Everybody dies and how we plan for the inevitable is important, says Mercy Health-Lourdes Hospital hospice and palliative program director Dr. James Long.
Long knows everyone is "scared to death of dying," but wants people to start talking about and thinking about what they want for their end-of-life care. He stressed the importance of this before a crowd of Paducah Rotary Club members Wednesday in the Myre River Room of the Carson Center, as he went over types of medical care, its benefits, advance directives and other related information.
"We get with our families. We talk about retirement," he said, during the club's weekly meeting. "We talk about college. We talk about marriage. We talk about all these things. We discuss these milestones, we plan for it, but rarely do we have conversations about how we want to be cared for in end-of-life."
Most people want to die at home, although only about 20 percent of people have that luxury, according to Long, while about 50 percent die in a hospital and about 30 percent in nursing homes.
Long said palliative care intends to reduce the burden of illness in chronically ill patients, and hospice care is part of palliative care's spectrum. Hospice care's goal is for patients to experience "death with dignity" and control, in addition to making different decisions that are consistent with their wants.
"We try to facilitate that with hospice," he said. "Quality is a big thing for us. Quality of life as opposed to quantity of life."
In addition to fewer out-of-pocket expenses, hospice care offers comprehensive management, 24-hour availability, symptom management, spiritual support, bereavement services and can be provided at a patient's home. It's not just for cancer-related conditions, as many believe.
"We take care of a lot of people with Alzheimer's, a lot of people with end-stage lung disease, a lot of people with end-stage heart disease," Long said.
Long also reflected on his work when it concerns the need for advance directives, such as living wills or a durable power of attorney when patients are too ill to speak for themselves. These directives can assist with difficult decisions, including resuscitation and tube feeding.
"As an internist, I can say that this is extremely important," he said. "There are very few things that are worse than having patients have to make a decision in crisis or families making a decision for a patient in crisis. Does that patient want to be on a ventilator if they're in respiratory failure? Have they indicated that? Many times we haven't indicated what we want."
In the end, Long urged Rotary Club members to "have the talk" with their families about what's important to them, to strongly consider advance directives, adding that doing so will help individuals experience death on their own terms.