Elder care

It’s best to be prepared in every situation, especially when it’s health-related.

According to Rabbi Akiva Feinstein, director of spiritual care at Montefiore in Beachwood, and Dr. Beth McLaughlin, chief medical officer at Hospice of the Western Reserve in Cleveland, creating a plan for advanced and palliative care makes decisions easier.

“Advanced care planning is important because any of us can have a major life change at any time,” McLaughlin stated. “It’s nice to have family and loved ones know what your wishes would be in that situation.”

Feinstein noted during one’s health journey, there are a lot of choices but the medical system is “not always good at pointing out the forks in the road.”

“Most times, patients are pushed towards more treatment and more surgery, and that approach is fine for some,” he said. “But, most people get to the point where they’ve endured a lot of difficult decisions. But with planning, as one learns about the disease and prognosis, it’s important to ask your healthcare provider about what you can do and your choices. 

He added, “The plan isn’t always so much about what you’re going to do, but what you want and how people can help you get that along the way.”

McLaughlin said advanced and palliative care planning has two components – completing legal documents, then communicating your wishes to family members.

“Both are important to do,” she explained. “Advanced care planning is anything you do ahead of time to plan for future health. There are resources online to help guide a conversation with family, like general things to talk about. And then, there are legal documents that are recognized in the state of Ohio like the living will, the health care power of attorney and the DNR form.”

Since an individual can’t expect to make decisions about their health in real time during a crisis, preparation is important. Feinstein said plans begin with appointing a healthcare proxy.

“They can listen to your wishes and make those decisions for you when you can’t anymore,” he said. “The subsequent stuff is working with your doctor on what he or she thinks about what could happen and what their goals are with the treatment.”

Feinstein said the last part of the process is discussing hospice.

“Many people don’t understand what hospice is,” he noted. “They think it’s either much worse than it is or they can’t perceive it as relevant at all. In America, understanding you do have an option and choices helps you make better medical decisions along the way.”

McLaughlin said there is merit in involving the family in the planning process.

“If something happens, the person who is making these decisions and plans isn’t going to usually be able to explain what their wishes are at that time,” she explained. “So, it’s important for the family to know what their wishes are. When that happens, the medical team will turn to the family for decisions.”

Feinstein added if the family can’t be involved, it’s critical to confide in someone.

“Culturally, I find that some families make decisions as collective groups,” he said. “But some people value autonomy. The main thing is finding a person you can go through the process with. Sometimes, it’s having that sounding board when you get information from doctors and make those decisions together.”

Though it’s best to make plans, Feinstein said many families don’t plan for crises. 

“They usually end up in the midst of a serious illness and suddenly wake up one day and realize they can’t do it,” he noted. “The typical family always find out they need to plan when it’s too late. It’s not about making people plan when it’s difficult. It’s about thinking about their values when it matters most.”

But McLaughlin said even starting a plan can reduce a bit of the stress that comes along with medical crises.

“Anytime someone is dying, it is very stressful and sad,” she explained. “There are often lots of medical decisions that have to be made. That is very overwhelming. It’s helpful to have these plans in place. It takes one bit of confusion and stress out of the equation.”

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