The Impossible Decisions of End-of-Life Care

Caregiving is full of tough moments—the repetition, the endless doctor appointments, the confusion that no one warns you about. But nothing quite prepares you for this part: the end-of-life decisions.

It’s the elephant in the room that caregivers tiptoe around until suddenly, it’s standing right in front of them, impossible to ignore. And let me tell you, making decisions about someone else’s final days? It’s a pressure that no one should have to carry alone.

The Conversations No One Wants to Have

Ideally, we’d all have these discussions ahead of time—when our loved one is lucid, when we’re not in crisis mode, when there’s space for thoughtful planning. I’m thankful that my parents prepared this gift for me, as even with it, the decisions are hard.

For many, reality doesn’t always work that way. Maybe their loved ones never wanted to talk about it. Maybe we all assumed we had more time. Maybe we’re just now realizing that we were never ready to face it.

Suddenly, doctors are asking about DNR orders and putting them on the refrigerator , hospice care, feeding tubes, ventilators. Suddenly, we have to decide: Are we prolonging life, or are we prolonging suffering?

And that? That’s a question that keeps you awake at night. At least it does me. I love my mom so much, and I want the absolute best for her. Even on the days she make me cray cray!

Listen, I’m not preaching to you. That envelope with those instructions is laying on my desk to put up on the fridge. Please believe me when I say that resuscitation efforts on the elderly cause suffering. It’s not pretty – it makes things worse – and they will be in so much pain. Writing these words make me cry – but they are true. When your loved one is in this situation, it’s time to let them go and avoid the agony. For their sake.

The Guilt and the “What-Ifs”

Listen, no matter what decision you make, guilt is going to sneak in like an uninvited guest. It is just insidious.

• What if I push too hard to keep them alive and they suffer longer than they should?
• What if I choose hospice and they had more time left than I thought? (Pssst. You can always bring them off hospice).
• What if they would’ve wanted something different? Is the decision made with love with compassion and dignity? It’s what they would want if they couldn’t make the decision their self.

It’s a cruel twist that in the moments we most need clarity, our emotions cloud everything. Guilt whispers that we’re failing them, no matter what choices we make. Don’t listen to it! The best advice is to make all your decisions with love and their dignity uppermost in mind. Everyone deserves that.

Hospice Isn’t Giving Up—It’s Changing the Goal

One of the hardest shifts in caregiving is going from keeping them alive to keeping them comfortable. It feels unnatural, almost like giving up. But it’s not. Hospice isn’t about death—it’s about making sure the time that’s left is filled with dignity, love, and as little pain as possible. You don’t have to make the choice alone. Professionals can and will help you make a good choice.

It’s about holding their hand instead of rushing to appointments. It’s about letting them eat the cake even if their diet says otherwise. It’s about letting go of the fight and just being present, and loving them.

So, What Now?

If you’re in this stage, facing these decisions, here’s what I want you to hear:

1. You are not alone. It feels lonely, but you are not the only one walking this impossible road.
2. You are doing the best you can with the information you have. No one has a handbook for this – and there are no rules.
3. Ask for help. Hospice, grief counselors, friends, online support groups—use them all. USE. THEM. ALL!
4. Give yourself grace. There is no perfect decision, only the best one you can make in the moment with the information you have.

End-of-life decisions will never be easy. But they can be made with love. And in the end, that’s what matters most.

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Caregiver Hack of the Week:

💡 “The Goodbye Letter” – If you can, encourage your loved one to write (or dictate) a letter to be read after they’re gone. Whether it’s words of wisdom, an inside joke, or just an “I love you,” it becomes a priceless gift in the hardest moments.

I know it’s a tough topic, but it’s one that we cannot ignore. Sending you all my love – see you at the next stop!