Research suggests Nevada’s senior population could triple from 2000 to 2030.
Some call it the silver tsunami. And among the many challenges this aging nation faces is — how to die?
A majority of people say they’d prefer to pass away in the comfort of their own home. The reality is, most die in a hospital.
But some health care providers in the community are working to change this by getting people to talk about the end of life in new ways.
Dr. Clevis Parker is the chief medical officer for Nathan Adelson Hospice. The hospice has been providing end-of-life care for 40 years.
The hospice is hosting an event November 4 at Downtown Summerlin called Before I Die. Artist Candy Chang created the event in New Orleans following Hurricane Katrina, when she put up a chalkboard wall where people could write out what they wanted to do before they died.
Parker said the idea is not to just list places you want to see or experiences you want to have, but to think more deeply about life's purpose.
“It’s an avenue," he said, "It’s a way for us to start having these conversations."
Parker said the problem is that people are often not having conversations about end-of-life care until much too late in the process. He said Nathan Adelson Hospice is trying to change that.
“We’re really trying to make a community push to make sure that we’re educating the community on that,” he said.
One of the ways to educate people is to explain the difference between hospice and palliative care.
Dr. Parker explained that hospice refers to care given after a patient has decided against any more curative treatments and has less than six months to live. Palliative care is managing the physical and emotional pain of an illness while continuing curative treatments for that illness.
Another thing he wanted to clarify is where hospice care takes place. He noted that hospice is not a place but a philosophy of care. Most people receive hospice care at home.
“With hospice care and palliative, it is really patient-centered and family-centered. We want to do whatever the patient and family want to our best ability. If they want to stay home, we’ll make every effort to make that happen,” he said.
The Cleveland Clinic Lou Ruvo Center for Brain Health is also planning an event to help people start conversations about death.
Ruth Almen is the clinical manager of social work and social services for the clinic. She said the event, Death Over Dinner, was started by a man whose father was diagnosed with Alzheimer's Disease, and whose loved ones struggled to talk about the condition and his future after the diagnosis.
The event works to give people tools to talk about death and make a plan over a nice meal.
Almen said it is vital for anyone over 18 to have an advanced care plan. It should include information about who should take over financials, who should make decisions about care, and an end-of-life plan.
"I know that it will be really ugly and unfortunate if they don't have an advanced care plan," she said, "If someone doesn't have the chance when they have the cognitive ability to make decisions about those things, then those decisions get taken away from them."
Almen said sometimes that means court proceedings and thousands in legal fees. She knows people are not having these conversations because people are not taking advantage of the remarkable support that hospice can bring.
Dr. Manpreet Sran is the attending physician for Infinity Hospice Care. He said the idea of talking about dying and end of life is a relatively new idea for the medical profession.
"It is very new. It is picking up," he said, "In medical school, you don't actually get formal training towards speaking about the death and dying process."
He said he learned about dealing with dying during his residency in internal medicine. Dr. Sran said in his second year of residencym he took on talking with families of patients who were dying because the other providers were afraid to have that conversation.
"To my surprise, [the families] were open to talking about these things," he said, "They actually really appreciated these conversations. What ends up happening is when you have these conversations and you give them the honest prognosis, they're able to plan, they're able to coordinate, there is a less likelihood of them having a complicated grief."
Dr. Sran said his work in hospice and palliative care has been rewarding. Both patients and families appreciate his help and honesty, he added.
He advises that people looking to open a conversation about end-of-life care should start with open-ended questions that allow for free conversation.
Dr. Sran also said it's unlikely that a discussion about death and dying will be completed in one sitting. Instead, everyone involved should be ready for several open conversations about it.
Dr. Parker agreed. He said understanding options and knowing what the future might hold makes the process easier for everyone.
"As people know better, they do better," Dr. Parker said, "If you're advocating and making sure that they totally understand what their options are and they're making decisions that are best in line with their goals and values, their outcomes are different."
Dr. Clevis Parker, chief medical officer, Nathan Adelson Hospice; Ruth Almen, clinical manager of social work and social services Cleveland Clinic Lou Ruvo Center for Brain Health; Dr. Manpreet Sran, attending physician, Infinity Hospital
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