I got a new form from the nursing home today, and long discussions, with more to come, on some of the points.
Mother is a candidate for "Comfort Care" and the form that I got lists each measure, with a yes/no column, plus a comments column. Here are the things you must decide on when a loved one is facing end of life issues. (notes are as I understand the issues from discussions today, with reference to my 95 yr old Mother's care specifically.)
1. Oxygen for comfort
2. suction for comfort
3. pain medication as needed
4. continue with other medications (BP, etc, this can be pick and choose, for example, delete the vitamins)
5. Intake as desired (what does patient want--not clear on distinction between this and #8 below).
6. Intake and output monitoring (How much eaten and how much excreted. With Mother, we don't care how much.)
7. Weights (on a regular basis. With Mother, for a while, but since she is not eating, we will stop this soon, because it is not anything that will help her.)
8. Meal monitoring (see #5, but today the dietician said that they figured that Mother ate between 20 and 30% of her meal volume)
9. Turning and repositioning to the resident's comfort
conservative wound and skin care
activity as tolerated (for Mother, this will be communion from the person who visits from the church)
minimal environmental stimuli (Sit outside on the patio? Visits from all the staff to say hello?)
transportation to hospital (This gets trickier... if she falls and gets hurt, yes, perhaps, the hospital is not the best place for a person in the last days... perhaps this is an open question in our case)
social service intervention as appropriate (Call me if I am not there)
Enteral feedings (tube? no)
Standard personal care as resident allows
Basic hydration by IV is not on this list, but we did discuss it. Obviously I didn't get the whole story, but I am working on it.
This list gets marked yes/no, and also signed by the patient's doctor.
It's a lot to think about, isn't it? Far beyond the "Advanced Directive".