Do you need or have a living will in Arizona? Then you need to read this article, especially if you don’t know about some troubling aspects associated with assisted living and hospice care. We are going to show you two disturbing realities that you should avoid if a peaceful end of life is important to you or someone you love.
As a certified end of life doula I attend many deaths. GoGracefully has been in Arizona for the last 3 months, supporting my 95-year-old uncle, who was diagnosed with terminal cancer. To see what Uncle Sonny had to say about the work we are doing click here on this video. Well, I am sorry to say we lost him on Christmas Eve, but not in the way that you are thinking.
At GoGracefully we are always promoting spiritual consciousness over material preparations, when it comes to end of life. Because of this, we were prepared to gracefully deal with a horrendous situation that came to a head on Christmas Eve. Hospice and the assisted living center he lives in failed him. And they will fail you, too, if you do not avoid the pitfalls we are about to share with you.
The Importance of a Living Will
First, let’s talk about the importance of a living will. Arizona is the state where my uncle created his living will, however, what I am about to share with you applies to all 50 states in the union. A living will is an important legal document because it communicates your wishes and gives your loved ones guidance in making difficult decisions when you are unable to do so yourself. On the services page at GoGracefully.com we provide a link to create all your essential documents, including a living will for any state. You can create your living will and all your estate planning documents for less than $40.
Uncle Sonny’s living will was very specific with respect to how he wanted his pain managed. He did not want opiates unless his pain became unbearable, and he wanted all other medications to allow him to keep his mental clarity for as long as possible. Not only did he write this in his living will for Arizona, he also expressed it verbally to me on multiple occasions.
Being his medical power of attorney, I took his living will for Arizona very seriously. In the months I spent with him he was never in such severe pain that I could not support him using alternative therapies like guided meditation and massage to relieve his discomfort. Often times, I could help reduce his pain of 6 on the 10 scale down to a zero within 30 minutes.
Uncle Sonny was a unique person in that he lived his life largely outside the paradigm of modern medicine. He shopped at health food stores, had cabinets full of supplements, opted for massage and chiropractic care, and maintained a strong and vigorous body until his cancer diagnosis. Even then, he insisted that he could cure himself of a massive stage 4 cancer in his chest. His tells of spiritual consciousness and faith in a very touching way in our video entitled “Estate Planning vs End of Life Planning.” I encourage you to watch it!
How Hospice & Assisted Living Will Fail You
And now the sad part. I am referring to him in the past tense here, not because he has died, but rather because his mental clarity has been eroded by the failure of both hospice and the assisted living center he trusted with his care. Both companies failed to honor his living will.
In essence, due to internal policies and procedures, these companies were unable to honor his most important wish for mental clarity at end of life. His deterioration was painful to watch and I did my very best to insist that both hospice and the care center honor his wishes. My efforts failed due to entrenched beliefs, inflexible policies, and even hostility. Within hours of telling the director of the care facility that she needs to honor his living will in Arizona as it is written, a new living will in Arizona was created. I was removed as the medical power of attorney. You might be asking how this could happen?
Simple, convince the patient to change his living will. Patients on strong medications, like opiates can be easily influenced. A new living will—complete with a new medical power of attorney—is just a signature away. Remember, a physician must declare the patient is mentally incompetent before the medical power of attorney springs into action. Interestingly, the patient will likely never see another physician once hospice is assigned. There are also no physicians on duty at assisted living facilities.
If you or your loved one value mental clarity at end of life, and don’t want to be doped up on haloperidol and morphine like my uncle was, consider these potential pitfalls as you decide on end-of-life care. These hazards are particularly relevant when either hospice or assisted living facilities are involved.
The Pain Management Pitfall
The first pitfall is a cultural phenomenon related to modern medicine and pain management. In short, most people today are more afraid of pain than they are of actually dying. Couple that with modern medicine’s ability to relieve pain in seconds and suddenly alternatives become too costly or time consuming. Forget not, there are also costs for such quick relief. Those are loss of mental clarity, drug side effects, and dependence on highly addictive opiates.
