Category Archives: Elder Law

Food, Feelings and End of Life Wishes

The New York Times has a recent article about Food and the Dying Patient. It talks about a patient with dementia who could no longer swallow. When they tried to feed her she aspirated the food into her lungs which was causing pneumonia. The doctors turned to the family to decide whether they wanted a feeding tube surgically put into the patient’s stomach to deliver nutrition.  In this case, the family felt as though not putting the feeding tube in was cruel, because she would be hungry.

The next day, my patient was wheeled down to the operating room for her feeding tube, then a few hours later wheeled back to intensive care. Over the next couple of weeks, her sister sat on a chair beside her most days, wearing the requisite paper gown and gloves for guests of patients with resistant bacteria from prolonged hospital stays. She sat off to the side, separated from her sister by tubes, bedrails and the bustle of activity around them.

The patients family thought they were doing the kind thing, but as the physician points out:

But contrary to popular belief, a feeding tube does not prolong life in a patient with dementia. It actually increases suffering. A stomach full of mechanically pumped artificial calories puts pressure on an already fragile digestive system, increasing the chance of pushing stomach contents up into the lungs. And surgically implanted tubes are a setup for complications: dislodgments, bleeding and infections that can result in pain, hospital admissions and the use of arm restraints in already confused patients. But maybe most important, the medicalization of food deprives the dying of some of the last remnants of the human experience: taste, smell, touch and connection to loved ones.

Prior to reading this article, I hadn’t thought about the possible down sides of feeding tubes for patients in this type of situation, where they would need the feeding tube until they died. (There are some cases, such as a person receiving radiation for cancer of the mouth or neck where short term feeding tubes are necessary and helpful.)

The thing I took away from it was that educating yourself on what the pros and cons of various procedures are at different point in an illness is vital. Thinking about scenarios ahead of time so that you can communicate your wishes to your family, and understanding the pros and cons if you are the person faced with making the decision are crucial steps in the process. Someone who may want a feeding tube for a short period of time to restore health, may not want one if it will simply delay death and possibly cause further complications or confusions in the patient.  The more information you and your family have about your condition and the suggested treatments the easier it will be to make decisions that are in line with your wishes.

Supporting Your Sibling Who Is a Caregiver

A lot of my clients are caregivers. They are adult children of parents whose health is failing, whose house may be falling apart, whose mind is fading and whose world is dwindling. They are the sibling of a person who has and will be dependent upon someone due to intellectual disabilities or severe mental healthContinue Reading

Moving An Out of State Guardianship To Massachusetts

Here is a scenario that happens everyday: Sue Jones lives with her daughter Mary Jones in Georgia. Mary has intellectual disabilities and Sue was appointed as her guardian by a court in Virginia. Sue and Mary move to Massachusetts. Sue visits with an attorney to make sure everything is in order and asks “does myContinue Reading

Happy Health Care Decisions Day!

April 16th is National Health Care Decisions Day.  While some of the seemingly fake holidays can make one roll their eyes, others, like Health Care Decisions Day (and Be Kind To Lawyers Day) are valuable reminders to pause and take care of important business. We are all in charge of our own health care decisionsContinue Reading

When Should I Write My Will? A Lesson from House, M.D.

I was watching a rerun of House, MD last night. One of the main character doctors became severely ill over the span of a couple of days. Finally, in severe pain, he was going to be put into a medically induced coma with the chance he might not survive. At this point he feebly tellsContinue Reading

Plymouth County Tracking For People With Alzheimer’s

There have been several local incidents over the past couple of months of people with Alzheimer’s who have wandered off. While most of them were found unharmed, in one of these cases, the man was found deceased a few days later. Even if the family has someone with the individual at all times, there isContinue Reading

Nursing Home? Rest Home? Assisted Living? Making Sense of Housing Options

There are several types of housing available to older and frail people in Massachusetts. Sometimes the different names can be confusing. I have outlined below three of the most common types. Nursing Home: A nursing home is licensed by the Department of Public Health. It provides 24 hour care for people – either those receivingContinue Reading

Avoiding Telephone Scams

It seems like every other week there are reports from the Hingham police or Massachusetts attorney general about telephone scams targeting seniors. While it is impossible to keep track of all of the variations, there are some themes that should make you suspicious.  These warning signs can also be applied to email scams. Beware ofContinue Reading

Gifts for Aging Parents (and other people who don’t need more stuff)

I remember when I was little trying to figure out a gift for my nana at Christmas. My mother used to to tell me that my grandmother didn’t want more stuff, but rather something from our heart.  A picture, a sleepover (where she let me cheat at go-fish and eat chocolate chips) or some helpContinue Reading

How To Talk About Your Wishes With Your Family

I encourage my clients to speak with their families about their estate plans and end of life wishes to make things easier on everyone during a crisis. I sometimes suggest that far flung families do this during get-togethers over the the holiday season. There are even services like Death Over Dinner that can help youContinue Reading