Death and Taxes

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Article by Hospice Sunset Administrator Jennifer Speer, a program of Lutheran Sunset Ministries.

I know you‘ve all heard the old cliché, nothing is guaranteed in life except death and taxes. Most of us plan to an extent for our taxes every year. Whether it is coming up with a plan to pay them or planning what we are going to do with our refunds, we plan. If you think about it, we plan for almost everything in our lives. We make plans for college; we make wedding plans; we plan for vacations; when to start a family; we plan what we are making for dinner; what we are going to do for the weekend; we make plans for retirement. If death is as much a guarantee as taxes in life, why don’t we plan for that?

Do we not plan for our deaths because it isn’t fun to think about and plan like weddings, college or vacations? Taxes aren’t fun, but they come around every year whether we are ready or not. As a society, we need to change the concept of death. It only comes around one time for us. That means we have one chance at getting it right. I know that sounds odd to think about getting death right, but let me tell you it is the truth. If we don’t start planning for our deaths and share our wishes with our families, the act of dying can be horrific for us and our families.

Death is a natural part of life and is someday coming for all of us. I used to be afraid of death and dying. Not that I didn’t know where I was going, but the whole idea of dying scared me. Now that I have worked in Hospice, it is not the idea of death that scares me, it’s the process of dying, and the journey to get there that scares me. I don’t want to hurt. I don’t want to be alone nor want my family to be alone. I don’t want to die in a hospital and be hooked up to a bunch of machines. If I had my wishes, I want a peaceful death at home with my loved ones beside me. None of us get to choose the way we die, and obviously those things are out of our control.

Talking about death is not something that is typically brought up on family holidays or talked about around the dinner table. If we don’t share our end of life wishes with our families, then they will be the ones to have to make those difficult decisions for us, not really knowing what we truly want to happen as we get close to dying. They will be making those decisions under a very emotional and stressful time. Difficult decisions which could haunt them for a long time, because they did not know what their loved one would want.

I encourage every one of you to have those difficult conversations with your loved ones and make your wishes known. None of us are promised another day. If your loved ones know your wishes, hopefully it can make a difficult transition a little easier for everyone. If your heart should stop, do you want the doctors and nurses to perform CPR and attempt to bring you back? Do you want to die in a hospital or at home? Do you want to be hooked up to machines or do you want a quiet peaceful death at home?

If you do not want CPR if your heart stops, I recommend talking with your doctor and healthcare team about obtaining Do not Resuscitate (DNR) paperwork. This will protect you and ensure that CPR is not performed if your heart should stop. So many different factors should be taken into account when considering obtaining a DNR. I always recommend looking at the overall quality of a person’s life to help make that decision. If the patient is terminal, seems to be suffering and is quiet frail the odds of CPR being successful are low, as well as recovery from injuries that can occur while performing CPR. Patients and families need to consider if the CPR attempts are successful, what quality of life that person will be returning to. Are they comatose and not going to return to a higher level of functioning? This is each individual’s choice of whether they want CPR or not when that time comes. Please tell your family your wishes so they don’t have to make those difficult decisions for you when they time comes.

Something else I would consider is after discussing your wishes with your family; appoint someone as your Medical Power of Attorney that will carry out decisions on your behalf once you are no longer able to make those decisions. When stressful situations come up, families don’t always agree on the best course of action for their loved ones. Appointing someone as Medical Power of Attorney gives that one person the ability to speak on your behalf to alert medical staff of your wishes. Medical staff will also turn to the Medical Power of Attorney to make those difficult decisions when needed.

Please note that a Medical Power of Attorney and Durable Power of Attorney are two different things. The Durable Power of Attorney is the person you appoint to handle financial things. The Medical Power of Attorney handles everything medical. A lot of people do not realize that there is a big difference between the two.

If you have a terminal prognosis of six months or less and don’t want to be hooked up to machines or die in a hospital, I would recommend Hospice care. Hospice can ensure an easier death with comfort and dignity and ensure support is there for your families. Hospice will come whenever the patient calls home and provide care. Hospice can be provided at home, Nursing Facilities and even Assisted Living Facilities.

Hospice is a scary word for many. So many people think of Hospice as a death sentence and think Hospice is brought in when there is no hope. But that is just the thing … Hospice care brings hope for dignity, comfort and peace and allows patients to spend quality time with their loved ones for however much times is left in this journey of life. Hospice focuses on living life and enjoying life to the fullest.

A referral to Hospice should be viewed as a referral to a specialist. Just like the cancer patient sees an Oncologist, a heart patient sees a cardiologist and someone with urinary tract disorders sees a Urologist, why not see a specialist for end of life care – a specialist who can help you and your loved ones walk through the most difficult journey of living.

Hospice neither hastens nor prolongs life. Studies have shown patients with Hospice lived an average of one month longer than those without Hospice, and the quality of life was consistently higher. Studies conducted by the National Hospice and Palliative Care Organization show that Hospice patients experience less depression and improve mentally, emotionally and physically over chronically ill pts who are not on hospice.

Once patients and families come on Hospice they usually say, “I wish I would have known about this sooner,” or they will say, “I wish mom/dad would have come on Hospice sooner.” There are many benefits to coming on Hospice services at the early stages of a terminal prognosis. The most important benefit is reaping the benefits sooner rather than later. Hospice can ease financial burdens by providing medical equipment and supplies that the patient needs and also covers the cost of medications related to the terminal prognosis and meds for comfort. For elderly patients on a fixed income this can be a huge benefit. As well as the fact that the cost of medical equipment and medications can add up very quickly.

Another benefit of Hospice services is that Hospice becomes your new 911. Hospice staff are available 24 hours/day for any questions, concerns or changes in condition that may arise. Hospice can alleviate unnecessary trips back and forth to the hospital. This is especially important now that the weather is getting cooler, and the time changed causing it to get darker earlier. It is hard on those with failing health to get out at night and especially in the cold or heat. Hospice staff will come to you at your home and perform assessments, then contact the doctor as needed for any concerns or medication needs.

Death and dying is inevitable for us all. We don’t get to choose how we die. Sometimes it comes unexpectedly and other times it comes with an illness and can be a long process. Regardless how it comes, death is a guarantee. Talk with your family and let them know your wishes for when the time comes. It’s a natural part of life that we all must endure. It will make the journey a little easier knowing they honored your wishes.

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