1. Caring for Aging Parents “Children, obey your parents in the Lord: for this is right. Honor your father and mother; which is the first commandment with promise; that it may be well with you, and that you may live long on the earth.” (Ephesians 6:1-3) Week 12 | End of Life Questions| May 24, 2015

2. End of Life Questions May 24, 2015  Living will  Who will make decisions and how will they be made  Hospice (why hospice care, when is it time, and what services are provided)  How does our Christian faith inform end-of-life decisions  Ethics of end-of-life decisions (honoring parent’s wishes, removing life support, euthanasia)  Support groups 2015-05-24 Caring for Aging Parents 2

3. Our Faith Job answered God: “I’m convinced: You can do anything and everything. Nothing and no one can upset your plans. You asked, ‘Who is this muddying the water, ignorantly confusing the issue, second-guessing my purposes?’ I admit it. I was the one. I babbled on about things far beyond me, made small talk about wonders way over my head. You told me, ‘Listen, and let me do the talking. Let me ask the questions. You give the answers.’ I admit I once lived by rumors of you; now I have it all firsthand—from my own eyes and ears! I’m sorry—forgive me. I’ll never do that again, I promise! I’ll never again live on crusts of hearsay, crumbs of rumor.” (Job 42:1-6, The Message) 2015-05-24 Caring for Aging Parents 3

4. Our Prayer today  Pray for wisdom. 2015-05-24 Caring for Aging Parents 4

5. Comments from our panelists… 2015-05-24 Caring for Aging Parents 5

6. Melinda Henderson Melinda Henderson, MD, is a National Medical Director for United Healthcare in their Medicaid- Medicare division. She is a graduate of the University of Tennessee and attended medical school at Emory University. Dr. Henderson completed her Geriatrics Fellowship at Vanderbilt University and practiced as a hospice physician for five years with Alive Hospice. She is board certified in Internal Medicine, Geriatrics and Hospice and Palliative Medicine. Melinda is an avid runner and lives in Williamson County with her 3 kids and husband. 2015-05-24 Caring for Aging Parents 6

7. Melinda Henderson Quote from Dame Cicely Saunders, the founder of Hospice Care: “You matter because you are you, and you matter to the end of your life. We will do all we can not only to help you die peacefully, but also to live until you die.” 2015-05-24 Caring for Aging Parents 7

8. Health Care Agent Define Quality of Life 2015-05-24 Caring for Aging Parents 8

9. End of life wishes 2015-05-24 Caring for Aging Parents 9

10. POST form Completed by/with your health care team; signed by a physician 2015-05-24 Caring for Aging Parents 10

11. Hospice Eligibility Criteria  Age: No restrictions  Patient must choose hospice care - informed consent  No limit to diagnosis.  Most common: Cancer, end stage lung or heart, Dementia  Two physicians must sign certification of patient’s medical prognosis stating life expectancy of 6 months or less. (one is the PCP or referring physician the other is the Hospice medical director) 2015-05-24 Caring for Aging Parents 11

12. Hospice Levels of Care  Routine home care  A members home or home of a family member  General Inpatient care  Short term by hospital, SNF, or hospital facility  For pain and symptom management  Support active dying phase  Management of complicated psychosocial issues  Continuous home care  To maintain the member at home  Intensive nursing care to achieve palliation/ manage acute symptoms  Does not have to be continuous, 4 hour periods, 51% must be provided by nurses, remainder by aides  Hour-by-hour documentation of services/ patient monitoring  Inpatient respite care  5 or fewer days to hospice facility or SNF  Total numbers of respite days are not limited to specific number 2015-05-24 Caring for Aging Parents 12

13. Hospice Provides:  Skilled nursing services  “Hospice aide” 2-5 x week of hand-on bathing/grooming assistance  DME related to the terminal illness  Medications related to the terminal illness  Chaplain, Social Worker and Volunteer  Decreased hospitalizations/ER visits; 24/7 nurse phone support and on call visits  Bereavement services for the family 2015-05-24 Caring for Aging Parents 13

14. Andy Baker 2015-05-24 Caring for Aging Parents 14

15. Hospice A Special Kind Of Caring 2015-05-24 Caring for Aging Parents 15

16. When You Are Facing End Of Life Issues  Most people want to be at home  Most people want to be with family  Most people want to act on their terms  You do not want to be in pain or alone 2015-05-24 Caring for Aging Parents 16

17. Hospice Is A Special Kind Of Caring  When the disease has won  When you must deal with pain, symptom relief and questions  When you need supplies, equipment and professional people to care 2015-05-24 Caring for Aging Parents 17

18. Hospice  Hospice is called in by your attending physician when you have an illness that should end your life within 6 months.  The goal now is symptom control. 2015-05-24 Caring for Aging Parents 18

19. What Does Hospice Do?  Hospice does not move in with you but they are on call for you 24/7 when changes/issues warrant.  It is a team approach: a nurse, a social worker, a chaplain, a home health aid, and a volunteer. 2015-05-24 Caring for Aging Parents 19

20. The Hospice Staff  Are experts with pain control  Are experts with the signs of approaching death  Answers your questions, gives you direction and assures you that you will not die alone 2015-05-24 Caring for Aging Parents 20

21. When Hospice Is Called In:  Do you now have a death sentence? No  Can you get out of hospice care? Yes  Is it covered by Medicare, Medicaid and health insurance? Yes  Does it offer nursing home care? Yes 2015-05-24 Caring for Aging Parents 21

22. What If:  I do not want my loved one to die at home or I just need a break? Inpatient care is offered by most hospices.  I am a baby, young child or a very old person? Hospice is available  I want to try some aggressive treatments to live? That is your call 2015-05-24 Caring for Aging Parents 22

23. What Happens With Hospice At The Time Of Death And After Death Has Occurred  They are there with you at death  They take care of death issues  They offer you bereavement support if you need or choose to have it 2015-05-24 Caring for Aging Parents 23

24. Hospices In Our Area Alive Hospice Willowbrook Hospice Caris Healthcare Odyssey Hospice Guardian Hospice Of Nashville 2015-05-24 Caring for Aging Parents 24

25. Resources Available 2015-05-24 Caring for Aging Parents 25

26. Everything in One Place 2015-05-24 Caring for Aging Parents 26 http://berryschapel.org/ministries/caring-for-aging-parents