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Answers To Frequently Asked Questions
The Westchester End-of-Life Coalition has prepared answers to your frequently asked questions. If you do not find the answer to your question on our Web site, contact us and we will try to help.
► FAQ's about Hospice and Palliative Care
► FAQ's about NY State Health Care Proxies
► FAQ's about Pain and Symptom Management
Questions about Hospice and Palliative Care:
What is Hospice?
When should a decision about entering a Hospice program be made -- and who should make it?
What if our physician doesn't know about Hospice?
Where can Hospice be provided?
Is Hospice affiliated with any religious organization?
Who is eligible for Hospice care?
What services does Hospice provide?
Who supplies these services?
Can my doctor continue to treat me under Hospice?
How does Hospice manage pain?
Is Hospice covered by insurance?
What does the admission process involve?
What are the advantages of Hospice care?
Is Hospice involved if a patient needs to be hospitalized?
Does hospice do anything to make death come sooner?
Does receiving Hospice care mean giving up on life?
Will the pain medication prevent the patient from talking, hearing, or knowing what is happening?
Are the pain-killers addictive?
What if the patient improves?
What diseases are most common among hospice patients?
How difficult is caring for a dying loved one at home?
Is there any special equipment or changes I have to make in my home before hospice care begins?
How many family members or friends does it take to care for a patient at home?
What happens if the patient can no longer be cared for at home?
Must someone be with the patient at all times?
Does hospice provide 24-hour continuous nursing care in the home?
What is palliative care?
What is the difference between palliative care and hospice care?
Other questions?
What is Hospice?
Hospice is a concept of health care that provides holistic services for the physical, emotional, and spiritual needs of terminally ill patients and their families. The goal of hospice is not to cure illness nor hasten death, but to ease a patient's passage from life. Hospice is a special kind of care for people who are living with an end-stage disease. With hospice, pain and discomfort are controlled with expertise and compassion. The unit of care is the family as well as the patient, and they choose from an array of services that ease the physical, psychological, social and spiritual stress that come at this time. The family receives ongoing support even after the patient dies.
When should a decision about entering a Hospice program be made -- and who should make it?
At any time during a life limiting illness, it is appropriate to discuss all of a patients care options, including hospice. By law the decision belongs to the patient. Understanding the hospice option enables the patient to have more control and choices about their end-of-life care. Hospice care is for people who have decided not to pursue further curative care, who want to emphasize comfort and improve their quality of life, and minimize suffering.
What if our physician doesn't know about Hospice?
Most physicians know about hospice. If your physician wants more information about hospice, it is available from the Academy of Hospice Physicians, medical societies, state hospice organizations, or the National Hospice Helpline, 1-800-658-8898.
Where can Hospice be provided?
About 90% of hospice care is received while patient continues to live in a personal residence, although some patients live in nursing homes, assisted living facilities, or hospice centers. In some cases, it is also available in hospitals.
Is Hospice affiliated with any religious organization?
Hospice care is not an off-shoot of any religion. While some religious organizations have started hospices, all hospices serve a broad community and do not require patients to adhere to any particular set of beliefs, or belong to any particular religion.
Who is eligible for Hospice care?
Individuals are eligible for hospice care who:
• have a life-limiting condition with a short prognosis
• have the support of their physician, need palliative care services, and wish to remain at home or in the environment of their choice
• seek caring support during the final stages of life
What services does Hospice provide?
Hospice provides the following services:
• seamless patient comfort and pain control
• nursing visits
• medical/social assessment
• family, individual and group psycho-social and spiritual counseling
• coordination of equipment and supplies
• support for caregivers
• physical, occupational, speech, or alternative methods of therapy, if requested, such as pet therapy, music therapy, acupuncture, in some cases.
• dietary and nutritional advice
• homemaking and certified nurse aide assistance
• spiritual guidance
• grief and bereavement support for family members after the patient's death
Who supplies these services?
The Hospice team includes doctors, nurses, nursing assistants, social workers, counselors, spiritual caregivers, and volunteers. Services are provided by registered and licensed hospice nurses, certified nurse aides, medical social workers, nutritionists, therapists, chaplains, and volunteers.
Can my doctor continue to treat me under Hospice?
