The nostalgia and spirit of the holiday season offer a special opportunity for patients on hospice and their family members to find meaningful ways to spend time together – even if that means shifting and adjusting the morning holiday celebration itinerary.

Holiday gatherings and family traditions offer the ideal window through which healing, processing, and the making of priceless memories can take place. Despite the mixed emotions and complexities, there are many ways to celebrate the holidays on hospice.

Holidays On Hospice: 6 Ideas to Create Meaning, Memories, and Joy

Also, please know it’s perfectly normal and expected to feel a deep sense of sadness or grief as you approach the holidays with a spouse or close family member on hospice. For many, it will be the last time you get to connect and share age-old traditions. Resist the urge to “fake it” or act like things are other than they are.  Your sadness and grief are anchored in love, history, and shared connection. Those feelings may also reflect emotions unprocessed or words unspoken. Therefore, we invite you to view the holiday season as a powerful portal you can enter to connect with a loved one in hospice in deep and meaningful ways. Here are some of our suggestions for how to celebrate the holidays on hospice.

Remain attuned to the needs of the one on hospice

Depending on where someone is at in their journey with hospice, they may be raring to go, taking advantage of every waking minute. OR, they may be in their last weeks or months, often indicated by a greater need to sleep, withdraw from the outside world, and spend quiet time in inward reflection.  This status can change rapidly, or without warning, so the main goal is to remain attuned – and in tune – with how your loved one is feeling. Your hospice team is a fantastic resource, and our nurses, volunteers, and other staff members can help you assess what makes the most sense for this year’s holiday planning.

Scale it down to the most important parts

One of the most important things to remember is that people on hospice are typically chair- and/or housebound. Things slow down, and loud, boisterous, or fast-paced activities are challenging. Hospice patients tend to tire more easily and need far more sleep in between energy bursts.  With that in mind, ask what parts of the holiday celebration appeal most to them and then find ways to create a scaled-down version. This may look different depending on the person’s favorite holiday traditions, who is local and who’s not, or where they’re living (people in a hospice house setting have different options than those living at home).  For example, it may make more sense to:

• Bring parts of the holiday traditions to the one you love, rather than going to heroic efforts to bring them to events or places that cannot accommodate their current needs.
• Check in with your loved one and their primary caregivers (or hospice team) to learn which times of the day are best for activities. Family events/plans may need to shift this year to accommodate when mom or grandad are most likely to feel social.
• Bring them one or two of their favorite parts of the holiday meal rather than a full meal (waning appetite is very common, and forcing food can create problems for a body that is no longer able to digest and process it anymore).
• Using video chat and hangout options to connect with out-of-town loved ones or to connect to the group events at specific times. Keep in-person visits solely to those requested by the patient.
• Add a few meaningful holiday decorations (preferably the ones they request or ask for) rather than creating a space that is visually overstimulating. Consider using dimmers to keep lights ambient rather than exciting.
• Work together going over old photos and albums, organizing and labeling them if key names or dates are missing. This can be a wonderful way for those on hospice to process their lives, share stories you haven’t heard before, or mend old rifts or wounds.
• Have people write letters saying all they’ve always wanted to say to be read as your loved one is able over the course of the holiday season.

This list could go on and on, but use the ideas to accommodate your loved one’s needs, wants, and cultural preferences.

Don’t focus on a single day (flexibility is key)

As we touched on above, the status of a person on hospice is ever-changing. Some days may sound good in theory, but then one rough night or a series of bad days can make it impossible for your loved one to participate the way they want.  Flexibility is key, and everyone involved should be prepared to surrender their set intentions to what may need to happen instead. Scheduling little things that can easily fit into a window of days is better than putting all of your holiday eggs in one day’s basket. Nobody should take it personally if a plan or event can’t occur. This is the way it goes sometimes, and the ability to flow with it provides the most ease for everyone involved.

Prioritize calm over chaos when celebrating holidays on hospice

Again, things move slower on hospice, and odds are your loved one now dwells in a much quieter mode of existence. Leave the chaos and excitement of the holidays for other locations and bring the more peaceful, calm, and rejuvenating traditions to the ones celebrating the holidays in a hospice setting. This is especially true for anyone with Alzheimer’s or dementia, or who is not as coherent as normal. Calm and soothing is always best, but feel free to pep things up if your loved one is feeling energetic or requests specific activities. 

