End of life planning made easier.

BestEndings provides all the information you need to discuss and plan End of Life Wishes with Advanced Care Directives for you and your family.

Caring for aging parents: Chronic Illness >

Heart and kidney failure, frailty, Alzheimer’s, Lung disease, Diabetes, Cancer

Comfort Care and Quality of Life >

The Palliative and Hospice approach: comfort and quality of life is what it’s all about

Understanding Medical Terms and Jargon >

Cardio Pulmonary Resuscitation: CPR; Do Not Resuscitate: DNR; Allow Natural Death: AND

Culture, Traditions and Being Remembered >

Time honored customs can help at life’s end, and to keep memories alive.

Modern Medicine can keep you alive >

Breathing Machines (Ventilators), Feeding Tubes, Dialysis and Medications.

End of Life: Grief and Bereavement >

Knowing what End of Life looks like can ease the process; often grief starts long before the end.

Decision Makers: Consent and Conflict >

Surrogate, Substitute, Agent, Proxy: who will make sure your end of life wishes are followed.

Advance Directives

Advance Directives, Living Wills, Estate Plans, Financial Plans, Power of Attorney, Funeral Plans.

“Kathy’s laid out the information in such an easy to follow and easy to understand. I felt much better equipped when I spoke to my 89 year old mother about completing her Advance Directive.” – Marcie G

“It’s such an emotional topic, but this makes it easier to talk about. It’s also given us lots to think about and helped with the right questions to ask about end of life planning.” – Ruth and Sudhir

“I spent some time on the site to get a better understanding of end of life ‘stuff’ The BestEndings Advance Directives itself only took about 10 minutes to complete and share.”– Kareem

End of Life Planning Blog

Medical jargon: even single-syllable words can confound

Who’d’ve thought that simple, one and two-syllable words – which is one of the the criteria for Grade 6 reading level – could cause so much confusion, upset and medication errors. Out of context, even every-day words can confound. Consider these (true) examples: In a maternity unit, expectant mom is thirsty and hungry. When she asked if she could eat or drink anything, nurse, hurrying to the next patient, answered, “only sips and chips.” Later, same nurse saw, with horror, mom eating potato chips, taking sips of a diet soda. To that mom-to-be, those one syllable words didn’t say sips of water and ice chips. Seeing his patient in the wrong hospital unit, Doc says, and patient hears: “We’re going to get you to a different floor.” After doc leaves, worried patient says to nurse, “The floors are so cold. Will I have a blanket on the other floor?” Son, taking his elderly mom to the doctor to have her rash checked out. First visit, no source was identified. Second visit, doctor said rash was static. Until the third visit, 3 months later, when doctor said the words: “the condition of the rash hasn’t changed”, the son had tried to find a fabric softener that’d reduce static in mom’s clothes. Early evening, as I was leaving an office building, one of cleaners in the elevator with me sighed so mournfully I asked if she was ok. “My husband is going for by-pass tomorrow. Last year, the doctor told him to take coated Asprin©. We didn’t understand coated, so he didn’t take it. Now he’s in the hospital.” (Note this... read more

Multiple Medications: too many for too many of us

By age 65, two thirds of us are taking 5 or more prescription medications a day so reports the Canadian Institute for Health Information (CIHI). Not included in that total is the number of times a day meds are taken. And it doesn’t include whatever non-prescription therapies we take. That’s a lot of swallowing, a lot to remember, and that’s certainly a lot of chemistry and chemicals acting and interacting in our bodies. Many drugs cause side effects, that require additional drugs to manage them. And too many of certain drugs together can mimic symptoms of alcoholism, substance abuse and Dementia. The Centre for Addiction and Mental Health (CAMH) , Choose to Change: A Client-Centered Approach to Alcohol and Medication Use by Older Adults  details those outward appearances that can be the result of medications: Confusion, disorientation, recent memory loss,slowed thought process,loss of muscle coordination, tremors, gastritis, depression, irregular heartbeat, high blood pressure, malnutrition, dehydration. In my conversation with  Dr. Paula Rochon, VP Research at Women’s College Hospital in Toronto, whose passion is medications as relates to the elderly, her strong recommendation: “Get medications reviewed regularly by a pharmacist. Ask questions that will help fit these meds into your lifestyle. If a pill is so large it’s hard to swallow, ask about tips to make it swallowing easier. Get specific about how to take it: if you’re not a big breakfast eater, and the meds indicate ‘take with food’ – determine what’s considered ‘food’.” For my thoughts on medication confusion, check out 10-second... read more

