1 cigna health care. health spring jeannette travis dr. chch newser dr. chch newser debbie garson dr. payne joanne lynn kathy mattea kathleen sebelius caregiver caregivers. >> jason:.
>> jason: prostate jaci and elisa henley acute crisis acute renal henley henley jaci and elisa henley elissa know able bob goldman life and death decision. validate validates mortgage mortgage mortis interruptus forestalling forestall icu
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dose colon colon::okay. me me colossians {tips} cpr vein veins psychologically bias neurologist hydrate secrecy metaphors loathe subset hospice chaplain chaplains e.r.a. ministry iv strickland methodist methylxanthine the the
3 methodist lebonheur healthcare naive dan wilburn on control gist curt afterer. oncologist dementia curative. william f. bolger center wnpt.org/childrenshealth testing then show starting. neurosurgeon colostomy tipps
vein veins dr. ira byock. dr. dr. ira byock. dr. ira byock occur cure cure occur occur cure cured cure sounds good sounds good no one wants to die. >> he didn't want it and it didn't help him. show starting show starting
show starting show starting. coming up on aging matters, end of life. >> i think we're dealing with 4 deep-rooted natural human fear of dying. no one wants to die. didn't help him but i thought
it was, so was i doing it for him or was i doing it for me? i don't know. >> we're in danger of consuming a lot of resources for care that isn't efficient or provides the kind of care that people really want. >> i had a good run.
i have enjoyed life. that's the way to go. just let nature take its course. >> we're going to have a large number of people who need hands on care, every day. we're going to have to figure 5
out how to function with that. >> major funding for npt reports, aging matters, is provided by cigna healthspring, lead sponsor of npt reports: aging matters. cigna healthspring where you get more from medicare and more from life.
the west end home foundation, support in the care of seniors through many organizations in middle tennessee. the jeanette travis foundation, dedicated to improving the health and well-being of the middle tennessee community.
the corporation for public broadcasting, and the members of npt. thank you. >> in a few short years, the number of tennesseans age 65 6 and older is expected to increase by a third.
and that's just the beginning. as the baby boom generation gets older. this growing population will affect all of us, no matter our age. hi, i'm kathy mattea. in response to this new reality, nashville public
television has undertaken a project to address the issues of aging in middle tennessee. over the next few years, npt will look at the strengths of our community as well as the challenges facing older citizens, their families, caregivers and institutions
that serve their needs. i'm privileged to be part of this thorough effort to bring our community together and learn more about the issues and challenge facing all of us 7 as we age. this first documentary takes
an in depth look with how we deal with the end of our lives. it's a difficult subject, but one each of us will have to address. i think most of us imagine our own deaths to be quick, peaceful and surrounded by
loved ones. when asked where they prefer to die, americans overwhelmingly say at home but most deaths actually happen in hospitals, or other long term care facilities. often many of us get aggressive medical treatment
that does little to improve our last days, weeks or months. why don't we get the death we say we want? how can we move more people 8 towards living with the best possible quality of life?
until their last moment. join me as we explore the answers to these questions on aging matters: end of life. >> jaci and elisa henley's father was diagnosed with prostate cancer when they were in college. for 18 years they watched him
fight the cancer, but in 2010, he suffered an acute crisis, perhaps from kidney failure. >> when he first entered into the hospital it didn't seem like this was going to be the end. we had gone through bouts before, so it didn't seem any
different than the other times. i don't know that he ever had renal failure though. we didn't realize how serious 9 a situation it was and i don't think anybody ever told us it was serious, a serious
situation. >> as their father's condition worsened, the henley family struggled to understand what was happening. >> we couldn't get doctors to, to come to explain what was happening, let us know is it the renal failure?
is it the cancer, what is causing the pain, what is happening? he didn't want to be there and we're like daddy, we need to talk to a doctor first. let's find out what is happening because we can't take you home.
you might not make it. we don't know what is happening. he was like no i want to go home. 10 i don't want to be here anymore. >> after a week in the
hospital, their father suffered a heart attack and died despite a long term chronic illness and plenty of time to prepare. this was not the good death he wanted and the family hoped for. >> i think if they had just
said he's not going to make it out of this, then we could have made some kind of arrangement to have him sent home or -- but it just never happened. >> most of the time people are living in fragile health for a long time, and some little
thing is going to be enough to mean it's the end, but whether that comes on tuesday or 11 thursday or in two weeks, is not so clear. >> the frustrations felt by the henleys over their father's death is shared by
some in the medical profession. >> the elephant in the room is that it is rare for the most part in a hospital, for the staff to be surprised when somebody dies. the hospital staff normally knows that it's coming.
