Who is Your Alpha Child?

images-1The Allianz Life Insurance Company conducted a study they defined as “The American Legacies Study”. They gathered information by conducting over 2000 interviews with Baby Boomers and their parents. One of the findings their study revealed was the existence of the “Alpha Child.” This is the child that keeps the family connected, who is always the first to make sure that family gatherings occur on a consistent basis, and communicates often with his siblings and parents.

Take a look at your relationship with your own siblings. Who is the Alpha Child in your family? It may be you. Examine your relationship with your parents. If the above listed characteristics describe you, then it is most likely that you are that person. But don’t let your ego get in the way. Be objective in your evaluation of your relationship with your parents and your siblings’ relationship with them. If you are married, discuss it with your spouse and ask for his or her feedback.

It is valuable for you to identify who your Alpha Child is. Who is the child your other children respect? Who is the child that you ask for feedback? Who is the child that acts as a leader in the family?

Once you have identified your Alpha Child its important to have a conversation with him or her, preferably face to face. Share with her what your plans are and the preparations you have made for your retirement years. Discuss your long term care planning. What happens if you or your spouse need care? Will you stay in your home? Will you move? Who will take care of you?

Share your end of life planning with her. I suggest strongly that you fill out “The Five Wishes: available from www.agingwithdignity.org before you do that. It is an extremely valuable tool to clarify your end of life wishes. I call it a living will with soul.

Ask you Alpha Child if he or she will help you organize a family meeting to discuss all of your retirement plans and concerns with the whole family. This meeting will have a life changing impact on your relationship with your children. It is most likely that you have never discussed these issues with your family before. Send me an email at:  (bob@giftofcommunication.com )and I will forward to you “The Seven Steps to Have a Successful Family Meeting”

Will Hospice Shorten Your Life?

images-1Many of us might believe that when we choose to accept hospice care at the end of our lives, our lives will be shortened as a result. After all, hospice patients often stop painful chemotherapy or other interventions that are expected to prolong their lives.

But a number of studies have proven this not to be true. A landmark study from the Massachusetts General Hospital in 2010 made some startling findings. Researchers randomly assigned 151 patients with Stage IV lung cancer to two possible approaches to treatment. Half received the usual oncological care. The other half received the same oncological care with additional visits from a palliative care specialist. These specialists focus on preventing and relieving the suffering of patients.

Those who saw a palliative care specialist chose to stop chemotherapy sooner, entered hospice far earlier and experienced much less suffering at the end of their lives. And they lived 25% longer that those who did not receive palliative care!

Atul Gawande, M.D. ,in his groundbreaking book, “Being Mortal”, states that “Like many other people, I had believed that hospice care hastens death, because patients forego hospital treatments and are allowed high-dose narcotics to combat pain. But multiple studies show otherwise.”

He adds, “For some conditions, hospice care seemed to extend survival. Those with pancreatic cancer gained an average of three weeks, those with lung cancer six weeks, and those with congestive heart failure gained three months. The lesson seems almost Zen: you live longer when you stop trying to live longer.”

Gawande, a practicing physican in Boston, reports that most terminally ill cancer patients have had no discussion with their doctors about their goals for end of life care despite being within months of death. But those patients who enrolled in hospice, suffered less and were better able to interact with others forlonger period of time. “People who had substantive discussions with their doctor about their end of life preferences were far more likely to die at peace and in control of their situation and to spare their family anguish.”

Is A Hospice Program Right For Your Mom Or Dad?

Mom's 90th BirthdayWhen the medical director of my mother’s assisted living residence called me I was curious to know what she wanted to talk to me about. After informing me how much everyone at the facility loved my mom she then made a statement that took me by surprise. “I think you mom would benefit greatly by going into a hospice program.”

My thoughts immediately jumped to “Oh my God, she’s about to die. The end is very near.” The next day a hospice nurse visited me and explained to me what hospice was and whom it could benefit. She did state that in order to qualify for hospice an individual is expected to die in 6 months or less. But she added that some patients have been in hospice for a year or more. And in some cases they have improved so much they are taken off of the program.