Yes. The interdisciplinary hospice team works directly with the patient's own doctor, if the patient so wishes. The hospice staff with the doctor develop an individualized plan of care to meet the patient's needs. Hospice staff functions as the "eyes and ears" of the patient's physician and consults with the physician in the signing of new orders for treatment and/or medication.
How does Hospice manage pain?
Hospice nurses and doctors are up to date on the latest medications and devices for pain and symptom relief.. Using some combination of medications, counseling and therapies, most patients can be kept pain free and comfortable. It is the goal of hospice to allow the patient to be pain free but alert. By constantly consulting with the patient, hospices have been very successful in reaching this goal.
Is Hospice covered by insurance?
Hospice coverage is widely available. It is provided by Medicare nationwide, by Medicaid in 42 states, and by most private insurance providers. To be sure of coverage, families should of course check with their employer or health insurance provider. In Westchester several of the hospices offer care regardless of the patient’s ability to pay. Lack of financial means should not be a deterrent to choosing hospice care.
Medicare beneficiaries may receive hospice care for two 90-day benefit periods, either consecutively or at intervals, followed by a 30-day period. At the beginning of each period the doctor must certify that the patient is terminally ill. If necessary, an extension period may be approved after the above have been used. If a patient changes his mind, or his condition improves, he or she can cancel hospice services.
What does the admission process involve?
The patient's family, a friend, the patient's physician, or a pastor can suggest or request hospice care. Hospice will contact the patient's physician to verify whether he or she agrees that hospice care is appropriate for the patient at this time, and the physician is asked to sign a referral form. The patient will be asked to sign consent and insurance forms. A hospice liaison nurse will make the first visit to the home to discuss the details of the program with the family. An early referral enables the hospice team to develop the relationships that meet the needs of the patient and caregivers.
What are the advantages of Hospice care?
• Hospice care enables terminally ill patients and their families to remain together in the comfort and dignity of their home and to die in familiar surroundings.
• Hospice care is a cost-effective alternative to the high costs associated with hospitals and traditional institutional care.
• Hospice treats the person, not the disease; focuses on the family, not only the individual patient; and emphasizes the quality of life, not its duration.
• Hospice care relies on the combined knowledge and skill of a team of professionals including physicians, nurses, certified nurse aides, social workers, counselors, chaplains, and volunteers.
Is Hospice involved if a patient needs to be hospitalized?
Yes, if the patient's condition requires symptom control, or respite care.
Does hospice do anything to make death come sooner?
Hospices do nothing either to speed up or to unduly prolong the dying process. Just as doctors and midwives lend support and expertise during the time of child birth, so hospice provides compassionate support through its presence and specialized knowledge during this particularly difficult time. Hospice services are designed to bring comfort, to control pain and other symptoms, and to address the emotional, social, and spiritual needs of both the patient and his or her loved ones.
Does receiving Hospice care mean giving up on life?
Many people are uncomfortable with the idea of stopping an all-out effort to "beat" a disease. Hospice care focuses on enhancing the quality of life in its final stages. It seeks neither to shorten nor prolong life. A patient can choose to leave hospice care at any time and return to aggressive curative treatment for the disease. The choice is always the patient's. A physician's referral to hospice care usually indicates that no other curative measures are appropriate.
Will the pain medication prevent the patient from talking, hearing, or knowing what is happening?
Usually not. It is the goal of hospice to enable the patient to be pain free but alert. Even if the patient appears to be groggy, their hearing is preserved and working
Are the pain-killers addictive?
Not in the doses and frequency they are given to these patients. The goal of these medications is to enable the patient to be pain free and function to the best of his or her ability, despite the illness.
What if the patient improves?
Hospice patients do improve! A patient can sign out of hospice any time their condition improves or they decide to pursue aggressive, curative treatment.
What diseases are most common among hospice patients?
About 60 percent of hospice patients are cancer patients, but an ever-increasing number of patients with other diseases (including Alzheimer’s or dementia, ALS, heart disease, lung disease, AIDS, stroke/coma, kidney disease and liver disease for example), receive hospice care.
How difficult is caring for a dying loved one at home?
It is never easy, and sometimes can be quite hard. Yet many caregivers have said it was an especially rewarding period of their lives, a time when they could express love and caring in a personal and meaningful way. One of the first things hospice will do is work with the patient and caregivers to prepare an individualized care plan. The hospice team works closely with the patient and caregivers to address their needs. At the end of a long, progressive illness, nights especially can be very long, lonely and scary. So, hospices have staff available around the clock to consult with the family and give the regular caretaker a break, if the need arises.
