Back To Top

Would you like to receive our newsletter?

You can stay informed about the latest news from ACCESS Health International! Enter your email address and first name and click Sign Up!

Strategies That Promote a Better End of Life

Print Friendly, PDF & Email

This is a guest blog post by Carol Marak, an aging advocate, columnist, and editor at Ms. Marak is a former family caregiver and promotes active aging. Contact Carol at

The death and dying conversation is top news these days. The recent Medicare ruling allowing hospice payments to cover counseling sessions has placed renewed attention on end of life concerns. Healthcare services in the last year of life constitute roughtly twenty five percent of Medicare services. The new ruling aims to create better quality of care options for beneficiaries with multiple severe and complicated conditions.

Older Americans want to live out their last days at home, but only twenty four percent have the choice. The other seventy six percent pass away in a hospital or nursing home because conditions stand in the way of their preferences. According to the Institute of Medicine (IOM), we are in this situation because many patients, families, and physicians have not discussed and recorded what the individual wants in the event that he or she can no longer commnicate. In this situation, the medical profession does everything it can to prolong life.

The Institute of Medicine has concluded that people need help to manage the healthcare options and services received in emergencies, especially at the end of life. It is essential that families and patients discuss their goals and preferences for medical treatment and to select surrogates who will stand in for them if they cannot speak for themselves.

The Institute of Medicine report Dying in America argues for a national dialogue on death and dying. To make that happen, we need to share our stories. When people hear and read stories about how others cope under distress, it can help normalize otherwise dreaded emotions.

To understand how those in the elder and long term care space can help families and patients become comfortable with death and dying, I asked the Aging Council, an online platform for long term care experts, to share useful strategies that help individuals receive better care at the end of their lives.

Draw Up Legal Documents

“To have a positive outcome, one must have all legal documents drawn, but more importantly, one must express what they want and do not want. People should build a supportive team (palliative care or hospice many times) and advocates (family and professional) to say when enough is enough for medical interventions in their situation.”

-Shannon Martin, Aging Wisely

“Recently, a gentleman called because he just received a diagnosis of Alzheimer’s disease. He felt like his life was already becoming less of his own. Within a week of diagnosis, he hired an elder law attorney to help him prepare his powers of attorney and complete his estate plan, will, and trust documents. By taking action immediately, he was able to participate in the decision making process.”

-Kerry R. Peck, Peck Ritchey

“Make sure that the [Durable Power of Attorney] is up to date and shared with family members. [This document] ensures that everyone is on the same page at the time of a decision. When my dad got pneumonia, we knew what to do and didn’t have to agonize over what to do. I advise that people read articles, watch TV shows, and see others’ experiences as they transition.

-Donna Schempp, Elder Care Specialist

“Our matriarch built a notebook dubbed ‘The Nutshell.’ It contained providers, policies, documents, and even a glaring orange sheet, the front page, giving us instructions to follow at the time of her death. Whether we were distraught with grief, numb with shock, or stoic in crisis, her wishes could be carried out. It afforded structure, timeline, and task sto the persons charged with action.”

-Nancy Wurtzel, NC Navigate

Learn the Palliative Care Options

“Three relatives used hospice within the span of one year, making true believers out of us! Grandfather passed at home, rather than in a hospital, with a focus on pain relief and without extraordinary measures expended. His hospice worker shared guidance, which opened our eyes to the subtle transitions occurring before his passing, helping us face them without fear.”

-Stephen D. Forman, CLTC (Certification in Long-term Care), Long-term Care Associates, LLC

“Most in this situation are going to determine a course for treatment and pain management, or turn to hospice. As a family, we selected one clear path to facilitate the end. We eliminated some of the potential challenges and family dysfunction afterward since we agreed as a family in the care our loved one received.”

-Dr. Eboni Green, Caregiver Support Services

Have Detailed Conversations

“The client knew what he wanted from our conversations. He went to the hospital when his condition worsened, and he was able to stop his painful and futile medical treatments. He recognized the need for hospice and to say goodbye to his family.”

-Eleanor Feldman Barbera, PhD, My Better Nursing Home

“Everything they had discussed was in writing. They documented personal stories and made legal any necessary paperwork to facilitate their wishes. Our friends shared with us how important these things were in confidently proceeding with end of life services. The whole family was in agreement and knew they were following their father’s wishes.”

-Nikki Buckelew, Senior Real Estate Institute



  1. Avatar Carol Marak on March 29, 2016 at 8:53 am

    Thank you for reading the article. I’m the author and hope you find the information useful. If you wish to start a dialog, please do it here by writing a comment.

  2. Avatar Laurie Douglass-Wilson on March 31, 2016 at 9:59 pm

    Thank you for this great article. The use of testimonials makes this important issue relatable and personal. Love the practical advice about having a notebook with instructions and seeking legal counsel for estate/will planning early before health declines further. While awareness regarding end of life issues among the general population has increased somewhat, most lack knowledge of practical steps to take or where to find the resources that can help. Thanks again.

  3. Avatar George Kurian on March 31, 2016 at 11:08 pm

    Hi Carol,

    Thanks to Jean Galiana for sharing your article and drawing attention to some important aspects of Geriatric care in this article which is quite relevant.

    As emphasized in this article, as seniors age, their mental faculties might be hampered due to the aging process or the progression of certain diseases. Such deterioration may adversely impact their ability to take care of their own health and financial matters, particularly so if they are staying with or physically dependent on their own children or a close relative, who might be taking important decisions and even pressurizing the elders emotionally to follow a specific course of action which the seniors have to bear under the circumstances and in the process unwillingly compromising on their own preferences.

    Besides the issue of healthcare preferences, a major cause of discord could be successors who might form contrary expectations in wealth related matters. If they consider the wealth distribution by the senior/parent inequitable, might exhibit dissatisfaction and that could affect the elder emotionally or adversely impact the care in their twilight years on an ongoing basis. For instance an allocation to a Foundation made by a senior out of their wealth for a specific charitable purpose, may be viewed with hostility by a son or daughter if they feel that it substantially reduces their future share of the estate.

    To avoid such situations, it is imperative that the senior be provided counselling support and assisted to engage a hospice service within a reasonable time of health deterioration, to handle and implement such decisions discussed above, with an extent of confidentiality and reliability.

    CA George Kurian
    Sustainability and CSR consultant

  4. Avatar Kim Ratcliff, DNP on April 3, 2016 at 9:12 pm

    I am an independent NP that works in LTC. Most of my discussions about end-of-life care are with family members. I have found that explaining that DNR does not mean Do Not Treat helps the family make that transition easier.
    Also, as an NP in the LTC setting I am expecte to do everything I can to keep the resident in the facility. We have trachs, serious ulcers, etc.
    We are also trying to cut some of that end-of-life expense as well.

Leave a Comment

Modern Aging: inspiring and empowering entrepreneurs of all ages and backgrounds to create businesses to serve the needs of the elderly.
We are no longer active in Strategies That Promote a Better End of Life. Projects and resources are available in the archive.