Alzheimer’s Caregiver, Daughter-in-law

Tina’s story of Alzheimer’s: love and understanding I was fortunate enough to walk through a journey of Alzheimer’s by my father-in-law’s side. Together we mastered the mysteries, the fears and the utter atrocity that the disease brings and we also discovered a deep rooted love and admiration for each other. He was 65 when he forgot his own birthday party My father-in-law, Poppa as he was known by family, was 65 when he forgot to attend the birthday party we were hosting for him. That is how the disease first introduced itself. As a family we all took on different roles. Some did his finances, others his legal counsel and I did the visiting. Being the extended member of the family, Poppa’s finances and legalities were not my business nor my strength. People and patience were and so began my adventure with Poppa and my role as a caregiver and battler of Alzheimer’s. I had never met the disease before, yet in today’s world technology gives us a library of information right in our own laptop. So I read, researched and spoke to anyone who would take a call. I learned quite quickly that Alzheimer’s would bring with it demons for Poppa that I would never be able to see or reason with. In order for Poppa to deal with those black thoughts I had to ensure that with every visit I arrived in a positive and open to anything kinda mood. Good days and bad days There were good days and there were bad days. The good days are when he recognized me or knew me as someone... read more

Dementia and Alzheimer’s Patients share hope and humour

“I’m 62. I was diagnosed at 46. You do the math” Christine Bryden, Person with Dementia 16 years of living with Alzheimer’s and Christine Bryden’s making the audience of 300 laugh and cry at A Changing Melody: A learning and sharing forum for persons with Early Stage Dementia and their partners in care. No surprise that Alzheimer’s is the second most feared disease (Cancer being #1). What I learned from the Forum helped put that fear into more practical perspective.   On overcoming fear and stigma: Fear of what others may think often prevents getting diagnosis. Get in early and get help early! Your life has meaning. Focus on relationships based on love and connectedness. Don’t let fear mask your worth. Reach out over the barrier of stigma to help overcome fears. (author’s note: doesn’t that apply to many health issues?) (An example from an audience member) “I talk to people in airplanes about having dementia. At first, they simply don’t believe it.”  (love it: educating a captive audience) From Mary McKinley, Canada (who organizes social events at retirement home, she uses an online journal set up by her son.) “Feeling is, we with dementia have no insight. That is so wrong! I have to use drugs to help deal with anxiety in others. Noise and sound are amplified. Multiple conversations are  really hard. Part of my brain that controls anxiety has no sense of proportion; Key words are: SLOW DOWN! The processor in my brain is struggling. When I need I quiet time, hiding out in the bathroom is a solution. However, my brain doesn’t send ‘bathroom’ signals.... read more

Grief and Grieving: death, dying and beyond

Grief and grieving: in life and death For each of us, our Book of Life has many chapters on grief and grieving, covering a broad spectrum: I can still conjure the pang of loss when my youngest went to Kindergarten;  the sense of betrayal caused by the end of a friendship, and seeing neighbourhoods change or vanish. I’ve grieved them all. We each grieve differently (I’m always taken aback by those who judge based on lack of ‘expected’ signs of grief) and we each grieve different things: One 30 year old grieves her thick auburn hair turning gray, while a 65-year old grieves her 40-year old son going bald. When it comes to aging and illness I am learning  – although not necessarily articulated as such – we grieve losses along the way: Roberta, 70, grieves arthritic knees that prevent her running – an activity that calmed her brain while keeping her fit. Then, there’s the grief and grieving that comes with end of life and death –  warranting separate chapters in our Book of Life. That grief is so specific that Meghan O’Rourke, in her book The Long Goodbye – written after her mother’s death,  quotes  Iris Murdoch: “The bereaved cannot talk to the un-bereaved.” It’s true that many of us are uncomfortable, uneasy and untrained in response to grief of any kind. However, for a death, there are long- practiced traditions and rituals in our respective cultures that have served as time-honoured comfort for those benumbed including our communities cocooning the bereaved. In some societies, there is no recovery from the grief brought on by death. Yet,... read more

As we age, do we become too thin-skinned?