>> bob goldmann witnessed a lot of patients dying while working as a doctor in an intensive care unit. >> the fact that i really fit into that world surprised me a little bit but what kind of got a little bit in the way was my tendency to want to
talk to patients and families. that was the part of critical care i really enjoyed. 12 >> after 25 years of working in the intensive care unit, his enthusiasm for his work began to fade. >> the biggest thing i get the
most frustration with is having to make life and death decisions on the fly in an emergency room, surrounded by people who don't know us, dealing with a crisis of literally minutes or sometimes less, and trying to make a decision that actually
respects and validates the patient's belief system. the number of conversations that i knew needed to have happened before that person ever saw an icu, kept multiplying. >> by 2001, goldman started dreading going to work.
eventually becoming emotionally and physically 13 drained. >> i had to walk away from the icu. my number one diagnoses was mortis interruptus. all i was doing was
forestalling people's deaths. we had the capacity to make you die a long time and i say that deliberately. our technologies and our abilities to prolong vital signs, to prolong existence have gotten far ahead of our ability to really sit down and
say is this what somebody really wants to be doing? >> in fact, a 2004 study found 1 in 5 americans died using intensive care services. however, more recent studies indicate that fewer people are dying in the icu. intensive care use has
actually increased among patients in their last month 14 of life. this increasing use of aggressive medical care at the end of life also doesn't match what patients say they want. 80% of patients with chronic
illnesses reported wanting to avoid hospitalization and the intensive care unit when they're in the terminal phase of their disease. despite what many americans say, they still have a good chance of dying in a hospital. >> i think we're dying in
hospitals because a lot of times we enter the hospital dying, but nobody really admits it. there's a standard joke that regardless of medical intervention the death rate remains stable at 100%. we're all going to do this.
the question is are we doing 15 it in the way that really is what we're looking for and if not, why not? >> dying in hospitals and icu's is a relatively new phenomena. a century ago americans had a
different relationship with death and medicine. people died of things that are now easily treatable, such as pneumonia, diarrhea and injury. >> the culture of death was very different in the 19th century.
for one thing, there was a sense that death was omnipresent, that life was fragile. medicine played a relatively small part in the dying process. doctors were relatively few and far between.
16 many people didn't have the money to pay for doctors. there were very few hospitals and in fact hospitals did not want dying people because they wanted to keep their mortality rates low. >> at the turn of the 20th
century, discoveries in biology and new diagnostic technologies changed the understanding of medicine. hospitals transformed from religious and welfare institutions into scientific enterprises. >> the doctors for the first
time felt that they really understood diseases and that they could cure diseases. doctors also really wanted to tend to patients who's diseases could rather quickly and successfully be resolved which men people of course who 17
could be cured rather than people with long diseases. obviously doctors did sometimes take care of people who were dying but the focus of medicine and doctors was on curing disease. >> a hospital building boom after world war ii and the
spread of health insurance brought more and sicker people into hospitals and newly-established intensive care units and started changing where people died. >> it wasn't until 1945 that 50% of all deaths happened in hospitals.
this was partly because hospitals expanded in size and number and also there were rising expectations of what medicine could accomplish. i would say the second world war inaugerated a period of medical triumph in this 18
country and that encouraged many people to enter >> until the mid-1900 a he's most americans died at home. but today a minority die there. between 2005 and 2010, 43% of americans died in a hospital. 21% died in nursing homes or
long term care facilities. only 25% died at home. >> american medicine has really accomplished wonderful things. however, i think its focus just on cure has had a distorting impact. there's very little premium
placed on preparing for death. in the 19th century people were definitely supposed to prepare for death. in fact they were supposed to be always prepared for death. but there's very little in our 19 culture that supports any kind
of preparation for death. whether it's emotional, social, saying goodbye to people, financial, spiritual --. >> my husband told jokes all the time. he was the life of the party. he was philanthropic.
he went to charity events. he played tennis, we took at least one or two ski trips every year. we had a big, beautiful life. it was a great life -- until it wasn't. >> october 1, 2007, i took him to the doctor.