Is there any special equipment or changes I have to make in my home before hospice care begins?
Your hospice provider will assess your needs, recommend any equipment, and help make arrangements to obtain the necessary equipment. Often the need for equipment is minimal at first and increases as the disease progresses. Hospice will assist in any way it can to make home care as convenient, clean and safe as possible.
How many family members or friends does it take to care for a patient at home?
There is no set number. One of the first things a hospice team will do is to prepare an individualized care plan that will, among other things, address the amount of care giving needed in your situation. Hospice staff visits regularly and are always accessible to answer medical questions and provide support. Hospice volunteers are usually available to assist with errands and to provide an occasional break.
What happens if the patient can no longer be cared for at home?
Sometimes this happens despite the best efforts of both hospice and the patient's family. Some hospice programs have inpatient units, some use dedicated hospital beds for hospice patients. Or the patient may be admitted to the hospital and continue to receive the interdisciplinary hospice care.
Must someone be with the patient at all times?
In the early weeks of care, it’s usually not necessary for someone to be with the patient all the time. Later, however, since one of the most common fears of patients is the fear of dying alone, hospice generally recommends someone be there continuously. Some of Westchester’s hospices have specially trained volunteers who are available to come into the home and sit vigil with the patient in the last days of life, in cases where the family members cannot constantly be at the patient’s bedside. Hospice can also provide trained volunteers for respite care, to give family members a break. The plan of care will be adjusted with the changing needs of the patient and family, to minimize suffering and improve the patient’s quality of life.
Does hospice provide 24-hour continuous nursing care in the home?
Yes, but only in times of crisis. Generally the home care program provides intermittent, skilled visits on an as-needed basis to support the patient and a primary care giver, often a family member. 24-hour on-call services are provided for emergency or acute care needs. If 24-hour continuous nursing care is necessary, most hospices will provide continuous care for a limited number of days.
What is palliative care?
Palliative care is interdisciplinary health care specializing in relief of suffering and achievement of the best quality of life for patients with advanced illness, and their families. It is offered simultaneously with all other appropriate medical treatments, such as blood transfusions, chemotherapy or radiation, if they are necessary to alleviate pain or enhance the quality of life. It does not include experimental procedures, and is supportive care rather than curative.
What is the difference between palliative care and hospice?
Palliative care supports seriously ill patients from the point of diagnosis throughout the course of their illness. It may be provided concurrent with other medical treatment, including curative treatment. Hospice focuses on providing supportive care for patients who are at the end-of-life and are no longer receiving curative treatment.
"While hope for a miracle cure may not be evident in hospice philosophy," states Jay Mahoney, former president of the National Hospice Foundation, "hospice care can be an extraordinary expression of hope and individual courage." This philosophy of hope for compassion, meaning and quality of life at the end is at the heart of the hospice movement.
Other questions?
Sources
Hospice of the Carolinas
Hospice Web
Hospice of the Panhandle, Inc.
Prospect Home Care Hospice
Center to Advance Palliative Care
Questions about NY State Health Care Proxies
The source for the information below is the New York State Department of Health page at: http://www.health.state.ny.us/nysdoh/hospital/healthcareproxy/intro.htm
The New York Health Care Proxy Law allows you to appoint someone you trust — for example, a family member or close friend — to make health care decisions for you if you lose the ability to make decisions yourself. By appointing a health care agent, you can make sure that health care providers follow your wishes. Your agent can also decide how your wishes apply as your medical condition changes. Hospitals, doctors and other health care providers must follow your agent’s decisions as if they were your own. You may give the person you select as your health care agent as little or as much authority as you want. You may allow your agent to make all health care decisions or only certain ones. You may also give your agent instructions that he or she has to follow. This form can also be used to document your wishes or instructions with regard to organ and/or tissue donation.
Why should I choose a health care agent?
Who can be a health care agent?
How do I appoint a health care agent?
When would my health care agent begin to make health care decisions for me?
What decisions can my health care agent make?
Why do I need to appoint a health care agent if I’m young and healthy?
How will my health care agent make decisions?
How will my health care agent know my wishes?
Can my health care agent overrule my wishes or prior treatment instructions?
Who will pay attention to my agent?
What if my health care agent is not available when decisions must be made?