Being there in silence may be the best gift you can give

Don’t underestimate the power of being present and spending time with someone you love in mostly silence. You can create a playlist of your loved one’s favorite holiday songs to play softly in the background. They may also enjoy sitting together and rewatching their favorite holiday movies (or home movies).  Don’t be surprised or take it personally if they drift in and out of consciousness, as sleep is the time when those who are dying process their lives and make peace with what’s behind them – as well as what’s ahead. Use this time to quietly and concisely express anything you feel needs to be said and invite them to do the same. These conversations can be remarkably healing and are one of the most important labors of love at the end of a person’s life.

Don’t forget about your loved one’s everyday care needs

Again, the hospice team and caregivers are a wealth of support. However, it’s not uncommon for families to take over the reins to have private quality time with their loved ones and give caregivers the chance to spend the holidays with their families. Regardless, it’s easy to forget that those on hospice have different care needs than they used to:

• Regularly check in to ask if they need anything or offer breaks/rest periods.
• Do they have access to regular privacy to use the bedside commode, or have their adult incontinence briefs changed?
• Are you allowing them enough time to rest in between visits or any activity?
• Are people respecting their lack of interest in eating or drinking so they don’t become physically uncomfortable or ill?
• Is someone setting a timer for medication reminders?
• Have they spent far longer than usual out in the living room or sitting upright? Give them time to lie down and rest again. 

Let Your Hospice Team Support Holiday Planning

Would you feel more comfortable getting first-hand or personalized advice about how to celebrate the holidays on hospice without overwhelming your loved one? The team at Hospice of the Golden Isles is here for you. Our team can work with you and our client to create a meaningful holiday for everyone while honoring and prioritizing the needs and well-being of your loved one.

One of the most common questions hospice nurses and staff receive is, “How will we know when they’re dying?” It’s challenging not to have a clear answer to the question. We never know if a person is truly dying until they die. Everyone’s journey and transition between living and dying are different.

However, what we can do is educate families about the dying process and some of the common signs that indicate a person is actively dying. Again, this won’t be a day, hourly, or minute prediction. Instead, recognizing these signs and being willing to face them with an open heart can completely transform an individual and family’s story.

Signs A Loved One Is Dying

To be clear: when we’re talking about the signs a person is dying, we’re speaking of a long-term death, as opposed to sudden death (unpredicted heart attack, aneurism, car accident, etc.) Most of the signs a person is dying occur in stages, some of which arise years and months before they die. Because our culture tries to ignore these signs or pretend that all medical issues can be fixed (they can’t), individuals and families are often shocked when death comes far faster than they were prepared for. This can lead to devastating emotional consequences, including not being prepared for all of the physical, mental/emotional, and practical aspects of dying and after-death care. The better able you are to have conversations about end-of-life, dying, and preparing for the future, the less stressful the process will be.

Years & Months Before Death: The Diagnosis

Most people die from a progressive disease or old age. In these cases, the signs a person is dying can start months or years beforehand. For many, it starts with an initial prognosis or diagnosis. You have chronic heart disease, cancer, Parkinson’s, ALS, COPD, etc.  Yes, there are treatments. Yes, you can take medication to notably minimize symptoms and side effects and to extend your quality of life. The fact remains that in most cases, that diagnosis is the first sign that you are dying.  Now, we’re all dying, and (in most cases) none of us know the exact “how” of the matter. A loved one may have a stage 4 cancer diagnosis that has you reeling, and they outlive you because you have a sudden heart attack or are hit by a car while crossing a street. None of us ever really know.  However, a terminal diagnosis should serve as a wake-up call. Being diagnosed with a disease that may be curable/treatable but may not is also a chance to prepare. An 80th, 85th, or 90th birthday is another sign you’re closer to dying than not. You and your loved ones are best served by recognizing this is “the first sign you’re dying,” and begin making comprehensive end-of-life plans that honor body, mind, and spirit. Rather than being scary or heartbreaking (which it may be at some level), we can guarantee this process will remove a huge sense of dread and alleviate stress, improving your quality of life.  This is also a good time to reach out to hospice and palliative care agencies in your area so you can begin taking advantage of their invaluable support services.

Months & Weeks Before Death: Lack of Appetite and Interest 

In the months and weeks before death, many clients lose their interest in a range of things – most notably food and the outside world.