on october 3rd, 2007 he had a biopsy and we determined that he had a glioblastoma brain tumor. nobody ever really said this is terminal. 20 the doctor didn't give me a sense of that because i didn't
ask. i didn't want to know. i wanted hope. i wanted peter to live. >> even though her husband's prognosis wasn't good debbie garson chose aggressive treatment. >> he would be sleeping in the
morning and it was 7:30 and we had a 9:00 appoint for him to have chemotherapy or blood drawn or whatever it might be. that was torture for him. having to get him up, get him showered, get him dressed. he wanted to sleep. i should have let him sleep.
trying to give him the chemotherapy pills was impossible. he would throw them back and then i would have to go look 21 in the carpet to see where he through it and pick it up and try to give it to him again.
he didn't want it. it didn't help him. but i thought it was. so was i doing it for him or was i doing it for me? >> you doing okay? all right. >> as far as the medical community was concerned, they
didn't up, ever, because we weren't giving up. they wanted to do what we wanted to do. ultimately they knew the outcome far better than we did but they knew we were fighting and they were fighting with us.
all the way. >> what happens in many hospitals is you have this 22 dynamic of the family saying dad is a fighter. we want to give him every possible chance. doc, we really want to you do
everything you can. we're not ready to pull the plug yet so there's this battle of imagery that almost gets heightened at the point where you'd be far better off with a conversation of where can you enjoy the last days or the last month of your
father's life the most, where is he going to be the most comfortable? >> against the advice of their neurosurgeon garson pushed to have her husband included in a clinical trial she found online. >> he didn't want us to do it
but he went along with me and he had the drug brought to 23 cleveland. peter had one dose of that drug and that was in april of 2008. it was not good. it was shortly thereafter that
peter's colon burst and he had to have yet another emergency surgery. he had to have colostomy so his life was a living hell. >> why so many people end up being treated aggressively the there are many reasons and that's what we pay for.
we pay doctors to do almost anything. another is that things that doctors offer are never completely futile. they are in some grand sense, this person will die of this anyway, no matter what we do but maybe we can give him two
more weeks. 24 >> the question of futility is a fascinating one. there is no good definition for it. the survival rate for in-hospital cpr is right around 17 to 18%.
some people would call that futile. some would say well if the alternative is dying, what have i got to lose? answer? we might get your heart started but your body will pay a price for it.
>> after the final surgery, peter garson never recovered enough to continue treatment. he died in august of 2008. >> if i had to do it over again, i would embrace him more and i would spend more time at the park, or take him to places that i knew he would
25 enjoy. yes we spent a lot of time together but our time was spend at the hospital, and i don't think all of that was necessary. >> let's go make coffee, darling.
>> okay. how can i help? >> just be with me for moral support. >> ronald tipps is dying. he knows it. >> a good woman keeps her man straight, and you do that. >> his wife knows it.
but his doctors never told him. >> for many years i have known my kidneys, capacity has been going down. when i moved to nashville it 26 got worse so my primary care physician said you better see
a nefrologist and i saw a great doctor. he said you'll have to go on dialysis eventually. he said no matter what you do you'll go on dialysis and that's it. >> in january 2013, ronald tipps experienced the modern
medical system's emphasis on cure when he suffered a heart attack and went to the hospital. >> finally got in the room and they check for everything under the sun, even ran a wire up through my veins or something to check my heart.
i had blockages but they were trying to compensate for it and there were branches coming out so i was okay. but they kept sticking me and 27 poking me and they just -- finally you'd get to sleep and the nurse, i need a blood
sample. different specialties were working on me. i ended up having about what, four different groups you know, cardiology and nephrology and pulmonology. what was the 4th one? there must have been a 4th
one. i want today go home, that's all i wanted to do and i kept asking, oh we can do that because this group hasn't approved yet. well, then you ask that group, no, this other group hasn't i thought to was kind of
inefficient. >> the medical care system has become profoundly 28 disfunctional around this part of life, so a person comes into the hospital and get doctor a and then 12 hours later doctor b and 12 hours
later doctor c and at best they're communicate ago couple minutes into a chart and then none of them are actually in touch with the doctor on the outside who is primarily responsible, or with the five or six specialists and that is just the doctor's side.
the social work thing, the nursing, the support to family, all of them are at least as broken up. >> we wake the person up with engineering problems and then attempt to solve the problems and then we try to get the teams together so that when
you solve the blood gas problem it doesn't keep me from solving the heart 29 problem. death is, there's no place for death in that. in that engineering scheme. so, to me this is one of the
most concrete places where our medical culture reinforces fairly dramatically our culture-wide unwillingness to talk about death. >> while in the hospital still recovering from the heart attack, ronald tipps was told it was time to start dialysis,
three times a week, for three hours for the rest of his life. no one discuss bad would happen if he chose not to do dialysis. >> you kind of regard them as experts, and take orders, so i didn't question him.
