This document discusses palliative care, hospice care, and end-of-life planning. It defines palliative care as treating people with serious illnesses through managing symptoms and improving quality of life. Hospice care provides medical care, pain management, and emotional/spiritual support for those facing a life-limiting illness. The document encourages having early conversations with loved ones about one's end-of-life wishes through completing advance directives that appoint a healthcare agent and document treatment preferences. It provides tips on involving loved ones, preparing, storing, and sharing advance directives to ensure one's wishes are followed.

1. +
By: Frederika Granger, LCSW-C
&
Sinoreh Daryadell

2. +
DEFINING DEATH
 Many among us now are crazy for meanings, and
crazed by seeking them out. The meanings of life aren’t
inherited. What is inherited is the mandate to make
meanings of life by how we live. The endings of life give
life’s meanings a chance to show. The beginning of the
end of our order, our way, is now in view. This isn’t
punishment, any more than dying is a punishment for
being born. Instead, the world whispers: All we need of
you is that you be human, now. Our work is to sort
out what being human should be in such a time.
Short film, shot & directed by Ian Mackenzie.

3. + Palliative Care?
 Palliative care treats people suffering from serious and chronic
illnesses such as cancer, cardiac disease such as congestive
heart failure (CHF), chronic obstructive pulmonary disease
(COPD), kidney failure, Alzheimer’s, Parkinson’s,
Amyotrophic Lateral Sclerosis (ALS) and many more.
 Palliative care focuses on symptoms such as pain, shortness of
breath, fatigue, constipation, nausea, loss of
appetite, difficulty sleeping and depression. It also helps you
gain the strength to carry on with daily life. It improves your
ability to tolerate medical treatments. And it helps you have
more control over your care by improving your
understanding of your choices for treatment.
 Retrieved from:
 https://getpalliativecare.org/whatis/

4. + Hospice Care?
Considered to be the model for quality,
compassionate care for people facing a life-limiting
illness or injury, hospice care involves a team-
oriented approach to expert medical care, pain
management and emotional and spiritual support
expressly tailored to the patient’s needs and wish’s.
Support is provided to the patient’s loved ones as
well. At the center of hospice and palliative care is
the belief that each of us has the right to die pain-
free and with dignity, and that our families will
receive the necessary support to allow us to do so.

5. + Hospice Care & When to Ask
Now is the best time to learn more about hospice
care and ask questions about what to expect.
Although end-of-life care may be difficult to
discuss, it is best for loved ones and family
members to share their wishes long before it
becomes a concern. This can greatly reduce stress
when the time for hospice becomes apparent. By
having these discussions in advance,
uncomfortable situations can be avoided. Instead,
educated decisions can be made that include the
advice and input of loved ones.

6. + Hospice Care: When to begin
Anyone can inquire about hospice services. You or your loved
one may call a local hospice and request services. The
hospice staff will then contact your physician to determine if a
referral to hospice is appropriate. Another way to inquire about
hospice is to talk with your physician, and he or she can make
a referral to hospice.

7. Hospice can begin as soon as a ‘referral’ is made by
the person’s doctor. The hospice staff will then
contact the person referred to set up an initial meeting
to review the services the hospice will offer and sign
the necessary consent forms for care to begin.
Usually, care is ready to begin within a day or two of a
referral. However, in urgent situations, service may
begin sooner.

8. +
A Group Thought Exercise
1. Describe the last three days of your life as you would like
them to be. Include whatever aspects of the situation seem
to be of greatest importance.
2. What will be your greatest sources of strength and support
during these last days of your life?

9. The Care Planning Act of 2015
Care Planning Act: Hospice
Action Network Video at:
https://www.youtube.com/
watch?v=V51HpkyD8Uc

10. + What are Advance Directives?
 A living will allows you to document your wishes concerning medical
treatments at the end of life.
 Before your living will can guide medical decision-making two physicians
must certify:
I. You are unable to make medical decisions
II. You are in the medical condition specified in the state's living
will law (such as "terminal illness" or "permanent
unconsciousness"),
III. Other requirements also may apply, depending upon the state.

