VSED Preparation Checklist

– Determine medical support

• Note names and contact numbers for client’s provider
• Ask if client has spoken with provider about VSED
• Determine if provider is supportive
  • If not, request referral to supportive provider
• Ask if client has seen complementary/holistic provider
• Identify complementary providers the client has seen
• Review advance directive, POLST

– Complete all legal work

• Release of Information (ROI) authorization signed, copied
• Advance directive completed with VSED addendum and copied
• POLST completed, signed by provider, and copied
• Prepare “Release and Assumption of Risk” document for caregivers & doula
• Identify client’s durable power of attorney (DPOA) for healthcare
  • If not supportive of VSED, choose another DPOA
  • Note contact numbers for DPOA
• Legal will completed, if desired
• Prepare two videos:
  • Longer one (2-3 minutes) for legal purposes
  • Shorter video (1 minute) for self-advocacy
• Determine if all family members are on board
• Provide legal resources provided if needed and desired

– Choose coordinator–trusted friend or death doula—who:

• Coordinates the team: family members, caregivers, hospice, friends, faith community representative
• Sets an atmosphere of peace and calm
  Embodies compassion; always follows client’s lead
• Liaisons with all: PCP, hospice, caregivers, holistic practitioners
• Consistently assesses needs of client, family, caregivers
• May need to be the gate keeper to client
  Educates family about dying process, VSED process
• Helps client prepare an after-death plan

– Choose point person

• Consistent spokesperson for client

– Select caregivers

• Discuss importance of full-time caregivers
• Discuss preference for caregivers:
  • Experienced with end-of-life and VSED
  • Available consistently for two-week period
  • Non–family care members
• Share resources for finding caregivers
• Share resources for teaching caregivers about VSED
• Discuss the financial cost of caregivers
• Sign “Release and Assumption of Risk” document
• Help client consider Comfort Measures list

– Choose start date or personal “markers”

• Identify when time is right to begin VSED

– Complete Comfort Measures list

– Arrange for Hospice referral

• Made by healthcare provider or client or doula
• Ask hospice to complete an intake, if possible
• If possible, obtain hospital bed from hospice

– Gather equipment and supplies

– Final to-do list

• Food and all cooking smells out of the house
• Bedroom and bathroom set-up
• Everyone knows their role
• Schedule of caregivers documented and in notebook
• Legal paperwork all together in notebook
• Hospice on standby
• Notify Hospice of start date
• Intestinal cleanse completed
• After-death arrangements completed

– Acknowledge the beginning in a personal way