>> me, too. and, matter of fact i was under i guess a house arrest 30 or whatever they call it at the hospital, and there's nothing i could do. they just wheeled me into the dialysis room and hooked me up
and that was it. >> after just three sessions round began to question the treatment his doctors ordered. >> it was terrible. the aftermath is what, what i could not tolerate. i said this is it. i'm not going to do this
anymore and they said oh, you will be back. you will be back the nurses said, all of them. you don't want to die. that's what they were saying. you will be back. i hasn't been back yet. i feel good.
>> health care today is 31 a curative model, a problem, a treatment, solution, it resolves and you move on. as we get older, as we get sicker, as we layer on disease after disease, there comes a point where the treatment is
sometimes the disease. >> even for patients with the most informed advocates, opting out of the medical system at the end of life can be difficult. >> my mom had horrible dementia and i had to fight with the cardiologist who was
called in as a consult and the when she was in the hospital with her hip fracture. he said what do you mean you don't want to get us in here? you don't want us to work it up? i was like no. what if she has x, i said
32 good. she doesn't know you're there. i think the doctors want good care for their patients. i think that the challenge in today's world is to really come to recognize that what we were taught was good care, and
fix it at all costs may not be good care anymore. it may not be the care that the patient wants. >> the era of modern medicine has dramatically changed when and how people die. today most americans will die old, about 20% will die from
cancer. another 25% will die of an organ system failure. such as heart, lungs, liver orchid knee. >> already though, we now face a whole new way of dying that 33 was really uncommon until
about 50 years ago and that is living with multiple chronic conditions, each of which is requiring some upkeep. and becoming more and more fragile in our existence but living a long time that way so that most of us now will die with years of being unable to
take care of ourselves. the end of life in which somebody else has to help you out on an every day basis is now the standard and that's new enough that people don't realize that's what most of us face. >> between 2000 and 2030, the
number of americans with chronic conditions will increase by 37%. or about 46 million people. although the way people are dying has changed, the medical system responsible for that 34 change has not.
>> so, we bill the system as if we were most scared of heart attacks in 55-year-old men and it's now a system that is mostly serving 85-year-old women living with very serious chronic illness. >> we have an acute disease detection and treatment
system. i don't even call it a health care system so we're head up to -- set up to diagnose and treat diseases and what people with chronic conditions need, if they have an acute flare-up of their condition they might need a short term stay in the
hospital but they need a lot of guidance in terms of what their goals of treatment should be, and particularly around goals that provide a better quality of life as opposed to just having a goal 35 to extend my life five or 10
or 20 more days, if that's only going to be in an icu setting. >> my mom was a meat and three type person --. >> the person is living with frailty often needs much more hands on care. the direct caregiver that
comes in and gives a bath, the person who helps spoon-feed, cleans the house, keeps people in the community longer, and not having to go into a nursing home. he we were working with sunset of hospitals getting rapid readmission.
it turned out one of the reasons why that meals on wheels had a 45-day wait. for somebody coming out of a hospital couldn't get on the meals on wheels program for a 36 month and a half. you either have to fix the
program or start delivering meals in some other way. people can't go a month and a half without meals. but the health care system doesn't see that. it's just a system that was built on very different presumptions.
>> although the model of health care delivery was designed for a different set of issues, the way we pay for health care particularly for older americans reinforces the for most americans overage 65, medical care is paid for by medicare insurance.