What if I change my mind?
Can my health care agent be legally liable for decisions made on my behalf?
Is a Health Care Proxy the same as a living will?
Where should I keep my Health Care Proxy form after it is signed?
May I use the Health Care Proxy form to express my wishes about organ and/or tissue donation?
Can my health care agent make decisions for me about organ and/or tissue donation?
Who can consent to a donation if I choose not to state my wishes at this time?
Why should I choose a health care agent?
If you become unable, even temporarily, to make health care decisions, someone else must decide for you. Health care providers often look to family members for guidance. Family members may express what they think your wishes are related to a particular treatment. However, in New York State, only a health care agent you appoint has the legal authority to make treatment decisions if you are unable to decide for yourself. Appointing an agent lets you control your medical treatment by:
• allowing your agent to make health care decisions on your behalf as you would want them decided;
• choosing one person to make health care decisions because you think that person would make the best decisions;
• choosing one person to avoid conflict or confusion among family members and/or significant others. You may also appoint an alternate agent to take over if your first choice cannot make decisions for you.
Who can be a health care agent?
Anyone 18 years of age or older can be a health care agent. The person you are appointing as your agent or your alternate agent cannot sign as a witness on your Health Care Proxy form.
How do I appoint a health care agent?
All competent adults, 18 years of age or older, can appoint a health care agent by signing a form called a Health Care Proxy. You don’t need a lawyer or a notary, just two adult witnesses. Your agent cannot sign as a witness. You can use the form printed here, but you don’t have to use this form.
When would my health care agent begin to make health care decisions for me?
Your health care agent would begin to make health care decisions after your doctor decides that you are not able to make your own health care decisions. As long as you are able to make health care decisions for yourself, you will have the right to do so.
What decisions can my health care agent make?
Unless you limit your health care agent’s authority, your agent will be able to make any health care decision that you could have made if you were able to decide for yourself. Your agent can agree that you should receive treatment, choose among different treatments and decide that treatments should not be provided, in accordance with your wishes and interests. However, your agent can only make decisions about artificial nutrition and hydration (nourishment and water provided by feeding tube or intravenous line) if he or she knows your wishes from what you have said or what you have written. The Health Care Proxy form does not give your agent the power to make non-health care decisions for you, such as financial decisions.
Why do I need to appoint a health care agent if I’m young and healthy?
Appointing a health care agent is a good idea even though you are not elderly or terminally ill. A health care agent can act on your behalf if you become even temporarily unable to make your own health care decisions (such as might occur if you are under general anesthesia or have become comatose because of an accident). When you again become able to make your own health care decisions, your health care agent will no longer be authorized to act.
How will my health care agent make decisions?
Your agent must follow your wishes, as well as your moral and religious beliefs. You may write instructions on your Health Care Proxy form or simply discuss them with your agent.
How will my health care agent know my wishes?
Having an open and frank discussion about your wishes with your health care agent will put him or her in a better position to serve your interests. If your agent does not know your wishes or beliefs, your agent is legally required to act in your best interest. Because this is a major responsibility for the person you appoint as your health care agent, you should have a discussion with the person about what types of treatments you would or would not want under different types of circumstances, such as:
• whether you would want life support initiated/continued/removed if you are in a permanent coma;
• whether you would want treatments initiated/continued/removed if you have a terminal illness;
• whether you would want artificial nutrition and hydration initiated/withheld or continued or withdrawn and under what types of circumstances.
Can my health care agent overrule my wishes or prior treatment instructions?
No. Your agent is obligated to make decisions based on your wishes. If you clearly expressed particular wishes, or gave particular treatment instructions, your agent has a duty to follow those wishes or instructions unless he or she has a good faith basis for believing that your wishes changed or do not apply to the circumstances.
Who will pay attention to my agent?
All hospitals, nursing homes, doctors and other health care providers are legally required to provide your health care agent with the same information that would be provided to you and to honor the decisions by your agent as if they were made by you. If a hospital or nursing home objects to some treatment options (such as removing certain treatment) they must tell you or your agent BEFORE or upon admission, if reasonably possible.
What if my health care agent is not available when decisions must be made?
You may appoint an alternate agent to decide for you if your health care agent is unavailable, unable or unwilling to act when decisions must be made. Otherwise, health care providers will make health care decisions for you that follow instructions you gave while you were still able to do so. Any instructions that you write on your Health Care Proxy form will guide health care providers under these circumstances.
