Facing the End of Life (Part One)
He leads me …
Death comes to all of us, yet how many of us are prepared for it? If we were asked what the process of death involved, how would we answer? We would think about making a will, and perhaps about the type of send-off service that we would like, but we would probably not have thought about any other aspects much at all.
While each of us faces death as uniquely as we live our life, we all hope that when death comes it will be as peaceful and dignified as possible. We also hope we will face it in comfortable surroundings, well cared for and that those who mourn after we die are well supported. Other things are a matter of personal preference.
This means that planning for the end of life is important for everyone involved. It is a good idea to try and have these conversations early, while it is still possible to make shared decisions with the people who matter. However, many people do not feel ready to think ahead about dying. In this case, knowing the person’s values, wishes and beliefs can help when decisions need to be made on their behalf.
The following is a guide of the things that should be considered in terms of end-of-life care. This is not meant to be a complete list. For more information start with the https://www.nznasca.co.nz/ site. The New Zealand Needs Assessment Service Co-ordination Association website - (https://www.govt.nz/browse/health/help-in-your-home/needs-assessment) is another site that provides useful information. A third option is option is Seniorline (seniorline.org.nz), They are contracted by all New Zealand District Health Boards as an information service to assist older people to navigate the health system. Information includes how to get help to stay at home and support services for caregivers. They also advise on the process for entry to rest home, dementia or hospital care, funding and the services that should be provided.
The first stage on this journey will probably be requiring help in the home. The patient may want assistance so that they can live in their home as long as possible while still maintaining some independence. No one should feel guilty about accepting help with things like shopping, cooking, or housework.
At around this time there should be an up-to-date care plan for the person, especially if they feel vulnerable and require medical help or personal care. This plan should include end of life plans and should be shared with those involved in the person’s care.
A power of attorney. The usual plan is to appoint one or two people to have power of attorney. Power of attorney is an authority where one person (the donor) gives authority to someone else (the attorney) to act in their name. An attorney could be a doctor, lawyer or accountant, but what is important is that they must be totally trustworthy and have the client’s wellbeing at heart. Then they can make the right personal decisions and sign any documents on the donors behalf if they are not confident of doing it themselves.
One attorney can act in relation to property, care, and welfare, but each area can be split so that there is one attorney for property and another for personal care and welfare. However, only a private individual can act as an attorney for personal care and welfare. They have no control over money so must consult and work closely with the attorney for property. Therefore, it is important to select attorneys that are able to communicate and work well together.
Consider whether the proposed attorney has the skills, judgment and time to handle these matters. Be aware that family members may find it difficult to act impartially or may be influenced by other relatives.[1]
What is a needs assessment?
When a needs assessment is required, a Needs Assessment Service Coordination (NASC) team[2] works with the applicant, along with their family if appropriate, to achieve the care that is needed.
NASC services are contracted by the Ministry of Health or District Health Boards to serve people with disabilities, or with mental health issue or older people needing age-related support.
After a needs assessment, assistance can be provided with:
· personal care, such as showering or dressing,
· cleaning, preparing meals or essential shopping,
· moving the applicant into residential care as in a rest home or hospital,
· working out how to pay for the applicants care.[3]
Residential Care
When looking to move into a rest home or hospital it is important to determine which facility is preferred using a checklist and /or visiting facilities and talking to the staff. An assessment of what kind of environment, care, services and vacancies are available is vital along with how the accommodation will be paid for.
Typical things to look out for -
Rooms –
Are the rooms sunny and well lit, with an outside window?
Is the home clean, warm, odour-free?
Are the toilets close by and easily accessible?
Atmosphere -
The care home should have a comfortable, inviting and have a confident feel about it.
Do the residents appear happy and well cared for?
Do residents have a collective voice, such as a residents’ committee?
Care -
Is there regular input from other health professionals, such as a physiotherapist?
Is there a GP on call at all times?
If your level of care changes, will you have to move to another room/care home?
Dignity, Privacy & Independence -
Are your sexual preferences, ethnic, cultural and spiritual values, beliefs and lifestyles respected and supported?
Meals
Meals should be varied, interesting, nutritious, appropriate and appetising.
Are the quantities sufficient?
A daily menu should be on display.
Are there choices at meal times?
Can you help yourself to drinks, fruit or snacks at any time?
Alternatively, the applicant might be happy to live in a unit in a retirement village which has facilities for full time care sometime later on.[4]
While this is not a Christian blog, it is an important issue that we all should think about
Dear Reader – If you have found some value in this blog, please feel free to send a copy on to your family and friends. Kind regards, John
[1] For more details regarding power of attorney read the Consumer NZ site - https://www.consumer.org.nz/articles/power-of-attorney
[2] https://www.nznasca.co.nz/
[3] For more information about support services funded by a District Health Board go to - https://www.tewhatuora.govt.nz/for-the-health-sector/specific-life-stage-health-information/health-of-older-people/needs-assessment
[4] https://www.eldernet.co.nz/residential-care