>> coming into the modern era, say around world war ii, you saw what the health care system needed to provide was surgical procedures and we 37 insured for that and we did pretty well. anybody who needs a surgery in
medicare could get one but we never saw large numbers of people who's major problem was the problems of living. we never built a system that tried to provide that kind of >> with all of the problems in our current system of end of life care, the future might be
our greatest challenge. >> the population is slowly getting older, actually not so slowly, getting older. the baby boomers, born in the late 1940s, 1950s are all now entering the medicare age and so we are facing some real challenges, and, in how health
care needs to be organized, financed, for this baby boomer 38 population. >> i can stand up. >> i know can you. i'm not touching you. >> think about having three times as many frail, elderly
as we had just a few years ago and we'll have that by 2040. so the obif part of the paper, if there still are papers, will be three times as long. there will be funeral homes where there now are elementary schools. it's going to be such a major
change we have to learn the language. >> we have this big surge of people expected over the next 20 to 30 years of baby boomers entering the medicare program where they have more chronic disease, it's being managed 39
but it's very expensive and among those who die it's really going to put a lot of stresses on the taxpayers to actually finance that care because again, it's a social insurance program financed by today's workers to pay for the hospital and medical care of
today's seniors. >> in 2011, 28% of medicare dollars were spent for care during patient's last six months of life, about $170 billion. the average person with medicare coverage also spent about $38,000 of their own
money on medical expenses in the last five years of life. that out-of-pocket expense increased to more than 66,000 for seniors with alzheimers disease. for 43% of household these medical bills exceeded 40
financial assets. >> i think we're facing two different kinds of challenges. one is going to be an economic challenge. the second thing will be a cultural, spiritual, philosophical question. death is going to be much more
obvious. it will be a necessary conversation all around us. how are we going to respond to that? where are we going to make a place for that? we're in danger of consuming a lot of resources for care that
isn't efficient, or provides the kind of care that people really want. i think more importantly it's not providing the holistic comprehensive care, not attending to the person with the illness in terms of their 41
physical, emotional and often spiritual needs, and so therefore having people suffer unnecessarily. >> the intensity of illness to be admitted to a hospital has to be pretty high and the minute you're remotely better you're out which leaves a
narrow window to have a long conversation. it's much faster to say let's just put the feeding tube in and i'm not saying that doctors do that for the wrong reasons but the system doesn't reward or compensate people for having the really long
conversations where that probably the health care decisions would change. >> those are conversation that's really should be had in a calmer environment, that's not intensive care unit so my 42 real desire and passion was
about moving upstream and making what was going to be, if not the end of life transitions towards an end of life situation. more understandable, more pallatable if possible, more respectable and by that i mean having families in a place
they can respect the patient's decisions. >> at age 59, goldmann gave up a career as a critical care doctor and returned to school becoming a board certified palliative care physician. >> palliative care is taking care of symptoms, taking care
of anybody with an advanced illness, not necessarily who is dying. it's a multidisplinary approach to having not just 43 doctors but nurses, social workers, chaplains, all trying to take care of a patient and
their family, doing it in a patient and family centered way so their needs and trying to maximize the quality of >> it's really about reclaiming the roots of medical care. it isn't just all about providing high technology
care. it's about sitting and listening and talking to people, to really understand their goals, values, preferences and it's not about second class care, not about giving up and it's not just about end of life care.
>> come in. >> hello, hello. >> hello. >> how are you doing? 44 >> not so well. >> we'll talk. >> how are things going? >> one of the patients that we
saw today has lung trouble and joint trouble and skin trouble and pain issues and breathing issues, knows her life will be {short}. she has a lot of problems that no one doctor should try to address all of the medical manage men issues of that.