Lack of appetite

This typically starts by consuming smaller and smaller portions, or they may skip some meals altogether. Over time, they may only want things like ice cream, yogurt, smoothies, or simple broths. Finally, in the weeks and days before death, they may not want to eat at all. Lack of appetite is completely normal. Your loved one’s lack of appetite or disinterest in food is one of the hardest things to stand by and support. Our culture equates food with nourishment, comfort, and love. In some cases, preparing, serving, and sharing meals and snacks together may be the only way you’ve “enjoyed life” together since they started dying.  Never force someone to eat if you know that they are in their last months or weeks of life. This is typically the body’s way of saying, “I don’t process food very well anymore. It takes a lot out of me to digest food and much of it isn’t digesting anyway.” Forcing someone to eat who doesn’t want to can lead to severe constipation or intestinal/g.i. blocks that are painful and stressful to treat. Instead, offer food regularly – but don’t take the “no thank you” personally. They are not suffering from eating. Instead, you may cause suffering by forcing or guilting them into eating.

Lack of interest in the outside world

This varies from person to person. Some clients watch football games the day they die, and others stop watching their favorite sports months or weeks before they die. In most cases, we notice a direct correlation between the level of need for inner processing and the level of outside engagement. The more personal and emotional work a loved one is doing on their own (or with the support of a spiritual counselor, therapist, hospice nurse, or loved ones) to work through their life, memories, fears, unresolved situations or emotions, etc. – the less likely they are to participate in the outside world. Remain open to their needs. This is also a good time to let them know the things you want them to know before they are no longer physically available.

Weeks & Days Before Death: More Sleeping & Less Engagement

By the time a client is weeks or days away from dying, odds are the efforts to “fix them” have ceased so they can be as comfortable as possible to do some of the most important work they’ll ever do. The labor of dying is not unlike the labor of being born into the world.  Odds are they will be asleep more than awake, and our job is to keep them comfortable using balanced medications as needed. Your loved ones should have enough to be comfortable but not so much medication that they are knocked out or unable to communicate when/if they want to. Hopefully, they’ve let you know what they want (or don’t want) around them so the space can be arranged to their wishes. 

Days & Hours Before Death: The Body Winds Down

Once death is imminent, we say the client is “actively dying” or “in transition.” During this time, you’ll notice several physical indicators that death is near:

• Blood pressure will become quite low or may not register (there is absolutely no need to take blood pressure at this point, so feel free to let the “vital sign readings” go so you can be present with your loved one).
• The extremities become cooler and may turn grey or blue.
• The heartbeat becomes very weak and irregular – it’s often very fast or fluttery.
• Breathing can be very congested and seem agitated (as many as 30 to 40 breaths per minute), or it may be very slow and seem to stop at times (as slow as six to ten breaths or less every minute).
• Their words may not make sense (people who are dying often begin speaking in metaphors or in symbolic ways, rather than linear ways, in the days or even weeks before death. Resist the urge to “clarify” or “correct”)
• They may be completely nonresponsive, but they can usually still hear you
• Their mouth may be open (they may make gasping sounds, or you may hear a loud, “scary” rattle – called the death rattle – this is normal), so feel free to use sponges to gently moisten the lips, but there is no need to hydrate at this point.

The key here is to keep a calm and peaceful presence. As we mentioned, people who know they are dying go through a “life review,” whether they let you know it or not. Silent companionship is often the preferred method of “communing” with someone who is dying, but it’s also important that loved ones have a chance to speak their last pieces if necessary, as this may also help with the dying person’s “life review” and process. On the flip side, if your loved one was a very private person, make sure to create spaces where they can be alone. For example, “Mom, we’ll slip out for a minute and give you some time alone. We’ll check back in 15 minutes.” Private people often choose to die when no one is present, while extroverts typically wait to die until they’ve seen/connected with certain people or have someone nearby. 

Contact Hospice If You Think Or Have Been Told Your Loved One Is Dying

Your hospice team is there for you 100% of the time, 24/7. If your loved one has taken a sudden turn or you feel concerned about whether or not they’re closer to dying than you thought, feel free to contact Hospice of the Golden Isles at 912.265.4735. We are here to provide comfort and support to our clients and their families and will do our best to stand by and provide insight if and when we know they’re dying.

