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Long Term Care Administration


Long Term Care Administration Thursday, November 18, 2010 Week 11 - Chapter 15 End-of-Life Issues End-of-Life Issues But in this world nothing can be said to be ... – PowerPoint PPT presentation

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Title: Long Term Care Administration

Long Term Care Administration
  • Thursday, November 18, 2010
  • Week 11 - Chapter 15
  • End-of-Life Issues

End-of-Life Issues
  • But in this world nothing can be said to be
    certain, except death and taxes.
  • Benjamin Franklin

End-of-Life Issues
  • There are two certainties in life death and
  • Little progress has been made identifying and
    addressing end-of-life issues.
  • Grand Solutions those which address all people
    equally through a narrowly focused policy or
    single program.
  • Death and dying one size does not fit all.

  • To the well-organized mind, death is but the
    next great adventure.
  • J.K. Rowling

End-of-Life Issues
  • One Size Does Not Fit All
  • Complex, ever changing interplay of culturally
    based traditions
  • Socially and family defined values
  • Individual interests and perspectives
  • Health care developments
  • Considerable number of other factors that
    influence on human needs and expectations

  • As a well-spent day brings happy sleep, so life
    well used brings happy death.
  • Leondardo da Vinci

End-of-Life Issues
  • Where Does Death and Dying Occur
  • (based on death certificate data)
  • 71.2 of deaths occur in hospitals (1998).
  • 3.2 of deaths in other institutions.
  • 21.8 of deaths in other places.
  • 3.9 of deaths unknown or missing.

  • Death ends a life, not a relationship.
  • Mitch Albom

End-of-Life Issues
  • Hospital-Based Care
  • Aggressive but futile diagnostic and
    cure-oriented treatment in hospitals.
  • Public fear aggressive treatment.
  • Fear of hospital MDs making decisions.
  • Fear of life supporting treatment even when there
    is no hope of recovery.
  • Advances in medical technology.

  • Death doesnt really worry me that much, Im not
    frightened about it I just dont want to be
    there when it happens.
  • Woody Allen

End-of-Life Issues
  • Cardiopulmonary Resuscitation (CPR)
  • Under 3 of patients receive CPR who died in a
  • CPR provided for unexpected deaths.
  • Do Not Resuscitate Order (DNR) is an advance

End-of-Life Issues
  • For three days after death hair and fingernails
    continue to grow, bit phone calls taper off.
  • Johnny Carson

End-of-Life Issues
  • Distributive Justice Use Scarce Resources
  • Scarce and expensive hospital resources for care,
    could be used elsewhere.
  • Dying people need nursing care which can be
    provided in home or long term care facilities
    which are less expensive.
  • Slow death trajectories, alternates to hospitals
    care can be more easily arranged.

End-of-Life Issues
  • I have lost friends, some by death other
    through sheer inability to cross the street
  • Virginia Woolf

End-of-Life Issues
  • California Daughter Syndrome
  • Some children, who have not seen their parents
    for months or years and thus do not realize or
    have not come to terms with the fact that death
    was inevitably near.
  • Children in this situation may insist on all
    possible treatment despite the existence of an
    advance directive.

End-of-Life Issues
  • Im completely in favour of the separation of
    Church and State. My idea is that these two
    institutions screw up enough on their own, so
    both of them together is certain death.
  • George Carlin

End-of-Life Issues
  • Decision Making Can be regretted later
  • Withdrawing life support perceived as euthanasia
    actively ending a life.
  • Withholding treatment perceived as letting nature
    takes its course.
  • Most family members are unaware of the care
    preferences of their loved ones.
  • Most deaths in Canada after a long life.

End-of-Life Issues
  • Sleep, those little slices of death Oh how I
    loathe them.
  • Edgar Allan Poe

End-of-Life Issues
  • Who Dies
  • Gradual increase in the average age at the time
    of death.
  • Two main contributing factors.
  • Major reduction in infant mortality.
  • Increasing proportion of seniors who reach an
    advanced old age.

End-of-Life Issues
  • Animals have these advantages over man they
    never hear the clock strike, they die without any
    idea of death, they have no theologians to
    instruct them, their last moments are not
    disturbed by unwelcome and unpleasant ceremonies,
    their funeral cost them nothing, and no one
    starts lawsuits over their wills.
  • Voltaire

End-of-Life Issues
  • Some Statistics
  • 41.9 80 years and older.
  • 12.3 90 years and older.
  • 12 of seniors served by home care.
  • 5-7 of seniors reside in institutions.
  • 84.2 average age of death in LTCF.
  • 73.2 average age of death in Hospitals.

