Statistically we want to die suddenly – overnight in our sleep or doing something fun like sky diving. You really don’t want to know this, but only 10% of us will achieve that goal. None of us has a particular interest in dying from a serious disease.
Eighty percent of us want to die at home. What a shame that 80% of us will actually die in facilities. How can we die at home? Think first before you go “down the rabbit hole” to the Emergency Room.
Here are some ideas to consider:
- Accept hospice care if you qualify. Having a “life-limiting” disease puts you in a position to be evaluated by hospice. The goal of hospice is to help you die at home comfortably and peacefully. This eliminates Ambulances, Emergency Departments and Intensive Care Units.
- Medical people don’t always think about hospice. Take the initiative to ask your provider directly.
- Embrace the term “Allow Natural Death” (AND). This is the kinder, gentler way to plan for your end of life at home. Plan for the comfort measures you want. See the Resources and Glossary page on this website for help thinking through your values.
- Ask your Medical provider about writing an order for No Cardiopulmonary Resuscitation (No CPR) or Do Not Resuscitate (DNR). If you have CPR you will not likely die comfortably at home. CPR is very aggressive. It is difficult to endure or watch, and is less successful the more we age and as our health status declines. Your provider will judge your CPR status based on your age and medical status.
- Old fashioned house calls may be available in your area. It can be hard to manage visits to a provider. House calls are a great way to stay warm at home. Check Physician House Calls in Denver:
- Do you have Long Term Care Insurance? By all means, get the policy out right now and see what the “waiting period” is before the benefits begin. The waiting period may be 90 days from when you first need care. Get the clock ticking at the first sign you may need home care in the future. It would be a shame to lose the benefit of the insurance you purchased.
- Medical and Non-Medical Home Care Companies are able to offer tremendous support services. Research them; the help they can give is immeasurable.
- Explore Emergency Services at home! In the Denver area Dispatch Health provides about 70% of the services you could have in an emergency room. View their services at: www.dispatchhealth.com. Hopefully this model of services will pop up in other locations.
- If you have a No CPR order, you or your physician should alert your local Emergency Medical Service (Fire and Rescue). They will add this information to their computer system. If 911 is called, the emergency medical team will have that information from their dispatcher and administer care accordingly without Cardiopulmonary Resuscitation.
- It may be hard to avoid CPR if that is your preference. Bystanders who have been trained in CPR may attempt CPR on you, as will professional responders if there is no credible information clearly visible. If you are a hospice patient do not call 911. Call hospice.
- If you wish to die at home, ask your physician what steps should be taken at end-of-life. Someone must pronounce the death. It can be the hospice nurse to the hospice medical director by phone, your medical provider, the rescue squad’s medical director by phone or the coroner.
- A death at home without CPR allows the individual to be transported directly to the funeral home. This avoids a trip to the Emergency Department to then await a second trip to the funeral home. The coroner will issue a death certificate.
- Unaccompanied deaths or those that “look” suspicious may trigger an investigation. That is a very difficult process for loved ones to bear. By following the steps above your death should not trigger any cause for suspicion.
- Medical-Aid-in-Dying is a new law for Colorado, and many states are considering it. This is no quick or simple option. Medical aid in dying requires a good deal of forethought, and a support system. It is one way for people to die at home and many of the people who actually get the prescription filled don’t use it. It is there “in case” and seems to offer a kind of “insurance plan” for a future need for those who are more comfortable with that.
- Voluntary Stopping of Eating and Drinking (VSED) – Details about this process are available at compassionandchoices.org. This personal choice is legal in all states. A link to a video about it is available on my website under Resources. Near end-of-life most people have little desire to eat as their bodies are shutting down, so this is a rather natural process for some.
In the event that you do call 911… If someone does call 911, your No CPR order must be in the hand of the person next to you to adjust the goals of care of the Emergency Responders. Because every second counts for rescuers, no one should expect them stand around waiting for paperwork to be found. Their job is to revive you. Without an order, consent to do CPR is assumed. Having your paperwork handy, and having made a call ahead to Emergency responders, hopefully you can be able to skip that step and receive comfort care.
Blog Post by Fran Myers, Executive Director
The Center for Advance Care Planning