Fear of pain is the #1 reason people name why they’re afraid of dying. This is where hospice care comes into play. The sooner you contact local hospice agencies and learn about the services, the sooner patients and families have access to an incredible array of support tools, including pain management and comfort care.

Hospice Supports Patients & Families With Pain Management

We can’t specify enough that early is better with bringing hospice support on board. In a perfect world, patients would contact hospice immediately after receiving a terminal diagnosis. However, this is the best time to receive the information offered and to learn that patients who enlist hospice care long before death enjoy the highest quality of life and reduced pain and discomfort.  Finding a hospice agency you trust that comes highly recommended by clients and that you feel comfortable with is essential to this process. Here are some of the ways hospice care supports healthy, balanced pain management and patient support to optimize comfort care for our clients.

Emotional and mental support eases pain

Studies have shown that people who experience high levels of anxiety, worry, and fear also have higher pain levels. When in the presence of these shadow emotions, inflammation increases, immune function decreases, sleep disorders are more common, and the body tenses up.  The full spectrum of hospice support offered to our clients and their families provides stress release, allowing patients to relax and rest more often. That naturally reduces pain levels.

Thoughtful, appropriate, and balanced use of pain medications

Dying is not painful. Nobody feels physical pain because they’re dying. Instead, those who are dying experience pain related to the disease or condition causing their death. The pain associated with your disease, condition, syndrome, or the physical discomfort of being bedridden can almost always be managed with thoughtful and balanced use of pain medications. We recommend watching this short video clip from the world-respected hospice guru, Barbara Karnes R.N., briefly explaining how hospice respects and honors balanced pain and narcotic pain relief. Pain medication should NEVER be used to completely sedate a patient or incapacitate them. The goal is to relieve pain and increase comfort while allowing the mind to be as alert as possible. Death is a natural process, not a medical process, and those who are dying deserve the clarity required to work through their thoughts and emotions so they can go with greater ease, trust, and peace.

Occasional use of anti-anxiety medication

In some cases, the family’s hospice box includes some type of anti-anxiety medication. We try to relieve anxiety without the use of medications whenever possible. If a client was on anti-anxiety or anti-depressants before they went on hospice, we continue that support along with any other hospice-related tools, equipment, or other support aids necessary. However, we may recommend the use of anti-anxiety medications if we notice common signs of heightened agitation with yet-to-be-discovered causes. This may show up in patients picking at bedsheets or their clothing, repeating physical motions, restless body language, moaning, etc. As with any pain medication, we use the smallest dose possible that provides relief. 

Emotional and spiritual support

We mentioned above that stress, anxiety, fear, and other “shadow” emotions have a direct correlation to physical pain. This is just as true for someone who faces the end of life. So often, our clients are working through deeply emotional experiences, traumas, regrets, grief, etc., Without proper support and resolution, those worries and concerns may manifest as misunderstood physical pain. Conversations about end-of-life thoughts, feelings, and emotions are essential to support a loved one where they’re at. However, there is a point where pretending the miracle is on the horizon or that they aren’t actually dying does far more harm than good. Your hospice team facilitates these conversations as desired, and we’re here to provide a wide range of FREE tools and support options, including:

• Information and education about any and all aspects of the dying process and what comes next
• Spiritual support by our non-denominational chaplains
• Emotional and mental support via licensed therapists
• Unlimited access to hospice nurse hotlines, 24/7
• Respite care for primary caregivers and other volunteer services are offered by compassionate community members who are honored to listen to stories, fears, and concerns without judgment or fear.
• Grief support for the client and their family members

Feeling supported provides invaluable comfort to clients, partners, and family members.

Ensuring end-of-life wishes are in order

Everyone knows they should complete advanced medical directives and end-of-life plans, but few do it before they absolutely have to. The desire to get your affairs in order is heightened when facing an end-of-life diagnosis – beyond practical wills, trusts, or funeral plans. However, the demands of medical appointments, increasing care needs, and any fear or anxiety can make it harder to think about and finalize the “practical” aspects of end-of-life care. Your hospice team can sit with you and work through end-of-life planning, doing all we can to provide you with the best quality of life while you’re still alive and to see your wishes carried out once you’ve died.

