Topic: 8

How to Make Tough Decisions

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What You Need to Know

Do any of these questions sound familiar?
Should I get help at home or is it time to find a different location for my loved one?

Should I stop my loved one from driving and take control of the finances?

What would happen if my health broke down?

What would happen to my loved one?

These are all questions that might require tough decisions.

Tough Decisions

A tough decision is very often a decision that makes us uncomfortable. You may be reluctant about making such a decision but believe that it is the right decision to make. Such reluctance causes us to hesitate because we want to do the right thing. After all, you wouldn’t be a caregiver in the first place if you didn’t want to do the right thing! Even when you have had conversations with loved ones about their wishes, life has a way of presenting you with new challenges. In short, life has a way of being messy. For this reason, caregivers often find themselves in the position of making tough decisions under less than ideal circumstances.

So, how can you move forward anyway?

Strategy

Here is a strategy that will help.

  1. Ask yourself if it is your decision to make? If the person that you are caring for is mentally competent then it is not your decision to make.
  2. Recall the four priorities of someone living with a life-limiting illness.
    • To maintain a sense of dignity and privacy, as much as possible.
    • To maintain a sense of control, as much as possible.
    • To be treated with respect, sensitivity and an awareness of their feelings.
    • To avoid being a burden to their family and friends, as much as possible.
  3. Consider just one issue at a time. Measure the potential tough decision in light of those priorities. Ask yourself, if the decision will impact the person’s sense of dignity, sense of control, feeling of being respected and desire not to be a burden, in a positive or negative way?
  4. Modify or change your “tough decision” based on those important priorities. For example, if the decision you think needs to be made will destroy the person’s sense of dignity, remove all control from their life or make them feel as if their feelings don’t matter, then it isn’t the right decision to make. What other alternatives can you think of? Take small steps one at a time.
  5. Time to decide. Once you feel that your solution is the best one in light of the four priorities then it is time to make your decision.
  6. Evaluate. Once the decision has been made and you have put an action in place, it is time to evaluate your “tough decision”.
    • Are things better off than before, and if so, how?
    • What improvement has this decision brought about?
    • Have unexpected obstacles arisen? Or unexpected benefits?
    • Should we give the plan more time to work? Or should we start working to change or replace it?
    • Is it time to call for more help?
Caregiving isn’t for the Faint of Heart Do the best you can. Admit your human imperfections. Respect for the person that you are caring for and respect for yourself will provide you with a solid foundation for making tough decisions.

 

1. Read this scenario.

Therese is 86 years old. She is becoming frailer as she ages. Her arthritis bothers her more these days and she has a heart condition that affects her ability to walk for very long. Her doctor would not be surprised if Therese died in the next three or four months but she could also live for another few years. Her husband died two years ago as did one of her neighbours who was also a close friend. Therese is aware that she is nearing the end of life. She has little desire to eat meals anymore. Therese is living alone. As Therese’s caregiver you are uncomfortable with the current situation but you are only able to help her for a few hours each week.

2. Think about the answers to these questions from the caregiver’s perspective before checking the sample responses.
  • What is the biggest problem in this situation?
  • What information do you need to make a good decision?
  • What are the alternatives?
  • What decision do you think you should make?
  • How would you know if you made a good decision?

Sample responses

What is the biggest problem in this situation?
Therese is living alone. She needs some more caregiver support.

What information do you need?
What help could make Therese’s life more pleasant for her? Is there any person who could provide some support and caregiving?

What are the alternatives?
Accessing the local community hospice program, accessing a residential hospice for planning, creating a care plan, the LHIN’s home and community support program, a paid caregiver, a web of various supports some volunteer, some paid, or a long-term care facility.

What decision do you think you should make?
The decision that Therese accepts and provides Therese with the most support.

How would you know if you made a good decision?
The four priorities would have been honoured. That is, Therese would maintain a sense of dignity and privacy, as much as possible; she would maintain a sense of control, as much as possible, she would be treated with respect, sensitivity and an awareness of their feelings and she wouldn’t feel like she was being a burden to others, as much as possible.

  • Are things better off than before, and if so, how?
  • What improvement has this decision brought about?
  • Have unexpected obstacles arisen? Or unexpected benefits?
  • Should we give the plan more time to work? Or should we start working to change or replace it?
  • Is it time to call for more help?
3. Read this scenario.

Michael is 22 years old. A bright, ambitious person, he just finished his three year college diploma. He has just been diagnosed with metastasized liver cancer. He has been living on his own for four years. His parents are no longer a part of his life. You are his only caregiver. You provide Michael with support once or twice a week when he asks for help.

4. Think about the answers to these questions from the caregiver’s perspective before checking the sample responses.
  • What is the biggest problem in this situation?
  • What information do you need?
  • What are the alternatives?
  • What decision do you think you should make?
  • How would you know if you made a good decision?

Sample responses

What is the biggest problem in this situation?
Michael is alone and dying.

What information do you need?
What does Michael need help with now? What else will Michael need help with moving forward? Are there other friends that could step in and help?

What are the alternatives?
Accessing the local community hospice program, accessing a residential hospice for planning, creating a care plan, the LHIN’s home and community support program, a family caregiver, a paid caregiver, a web of various supports some volunteer, some paid.

What decision do you think you should make?
Michael needs help so he is not alone. Accessing that help immediately is critical.

How would you know if you made a good decision?
The four priorities would have been honoured. That is, Michael would maintain a sense of dignity and privacy, as much as possible; she would maintain a sense of control, as much as possible, she would be treated with respect, sensitivity and an awareness of their feelings and she wouldn’t feel like she was being a burden to others, as much as possible.

  • Are things better off than before, and if so, how?
  • What improvement has this decision brought about?
  • Have unexpected obstacles arisen? Or unexpected benefits?
  • Should we give the plan more time to work? Or should we start working to change or replace it?
  • Is it time to call for more help?

 

There are several resources available online if you search on Caregiver Decisions.