End-of-Life Issues
  • We believe that an informed citizenry will act
    for life and not for death.
  • Albert Einstein

End-of-Life Issues
  • LTCF end-of-life care more likely for widowed
  • Married people more likely to receive short term
    end-of-life care in hospitals.
  • Average stay in a LTCF is 3-4 years.
  • More females than males died in LTCF and more
    males than females died in hospitals.

End-of-Life Issues
  • A single death is a tragedy a million deaths is
    a statistic.
  • Joseph Stalin

End-of-Life Issues
  • Why do Canadians Die?
  • 999 different causes of death
  • 36.3 Cardiovascular Disorders
  • 27.8 Cancer
  • 11.1 other causes
  • 10 respiratory disorders
  • 6.1 injuries and suicides

End-of-Life Issues
  • A nation or civilization that continues to
    produce soft-minded men purchases its own
    spiritual death on an installment plan.
  • Martin Luther King Jr.

End-of-Life Issues
  • When Does Death and Dying Occur?
  • Two times as many deaths in the winter as in the
  • Winter-time flu, colds, falls related to winter
  • Some people hold on to life until an important
    social event passes.
  • Little research in this area.

End-of-Life Issues
  • I wish to be cremated. One tenth of my ashes
    shall be given to my agent, as written in our
  • Groucho Marx

End-of-Life Issues
  • What Also Influences Death and Dying?
  • Long life expectation amongst Canadians.
  • Premature death prevented in most cases.
  • Gene therapy, advances in health care technology,
    and drug advances promise to prevent or abate
  • Health care utilization and costs increases, lead
    to health care system unsustainability

  • The valuing or sanctity of life is considered
    one of the prime values underlying Western
  • Beauchamp and Childress

End-of-Life Issues
  • Fears about Death and Dying
  • Painful, drawn-out process, dependency
  • Uncertainty of what comes next
  • Irreversibility or finality of death
  • Emotional, physical, financial impact on loved

End-of-Life Issues
  • It is the unknown we fear when we look upon
    death and darkness, nothing more.
  • J.K. Rowling

End-of-Life Issues
  • Societal Value of Life - Taxes pay to preserve
    and sustain life
  • Rescuers risk their life to save another.
  • Safe air ground transportation.
  • Safe hospitals and medications.
  • Seatbelt laws, non smoking laws.
  • Hospitals funded better than LTCF

End-of-Life Issues
  • Healthy children will not fear life if their
    elders have integrity enough not to fear death.
  • Erik H. Erikson

End-of-Life Issues
  • Safe Society
  • Most Canadians dont think about a premature
  • Small proportion of people sign an organ donation
  • 50 have a will for estate planning.
  • Fewer have an advance directive.

End-of-Life Issues
  • I'd rather die while I'm living then live while
    I'm dead.
  • Jimmy Buffet

End-of-Life Issues
  • Nurses, physicians, clergy, bereavement
    counsellors, funeral directors have taken over
    the role of family members.
  • Palliative care is a noncurative,
    comfort-oriented care provided to dying persons
    and their families.
  • Palliative care good, healthy death.
  • Death tragedy, not ordinary experience.

End-of-Life Issues
  • In the stars is written the death of every
  • Geoffrey Chaucer

End-of-Life Issues
  • Ageism
  • Death is viewed negatively in Cdn Society
  • Death is an event of old age.
  • Death of an older person is a tragedy for the
    family, for a younger person to die it is a
    tragedy for society.
  • Older people are often considered a burden on
    their family and society

End-of-Life Issues
  • It's funny the way most people love the dead.
    Once you are dead, you are made for life.
  • Jimi Hendrix

End-of-Life Issues
  • Assisted Suicide and Euthanasia
  • Bob Latimer and Sue Rodriguez to high profile
    cases in Canada not legal.
  • Legalized in other jurisdictions such as Holland,
  • An aged society can expect to have different
    values and customs than a more youth-oriented

End-of-Life Issues
  • A beautiful death is for people who have lived
    like animals to die like angels.
  • Mother Teresa

End-of-Life Issues
  • Options for End-of-Life Care
  • Aggressive or non aggressive care.
  • Choice of care setting when dying.
  • Choice of caregivers formal or informal.
  • Assistance in ending life or not.
  • People differ in their preferences.

End-of-Life Issues
  • "Look, I don't want to wax philosophic, but I
    will say that if you're alive you've got to flap
    your arms and legs, you've got to jump around a
    lot, for life is the very opposite of death, and
    therefore you must at very least think noisy and
    colourfully, or you're not alive."
  • Mel Brooks

End-of-Life Issues
  • Dying people are physically, mentally,
    emotionally dependent on others.
  • Average end-of-life hospital stay 21 days.
  • Dying patients can feed, bathe and speak for
    themselves until near the end.
  • Dying in LTCF are dependent on others for months
    and sometime years.
  • Resources are limited, few options exist.

