This is the 16th installment in the Critical Dementia Skills (CDS) series. For more information on the series, start HERE. You can also click on the CDS tags in the blog for more.
In CDS #9, we discussed making your healthcare wishes know as it relates to a healthcare proxy and living will at the end of life.
In this article, we will step back a bit and discuss what matters overall in life that will influence end of life care wishes, but also healthcare before that stage. In other words, this is something that will start shaping your healthcare today.
As an example, consider Mrs. T. She is a care partner to her husband who has young-onset dementia at age 60. Mrs. T has a chronic heart condition and has survived a heart attack in the past. Her doctor asks her what is really important to her and the answer is not surprising; she wants to avoid another heart attack so that she can keep her husband living at home for as long as possible. Mrs. T also has several grandchildren and she enjoys every opportunity to be with them.
Ideally, a physician or other medical provider initiates this conversation and there is currently a movement by the Institute for Healthcare Improvement (IHI) to educate providers about this important start. IHI is a secular organization with some worthy education and tools that I will link to at the bottom of the page. The tools seem to ask questions and do not give advice, so please know to always use a Catholic-lens when considering your actual healthcare decisions.
The conversation about “what matters’ can happen at an annual check-up, but also at a new diagnosis, a hospitalization, or life event (e.g. retirement).
Since he knows Mrs. T’s motivations to be as healthy as she can be for her states reasons, Dr. M is confident that she will stick with his recommendations to eat sensible meals most of the time, find time for physical exercise three times a week, and bring in extra help with her husband so she can play bridge every two weeks.
Dr. M takes an interest in Mrs. T’s spiritual life because he understands it as a potential source of meaning and strength to help her as a care partner. Mrs. T is a convert to the Catholic faith and he encourages her to keep up her practice and consider meeting with her pastor about her challenges as a care partner and about what matters in this area. She expresses her desire (for her and her husband) to be in a state of grace and they are able to schedule regular confession and reception of the Eucharist. Mrs. T is also able to arrange for Anointing of the Sick for her husband.
A great deal has happened since Dr. M kicked off the conversation about “What matters” with Mrs. T. She was able to express what was important (her husband and grandchildren; being in a state of grace) and Dr. M recommended several things to increase the chance of continuing what matters (diet, exercise, socialization, pastoral care), documenting all of it in her medical record/plan of care.
Let’s imagine that your physician does not start this conversation of “What matters” with you. As an educated client of your doctor, you have the opportunity to let him or her know. This goes back to being an advocate (CDS#13) and we encourage you to revisit that article.
Mrs. T was an easy example. What about Mr. J who is 88 years old, widowed, and a dozen medications for chronic conditions, and could use a knee replacement? Does he need all of the medications or are they causing unintended side effects? Does Mr. J get the knee replacement surgery? Dr. M would start in the same place, “What Matters” to see what Mr. J values.
Questions for you to think, write down, and share in the comments section (any or all):
- Has your doctor asked you “What Matters”?
- Would you be comfortable initiating this conversation with your doctor/nurse? Why or why not?
The Institute for Healthcare Improvement have some example videos about “What Matters to You” here.
Thank you for reading this far and for commenting. Let’s tell hundreds more care partners about this concept by sharing the article. God bless you.
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