Preparing for the end


Few people enjoy owning up to their mortality, but medical, legal and financial advisers agree that one of the biggest mistakes older adults make is failing to arrange properly for the inevitable.

Lack of preparation that results from denial of death comes at a cost to those left behind. That includes sometimes-stressful health care decisions on behalf of someone who’s incapacitated, as well as complications in handling the assets of someone who’s died.

Honest and open family discussion about late-life issues, difficult as it may be, is usually recommended at the time parents approach increased risk for serious health incidents that could impair their own decision-making ability. An older person’s loved ones should all understand what kind of life-sustaining treatment he or she would want in such instances. That communication can reduce expensive, invasive hospital procedures that may not be desired by someone who’s terminally ill and wants to spend remaining days as comfortably as possible. Nancy Zionts, chairwoman of the regional Coalition for Quality at the End of Life, explained that advocacy group’s thinking on the subject in an Aging Edge Expert Q-and-A.

Some people are unwilling to make any preparations in advance; others take them to the max, planning and paying for their funeral and cemetery arrangements to ease the burden on survivors.

While any degree of advance planning is a personal decision, the federal government recognized its value by beginning this year to pay routinely for end-of-life planning discussions between Medicare patients and medical professionals

Older adults can have greater confidence that their wishes will be followed by putting them into writing and communicating about them with a family physician or other health care provider, in addition to their own loved ones.

Documents including the following are recommended by medical and legal professionals:

Health Care Power of Attorney: Separate from anyone handling financial issues, a relative or other individual is designated to make medical-related decisions on behalf of a patient in the event the latter loses decision-making ability.

Living Will: An individual outlines his or her attitude about receiving certain life-saving treatments, such as feeding tubes or CPR, in the event of a terminal condition from which recovery is unlikely.

POLST: Filled out with their medical professionals by individuals who already have serious illnesses and thus may wind up shuttled between hospitals and nursing homes, this guides paramedics, emergency room physicians and other health care providers about life-prolonging care in a more compelling way than a living will may be able to do.

Such documents about health care decisions don’t require a lawyer’s participation. People leaving estates to heirs, however, will want to meet with a professional such as an elder law attorney or financial planner for guidance on distribution of their assets.

When it comes to late-life medical treatment, many people are confused about the terms hospice and palliative care, both of which may be very helpful to patients.

Hospice care is available as a Medicare benefit in different settings for those whom a doctor has judged may have just six months of life (or less) remaining. As an alternative to continuing hospital medical procedures aimed at curing disease, hospice care is most often provided in the patient’s home by visiting nurses and aides, with a focus on pain relief, comfort care and counseling of the individual’s relatives

During later stages close to death, a patient may also opt to ease burdens on family members by moving short-term into one of various residential hospice facilities in the region. These are typically designed as quieter, more restful settings than nursing homes or hospitals, with a staff especially trained and equipped to care for the dying.

Palliative treatment is a medical specialty in which doctors and other professionals focus on patients’ pain relief and comfort at the same time they may also continue other curative treatment. It can be offered in various settings, including for patients in hospital beds who are suffering pain from cancer or other disease. Patients and their families have the right to tell doctors they would like to be seen by a palliative specialist if one is not offered, as described in this profile of UPMC palliative care physician Robert Arnold.

Once a family member is gone, an emotional experience of grieving often ensues, accompanied by an entirely different set of issues for which many people are unprepared. The Post-Gazette’s recent series, “Journeys Out of Darkness,” offers a collection of stories to help understand the difficult issues involved. 


Information and documents from Allegheny County Bar Association and Allegheny County Medical Society on end-of-life advance care planning:

The Closure initiative of the Jewish Healthcare Foundation seeks to educate both consumers and professionals about the various issues important to consider related to terminal illnesses:

The National Hospice and Palliative Care Organization provides a range of information related to treatment options for those receiving late-life care:


Expert Q&A