but as a human being, who is going to look at that entire person and help them feel empowered to put together a plan of care for themselves that really validates what they want to do with their care? those are not the types of
decision that's need to be happening in the middle of a crisis. 45 that's usually what we end up doing. >> i have conversations it's not about how they want to die, it's about their goals
and values. always emphasizing quality of life and goals, not about death and dying. that's how i approach this. planning, it's not planning for your death, it's how you live your life. >> you have more function on
less medicine and that's a real victory. >> palliative care is is a relatively new field of medicine that has grown quickly in the past decade. today, 67% of hospitals with more than 50 beds report having a palliative care
program. that number continues to grow each year. 46 however, a 2009 survey found many cancer centers did not refer patients until late in their disease process. >> what i hear over and over
and over is oh i wish someone called new earlier. oh, this is exactly what we needed. this is great. but it's the perception of the physician to say are we ready to call them in yet, because it's almost to them a fear
that we have changed our hopes and really what we want to be able to do is do these things in parallel. >> are you second guessing yourself on what else you should have done? >> there are studies that show when you introduce palliative
care early, people don't die 47 faster, they utilize services better. i'm not arguing we make people live longer. maybe we do but we're certainly not making people live shorter but if you can
make feel feel -- people feel better and better under stan the illness, why wouldn't you do that? >> when ronald tipps decided to forego dialysis for his kidney failure he enrolled in a hospice program. >> hospice is one is up set of
palliative care and that's for people with a defense prognosis so in our best judgment people we think will lifeless than six months based on the course of someone's disease and that the focus is for comfort only. 48
>> not simply symptom control but it's for the purpose 6 of moving those things out of the way to focus on what is really meaningful in someone's life, to get a focus on their spiritual life and things that are important to them so they can deal with those important
relationships and do what dr. ira byock calls the five things and that's saying to the folks that mean the most to me, you know, please forgive me, i forgive you. thank you, i love you and goodbye. to help folks have those kinds
of really crucial, important conversations can really be life transforming and life affirming. >> the people that i have interacted with are so nice and caring and compassionate. 49 it's the emotional part that
to me is so good at this stage of my dying process. >> hospice care also works with the patient and family to provide education on the illness, spiritual support, grief counseling and respite >> i think i would, was to afraid to undertake this with
him, without the support of hospice staff. i'm not a nurse and i don't know what to do, and that is upsetting, not to know how to manage a certain crisis or pain. >> when you're anticipating what might happen, it might be
so scary that you don't even want to think about it or can't bear to think about it so one of the things that can really help to ease that burden is to know that no 50 matter what comes down the pike, you and your family are
not going to have to face this alone. >> from 2000 to 2009, hospice use in the u.s. nearly doubled. however, in the same time period, there was also a significant increase in intensive care use in the last
month of life, and about 40% of the hospice transfers came from an acute care hospital in only the last three days of the patient's life. >> all of the good stuff, the life affirming, healing kinds of things that this kind of care can do, are difficult to
do if a patient comes to hospice but they only have three days left in their life. it's a difficult thing to get one's head around as a 51 patient, it's difficult as a family member. it's difficult as a physician
to get your head around you know, we're really at the point where cure is not a reasonable expectation. it takes some courage to face it. but, facing that reality then opens up whole vistas of opportunity to shape the care
so that all of these other goals can be met. >> by choosing hospice care early in his disease progression, ronald and his family have had time to prepare for his death. >> good girl. >> in a way it's been really
good experience to do this, because we have had our children come. they know it's going to happen, and it is in a way 52 helping them to deal with what is coming. so, i'm happy for that.
we all get to tie loose ends. you know, really say meaningful farewell. >> i have had a good run. that's why i refused further just let nature takes its i ended up with the love of my life and that's the way to go. i want to go out my way.
>> we actually know how to get people out of the hospital and into their homes for a death at home. we know what it looks like. we don't do it so it's not just the people, that people want it, and they don't get it but we know how to do it.
53 what we don't know, what we're unable to do is to break the conversation and the institutional patterns around fighting death. how you change those conversations, i think is just very, very difficult.
>> my father was always scared of death. he was horrified of death. but he did tell me at one point, he didn't want people to under hook him -- unhook him before it was time. that was the only thing he really ever was forceful with
me about and that he talked about. the rest of it he won discuss. he just would not discuss death. >> liz's father is not alone. in a recent survey, almost 30% of americans have not discussed their end of life
54 treatment preferences with anyone, even among severely or terminally ill patients, fewer than 50% had documented their treatment preferences in their medical record. >> we don't have the language, we don't have the metaphors,
the families don't know how to bring the issue up. if you start talking to your 82-year-old great grandmother about how she thinks about dying, there's a sense of just bringing it up is improper or i'm polite. of course she's thinking about
she's buried her parents and two or three siblings, maybe a couple children so this is in our ability to talk it over. >> i'm keith king with the live hospice. everybody wants to get to heaven but nobody wants to get 55
on the bus. we want to get to heaven but we have to find another way because getting there means i have to die. >> keith king's job is to get people talking about death or the end of their lives at a community outreach coordinator
for alive hospice. >> there's times i have gone out and there have been good crowds and then times i have gone out and it doesn't matter, the income level of the neighborhood, the race, or the denomination. you'll go out and you're
expecting a big crowd and when you get there, there's not that many people there. it's nothing we did, it's just the people don't want to talk about death. they're not ready to talk 56 people don't go to the
hospital to die. people don't go to the doctor to die. people really want to live as well as they can for as long as they can, so a lot of things have to happen for this conversation to be done and done well.
