By Betsy Weiss
This community is fortunate to have the opportunity to participate in a seminar coming up April 19 at the Winthrop Barn to help you develop an advance directive. It is jointly sponsored by The Methow Valley Clinic, Family Health Center of Twisp, Methow At Home, Room One, Aging and Adult Care and Confluence Health. The purpose is to facilitate the discussion and develop the document that will allow your voice to be heard as health care decisions are made if you are too ill to speak for yourself.
Honoring Choices is an initiative across the country promoting advance care planning: the process of discussing and recording what is important to you in life, your values and preferences to inform and guide the person you designate as your health care agent. Writing an advance directive is important. Talking with your health care agent about your choices is equally so. Only 25 percent of people in the country have an advance directive.
In 2011, my 91-year-old mother was well on her way down the path dementia was taking her. A woman who read three newspapers a day most of her life, she now read the obituary page of the local newspaper for hours and remembered none of it. She lived with me and my husband, requiring a full-time caregiver while we worked. While walking to her bed on Thanksgiving weekend she fell, breaking her hip.
My mother had cared for her father who died of dementia. He had forgotten how to walk, which was his greatest love, and he was unable to eat. She was adamant throughout her life that she did not want that end for herself. She was a member of the Hemlock Society, the organization that originally advocated for Death with Dignity legislation although she knew it would not apply to people with dementia. She was very clear that she wanted no interventions to extend her life if she developed dementia.
After the fracture
The reported one-year mortality after sustaining a hip fracture has been estimated to be 14 percent to 58 percent. I knew we could control her pain at home and that if she had surgery for her broken hip, because of her inability to follow directions, she would not be able to participate with physical therapy and likely would not walk again. I told her we were considering not sending her to the hospital and treating her pain at home. She said, “Oh good.” I then told her that might mean she would die at home. She said dismissively, “Oh, that.”
My mother had completed an advance directive that gave me the power to make medical decisions for her that I knew to be consistent with her wishes. She completed this when she was fully competent. She had discussed with me and my brothers on many occasions what was important to her about her care. By keeping my mother at home with the support of hospice for pain control, my mother died gently and gracefully in a familiar space surrounded by people who loved her deeply. She gave us a great gift by telling us what she wanted us to do.
Since moving to the Methow Valley, I have worked with many people through the Lookout Coalition who value their autonomy and independence. Many people have expressed their goal of remaining in their own home until they die. Rarely have they completed an advance directive and often they have not spoken with family about their health care wishes. When a catastrophe happens, without direction, the family and physicians are left with the only choice being aggressive care.
Looking ahead
I was asked by an elderly couple’s daughter to help them address planning in their home in the valley. They were both in their late 80s with some memory loss, she was more impaired than he was. They had no intention of leaving their home or one another. They had just enough money to make them ineligible for many services while too little to afford help at home. Their daughter lived three hours away and came by once a week to help as she could. They were not really able nor did they want to discuss their end of life wishes. They were both quite frail and ultimately she fell, striking her head on the floor.
Aero Methow Rescue Service was called and she was taken to the hospital, where she was found to have a big bleed in her brain. She was transported by air to Harborview Medical Center in Seattle and supported on machines.
Ultimately the family gathered and they were advised that recovery was not expected and she passed away after several days. Her daughter was haunted for months by not knowing if she had done the right things for her mother. She could not have spared her mother from falling, but she might have known what her mother would have wanted her to do after her accident if they had been able to discuss it ahead of time.
On April 19 at the Winthrop Barn from 3 – 5 p.m., you will have the opportunity to learn more about this important process and initiate your own advance directive document. Please come and if possible bring the person who you feel will be best able to honor your wishes and advocate for what you would want in a medical situation when you are unable to speak for yourself. The first hour will cover understanding and communicating your wishes.
The program will end with conversation tables, led by facilitators who will help complete advance directives, let you know about community resources, and representatives to discuss services available. If you have questions please contact any of the sponsors listed above.
Betsy Weiss is president of Methow At Home