In a word: Yep. Our skin thins and gets dry Thin, dry skin often gets itchy. And that can lead to a mess of problems. Hence, the expression: thin-skinned. Perhaps not as talked about as the other issues of aging, but should be – considering how much skin we have. Dr Richard Usatine my fellow Society of Teachers of Family Medicine (STFM) is a primary care doc and lead author of The Color Atlas of Family Medicine. A lesson in elder-skincare “Our glands produce less natural oil which leads to dry skin. We scratch and we pick and broken skin can lead to infections. often the backs of our hands and forearms that are first affected.” In addition to the natural aging process, there are factors that influence the thinning of the skin: genetics, lifestyle specifically sun exposure, smoking and alcohol, and some medications can make skin more sensitive. What to do to protect our skin? The good doc offers these tips: Gloves: for gardening, biking, cleaning. Moisturize: doesn’t have to be expensive product. Good time to moisturize is after a bath or shower – which should not be too hot. Gentle cleaning, proper drying and staying dry – including sweaty parts like armpits, folds of skin, groin – can help prevent skin break-down. Keep hydrated: drink more water. Alcohol doesn’t count. Eat properly: good nutrition helps in so many ways Wear a hat: The tops of our heads also need care: skin thins there, too. Use sunscreen and stay out of the sun, especially between those hottest hours 11 – 3pm. Feet: a high-risk area – as those... read more

Alzheimer’s Caregiver, Daughter-in-law

Tina’s story of Alzheimer’s: love and understanding I was fortunate enough to walk through a journey of Alzheimer’s by my father-in-law’s side. Together we mastered the mysteries, the fears and the utter atrocity that the disease brings and we also discovered a deep rooted love and admiration for each other. He was 65 when he forgot his own birthday party My father-in-law, Poppa as he was known by family, was 65 when he forgot to attend the birthday party we were hosting for him. That is how the disease first introduced itself. As a family we all took on different roles. Some did his finances, others his legal counsel and I did the visiting. Being the extended member of the family, Poppa’s finances and legalities were not my business nor my strength. People and patience were and so began my adventure with Poppa and my role as a caregiver and battler of Alzheimer’s. I had never met the disease before, yet in today’s world technology gives us a library of information right in our own laptop. So I read, researched and spoke to anyone who would take a call. I learned quite quickly that Alzheimer’s would bring with it demons for Poppa that I would never be able to see or reason with. In order for Poppa to deal with those black thoughts I had to ensure that with every visit I arrived in a positive and open to anything kinda mood. Good days and bad days There were good days and there were bad days. The good days are when he recognized me or knew me as someone... read more

Dementia and Alzheimer’s Patients share hope and humour

“I’m 62. I was diagnosed at 46. You do the math” Christine Bryden, Person with Dementia 16 years of living with Alzheimer’s and Christine Bryden’s making the audience of 300 laugh and cry at A Changing Melody: A learning and sharing forum for persons with Early Stage Dementia and their partners in care. No surprise that Alzheimer’s is the second most feared disease (Cancer being #1). What I learned from the Forum helped put that fear into more practical perspective.   On overcoming fear and stigma: Fear of what others may think often prevents getting diagnosis. Get in early and get help early! Your life has meaning. Focus on relationships based on love and connectedness. Don’t let fear mask your worth. Reach out over the barrier of stigma to help overcome fears. (author’s note: doesn’t that apply to many health issues?) (An example from an audience member) “I talk to people in airplanes about having dementia. At first, they simply don’t believe it.”  (love it: educating a captive audience) From Mary McKinley, Canada (who organizes social events at retirement home, she uses an online journal set up by her son.) “Feeling is, we with dementia have no insight. That is so wrong! I have to use drugs to help deal with anxiety in others. Noise and sound are amplified. Multiple conversations are  really hard. Part of my brain that controls anxiety has no sense of proportion; Key words are: SLOW DOWN! The processor in my brain is struggling. When I need I quiet time, hiding out in the bathroom is a solution. However, my brain doesn’t send ‘bathroom’ signals.... read more

