End of Life Decisions and Concerns: The Resident's Perspective
Residents in this program are filmed in long-term care facilities. When asked questions about their end of life decisions and concerns, it becomes very clear that these are difficult topics for them. It’s also evident that they have not been educated about their options. A fear expressed by many is that if they request hospice or to have no life-saving interventions, this would mean starvation, pain and isolation. It is also clear that the risks and poor outcomes of gastrostomy tubes and CPR for the frail elderly have not been discussed with them.
When asked if they have had discussions with their family or health professionals about their choices, they give several reasons for not having done so. First, they do not wish to burden family members. Second, they are so consumed with unspoken fears, they prefer not to think about end of life decisions. In their interviews, most residents request their preference for what they call “natural endings,” provided they will have comfort, pain management and support.
Brief commentary is provided by Debra Wertheimer, MD, who urges long term care staff and family members to have these important discussions with residents. She says knowing what options are available and knowing what support can be called in will be extremely helpful to residents. Reducing fear and providing information allows them to make decisions which best reflect their wishes. This will also enable them to make advance directives which are essential for the staff caring for them.
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