Dignity

• Reassess patient's wishes.
• Reassess how patient's needs are being met.
• Reassess the condition of the patient.
• Reassess the resources available.
• Modify plans willingly as needed to meet patient's wishes and changing circumstances!
• The ROYL Family Conference.

Curative intent

• Is a cure possible?
• Is long term survival possible?

Comfort Care and Hospice-Medicare Hospice Benefit

This is available, discuss with Social Service workers and Hospice team.

• Symptom relief
• Alternative treatments- discuss with primary doctor
• Holistic Medicine
• Yoga, massage, visualization

Research treatments- require university or research institute participation. Information may be available from your primary doctor or primary specialist.

Patient's wishes

• Most patients would like to die at home.
• Few patients actually die at home today.

Family or loved ones resources

• Dying at home can be a huge burden on the family.
• This burden can be managed with caregivers, home health, home hospice and social service support.

Cultural variables include differences between races, religions, and ethnicities, in addition to individual differences between patients.

This decision isn't written in stone. May change with the situation and resources available.

• Introduction to Palliative and Hospice Care
• Inpatient Hospice Care
• American Academy of Hospice and Palliative Medicine Web Site

Places to die

• Home with Home Hospice
• Assisted living center
• Nursing home
• Inpatient Hospice
• Blended Plans: Hospice with some disease treatment

Even if a patient can't die at home, it is possible to make another place more like home:

• Bring in objects from home.
• Bring in photos from home.
• Bring in favorite foods from home.

Show compassion, kindness, gentleness and honesty.

Make eye contact and physical contact, BE THERE, listen, support, trust, and provide adequate time and multiple visits.

Value the patient with meaningful and continuous relationships until the end.

Even unresponsive patients may be able to hear, so feel free to speak to them.

Even unresponsive patients may be able to feel, so feel free to touch them.

Have care givers at the scene to facilitate your conversations.

Discuss the meaning of illness, if patient believes in one.

Treat depression.

Support groups for patient, family and loved ones.

Ease loneliness

Patient fears in facing the end of life:

• Fear of death
• Fear of the unknown
• Fear of being alone
• Fear of being a vegetable
• Fear of pain and other symptoms
• Fear of loss of control

HOPE - There is always hope. Physically living forever is a false hope, but every patient can hope for many things.

There is Hope:

• For freedom from pain and suffering
• For freedom from being alone
• For compassion, kindness, and gentleness
• That ROYL planning has unburdened family and loved ones from difficult decisions

Religious and Spiritual based Hope