Alzheimer’s and Restraints: Benefits and Risks

To restrain or not to restrain Until I met Sylvia Davidson, the word restraints scared the bejesus out of me, conjuring up straight jackets, handcuffs, ropes tape over mouth and struggling terrified restrainees. (clearly, I’m watching too many crime shows). That was B-S: Before Sylvia – Advanced Practice Leader, Geriatrics at Toronto Rehab and past President Ontario PsychoGeriatric Association. In Sylvia, I found a woman whose first concern is what’s best for the patient. Considering her patient population has dementia, gaining an understanding of the patient, to determine what’s best for them, is not all that dissimilar to a crime investigation – where the goal is to gain trust towards getting the truth. More than technical skills, this requires an emotional connection. “Nurses here are schooled in the 3 D’s: Delirium, Depression, Dementia. It’s our job to figure out who and how he/she was before dementia.” The Restraints Minimization Act describes when they are to be used: “for the prevention of serious bodily harm to a patient or to others”. There are three categories of restraints: Chemical Environmental Physical Before restraints of any kind are considered, there has to be consent – usually from the surrogate/substitute decision-maker, who is made aware of risks and benefits, a couple of examples of which are: Benefits: facilitating activities, calming and preventing harm. Risks: becoming more agitated, not being able to get to the bathroom (incontinence), being more unsteady afterwards. With consent, a comprehensive assessment process – with the family and the patient at its center. “Family members are so important because they knew this person before dementia set in. If we learn... read more

Medications: work differently and more dangerously as we age

Drug Use and Seniors 1 in 5 over age 65 are taking 10 or more prescription medications, 1 in 20 are taking 15 more so reports Canadian Institute of Health Information (CIHI). Not included in that total: the number of times a day meds are taken and non-prescription products. Not detailed are medications taken to counteract side effects of medications, and whether medications are being taken properly. That’s lot of chemistry and chemicals acting, reacting and and interacting in our bodies and huge room for error: the Institute of Medicine (IOM) reports more than a million (U.S.) hospitalizations and emergency room visits are the result of an ‘adverse event’. Some of the medication errors I’ve heard about, that can lead to serious harm: Directions said: take one when you wake up. 80-year old man nods off during the day, and takes one every time he wakes up. This is only discovered at a family get together when his 3 children realize they’ve each been getting his prescription refilled. Capsules for an ear infection: put in the ear instead of swallowing. Capsule for a puffer wrenched out of puffer-enclosure and swallowed. Take twice a day interpreted as two capsules two times daily taken 15 minutes apart. An Australian study, focusing on why seniors are particularly at risk for medication errors: large quantities of medication, trouble opening the package, trouble swallowing, troubling side effects, and confusion — often caused by medications. The Centre for Addiction and Mental Health (CAMH): Choose to Change: A Client-Centered Approach to Alcohol and Medication Use by Older Adults, details outward appearances –  resulting from multiple medications... read more

Comfort: How important is it to you at life’s end?

For many – perhaps most – suffering is the biggest worry about life’s end. Suffering doesn’t start and end with pain management. It includes peace of mind and comfort – both of which are highly individual, and can hold the keys to perception of and requirements for a ‘good death’: What comforts you, or what brings you comfort? What are your small pleasures, or what gives you pleasure?  What brings you peace of mind? Comfort and feeling good about herself is the gift a palliative doctor gave to a terminally ill patient who wanted no further medical treatment. He simply asked: “What would make this a good day for you?” “If I could sing” The patient, Dolly Baker (nee Thelma Botelho), was once a renowned songstress.  And sing she did. I have sat in countless meetings, workshops, think tanks, round-tables where everything but the word, comfort is used to help us on the way to as good a death as possible. Amongst the questions commonly asked: What are your values? What are your beliefs? What’s important to you? What are your goals of care? These may may all play into what makes us feel good,  and brings comfort, but these approaches often then require further probing and questioning which takes so much more of that precious thing that’s often in short supply: health care professionals time. Revealing answers, reveal simple solutions Answers about comfort reveal solutions that: often have nothing to do with medical interventions; can bring comfort and joy to attending healthcare professionals; can help family and friends support more purposefully and meaningfully; As a ‘layperson’ whose focus... read more

Bringing Creativity into Clinical Practice with Older Adults.

It was a day of music, arts and drama, of passion and compassion, entitled, Bringing Creativity into Clinical Practice with older adults. Bringing creativity into a Clinic Day brought relief and hope to many working with Dementia and Alzheimer’s patients. The presentation was refreshingly unlike most clinical education and on breaks, we were greeted by a Drum Circle, lead by Terri Segal, Expressive Arts Therapist, Not just a demonstration, we were encouraged to pick up a percussion tool and join in. A combination exercise and mental health break. Another presenter – a psychiatrist –  showed photography assignments from nursing home residents, whose average age was 87, entitled: “A View of the World though the eyes of the Elderly: I’m 90 going on middle Age.” One of the photos – a self-portrait assignment – won first prize at an art show: it had been submitted anonymously and the winner surprised everyone when she wheeled over to accept. Robin Glazer, Director of the Creative Center: Arts in healthcare, in NYC was quick to point out that her ‘arts’ are not the same as Art Therapy. “There is no agenda here. It’s de-stressing and fun. We have excellent artists who are flexible and design their approach to the audience. For example, in a group of Japanese elders, our artist started with simple Japanese brush strokes: something they’d be familiar with.” She told of her own experience – which she attributes to honing her observational skills through art appreciation: “I was invited to Grand Rounds at a hospital that one of our artists is at. I saw a young man with an unexplained... read more