I learned that Medicare would pay for an upgrade to her wheelchair that would make her much more comfortable and provide for any other medical equipment she needed. A nurse would be assigned to her who would monitor her condition weekly, review her medications and report back to us if any changes in her condition occurred. In addition a home health aid would visit her three to four times a week to bathe her or provide any other personal care that would benefit her.

She would be assigned a social worker that could assist her and our family with any emotional support that was needed. An experienced physician would participate in the development of her care plan and oversee her medical regimen. And all of these services would be fully covered by Medicare.

Within two days the nurse had visited her, made specific recommendations to changes in her meds and brought in a new mattress and a more comfortable wheelchair for her. I was amazed at how quickly she went into action and how knowledgeable she was about the aging process.

I had noticed for a few months that my mother had deteriorated significantly but I wasn’t sure how to deal with this and who to talk to. The hospice nurse made it clear to me she was available 24 hours a day, seven days a week if I had any questions or concerns. I immediately felt much more comfortable knowing that someone was watching her situation closely and would be available whenever we needed her.

If you have a family member who is beginning to show signs of slipping away I would recommend strongly that you find out more about the hospice program and have a hospice nurse visit you to answer your questions. In most cases she will do an evaluation of your loved one at no cost. The website for the National Hospice and Palliative Care Organization (www.nhpco.org) will help you find a hospice organization in your area.

Consider a POLST Form for an ailing parent

images-1In 2011 I wrote a post that describes DNR’s (Do Not Resuscitate Orders) http://parentcareplanning.wordpress.com/2011/05/26/do-not-resuscitate/

“A do not resuscitate order is a binding legal document that states resuscitation should not be attempted if a person suffers cardiac or respiratory arrest. A DNR does not affect any treatment other than that which would require intubation or CPR. Patients who are DNR can continue to get chemotherapy, antibiotics, dialysis, or any other appropriate treatment.

If you have an ailing family member who does not wish to be resuscitated they should complete this document and have it signed by their physician. But please be careful to use the form approved in your state.

This summer I attended an excellent seminar presented by Amy Florian, founder of Corgenius, www.corgenius.com. Amy described another tool that can be used to supplement the DNR. It is called the POLST form.

POLST stands for Physician Orders for Life Sustaining Treatment. It is is a form that gives seriously-ill patients more control over their end-of-life care, including medical treatment, extraordinary measures (such as a ventilator or feeding tube) and CPR.

The POLST Paradigm is an approach to end-of-life planning emphasizing: (i) advance care planning conversations between patients, health care professionals and loved ones; (ii) shared decision-making between a patient and his/her health care professional about the care the patient would like to receive at the end of his/her life; and (iii) ensuring patient wishes are honored.

As a result of these conversations, patient wishes may be documented in a POLST form, which translates the shared decisions into actionable medical orders. The POLST form assures patients that health care professionals will provide only the treatments that patients themselves wish to receive, and decreases the frequency of medical errors.

The National POLST Paradigm originated in Oregon in 1991 as leading medical ethicists discovered that patient preferences for end-of-life care were not consistently honored. Recognizing that advance directives were inadequate for the patients with serious illness or frailty– who frequently require emergency medical care – a group of stakeholders developed a new tool for honoring patients’ wishes for end-of-life treatment.

Although the POLST Paradigm began in Oregon, it quickly spread to other states, which tailored the paradigm to fit their unique legal, medical, and cultural contexts. Among the first states to develop POLST Programs were New York, Pennsylvania, Washington, West Virginia, and Wisconsin. These states – and others – have become leaders in improving the POLST Paradigm and demonstrating its importance to achieving patient-centered outcomes.

You can go to the POLST site to determine if there is a POLST program approved in your state http://www.polst.org/programs-in-your-state/