>> for liz her father's inability to talk about his end of life wishes left her scrambling to help him when his dementia made it too dangerous for him to live >> when he began to really falter and we wanted to move him down here to nashville, i
57 didn't have power of attorney, so i called his lawyer's office and i said look, my dad is really failing fast. i need to get power of attorney here or something so that i can take control of this situation.
the lawyer said you mean more than the power of attorney that is already in the file? my dad had signed a power of attorney 10 years earlier and never told anyone. i was absolutely dumfounded. i just thought oh my gosh, had we only known.
why didn't he tell me? why? >> the way we see dying in america is painful. there's no peace involved. we have either witnessed it on tv or with our family members. i have, i know other people 58
have, when you have a family member who passes away in a very uncomfortable condition, in the hospital. there's tubes everywhere. people everywhere. crash carts, it's not comfortable. we don't want to deal with
that. >> acknowledging and talking about the end of life is also something many doctors don't do well in fact doctors were trained to not tell patients the truth of their condition. >> doctors were very loath to tell the truth.
it was tremendous the secrecy. about 1900, almost all doctors concealed a cancer diagnoses and that was true until the late 1960s. doctors increasingly of course today tell patients if they 59 have a cancer diagnoses but
what they hide is the prognosis. >> if fact, studies found that doctors routinely overestimate survival times of terminally ill patients. at the same time, patients and families also tend to overestimate their chances of
surviving, despite what the physicians tell them. >> psychologically human beings including doctors and nurses, have an optimistic bias. we ten to think that we're going to do well. we tend to think we'll be the
exception to the rule. translates over into how i might feel about my illness, how i'm going to do compared to the statistics about folks with my particular problem. it translates into how i 60 practice medicine because i
have an optimistic confidence that i'm a very good physician and my patients will do well. it's ability in part of being human, coupled with a fear and discomfort with dying, so it's a difficult thing to talk >> shortly after liz moved her father to nashville, he
suffered two major strokes. the neurosurgeon said there was no hope of recovery. >> my initially action was no! isn't there something we can do? can we put an iv in, can't we hydrate him? can't we bring him back
somehow, and the neurologist said liz, it's over. >> suddenly it became real to me what was happening was this 61 man who had taught me to ride a bike, had been there on the front row of my school plays, walked me down the aisle, was
about to permanently leave. and that was the reality that hit home. >> with no hope that her father would recover from the stroke, she made the decision to move her father to hospice >> when the hospice staff came on board, they brought a sense
of peace to a very traumatic i felt very bad. i felt like i was throwing in the towel on my dad. they helped me reconcile those feelings. they gave me not only compassion for my father's situation, but self-compassion
because you can be very hard on yourself at that moment. 62 i didn't feel like i was in this alone anymore. that was a tremendous support. it really was. i felt like the weight had been lifted off my shoulders
at that point. one good thing that has come out of all of this, is my husband and i sat down with our son and we told him point by point by point how we wanted all of this done and we have filled out the documents and we have got it all -- i
even have the funeral service planned. i have everything plan. everything. my son will not be faced with these kinds of burdens when i go. >> today we're talking about our physical lives as it
relates to living well, and 63 dying well. i think our medical advancements have out paced our spiritual understanding. our technology has out paced our morality. in my almost 40 years of
ministry, honestly this is the first time i have ever tackled the subject. i don't even know why. it's never dawned on me to tackle the subject and i'm not i mean i think most ministers are where i am. >> craig strickland's church,
hope presbyterian, is located outside of memphis in shelby county, tennessee. in 2010, the residents of this area got some bad news. their region was one of the most expensive places to die in the u.s.. marked by high rates of
64 intensive care use and in patient hospital stays in the last two years of life. none of which improved outcomes in comparison to other regions. in response, community leaders thought outweighs to get
people thinking about and planning for the end of their >> it's hard work to change culture. one of the things i think though is so many more of us are dealing with our parents, our spouses, it's not easy to do but i do believe it's
becoming much more accepted and people are much more responsive and want to hear how to plan for this better. >> in 2010, methodist lebonheur healthcare joined all other major health care organizations in the memphis 65
region to take on the task of improving end of life care. the group, working under the organization healthy shelby, focused on getting as many people as possible to create an advanced care plan. a formal document that outlines the kind of care
someone may want and who would have the power to make health care decisions if he or she is unable. >> we first looked a lot at acute care, saying well of course we should have conversations with chronicly ill people over the bed as
they're dealing with end of life issues. probably pretty naive because we quickly learned that that's the worst time to be having the conversation. we backed up and said let's go upstream, let's look at how we 66
can have these conversations before the crisis. >> the group began offering training to all staff on advanced care plans as part of the benefits package. as major employers in the region they could reach more than 20,000 employees and
their families. >> chaplain dan wilburn. >> the hospitals also offer information about advanced care planning to everyone admitted, regardless much their health status. >> so for anyone who is interested our chaplains go in
and bring them a copy of five wishes and talk a little bit about the document itself. one of the things we love about the five wishes document is it's not just the medical side of what do i want to happen medicine he can lie. 67
it has -- medically. it has a spiritual aspect about what i want my family to know. how i want today treated and feel at those points in time. >> the community efforts are now reaching local congregations.
