topic | preparing for end of life - final days

Step 2: determine if a change of residence is required

Diagnosis of a terminal condition will precipitate a discussion regarding any changes of housing. Taking into account the loved one's current residence, services and options to consider include:

  1. At home supplemented with home health care. Home health care provides a wide array of services that are usually less expensive and more convenient than a hospital or skilled nursing facility.
  2. Additional needs can also be provided through home health care at an independent living facility. This is a community environment that allows seniors to be on their own, but have the availability of transportation, recreational activities, meals, and housekeeping.
  3. Assisted living is similar to independent living, except that residents also receive assistance with the basic activities of daily living, including grooming, exercise, and medicines (in some states).
  4. Nursing homes: These facilities provide nursing care for people who cannot live in an assisted living environment.  They are provided with 24 hour care and medicines for their treatment.
  5. Hospice is specialized medical care and practical support for patients facing a terminal or life-limiting illness. Hospice provides patients medical relief from pain and other symptoms, as well as emotional and spiritual support for both patients and their loved ones. The hospice care team includes a physician or nurse practitioner, nurse and certified nursing assistant, counselor, chaplain, and volunteer. Care plans are developed and tailored to each patient’s specific needs and wishes, and care is offered wherever a patient resides – in their home, in long-term care or assisted living facility. Some hospice providers offer inpatient options for acute care needs. Medicare, Medicaid and most private insurance plans cover hospice care, including in-home services, medications, equipment, and short-term inpatient crisis care.

Considerations affecting choice of the options above include current housing, healthcare requirements, life expectancy, family dynamics, financial status, and end of life preferences.


Activity 1
Identify healthcare needs.

Factors for consideration include:

  • day-to-day medical needs
  • safety
  • environmental security
  • dietary requirements
  • general comfort

Also consider capabilities of the current care giver.  Have time, physical requirements, and healthcare skills become too burdensome for the current care giver?

Best Practices

Safety is a very important part of this activity.  For example, 'is it time to take away the car keys?'  Automobiles are the mark of independence. Approaching this subject should be thought through. 


Activity 2
Determine life expectancy.

Life expectancy impacts housing options available.

  1. Generally speaking, hospice is a last resort. Physician certification that there is less than six months of life expectancy is required.
  2. Home care may be a viable option if the expected remaining life is short, but may not be appropriate for a long-term situation.
  3. Nursing homes typically cater to long-term situations.


Activity 3
Evaluate family dynamics and financial circumstances.

Many dynamics impact the choice of where to spend the final months:

  • possible feelings of abandonment by the loved one
  • family consensus
  • financial issues
  • distance from family, friends, and familiar surroundings

Estimate total expenses for end-of-life care and assess available Medicare, Medicaid, insurance coverage, and family resources.

Generally, Medicare does not cover long term 'custodial care' and is designed to cover only those medical expenses deemed necessary. For example, to be eligible for home health care coverage the following rules apply:
  • under the care of a doctor and receive services ordered by the doctor
  • certified by the doctor that one or more of the following services are required:  intermittent skilled nursing, physical therapy, speech-language pathology
  • Medicare approved facility
  • 'homebound'

Best Practices

Elder Law attorneys negotiate Medicare reimbursement. We recommend contacting an attorney that specializes in Elder Law.


Activity 4
Solicit outside opinions and make decision

It is recommended that a Medicarespecialist and the attending physician (see Medical Contacts) be contacted prior to making any commitment to a change of residence.

If the families cannot come to a consensus on a long term plan, they might consider asking clergy, the attending physician, or a non-partisan friend for guidance.

Best Practices

Geriatric Care Managers are skilled in care planning, crisis intervention, moving to or from care centers, etc.  They are particularly helpful in assisting distant relatives with the management of an elder person.  To find a Geriatric Care manager, enter your zip code in the box on the left and click on Home Health Care providers or go to www.caremanager.org.




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