What if I change my mind?
It is easy to cancel your Health Care Proxy, to change the person you have chosen as your health care agent or to change any instructions or limitations you have included on the form. Simply fill out a new form. In addition, you may indicate that your Health Care Proxy expires on a specified date or if certain events occur. Otherwise, the Health Care Proxy will be valid indefinitely. If you choose your spouse as your health care agent or as your alternate, and you get divorced or legally separated, the appointment is automatically cancelled. However, if you would like your former spouse to remain your agent, you may note this on your current form and date it or complete a new form naming your former spouse.
Can my health care agent be legally liable for decisions made on my behalf?
No. Your health care agent will not be liable for health care decisions made in good faith on your behalf. Also, he or she cannot be held liable for costs of your care, just because he or she is your agent.
Is a Health Care Proxy the same as a living will?
No. A living will is a document that provides specific instructions about health care decisions. You may put such instructions on your Health Care Proxy form. The Health Care Proxy allows you to choose someone you trust to make health care decisions on your behalf. Unlike a living will, a Health Care Proxy does not require that you know in advance all the decisions that may arise. Instead, your health care agent can interpret your wishes as medical circumstances change and can make decisions you could not have known would have to be made.
Where should I keep my Health Care Proxy form after it is signed?
Give a copy to your agent, your doctor, your attorney and any other family members or close friends you want. Keep a copy in your wallet or purse or with other important papers, but not in a location where no one can access it, like a safe deposit box. Bring a copy if you are admitted to the hospital, even for minor surgery, or if you undergo outpatient surgery.
May I use the Health Care Proxy form to express my wishes about organ and/or tissue donation?
Yes. Use the optional organ and tissue donation section on the Health Care Proxy form and be sure to have the section witnessed by two people. You may specify that your organs and/or tissues be used for transplantation, research or educational purposes. Any limitation( s) associated with your wishes should be noted in this section of the proxy.
Failure to include your wishes and instructions on your Health Care Proxy form will not be taken to mean that you do not want to be an organ and/or tissue donor.
Can my health care agent make decisions for me about organ and/or tissue donation?
No. The power of a health care agent to make health care decisions on your behalf ends upon your death. Noting your wishes on your Health Care Proxy form allows you to clearly state your wishes about organ and tissue donation.
Who can consent to a donation if I choose not to state my wishes at this time?
It is important to note your wishes about organ and/or tissue donation so that family members who will be approached about donation are aware of your wishes. However, New York Law provides a list of individuals who are authorized to consent to organ and/or tissue donation on your behalf. They are listed in order of priority: your spouse, a son or daughter 18 years of age or older, either of your parents, a brother or sister 18 years of age or older, a guardian appointed by a court prior to the donor’s death, or any other legally authorized person.
Questions about Pain and Symptom Management:
What is meant by “pain”?
How can a patient get relief from suffering and pain?
If pain continues despite treatment, where can we turn?
What are common physical symptoms at the end of life?
Who manages the pain and symptoms of a terminal ill patient?
How can psychological, emotional and spiritual suffering be alleviated?
What is meant by “pain”?
Pain is when it hurts so badly that it interferes with quality of life and usually daily functioning. Pain can express itself in many ways and be of many different origins. Besides the physical related to the disease, patients may suffer from social or psychological conditions that cause emotional pain, such as isolation, stigmatization, depression, existential pain, spiritual distress and the lack of hope. Severe emotional pain can increase the feeling of physical pain. Concerns about family and other relationships or financial worries can also be so overwhelming that they contribute to suffering at the end of life.
How can a patient get relief from suffering and pain?
The patient’s pain and needs for relief should be clearly stated to the physician. When a patient is suffering at the end of life, it is important to follow the patient’s wishes for pain relief.
With the medications available today, no patient needs to live at the end of life in excessive pain and discomfort. Almost all physical pain and discomfort can be alleviated and a patient has a right to request appropriate pain medication.
Morphine is often used to relieve the severe pain that some individuals experience at the end of life. This may be particularly true of patients with certain kinds of cancers. Physicians and patients are often concerned about using morphine and other opiates because of fear of addiction. This should not be a concern. Patients request and receive only the amounts of drug needed to alleviate their pain and they do not develop an addiction. The objective is to keep the patient comfortable and pain free. A conscious patient will often be given the opportunity to choose the dosage, through the use of a self-administering pump, so he can balance the level of alertness and comfort that suits him.
