Deciding where you will receive care as your illness progresses can be challenging, but planning now for your care can decrease your anxiety later on. Talk to your loved ones about the type of care you would like to receive at the end of your life. Discuss their expectations as well as your wishes, care needs, finances, and the needs of your family. Your choice may change as your illness changes.

A study of seriously ill patients in hospitals and their family members showed that the most important elements of end-of-life care were:⁴

• Trust and confidence in the doctor who is treating the patient.
• Having the option of not being on life support.
• Effective communication between the patient, the patient's family, and the doctor.

Several care options are available, including hospice, home care, nursing home placement, or care from an assisted-living facility. A study of the last place of care for people at the end of life found that 69% of people were in a hospital or nursing home for their last place of care, and 31% of people were at home for their last place of care.⁵ The same study found that patients and their families were the most satisfied with home hospice care.

Hospice care

As death nears, you may choose to receive help and support from hospice. Hospice care focuses on using palliative therapies exclusively to manage pain and other symptoms when there is no cure for your condition and death is anticipated within the next 6 months. Part of this care is keeping you as alert and comfortable as possible in a familiar environment, surrounded by your family and friends. When you choose hospice care, you agree to forego curative and life-sustaining treatments. However, you can change your treatment plan at any time.

Hospice care is provided by a team of health workers, including nurses, social workers, volunteers, counselors, and personal care assistants. Your doctor can continue to direct your care and work closely with you and the hospice team. Hospice care most often occurs at your home, although it can be given in a nursing home, a hospital, or a hospice center. If you remain at home, the hospice team supports your family in their caregiving. And "family" is not limited to your spouse (or partner) or blood relatives; friends from your workplace, church, community, or neighborhood may be considered part of your family.

Hospice care seeks to relieve physical symptoms and address your emotional, social, and spiritual needs, as well as the needs of your loved ones. Hospice offers a chance to address difficult but normal concerns that you and those you love may have about death and dying, such as pain, unresolved issues, and caregiving needs. If you choose, the counseling and support services that hospice provides will offer opportunities to work on mending important relationships and to explore spiritual issues.