'Tis the Season to Have an Advance Care Planning Conversation

This is time of year that we (and others) remind everyone to have an advance care planning conversation when sitting around the holiday table. While this is arguably the most important year to start or continue the conversation, these conversations are most likely not happening in person around that holiday table. Luckily technology still make these conversations able to happen.

As hopefully more people are having these conversations, the reality is that only 37% of Americans have an advance directive. An advance directive is a document that allows an individual to specify treatments and procedures they would want performed should they not be able to speak for themselves. While this may be daunting to think about, it is important to start thinking about this early and often. It is encouraged that anyone 18 or over have an advance directive.

Equally important is having an advance care planning conversation with loved ones, expressing those preferences. Too often, the conversation is had with one, or maybe no loved ones, leading to stress and disagreements among family members when life or death decisions have to be made.

One Last Time

The week before Thanksgiving, my grandmother passed away. She was 95, and other than her mind, she was in good health for her age. Over the years, she had a number of mini strokes. At first it impacted her short-term memory, but eventually her long-term memory was gone. This is what put her in the hospital one final time.

Just one month earlier, she got out of bed in the middle of the night and broke her femur. While there were two options – surgery or let it heal on its own – her children discussed her options and decided it was best for her to have surgery. While she would not walk again, surgery would allow her to be mobile. Opting for no surgery would likely result in a slow painful death in the coming months, dealing with pressure ulcers and other complications that come with being bedridden.

The Monday before Thanksgiving, my grandmother went to get out of bed, forgetting that she had a broken leg, causing a break in the lower part of the same leg. This landed her in the hospital again, resulting in another surgery. While my aunt, her healthcare proxy, sat in the hospital (she was the one guest allowed), she thought to herself, is this how the next year is going to be?

That Wednesday, my grandmother was very restless, had a horrible night sleep, and complaining to my aunt and her nurses. This is a woman who never complained and never wanted to put anyone out; as in she would pay for AAA, but would not call them when her car wouldn’t start because she didn’t want to bother them. Later that day, she passed away with no interventions, and with my aunt by her side. She had a DNR that stated she did not want to be resuscitated, and her orders were followed.

The Conversations

I realize how lucky and unfortunately how uncommon it is that my mother and her siblings all knew may grandmother’s end-of-life wishes, and that they were able to be honored in her final moments. They were also all in agreement with the care she should receive. They often relied on my mother for guidance, as she had worked in a SNF, and saw first hand how people of my grandmother’s age could die – the good and the bad deaths. But they were all on the same page, and had a conversation anytime my grandmother had an incident or a change in status.

I have to think we were fortunate that my grandmother died in the hospital. In normal times, I probably would not say that. My grandmother spent the last 7 years of her life in a CCRC, starting out in independent living, and eventually ending up in the skilled nursing unit. This community was fortunate that they did not have any COVID cases up until November, when there was an outbreak among some staff and residents. With my grandmother in the hospital, and the quick death she experienced, my aunt was able to be by her side. Had the same or similar situation occurred while my grandmother was in the skilled unit, she like so many others would have died alone.