In addition to prescribed medications, discomfort may also be alleviated by complementary therapies, such as massage, music and art therapy, aromatherapy, Reiki, yoga, visualization and other non-medical methods of relief. Most hospices offer these services.
If pain continues despite treatment, where can we turn?
If the patient is not getting sufficient pain relief, a pain management specialist should be requested. A palliative care team may be helpful.
The palliative care team has a physician, specially trained in pain and symptom management, who is familiar with the newest pain relieving medications and how they interact with other drugs. This specialist is usually able to recommend a combination of medications that will help the pain subside and improve the patient’s quality of life. The palliative care team also includes a social worker and other professionals who may be trained in complementary therapies.
What are common physical symptoms at the end of life?
Each patient is different and experiences a particular disease in his or her own way. In addition to the possibility of pain, symptoms at the end of life may include fatigue, insomnia, drowsiness, lack of appetite (anorexia), constipation, shortness of breath (dyspnea) and nausea. The patient’s physician (or a nurse practitioner) can prescribe medication to alleviate most of these symptoms.
When the patient is close to dying and the biological systems are beginning to shut down, the withholding of food (nutrition) and liquids (hydration) may be the best way to relieve the patient from suffering. If the attending nurse or physician suggests this, family members need not be concerned that the patient is being deprived of foods, since the body is no longer able to process (metabolize) what is taken in. The patient will die of the disease, whenever that happens, but not of starvation.
Depression is not uncommon among the terminally ill. If depression is suspected to play a role in the patient’s suffering, the patient need to be assessed for this condition and appropriate treatment administered. The treatment may be in the form of drugs or counseling, or a combination of both.
Who manages the pain and symptoms of a terminal ill patient?
The patient’s primary care giver - usually a relative, close friend or aid – is often the first to learn about changes in the patient’s condition. He or she acts as advocate for the patient and asks a health care professional for help in managing the patient’s discomfort and suffering.
The patient’s personal physician has the primary responsibility for assessing the medical needs of the patient and for prescribing appropriate medications. If the patient is enrolled in a hospice program, the physician of the hospice program will assess the patient and prescribe the appropriate medication. Medications may be administered by a physician, a nurse practitioner, a nurse or, if appropriate, the patient herself or a family member who has received the appropriate training.
Hospice aids and home health aids are usually NOT authorized to give the patient medications but play an important role in keeping the patient comfortable. Keeping the patient clean and frequently changing bed sheets and bedclothes are an important part of this comfort care and a major contributor to the patient’s quality of life.
How can psychological, emotional and spiritual suffering be alleviated?
Family members, friends and neighbors often offer the primary emotional support for a dying person. Complementary therapies, such as yoga, massage, music and art therapy, aromatherapy, Reiki, visualization and other non-medical approaches may also help alleviate suffering.
Discussing the issues that cause concern and suffering with a professional may help.
Spiritual issues can be explored with a religious leader in the patient’s congregation or with a caring and understanding individual who may not subscribe to any particular religion. Explorations about the meaning of life and death may be especially reassuring for people who feel they have lost hope. Many congregations have staff trained specifically to help families in this area. Every hospice has a chaplain who is available for the patients in its hospice programs. The Westchester-End-of-Life Coalition can connect a patient or the patient’s family with caring and knowledgeable professionals of different faith-based groups in Westchester, or with spiritual care workers who are not connected with any particular congregation. For information contact info@westchesterendoflife.org
Family and practical care giving concerns may be discussed with a social worker. All hospice programs offer this service for the patients in their care. The Westchester End-of-Life Coalition can help direct you to a suitable program or person. Please contact, Susan Gerbino at sgerbino@westchesterendoflife.org
Financial and legal concerns, such as estate and tax planning, public benefits, guardianship, estate administration/probate, and trusts and estates, may be discussed with an attorney. Attorneys specializing in elder law are familiar with issues related to the end of life. To locate an elder law attorney near you, go to www.elderlawanswers.com and enter your area code.
Individual psychological counseling and support groups for those at the end of life and their families and caregivers are available through many organizations and agencies in Westchester. For a selection of resources, go to Counseling Services and Support Groups for the End-of-Life.
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