Our view: Who knows what your last wishes are?

Sometimes the most awkward conversations are the most rewarding ones.

Most of us know that our end-of-life wishes should be made years — make that decades — in advance. The Conversation Project , an organization dedicated to foster those discussions, found that 90 percent of Americans agree that it's important to make our end-of-life preferences known to our loved ones, yet the same survey found that only 30 percent have had that discussion.

Sometimes people will tell strangers something they're too uncomfortable to tell their next of kin, such as a Gallup poll that found that a vast majority of us — 88 percent — prefer to die in our homes , free of pain, surrounded by family and loved ones.

Hospice exists to make this happen. With November designated as National Hospice and Palliative Care Month , now is the time to have that conversation, no matter how emotionally uncomfortable it can be.

While the hospice concept has been around for 1,000 years, there still are misunderstandings about what hospice care is about, said Darlene Feltes, administrator at Heartland Hospice in Rochester.


"There's a perception that hospice is a place," Feltes said. "It's more of a philosophy of care, not a place. It can be provided in a personal home, a skilled nursing center, an assisted-living center or anywhere else."

Hospice focuses on easing the pain and symptoms of someone who is terminally ill or chronically ill, as well as attending to their emotional and spiritual needs.

The Medicare hospice benefit, which was approved by Congress in 1982, provides full coverage for those believed to have six months or less to live. That should explain away the misconception that hospice care is expensive, Feltes said, but the myth persists.

"They feel they have to save everything so they can pay for their care," Feltes said. "Actually, Medicare covers 100 percent of hospice. There's no deductible and no co-insurance."

Jeff Trotman, Heartland's manager of business development, also said there's a false impression that patients receiving chemotherapy and blood transfusions are not eligible for hospice care, so they don't consider it soon enough, even though those treatments are covered because they ease pain and symptoms.

Another misunderstanding is that hospice is solely for cancer patients. Going back to the 1970s, Trotman said that most hospice patients had cancer, but today more than 60 percent have been diagnosed with another condition. "(Eligibility) really doesn't come from the diagnosis, but rather the prognosis," he said.

When Heartland surveys the patients it serves, most of them wish they had considered hospice earlier.

"A lot of people still look at it as the last two to three weeks of life, but it's really a six-month benefit," Trotman said. "The sooner that hospice can get in there and start helping with mind, body and spirit, working with a full team and getting to know the family, it's very beneficial."


Feltes encourages those conversations, too.

"I have an advanced directive and am glad I was able to do that," said Feltes, who is in her 50s. "My kids now know what my wishes are. And I think it's an important step for everybody."

These are decisions that should be made now, not in a hospital room or in a nursing home by relatives uncertain what to do. The most loving thing you can do is to leave no doubt what your last wishes are.

That way, everyone will be at peace.

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