Say No To Pain And Yes to Comfort

Hospice of the Golden Isles is dedicated to helping our clients say no to pain and yes to comfort in all realms of their life. You deserve to spend your remaining days making the most of your time, surrounded by the people, pets, and things you love most. Contact us to learn more about how palliative and hospice care are uniquely designed to provide sound pain management and comfort care.

There are many reasons people are resistant to hospice care, but reasons typically fall into one of three categories: fear of death/dying, difficulty accepting treatments are not working, or misunderstandings about what hospice is or what we do.

Common Reasons One Resists Hospice And How To Support Them

As hospice care providers, our primary goal is to serve the client. Serving the family and close loved ones is a very close second. However, we can’t do our job without a client’s willingness to explore our services and take advantage of the benefits we offer.  That is unfortunate because in almost all cases, the thoughts, “we need extra help,” “should we think about hospice (or palliative care),” or “I don’t want to live like this anymore,” are all signs that it’s time for hospice care. That said, your helpful brochures, pressing information/research, or pleas may fall on deaf ears if your spouse, partner, or family member is resistant to hospice.  In that case, it’s important to remain compassionate, patient, and curious about WHY they resist. Here are some of the most common reasons people resist hospice and how you may be able to support their shift into considering it.

They equate hospice with dying or giving up

This is one of the biggest reasons individuals or their spouses/partners are resistant to hospice. Hospice does not mean you are giving up or that death is imminent (although the longer you wait, the more likely the latter will become true).  In fact, hospice means you have a terminal or chronic illness/condition with a prognosis of six months or less if the disease runs its course or the client experiences disease complications. That said, quality of life often improves so much that many clients have hospice for many months or even upwards of a year or more after ceasing curative treatments. Flip the script: Acknowledging and preparing for the end-of-life is essential for every adult, especially those with chronic or terminal conditions. Learning all you can about end-of-life care options, including palliative and hospice services, is empowering and helps clients and families make the right decisions to improve their quality of life sooner rather than later.  Hiding your head in the sand means missing out on making the most of the time you have left. If someone fears death or struggles to speak about end-of-life, hospice social workers, counselors, and chaplains are available anytime to work through these conversations with open and empathetic awareness.

They are afraid to admit treatments aren’t working OR treatments are making life worse and not better

There are only so many treatments or medical procedures can do to heal, provide relief, or make things better. In many cases, a chronic condition overcomes a treatment’s ability to heal or help. At that point, the treatment or rigor of the appointments necessary to provide treatment becomes exhausting and debilitating. This wall can be crippling for some patients, but their unwillingness to accept the beginning of the last chapter of their life means they refuse any palliative care or hospice services. Shift the focus: Instead of forcing acceptance about end-of-life issues, talk about taking a much-needed break to regroup, reassess, and make decisions that align with their values and perceptions of quality of life. Hospice can come on board to provide the support necessary during that reprieve and wise counsel – and patients can go back off hospice to resume treatments – or pursue new treatments – whenever they choose.

Resists hospice because they’ve fallen prey to hospice myths

 Hospice myths abound. Some of the most common hospice myths that make people resistant to hospice are:

• We can’t afford it. In fact, hospice is 100% free to all qualifying patients, regardless of age or economic status. It is paid for by Medicare, although private insurance benefits may also cover hospice services. We’ll help you do everything required to bring hospice to your home, hospital/assisted living facility, or our hospice house.
• It’s only for people on Medicare. Similarly, many believe they have to be on Medicare to get hospice care. However, Medicare pays for hospice services for anyone who is a legal U.S. citizen or resident, whether they’re currently on Medicare or not. Once you qualify for hospice service, which occurs during an assessment by a hospice physician and intake team, you qualify for Medicare’s hospice coverage.
• I’m not close enough to dying yet. The longer qualifying clients are on hospice the better. Studies show that while most people wait too late to contact hospice (in the last week or days of life), clients’ quality of life and their life expectancy improves drastically by enlisting hospice care sooner rather than later. Our services provide tremendous relief and peace of mind, which makes the day-to-day more comfortable, stress-free, and meaningful for clients and loved ones.

Other common hospice myths that keep people from contacting hospice when they should are:

• Hospice means giving up any hope of future treatments
• You only call hospice when a person is actively dying
• Choosing hospice means giving up control
• I’ll have to leave my home or hospital/facility to get hospice
• I’m not ready to sign a DNR, and I heard you have to for hospice

Choose to be informed: The best thing you can do to help someone see outside of these common myths or hospice resisting narratives is to get them accurate information. Hospice and palliative care agencies are happy to meet with you at any time to discuss their services and how they can support you. Personalized care is our highest priority. And, as mentioned above, the client is always in control.

