1. Bosler, Barbara JD, MHE, RHIA

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It is sometimes necessary to overcome preconceived notions about home healthcare before a patient can return home from a hospital stay or skilled or assisted living facility when they can no longer manage on their own. Objections to home healthcare range from concerns of pilferage in the home, to aides and nurses being paid for "doing nothing." Objections can also be the result of fear by family members of not knowing the proper medications to give or how to assist the patient in managing normal activities of daily living when home healthcare professionals have left for the day. Rather than confront and problem-solve the discomfort of having the patient remain in their home or return after a hospital admission, it becomes easier to attack the home healthcare model. Matthews (2016) outlines why long-term home care is not always practical. Depending on the patient's condition, there may be difficulty in coordinating all the care required by nurses, physical and occupational therapists, and overseeing the primary care provider. Family members may be required to fill in when outside services are not scheduled or fall through. And, over time, the cost of home healthcare may become prohibitive. Yet, a patient's desire to return home to recuperate or enjoy their remaining days is real and understandable. Each person's home is familiar to them, made of memories, belongings, smells, sounds, and imagery. All of this brings the comfort of belonging. This column will be devoted to a program developed by Aging with Dignity called Five Wishes to ensure patient desires are carried out.


Five Wishes is a program that facilitates thoughtful consideration on difficult end-of-life decision to be made by the individual with their family and healthcare team. It is the most widely used Advanced Directive in America (Aging with Dignity, 2016, p. 2). An Advanced Directive conveys medical care decisions that a patient wants to be carried out when he or she is no longer able to speak or do for themselves. When properly signed, the Five Wish document is valid under the laws of most states (Aging with Dignity, 2011, p. 2). It was developed by Aging with Dignity, a private, nonprofit organization with the help of The American Bar Association's Commission on Law and Aging and top experts on end-of-life issues in the United States. It was crafted in simplicity, yet carries the power of a fully executed legal document that is currently honored by 42 states to allow patients to enter their end-of-life wishes in their own words, rather than through boiler plate or state-written templates (Aging with Dignity, 2016, pp. 1-2). Aging with Dignity has worked tirelessly over the last 20 years, touching more than 25 million people and their families to advocate for laws and policies that make patient wishes more clearly stated, avoiding cumbersome legal language and nuances.


This program is for anyone 18 years or older and has been used by legal and medical disciplines, faith communities, and healthcare systems because it is straightforward and complete (Aging with Dignity, 2011, p. 3). Five Wishes centers on: My Wish For:


* The Person I Want to Make Care Decisions for Me When I Can't;


* The Kind of Medical Treatment I Want or Don't Want;


* How Comfortable I Want to Be;


* How I Want People to Treat Me;


* What I Want My Loved Ones to Know (Aging with Dignity, 2011, p. 1).



Wish One is the key to all the others: identifying who will be chosen as the healthcare agent to advocate for the patient when they can no longer speak for themselves. The healthcare advocate must be someone who knows the patient well, listens and understands their wishes, and is able to make difficult decisions (Aging with Dignity, 2011, pp. 4-5). Wishes two and three focus on the degree of medical treatment the patient wants or does not want in sustaining life, and specific requests to bring comfort, like playing music, receiving a massage, and/or reviewing palliative care options (Aging with Dignity, 2011, pp. 6-8).


Wish four identifies how the patient wants to be treated by others toward the end of life. This can be holding the patient's hand, not being left alone, and having familiar pictures and mementos close at hand (Aging with Dignity, 2011, p. 8).


Wish five allows the patient to share special words and remembrances with family and loved ones. It can be a request for forgiveness by the patient for a past deed or a request that family remember the patient as they were before they became seriously sick (Aging with Dignity, 2011, p. 9).


The beauty of the program is that each of the five wishes is scripted in straightforward language that already includes examples of items to discuss and consider for each. The patient can add or delete those that do not apply. The last page is the signature page that must be witnessed by two individuals to make this Advance Directive valid. It only needs to be notarized in the states of Missouri, North Carolina, South Carolina, and West Virginia (Aging with Dignity, 2011, p. 10). Page three of Five Wishes identifies the 42 states that honor it as a properly executed Advance Directive and steps to take if a patient already has a living will, advance directive, or other medical durable power of attorney and wants to use Five Wishes instead.


Whether you are young or old, Aging with Dignity and Five Wishes are worth your consideration in helping yourself, a loved one, or a patient think about some of the most difficult decisions ever to be faced in a kind and gracious way. It can be accessed at


If it is a Wish by you or a loved one to receive home care, do your part in making sure it is discussed and documented in the Advanced Directive. You will be grateful you did.


In loving memory of Joan Marie Bosler, 6-12-1924 to 4-8-2016.


The Brew, in Any Form, Might Cut Colon Cancer Risk

Drinking coffee may cut your risk of colon cancer by as much as 50%, a new study suggests. The more you drink, the more you may reduce your risk-and it makes no difference whether the coffee is regular or decaf, researchers said. "The protective effect is not caffeine, per se, but probably a lot of other antioxidant ingredients in the coffee that are released in the roasting process," said senior researcher Dr. Gad Rennert. These findings can't prove that coffee reduces the risk of colon cancer, only that coffee is associated with a reduced risk; however, the association appears strong. For the study, Rennert's team-which included researchers at the University of Southern California's Norris Comprehensive Cancer Center, collected data on more than 5,100 men and women in northern Israel who were diagnosed with colon cancer. These patients were compared with more than 4,000 men and women with no history of colon cancer. All of the participants reported how much coffee they drank, including espresso, instant, decaffeinated, and filtered coffee. They also reported risk factors for colon cancer, such as family history of cancer, diet, physical activity, and smoking. The researchers found that having one to two cups of coffee a day was linked to a 26% reduced risk of colon cancer. For those who drank more than 2.5 cups, the risk was reduced by as much as 50%.

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Aging with Dignity. (2011). Five wishes. Retrieved from[Context Link]


Aging with Dignity. (2016). History and mission. Retrieved from[Context Link]


Matthews J. (2016). Is home health care an option? Nolo. Retrieved from[Context Link]