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Seniors urged to be proactive about end-of-life planning

MIDDLEBURY — These were difficult times for Frank “Sandy” Rose and his family. His longtime spouse, Anne, had been diagnosed with Alzheimer’s two years prior, and it was heartbreaking to see her memory and physical well-being fade.
“She got progressively worse,” recalled Rose, who now lives at the Residence at Otter Creek in Middlebury.
But advance planning by Anne and her family allowed her to pass away this past Sept. 21 on her own terms — at home, surrounded by loved ones. She had signed a Do Not Resuscitate, or DNR, document and taken other measures so that her life would not be prolonged by artificial means.
“When the time came, she was thankful the end was close and we knew she would be at peace,” Rose said.
Rose and some other senior clients of the Residence at Otter Creek shared their views on Nov. 14 as part of a talk on end-of-life planning. The event was sponsored by Addison County Home Health & Hospice and featured palliative care physician Dr. Diana Barnard, formerly of Porter Medical Center and now of the University of Vermont Medical Center.
Barnard told seniors at the gathering that they should not allow medical workers or lawyers to make health care decisions for them should they suffer a debilitating stroke or be in the final throes of a terminal illness. Rather, she urged the seniors to become proactive and plan, with input from their respective families, the extent of medical treatment they would like to receive when they are close to death.
Life-saving machinery and medical techniques have made tremendous advances during the past 20 to 30 years, Barnard noted, to the extent that patients are living longer, albeit not always with great quality of life. These advances, she added, have given many families a false sense of security in terms of postponing end-of-life discussions.
“We got a little distracted; we became drunk with our success,” Barnard said of the medical community. “We have forgotten that despite all these great things, life comes to an end.”
Barnard also noted that confronting a parent’s death forces a middle-aged person to face their own mortality — something that many people of that age are reluctant to do.
“But it’s a problem I think we can overcome,” she said.
That said, Barnard urged seniors to consider the following actions to ensure their end-of-life decisions are carried out:
•  Sign an advanced directive, or living will. This is a document that specifies, among other things, if you would like to be connected with dialysis, breathing machines and/or tube feeding to sustain your life. A living will also specifies whether you would like to donate tissues and/or organs following your death.
“You are never too old to be an organ donor,” Barnard said.
There is an advanced directive registry in which this information is stored in case the patient has a medical episode outside of his or her home state, though Barnard stressed the importance of telling friends and relatives about their wishes for added peace of mind.
•  Complete a Clinician Order for Life-Sustaining Treatment, also known as a COLST. The COLST document can also cover such possible medical interventions as antibiotics, supplemental nutrition and hydration, and transfer to a hospital.
“If you don’t have the COLST with you, they will try to resuscitate,” Barnard warned. For this reason, Barnard suggested the industry create bracelets or some other form of COLST identification that people can have on their person all the time.
Vermont also has a “death with dignity” law that allows terminally ill patients tovoluntarily request and receive a prescription medication to hasten their death, provided they follow a series of specific medical and legal protocols.
And Barnard recommended hospice care for terminally ill patients for whom such care is an option. She noted Medicare will pay toward hospice expenses in the cases of patients who have been diagnosed as having six months or less to live. If the patient lives beyond that timeframe, the patient’s benefits are usually not in jeopardy. Hospice services include visits form health care professionals dispensing care focusing on the patient’s comfort when recuperation isn’t a realistic option.
“It’s about how you are going to live as best as you can until you take your last breath,” Barnard said.
Vermont needs to become more proactive about enrolling patients in hospice for longer periods of time, according to Barnard, who said terminally ill patients are now too-commonly being extended such care only when they are very close to death.
Arnold Abelson, also a resident of the Residence at Otter Creek, noted his late wife Millie received hospice care and survived for an additional two years.
“The care she got was absolutely wonderful,” Abelson, 92, said. “Her actual death was painless. She was in a deep sleep for two weeks before she died. If we could have designed an (end-of-life) experience, it couldn’t have turned out better.”
Reporter John Flowers is at [email protected].

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