in the spring of 2013, past or craig strict land invited oncologist curt taver to have a conversation about dying well. >> when there's no more treatment, the poor soul with the cancer doesn't want to say i want to quit.
i don't want to do it anymore and the family doesn't want to let go and so somebody has to say it's okay. >> we gauged the success of the interview that curt and i did together, by the people who came back, the following 68
wednesday night, just to continue the debate. we have a wednesday night program, many churches do, and there might be, i don't know, 1200 people that come to it. on this night, i think there might have been twice that number.
so, we could tell we hit a mark. it was the biggest attendance we have had on a wednesday night. >> healthy shelby is moving the education efforts out to the broader community. they hope to reach people like
joyce waters. >> i might come to work and say oh, i got to thinking about death this morning and you know it was so real it woke me up but i never took it any farther than that. 69 of course, you know, now that
i'm approaching 70, it gets more real to you, the older you get. >> though she was initially uncomfortable with the idea, waters participated in a class on advanced care planning offered through the healthy shelby initiative.
>> it helps you to be able to, with much greater ease, to broach the subject like i want music played, i want loved ones to hold my hands. i don't want to be in pain. get me out of pain at all costs. those kinds of things.
i want socks on because my feet have been cold all my life and when i get to the end i want my feet warm and put some socks on me. >> with no family living in 70 town, waters has also chosen a good friend to make her health
care decisions if she is >> it was important for me to have the document in place because i have no children, and i have no spouse. i have three siblings who live out of town. i think i'm doing them a favor by putting in writing the
things that i would like to have happen as i near the end of my life and cannot make decisions at that point for myself. >> we shouldn't leave that discussion for doctors that barely know us, to have to have with us.
we need to have that discussion in community, among people that we worship with, that thing like we think, that 71 believe what we believe. that's a much more natural place for that debate to take place and up until this
generation it did. >> it's about taking control of some very important decisions in our life that i think many of us just by nature, defer. we wait and we wait until it's too late and so we're trying to make the discussion about
the quality of your life towards the end of your life mainstream and it's acceptable and it's something everyone should give as a gift to their family. >> the health care system and the culture at large, faces an enormous task as the baby boom
generation go into the phase of care that we think of as geriatric care. 72 there will be lots of people dying and they have to die somewhere. we're going to have to have the social conversations where
our fundamental health care system and our economic system along with it, are just going to collapse. >> we'll have to be willing to talk honestly with one another in the way that we have not been willing to talk honestly. keep thinking somehow if we do
the right thing in prevention and if we somehow manipulate the medicare fund ago little bit, somehow something wonderful will happen. we're going to have a large hands on care every day. 73 >> as individuals, as families
and community, we can no longer afford to ignore the inevitable. the needs of the aging baby boom generation will make it very clear how well we deal with today's challenges in end of life care. while we cannot predict our
future, we can prepare for the possibility by letting those closest to us know what our treatment preferences are. talking to your loved ones about end of life issues doesn't have to be difficult. there are many resources available to help you start
please go to our website at wnpt.org/agingmatters thank you. reports: aging matters, is 74 provided by cigna health springs, lead sponsor of npt reports: aging matters. cigna health springs where you
the west end home foundation support and the care of seniors through many organizations in middle tennessee. broadcasting and by members of npt.
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