin Brown grew up in Raleigh County and has been back and forth as a resident of Bowers house as his cancer has progressed when he first found out they could get second those took your terminal when you have cancer and stuff looks like a bomb going off to laughing and yeah places are dishing contain my paste my medical pair attorney is to say that my wishes they carry after no feeding tubes you know life supports not to open or anything like that and just to be kept out of pain weapon pace is that a tough decision yes at first and Dana did not resuscitate I definitely don't want cigar custom I want to be like that I don't want to be brought back it's can tear it to battle it's a lot of painful it's painful and I don't want to go brought back to sever more tell us how you want to live the rest of your life I want to be happy I won't spend much time attending my friend win friends I just want to be pain-free and they'd be ready one car comes and I want to be here and I understand there there's still plenty moments of joy yes the staff here tells me that you had a mini party a couple days ago oh yeah yeah the whole wing thing we had mice they probably and my wife you must set up in sick this past week they when I'm Halloween mask scared each other suffocated a couple nurses dressed up we had a great time I - Greg it's just it's not sadness it's left on everything I did her best to make your joy I mean to make you laugh when you come in and everything and it was worth a lot in the middle and it just it's a real joy some other people out there to catch them to reach out like that to help you and it's not all my parents about with him and being having been happy in the last days they're probably surprised to know that it can be wonderful and satisfying experience speaking to you I'm a social worker who's been in health care for close to 15 years probably five years ago would have told you that Hospice was not the place for me but I have really enjoyed this work and it's a beautiful thing and it's a very satisfying experience to be a professional on the outside but also to see families come together we we don't we don't cure people but we see a lot of healing we see a lot of families coming together where there may have been rifts and between relationships where the being faced with the with the dying allows people to to heal those relationships they can come together they can remember things from if it's a brothers and sisters who maybe haven't spoken for years they can get together and talk about their childhood and reflect on their parents and so we see a lot of healing here [Music] three quarters the people who died in this country are over the age of 65 and so with a very old population these types of decisions are even that much more important to do in advance [Music] it's involving the page involving the family involving their friends involving the religious or spiritual issues so you have a whole package that's making the decision and there's some peace to be had when this information is available ahead of time and so I guess the best thing is don't be afraid to bring it up the conversation will flow [Music] [Music] support for this program is provided by the ECA Foundation learn more about the Foundation's work at Energy Corporation of America com the preceding has been a news and public affairs presentation of West Virginia Public Broadcasting

Channel: West Virginia Public Broadcasting

Views: 1,492,316

Rating: 4.6634459 out of 5

Keywords: Advance, Directives, End, of, Life, Care

Id: 8jKUZ8lS9b4

Length: 56min 48sec (3408 seconds)

Published: Tue Dec 28 2010