Have copies of your medical directives for healthcare providers.

It is important that people give copies of their healthcare advanced directives to their healthcare providers and facilities, so their wishes can be honored. Such documents include DNR (do not resuscitate), DNI (do not intubate) and/or Power of Attorney.

Be sure to check my book, Healthcare Handbook for Senior Citizens and Their Families at: http://www.seniorhealthbook.com for more information about advanced directives.



What should I talk about with someone who is dying ? I am afraid that I may say the wrong thing.

 In my book, Healthcare Handbook for Seniors and Their Families, I encourage Seniors to talk about their wishes when they are dying. I also encourage people to spend time with individuals who are dying. Everyone is so afraid that they will say the wrong thing. I have found that if you let them set the conversation, they will bring up the subject of their death, if they feel the need and sense that you are open to discussing the subject. One of the greatest fears of those who are dying is the fear of being isolated.

Reminiscence is a handy method that can be used. It helps them to review and evaluate their lives. The use of old photo albums can facilitate the process.

More information about my book can be found at my website

Three Resources for someone needing Skilled Nursing Care

First, each state has an ombudsman program for long term care residents.The local ombudsman is a trained advocate for long term care residents in
their area. They can provide information about available long term care options in the area. They will, also, follow up on and try to resolve any complaints
submitted by residents or their representatives.

Second, Nursing Home Compare examines information about skilled nursing facilities in your area. The information is laid out in an easy to understand
manner. The staffing section identifies the various levels of staff and how many hours per resident per day is available at the facility. This data is based on
state inspections of the facilities. You can access this information at http://www.medicare.gov/NHcompare.

Third, each skilled nursing facility should have a resident/family council. Becoming involved in the facility’s council would help you become
aware of special issues concerning the facility and provide an avenue to foster improvements of care, if needed.

In addition to these three resources, don’t forget about your state’s Department of Health Services. They have a lot of useful information available on
their website and valuable contact information.

Deciding When it is Time for Hospice.

The Medicare rules for hospice services require certification from 2 physicians to verify that the individual is expected to live 6 months or less, if the disease runs its natural course. Usually, the 2 physicians would include the individual’s primary care physician. This is the person that you would want to consult with first. The other physician can be the medical director of the hospice agency. 

It is expected that anyone who receives hospice services will no longer receive any life saving treatments, such as chemotherapy. The focus will then become the alleviation of physical, emotional, and social symptoms. Hospice can provide some valuable end-of-life services for patients and families.

The 6 month rule does not mean that if the individuals do not die in 6 months, they can no longer receive hospice. It just means that they need to be recertified by the hospice agency.

If one is not quite ready to make the decision for hospice services, it does not hurt to investigate obtaining palliative care services that focus on alleviation of symptoms experienced with diseases and their treatments. Receiving palliative care does not automatically disqualify one from continued life saving treatment.

My book, Healthcare Handbook For Senior Citizens and Their Families, provides more details about Hospice services and end-of-life care. See my website http://www.seniorhealthbook.com. Also, you can find information about the hospice regulations on the Centers for Medicare and Medicaid Services CMS website (www.cms.gov).


Do Not Forget Home Health Care Can Be An Option.

If you or a loved one is being discharged from a hospital or care facility, be aware that if you run into problems caring for yourself after you get home, home health care is a good option. The doctor or nurse may ask you if you need a home health visit before you are discharged. At that time you may not see the need for a visit, but that does not mean that you can not change your mind after you get home. Also, do not assume that the doctor will automatically refer you, if you qualify. The doctor does not always know if your home situation would call for a home visit. Home Health agencies will make an evaluation visit to see if there is a skilled need and if your health insurance will cover the visits. Frequently, it only takes a few visits to help you adjust your care. My book, Healthcare Handbook for Senior Citizens and Their Families discusses the requirements for reimbursement for home care services.