how-to-help-plan-for-end-of-life-careBy: Christine Cowgill, MS, CRC

Every day, we see an increasing number of baby boomers with aging parents who need caretaking. As the difficult task of providing care to parents can certainly take a toll on the most loving of children, there are certain things that should always be considered when addressing medical care at the end of life. While an aging parent may develop memory related issues, it is still important to hold a family meeting to openly discuss the important topics of how to best handle the inevitable event of sickness and death. This can be a very difficult subject to bring up with an aging parent, but a necessary one. It is best to have this discussion well before the time comes when these decisions become necessary.

One way to start this conversation is to start with small talk to gauge what your parents’ level of openness will be. If your parent seems approachable bring up the health care issues, otherwise wait for a better time. Be sure to stress how talking now can circumvent problems later with extended life support and medical bills. Be certain that your parents understand that they can trust you and will not be robbed of their decision making abilities.

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Most doctors and nurses are trained for the birth process with an OB/GYN rotation but there is no or very little rotation or training for the end of life process. While some of us will have a baby, we all will eventually depart this world.

Christine Cowgill’s new book ‘Soul Service: A Hospice Guide to the Emotional and Spiritual Care for the Dying’ is focused on providing information for everyone interested in making the death process more natural and positive. The approach to mortality is not to be feared; rather a process to be better understood by the patient, caregiver, family members, friends and loved ones.

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This book is a guide to servicing all aspects of the soul in transcendence. It concentrates on the need for spiritual, emotional and complementary care to the terminally ill.

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Federal law in 1991 allows for medical advanced directives. These offer the patient and the family an opportunity to have a say in their own care. Advance Directives are also called a living will, which appoints a legal health care representative and gives instructions for future life-sustaining treatment plans if one is unable to make those decisions for oneself.

A do not resuscitate order (DNR) is accepted by doctors and hospitals in all U.S. states. It serves as a request to not have cardiopulmonary resuscitation (CPR) if the heart stops beating or breathing ceases.

A medical power of attorney, also called a health care power of attorney gives someone your parent trusts legal authority to act on  their behalf regarding health care decisions in case of mental disability or any health issue that might affect their  ability to think on  their own.

Of course getting one’s legal will or trust in order with a qualified legal representative should always be done regardless of one’s health status.  If your parent currently does not have a legal representative to assist with advanced medical directives, you or they can go to the websites of online providers for legal assistance, such as, or to download self-service forms for all states.

One newer development has been the Physician Orders for Life-Sustaining Treatment (POLST) Paradigm form. This form has become part of the care offered at hospitals and health facilities. This is a voluntary form, not required by law.  The POLST Paradigm form was developed to help honor preferences at the end of life, regarding having or not having treatments continued. The POLST form is a medical form and is not completed by the patient, but rather a health professional. The POLST programs are not available in every state. The form must be signed by the patient’s doctor, in some states a physician assistant (PA) or a nurse practitioner (NP) may sign off on it, some states require the patient and the chosen decision maker to also sign. The original form stays with the patient. It is advised to keep this form in a location that can be readily available to emergency personnel, such as the refrigerator door.

The POLST Paradigm form is considered appropriate for terminally ill patients with life threating (within one year) conditions. The form remains with the patient even if they are moved between various medical facilities. The POLST form will be kept in your chart if you are staying in a nursing home.

A POLST Paradigm form will only be recognized in states where the program is allowed. It is always recommended to talk directly with the primary care physician about the form and how to best communicate  the patient’s wishes.

By addressing these important issues now with your aging parent it can save a lot of stress and trouble later when they will come up at the end-of-life.


Christine Cowgill, MS, CRC is the Author of Soul Service: A Hospice Guide to the Emotional and Spiritual Care for the Dying (Balboa Press, 2013) Christine is a certified rehabilitation counselor with over ten years of experience in medical and vocational case management. She is also a licensed life and health insurance agent.


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