  • I answer the heroic question "Death, where is
    they sting?" with "It is here in my heart and
    mind and memories."
  • Maya Angelou

End-of-Life Issues
  • Palliative Care
  • Community based programs increasing.
  • Shrinking number of hospital beds.
  • Started in Canada in the mid 1970s.
  • Has competed unsuccessfully for hospital
    resources hospitals diagnose and cure.

End-of-Life Issues
  • "I am ready to meet my maker, but whether my
    maker is prepared for the great ordeal of meeting
    me is another matter."
  • Winston Churchill

Preparing for the End-of-Life
  • DNR
  • Most LTCF have DNR policies.
  • Policies have developed on transfer to a
    hospital, the initiation of antibiotics and other
    potentially life-prolonging medications.
  • Policies around living wills.

End-of-Life Issues
  • People say satire is dead. It's not dead. It's
    alive and living in the White House.
  • Robin Williams

End-of-Life Issues
  • Private suite for dying patients families.
  • Upgraded equipment and staff training.
  • Commitment to aging in place.
  • Training in-house palliative care expertise.
  • Access to outside palliative care experts.
  • Goal to improve are of dying seniors.

On Death and Dying
  • I've told my children that when I die, to
    release balloons in the sky to celebrate that I
    graduated. For me, death is a graduation.
  • Elisabeth Kubler-Ross

On Death and Dying
  • The book introduced the author's seminal "stages
    of dying" or "stages of grief" model which is
    still widely quoted.
  • According the Kübler-Ross model, there are five
    stages that a dying person goes through when they
    are told that they have a terminal illness.
  • The five stages go in progression through denial,
    anger, bargaining, depression, and acceptance.
  • This model has been widely adopted by other
    authors and applied to many other situations
    where someone suffers a loss or change in social
  • The model is often used in bereavement work.
  • Not all workers in the field agree with the
    Kübler-Ross model, and some critics feel the
    stages are too rigid.

On Death and Dying
  • I always say that death can be one of the
    greatest experiences ever. If you live each day
    of your life right, then you have nothing to
  • Elisabeth Kubler-Ross

On Death and Dying
  • This is the world-famous best-seller by the woman
    who popularized the field of thanatology as a
    subject for general social commentary.
  • Written in plain language that anyone can
    understand, this important book can help families
    understand what's going on as death of a loved
    one draws near.
  • This was Elisabeth Kübler-Ross' first book on the
  • It is still considered a classic.
  • It is required reading in many academic settings,
    including medical and nursing schools,
    theological seminaries, and popular psychology

End-of-Life Issues
  • The prejudice surrounding AIDS exacts a social
    death which precedes the actual physical one.
  • Tom Hanks

St. Christophers Hospice
  • Founded by Cicely Saunders in 1967 and
    her extraordinary contribution to alleviating
    human suffering has resulted in the hospice being
    considered a centre of innovation and insight
    ever since.
  • Widely acknowledged as the pioneer of the modern
    hospice movement and has earned a reputation for
    excellence in clinical practice, research and

St. Christophers Hospice
  • Patients are treated as individuals and strives
    to understand and meet their unique needs, in the
    hospice or in the familiar surroundings of their
    own homes.
  • Through bereavement counselling and advice
    families are helped, including children, to learn
    to face the future.
  • When someone is very ill, all of the family is
  • Care extends beyond the treatment of physical
    symptoms to consider the emotional and social
    needs of patients, families and their friends and

St. Christophers Hospice
Setting Limits Medical Goals in an Aging Society
  • Faults the health care system for devoting
    disproportionate resources and technology on
    extending the lives of the elderly regardless of
    the quality of their lives.
  • He also warns against the social and economic
    consequences of the increased ratio of old people
    in the population.
  • Medical care, he suggests, should be allocated
    based on standards of need and priorities to meet
    them over a "normal life-span opportunity range,"
    limiting the use of new technology to that which
    improves the quality of life.
  • He also discusses the ethics of withholding
    artificial sustenance from the terminally ill,
    euthanasia and assisted suicide.

Setting Limits Medical Goals in an Aging Society
  • "The proper question is not whether we are
    succeeding in giving a longer life to the aged,"
    he argues, but "whether we are making of old age
    a decent and honorable time of life."
  • Daniel Callahan

  • The goal of all life is death
  • Sigmund Freud
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