11.  A medical power of attorney (or healthcare proxy) allows you to appoint
a person you trust as your healthcare agent (or surrogate decision
maker), who is authorized to make medical decisions on your behalf.
 Before a medical power of attorney goes into effect a person’s
physician must conclude that they are unable to make their own
medical decisions. In addition:
 If a person regains the ability to make decisions, the agent cannot
continue to act on the person's behalf.
 Many states have additional requirements that apply only to decisions
about life-sustaining medical treatments.
 For example, before your agent can refuse a life-sustaining treatment
on your behalf, a second physician may have to confirm your doctor's
assessment that you are incapable of making treatment decisions.

12. + Your Healthcare Agent/s
 Select a Person (and a Backup) To Be Your Healthcare Agent. This should be someone who:
A. Knows you well
B. Is calm in a crisis
C. Understands how you would make the decision if you were able
D. Is not afraid to ask questions and advocate to doctors
E. Can reassure and communicate with your family
F. A healthcare agent (surrogate or proxy) is someone you designate to make medical
decisions for you if, at some future time, you are unable to make decisions yourself. Your
agent can be a close relative or friend, but should be someone who knows you well and
someone you trust. In most states, your agent can make decisions any time you lose the
ability to make a medical decision, not just decisions about the end of life.

13. + Addressing Your Wishes
Explain what you are asking of them and talk about why
you picked them. Your healthcare agent needs to know
about the quality of life that is important to you and when
and what medical treatments you would want.
Talking to your agent means discussing values and
quality-of-life issues as well as treatments and medical
situations. Because situations could occur that you
might not anticipate, your agent may need to base a
decision on what he or she knows about your values and
your views of what makes life worth living. These are not
simple questions, and your views may change. For this
reason, you need to talk to your agent in depth and over
time.

14. + Preparing Your Advance Directives
 Before you prepare your advance directives:
 Get information on the types of life-sustaining treatments that are
available.
 Decide what types of treatment you would want or would not want.
 Share your end-of-life wishes and preferences with your loved ones.
 Preparing your own advance directives:
 You do not need a lawyer to prepare advance directives.
 Make sure you prepare your advance directive to accurately reflect your
decisions.
 Complete your state-specific advance directives.

15. In most states, you can include special requests in your advance
directives such as wishes about organ donation, cremation or burial.
You also should be sure to make your physician and loved ones aware of
your specific requests so appropriate referrals and arrangements can be
made.
Ask someone else to look over the documents for you to be sure that you
have filled them out correctly.
Read all of the instructions carefully to ensure that you have included all of
the necessary information and that your documents are witnessed properly.
Once you have completed your advance directive you need to talk to
anyone who might be involved in your healthcare decision making. This
includes family members, loved ones and your healthcare providers. You
want them to understand how you feel about medical treatment at the end of
life.

16. + Storing Your Advance Directives
A. They must be portable; they can be available wherever you
are in the world.
B. They must be available in a timely manner.
C. They must be in a safe place, protected from theft, fire, flood
or other natural disasters SUGGESTIONS:
D. Make several photocopies of the completed documents.
E. Keep the original documents in a safe but easily accessible
place, and tell others where you put them; you can note on
the photocopies the location where the originals are kept.

17. +DO NOT KEEP YOUR ADVANCE DIRECTIVES IN A SAFE
DEPOSIT BOX. Other people may need access to them.
Give photocopies to your agent and alternate agent.
Be sure your doctors have copies of your advance directives and
give copies to everyone who might be involved with your
healthcare, such as your family, clergy, or friends. Your local
hospital might also be willing to file your advance directives in
case you are admitted in the future.
There are services available that will store copies of your
documents and can make them available on your behalf. This is a
particularly effective way to store your documents to protect
against theft, fire, flood or other natural disasters as well as for
people who travel.

18. +Poem- Henry Scott Holland

19. +National Hospice & Palliative Care Org.

20. + Hospice Care Team

21. + Health Conditions with Hospice Patients

22. + What Really Matters at the End of Life
BJ MILLER

23. + Quote: Mark Twain

24. + Facts to Keep In Mind
Sharing your wishes for end-of-life care can bring you closer to the people you
love! Consider these facts:
 .90% of people say that talking with their loved ones about end-of-life care
is important.
 82% of people say it’s important to put their wishes in writing.
 80% of people say that if seriously ill, they would want to talk to their doctor
about wishes for medical treatment toward the end of their life.
 60% of people say that making sure their family is not burdened by tough
decisions is extremely important.
 56% have not communicated their end-of-life wishes.
 23% have actually done it.
 7% report having had this conversation with their doctor.

25. +
Have you spoken to your
loved ones regarding your
End-of-Life Care?