Room 217: Care Through Music

Guest blog by Bev Foster A lot of life happens in rooms and so does a lot of death. One room I will always remember is Room 217, where my mom, five siblings, and I sang around dad’s bedside as he was dying in a hospital northeast of Toronto. Whether it was the lingering words, simple melodies, or our faltering voices, what was undeniable was the calming and soothing impact of our music on dad in this sacred space. Music had been my way of connecting with dad in life, and it became my way of supporting him at poignant moments during the course of his illness. This final experience in Room 217 compelled me to ask some deeper questions. Why was music never offered to dad, live or recorded at the hospital? What did other families do while they waited and held vigil? Did they use music? Would they use music if it was designed for palliative care? Are there especially designed music resources for to accompany families in life threatening or complex care circumstances? The answers to those questions led me to create the Room 217 Foundation in 2009. Our mission is care through music. We do this in three ways: Producing research-informed, and artistically excellent music care resources targeted for specific situations and populations. These resources are ready and easy to use. Providing music care education for caregivers who want to learn how to integrate music into their regular care practice through the annual Music Care Conference, the Music Care Certificate Program, free monthly music care webinars, and workshops. Collaborating on research that optimizes or advances... read more

Medical jargon: even single-syllable words can confound

Who’d’ve thought that simple, one and two-syllable words – which is one of the the criteria for Grade 6 reading level – could cause so much confusion, upset and medication errors. Out of context, even every-day words can confound. Consider these (true) examples: In a maternity unit, expectant mom is thirsty and hungry. When she asked if she could eat or drink anything, nurse, hurrying to the next patient, answered, “only sips and chips.” Later, same nurse saw, with horror, mom eating potato chips, taking sips of a diet soda. To that mom-to-be, those one syllable words didn’t say sips of water and ice chips. Seeing his patient in the wrong hospital unit, Doc says, and patient hears: “We’re going to get you to a different floor.” After doc leaves, worried patient says to nurse, “The floors are so cold. Will I have a blanket on the other floor?” Son, taking his elderly mom to the doctor to have her rash checked out. First visit, no source was identified. Second visit, doctor said rash was static. Until the third visit, 3 months later, when doctor said the words: “the condition of the rash hasn’t changed”, the son had tried to find a fabric softener that’d reduce static in mom’s clothes. Early evening, as I was leaving an office building, one of cleaners in the elevator with me sighed so mournfully I asked if she was ok. “My husband is going for by-pass tomorrow. Last year, the doctor told him to take coated Asprin©. We didn’t understand coated, so he didn’t take it. Now he’s in the hospital.” (Note this... read more

Grief and Grieving: death, dying and beyond

Grief and grieving: in life and death For each of us, our Book of Life has many chapters on grief and grieving, covering a broad spectrum: I can still conjure the pang of loss when my youngest went to Kindergarten;  the sense of betrayal caused by the end of a friendship, and seeing neighbourhoods change or vanish. I’ve grieved them all. We each grieve differently (I’m always taken aback by those who judge based on lack of ‘expected’ signs of grief) and we each grieve different things: One 30 year old grieves her thick auburn hair turning gray, while a 65-year old grieves her 40-year old son going bald. When it comes to aging and illness I am learning  – although not necessarily articulated as such – we grieve losses along the way: Roberta, 70, grieves arthritic knees that prevent her running – an activity that calmed her brain while keeping her fit. Then, there’s the grief and grieving that comes with end of life and death –  warranting separate chapters in our Book of Life. That grief is so specific that Meghan O’Rourke, in her book The Long Goodbye – written after her mother’s death,  quotes  Iris Murdoch: “The bereaved cannot talk to the un-bereaved.” It’s true that many of us are uncomfortable, uneasy and untrained in response to grief of any kind. However, for a death, there are long- practiced traditions and rituals in our respective cultures that have served as time-honoured comfort for those benumbed including our communities cocooning the bereaved. In some societies, there is no recovery from the grief brought on by death. Yet,... read more

Create your own end of life Advance Directives Care Plan and share your completed plan with everyone who matters to you

Start Now