End-of-life issues

Advance care directives
Hospice care
More information on end-of-life issues

Most people don't like to think or talk about getting sick or dying. But as you age, it’s important to think about end-of-life issues and to write a statement about how much medical care you would want if you got very sick. That way, if you get sick, your family and doctor will know exactly what you want.

Advance care directives

Advance care directives, also known as advance directives, can help to make your wishes about end-of-life care clear. These are instructions, prepared ahead of time, that direct a person's medical care should she become unable to do so herself. You can also make a directive that appoints someone to make health care decisions for you. Laws about advance care directives vary from state to state.

Advance care directives can include:

Verbal instructions – The patient tells her doctor and family members her wishes. It's good to discuss your wishes with your doctor and family. But in an emergency, your family may be too upset to remember your instructions. Or, they may not get to the hospital in time to make sure your wishes are carried out. Or, your family might not agree with your choices. For these reasons, it’s best to provide written instruction.
Organ donation – A person fills out an organ donation card and keeps it in her wallet. Many states let you choose to become an organ donor when you get your driver's license. It's also a good idea to tell your family that you definitely want to be a donor.
Living will – This is a written, legal document that spells out the wishes of the patient in the event of terminal illness or life-threatening injury. A living will usually includes specific situations and treatments the patient does not want (such as CPR, tube feeding, hydration, etc.).
Special medical power of attorney – This is a legal document in which a person names someone else to make her health care decisions for her should she become unable to communicate.
Do not resuscitate (DNR) order – This document states that CPR is not to be performed if the person stops breathing or the heart stops beating.

Hospice care

With hospice care, a team of caregivers provide medical, emotional, and spiritual support to people who are dying. The goal is quality of life during a person's final days. Doctors and nurses try to control pain and other symptoms so that the patient can remain as alert and comfortable as possible. Social workers, spiritual caregivers, and volunteers provide supportive services to the hospice patient and family. Hospice care can take place:

At home
At a hospice center
In a hospital
In a skilled nursing facility

Generally, hospice care is for people who have six or fewer months to live. Hospice care is a benefit covered by Medicare, Medicaid, and most private insurance plans.

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More information on End-of-life issues

Explore other publications and websites

Advance Directives and Do Not Resuscitate Orders (Copyright © American Academy of Family Physicians) - This fact sheet provides information on advance directives, living wills, durable power of attorney for heath care, and do not resuscitate orders. It also explains how to write and change an advance directive.
http://familydoctor.org/online/famdocen/home/pat-advocacy/endoflife/003.html
Age Page: Getting Your Affairs in Order - This brochure discusses the steps you can take to prepare for the future. In addition, it includes information about important legal documents such as wills and trusts, advanced directives, power of attorney, and living wills.
http://www.niapublications.org/agepages/affairs.asp
Cancer Facts — Hospice - This publication provides information on hospice programs and contact information for national hospice-related organizations.
http://www.cancer.gov/cancertopics/factsheet/support/hospice
Medicare Hospice Benefits - This is the official government publication for Medicare hospice benefits. It includes important information about the hospice program and who is eligible, your Medicare hospice benefits, how to find a hospice program, and where you can get more help.
http://www.medicare.gov/Publications/Pubs/pdf/02154.pdf
Planning for End-of-Life Care Decisions - By deciding what end-of-life care best suits your needs when you are healthy, you can help those close to you make the right choices when the time comes. This article discusses ways in which to make this transition as smooth as possible.
http://www.nia.nih.gov/HealthInformation/Publications/endoflife/08_planning.htm

Connect with other organizations

Administration on Aging, HHS
http://www.aoa.gov
American Association of Retired Persons (AARP)
http://www.aarp.org/
Centers for Medicare and Medicaid Services, HHS
http://www.cms.hhs.gov/default.asp?
National Senior Citizens Law Center
http://www.nsclc.org/

Content last updated August 12, 2010.

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