Many Americans with serious chronic illnesses spend their last months or years being shuttled from a nursing home to the hospital and back to the nursing home — again and again. During each hospital stay, they may be subjected to painful, invasive and expensive procedures that neither ease discomfort nor extend life.

It’s a chilling scenario, but all too common — particularly for women. Robert Martensen, MD, PhD, author of A Life Worth Living: A Doctor’s Reflections on Illness in a High-Tech Era, explained, “Many more older women than men are single because women live longer, on average. If a patient cannot speak for herself regarding her preferences on end-of-life care — and no family member speaks for her — she is at the mercy of the ‘default behavior’ of medical institutions. Typically, this means that the nursing home automatically sends the patient to the hospital if her health becomes unstable… and that the hospital aggressively treats her until she is stable enough to be discharged back to the nursing home — even if treatment does not increase comfort or restore any physical function that improves quality of life. It goes around and around this way until the patient’s body no longer responds to treatment.”

Do you have a loved one in, or headed for, a nursing home? Don’t let this happen to her.

If the patient can participate in decisions about her own care…

Clarify your loved one’s preferences. Dr. Martensen said, “When a person with serious chronic illnesses starts to lose significant function (recurrent hospitalizations are an indicator of that) or says that she ‘doesn’t expect to live much longer,’ it’s time to talk.” Discuss how intensively she wants to be treated when it’s likely that no aggressive treatments will restore function and comfort.

Help her prepare an advance directive. This legal document, which the patient can revise at any time, outlines her preferences regarding future medical care. A lawyer can handle this… or you can do it yourself by getting advance directive forms from the hospital admissions department or the Internet (do a search for the patient’s state plus “advance directive”). Copies should go to the patient’s doctor, hospital, nursing home and closest relatives.

State laws vary, but basically there are two types of advance directives — and it’s wise to have both. A living will specifies the type of treatment a person wants or does not want under various circumstances. A durable power of attorney for health care appoints a particular person to make health-care decisions in the event that the patient can no longer do so. Dr. Martensen explained, “Since it is hard to predict how a final illness will play out, a living will checklist may not cover all contingencies. For example, administering intravenous antibiotics may make sense in some situations and not in others — so it helps to have someone who can assert the patient’s preferences in terms of a specific therapy.” [Editor’s note: While you’re at it, it’s prudent to prepare an advance directive for yourself, too, especially if you live alone.]

If your loved one cannot speak for herself…

Ask questions if aggressive treatments are proposed. “Advanced interventions, such as mechanical ventilation or artificial nutrition, were designed as bridges from a medical catastrophe to reasonably good health,” Dr. Martensen said. “When crossing the bridge is not going to lead to reasonably good health, we must look at what really matters to the patient.”

Example: Using a ventilator may make sense if it helps a pneumonia patient recover… but may not make sense as a semipermanent mode of living to a person with advanced chronic lung and heart disease whose lungs will no longer function on their own.

So: Ask the doctor, “What is the goal of the proposed treatment? How will it affect the patient’s comfort, function and longevity? How long would treatment be continued?” If the answer is basically “I don’t know,” you may want to agree to a trial period of a few days or a week and then reevaluate.

Request a palliative consultation. Palliative approaches, including hospice, aim to find a balance between a treatment’s potential benefits and its harms (such as pain and being utterly dependent on machines and other people). Once a palliative care plan is in place, your loved one can get off the hospital-nursing home shuttle… and live out her days in greater peace.