Having A Hard Time Opening The Conversation Around Hospice?

If you’re having a hard time opening the conversation around hospice care or end-of-life care, we’re here to help in any way we can. The staff at Hospice of the Golden Isles is passionate about educating the public and making sure they understand the numerous and invaluable benefits of choosing hospice care as soon as you possibly can. Contact us to learn more, at 912-265-4735, or to schedule a consultation.

Frequently Asked Questions

Can a patient refuse hospice care?

Yes, patients have the right to refuse hospice care. In English-speaking countries, patients are given the autonomy to make decisions regarding their healthcare, including whether or not to accept hospice care. However, it is important for patients to discuss their concerns and preferences with their healthcare provider and loved ones to ensure they understand the implications of their decision.

How long to people usually stay in hospice?

The average length of stay in hospice care varies depending on the individual’s condition and needs. In general, patients in English-speaking countries stay in hospice for an average of 17-24 days. However, some individuals may receive care for a few months, while others may require hospice support for only a few days.

Can a hospice refuse to treat a patient?

Yes, hospices have the right to deny admission to individuals for various reasons. While hospice care aims to provide comfort and support to individuals with terminal illnesses, specific criteria must be met for admission. Factors that may lead to the refusal of a patient could include non-eligibility for hospice care, such as not having a life-limiting illness or not meeting the necessary medical requirements. Additionally, if a hospice program does not have the capacity or resources to adequately cater to a patient’s needs, they may choose to decline admission. The decision to refuse a patient is typically made after careful consideration by the hospice’s professional team in order to ensure that the best possible care can be provided to those who meet the necessary criteria.

Why Do People Not Choose Hospice?

People may not choose hospice due to various reasons. Some may be unaware of the benefits it offers, while others might fear losing control of their medical decisions. Additionally, misconceptions about hospice being solely for end-of-life care or a lack of understanding about the available support services may also deter individuals from considering hospice care.

Preparing for the passing of a loved one may start the moment they receive a terminal diagnosis. In some cases, preparing for a person’s death takes place as the result of a sudden accident, unplanned accident, or as the reality sinks in that the end is near due to old age or the slow progression of a chronic condition. Whatever the case, setting the sacred tone for the passing of a loved one occurs in two parts. 

The first part is dedicated to honoring a dying loved one’s comfort, ease, and well-being to the best of your ability. The second part is the self-care you practice as you give yourself and others the time needed to feel and express emotions and to feel nourished and rested for the days, weeks, or months ahead.

If we had our way, clients would contact hospice agencies and begin learning more immediately after receiving a terminal prognosis or diagnosis. Hospice is an incredible organization. Our services are completely free of charge, covered by Medicare, and provide a well-rounded net of physical, mental, emotional, and spiritual support that goes far beyond the clinical care realm.

Did you know that in addition to living longer and with a higher quality of life, hospice services also extend to your family? We take a whole-family approach to caregiving and it’s never too early to learn more about what we have to offer, so you’re ready to move forward with our services when you’re ready.

One of the biggest commonalities between nearly all of our hospice clients, particularly those that are 70 years old or younger, is the shock that they have an end of life prognosis. While we all know we’re going to die someday, most of us think of that someday as far into the future. This means our culture isn’t preparing for the end of life the way it should be.

It’s never too early to begin your end of life plan. Doing so eases the way for yourself and your family, and it helps you to live the best quality of life while you can.

End of life care is an umbrella term covering all of the ways we hope to be cared for and supported when we’re nearing and at the end of our lives. For those who are diligent about long-term-care planning, end of life care begins with completing advanced medical directives, ensuring your wishes are honored in various, unpredictable medical situations. It continues on to consider the types of treatment or support you’d prefer as age- or health-related declines make it impossible to care for themselves.

In a culture that focuses more on medical treatments than quality end of life care, this term is quickly distilled to the question of palliative care or hospice? If you’re in an immediate healthcare crisis, that’s where you should start. Otherwise, feel free to scroll down to the section “It’s Never Too Early to Begin Thinking About End of Life Care.”