So, how did we die before opiates? Certainly many people suffered, however, many others received comfort and love by those close to them. Loving touch and massage were essential to end of life care. Acupuncture, hypnosis, guided meditation, and herbal remedies were—and are still—part of a good end-of-life care plan. Moreover, greater emphasis was placed upon mental and emotional preparation for death. In many cultures, death and the associated pain were an essential rite of passage. Am I saying that modern people have become cowards? That is for you to answer for yourself, but I can assure you, my uncle was not a coward when he wrote these words in his living will for Arizona:
“I wish to die naturally with minimal interventions. Please minimize pain management with opiates and other mind altering medications unless I am in severe pain.”Edward Milton Barber III
The second downside when blending hospice and assisted living is the bureaucracy involved. Both types of care are governed by extensive laws and regulations. Additionally, such institutions adopt policies that enable them to function in the difficult climate of rules and regulations they must comply with. Allow me to make this more understandable.
As a hospice volunteer for the past 10 years I have sat in the homes of many a dying person receiving hospice care. In these homes I witnessed hospice provide what is often referred to as a “comfort care kit.” These kits include many different drugs and tools to support difficult end of life situations. If a family is wise enough to obtain the assistance of an end of life doula, the family will also be benefitted by having an on-site guide and resource for addressing the challenges that come up at end of life.
In these situations, bureaucracy is virtually eliminated. The patient is able to make clear their wishes and families are able to carry them out. If mental clarity is a top priority, it will most certainly be honored using the alternative therapies mentioned above. In my years with hospice, I have witnessed many unopened bottles of morphine returned to hospice after the patient’s death.
Watch Out Boomers
When this is contrasted with the care my uncle received, we get a glimpse of an ugly phenomenon that will only get worse as the baby-boomer generation ages. In Uncle Sonny’s case, the system seemed unable to respond in any other way than giving drugs. After all, the hospice nurse shows up once or twice a week for an hour where his bodily functions are assessed and his drug dosing is reviewed. This is not even close to what a patient needs in terms of care.
This is where the assisted living facility is supposed to fill the void. Yet, they were unable to do so. Here’s why! In the care facility where my uncle lived, there were only two care providers per shift—not even nurses—caring for 20 patients in different rooms. Those rooms housed patients with complicated symptoms and diagnosis including incontinence, dementia, Alzheimer’s, terminal cancer, wheelchair-bound amputees, and more. Each of these patients has medications which are locked in a cabinet and dispensed to patients regularly and audited every shift change.
It should now be clear that even in the presence of a strong advocate for the patients living will in Arizona, or any state, it is a certainty that alternatives to opiates will never be used, there isn’t the time or energy. The bitter irony of this truth is seen by the fact that both the hospice facility and the assisted living center cast me as the villain for standing up for his mental clarity. This act left him without a single family member to love and support him. Indeed, they dubbed me a trouble maker and threatened to escort me from the building and ultimately locked his door to keep me from seeing him for anything other than a supervised visit.
Changing A Living Will is Too Easy
24 hours after my strong petition for my uncle’s rights to both hospice and the care facility, he had a new living will in Arizona and was telling the staff he no longer wanted visits from me. This was just days after they tripled his morphine dose and started him on a regular dose of haloperidol to “help with his agitation and allow him to get some sleep!” You can see for yourself that haloperidol is a strong anti-psychotic drug effecting both verbal and motor control. Certainly, a person on this drug should not be executing a new living will. Sadly, my uncle is no longer even the person I knew just a week ago.
Every living will addresses pain management, yet few people consider the consciousness altering effects of typical hospice drugs. My uncle was someone who did think this through carefully. Nevertheless, the people he trusted with his care let him down. It’s easy to ask someone if they are in pain and hand them a pill. It is much more difficult to talk to them about their pain, offer alternatives, and guide them though it using alternative therapies. My uncle’s experience is typical for anyone wishing to maintain their mental clarity at end of life. Especially, when housed in an assisted living facility and on hospice care. Unfortunately, we need only to follow the money to see how morals can quickly become revalued.
Uncle Dies Alone
I received a phone call on January 13, 2020 from my uncle’s dear friend. She informed me that he died in the early morning hours of the day. She also told me that his favorite nurse (caregiver—not an RN) checked on him at midnight and he was doing fine. Hours later, when she checked on him again, he was dead.
Edward Milton Barber III died alone, in his room, without anyone in attendance. This breaks my heart because of all the lovely conversations I had with him, where he reminded me of a conversation I had back in 1989. He said to me the very week this facility locked me out the following:
Jim, you always said you would be there for me in the end. I can’t believe a young man would have said such a thing 30 years ago. And now you are here with me. This gives me great comfort. I love you.Uncle Sonny
If you want to avoid the two specific businesses that failed my uncle, be sure to check out the google reviews. You can find them by searching Christian Care Cottonwood Arizona and Maggie’s Hospice Prescott Arizona listed in the description below.