1. Emotional Side of End-of-Life Care Decisions
How to decide for yourself and
how to support others in their decisions
Presented by Carri Ratazzi, MSW
Program Director and Aging Life Care Manager
January 2017

2. Purpose of this section
Understand how to think and talk about your own end-of- life wishes
Understand how to select a Medical Durable Power of Attorney (MDPOA) AND how to decide if you can be an agent for someone else
Understand how to talk with loved ones about your values and how to get them to talk about theirs

3. Deciding on End-of-Life Wishes
ID what you want for yourself – think of your medical conditions and prognosis, age/stage of life, personal values
Understand and educate yourself about options
Some commonly used life-sustaining treatment includes:
Cardiopulmonary resuscitation, Intubation and mechanical ventilation, Artificial nutrition and hydration, Antibiotics, Dialysis
What type of treatments you would/would not want should you be diagnosed with life-limiting illness.
When making decisions about life support, it is important to consider the following questions:
Will the treatment make a difference?
Do the burdens of treatment outweigh the benefits? 
Is there hope for recovery? If so, what will life be like afterward?
What do I value?

4. Choosing or deciding to be a Medical Durable Power of Attorney (agent)
Your agent does not have to be your spouse or someone closely related to you - the key is to trust them.
In Colorado you can choose anyone over the age of 21 to be your health care agent.
It is a good idea to choose or request an alternate agent.
If selecting someone to be your agent, talk to them before you appoint them. Make sure they understand your wishes and agree to serve. If selected to serve as someone’s agent, make sure you know their wishes and can serve them.
Select someone who:
is willing and available (preferably not, for instance, living in another state)
knows your values and life goals and your preferences for life-sustaining treatment
will honor and follow your wishes
is able to make difficult choices, usually under stress
has the time and commitment to serve as your agent for however long is necessary

5. Completing your Advance Directives:
Once you are ready to complete your Advance Directives, get them done!
Share with your agent and medical professionals (don’t just store in a drawer at home)
Resources
Schedule a meeting with an expert:
Older Adult and Caregiver Services, Lutheran Family Services – Larimer County & Denver Metro area
Northern Colorado Health District
SOCI – Greeley
Do it on your own:
Forms available on Colorado Advance Directives Consortium

6. Getting others to talk about their end-of-life wishes and values
Get your own house in order – complete your own documents
Get comfortable talking about your own values and decisions
talk with family and friends about what your plans are
Ask what others are doing to prepare
Be open to conversations when they naturally occur
often these conversation happen at inopportune moments – driving with mom in the car, in waiting room with dad, on the phone just before you hang up
If you can’t have the conversation then and there, set a time to revisit (“dad, we’re about to go into this appointment, can we talk about this afterwards? I’ll take you for coffee.”) And then follow through.

7. Be aware of your own feelings about the subject
Open listening – listen hard and repeat back for clarity and understanding.
Be aware of your own feelings about the subject
if you are anxious, they will feel it – name it and move forward: “mom, this is hard for me to talk about but I want to keep talking.” Most likely they are feeling it too.
Just keep talking even if it is awkward and hard
this type of conversation is not completed in one day, it happens during many large and small conversations over time.
When person is ready to document their wishes, support them in getting documents completed.

8. You are not alone! When all else fails, use experts to guide you
Older Adult and Caregiver Services
Aging Life Care Managers skilled at navigating difficult conversations with family members
Conversation Project
Starter kits and groups designed to support families in talking about these issues

9. Older Adult and Caregiver Services
Thank you!
Carri Ratazzi, MSW
Older Adult and Caregiver Services
Lutheran Family Services Rocky Mountains
Providing quality and affordable Geriatric Care Management and Mental Health Counseling to older adults and families living in Central and Northern Colorado