What’s the difference between a POLST form and an advance directive?

By Lyle Solomon

Important terms

Advance directive: An advance directive is a document specifying who will make medical choices on the patient’s behalf if and when they become incapable of doing so. This document is also called a “health care power of attorney.”

POLST form: A Portable Medical Orders form, or POLST, is a list of medical directives that only apply to a specific patient population and deal with a small number of crucial medical choices.

Question: What’s the difference between a POLST form and an advance directive?

Answer: An advance directive is not a replacement for a POLST form, nor are POLST forms an alternative to an advance directive. However, when appropriately used, advance directives and POLST forms are helpful as advance care planning tools for expressing patient preferences.

An advance directive specifies who will make medical choices on the patient’s behalf if and when they become incapable of doing so. This document is also called “health care power of attorney.” It also offers direction or instructions for choosing medical care, usually in cases involving end-of-life care, and is also referred to as a “living will.” An advance directive is not a medical order but a directive or an authoritative instruction from the patient.

A POLST form, in contrast, consists of a list of medical directives that only apply to a specific patient population and deal with a small number of crucial medical choices. The form is meant to be used in conjunction with advance directives because it ensures continuity of care and acts as a translational tool.

An advance directive, sometimes known as a living will or health care power of attorney, is used to specify the types of treatments a patient may desire to receive in the event of a future, unforeseen medical emergency. It also allows patients to name a surrogate, and this is something every adult should have.

The POLST form is a portable medical order for specific medical care the patient would need immediately, depending on their diagnosis, prognosis and care goals. It has different names in different states, and POLST forms are suitable for people close to the end of their lives and with a severe illness or frailty.

POLST forms are suitable for people close to the end of their lives and with a severe illness or frailty.

It’s highly recommended the patient has an advance directive in place before requesting a POLST form. If patients participate in a POLST conversation, they can probably choose a surrogate. A POLST form can only be created, modified or revoked by the surrogate the patient specified in their advance directive if they ever lose the ability to make decisions themselves.

Complete Article HERE!

How Does A Living Will Work?

By Deb Hipp

During a medical crisis, loved ones must often make decisions quickly on whether to withhold or provide life-sustaining treatments. An element of advance care planning, a living will is a legal document that provides specific instructions on how to carry out your wishes to receive or decline such treatments when you otherwise can’t communicate those wishes yourself.

You may already have a durable power of attorney for health care—a legal document that allows your designated agent or proxy to make medical decisions for you if you become incapacitated. Unlike that document, however, instructions in a living will can be used only when the person named in the living will has no hope of recovery or cure.

Adding a living will to your estate plan can mean the difference between your loved ones living with doubts later or knowing they made the right decision for you when you were unable to make end-of-life medical decisions for yourself.

What Is a Living Will?

A living will is a legal document expressing your wishes on receiving or declining medical care or life-sustaining treatments should you become terminally ill or injured and unable to communicate those decisions for yourself. Each state has its own laws on living wills, including definitions of life-sustaining treatments, restrictions and instructions that can be included in a living will.

The person named in the living will is known as the “principal” or “declarant.” However, terminology may differ depending on state laws. The person designated to carry out the wishes of the principal on the living will may be called the attorney-in-fact, health care proxy or another name depending on the state.

“The living will confers limited authority of the attorney-in-fact on behalf of the principal who is no longer able to communicate their preferences to withhold or withdraw artificial means of life support or life-sustaining treatments,” says Jane Fearn-Zimmer, an elder law and estate planning attorney and partner at Archer Brogan LLP in Cherry Hill, New Jersey.

What to Include in a Living Will

A living will should include your wishes for receiving or going without treatment when your condition isn’t expected to improve and treatment would extend your life for only a limited time.

“The living will is intended to apply only in very limited situations where the principal who signed the document has an incurable or irreversible medical condition or conditions that will probably result in the principal’s death within a short period of time—typically six months or less,” says Fearn-Zimmer.

Life-sustaining treatments addressed in a living will may include:

  • Heart-lung machines
  • Mechanical ventilators
  • Artificial nutrition (via feeding tube)
  • Artificial hydration (via feeding tube or IV)
  • Cardio-pulmonary resuscitation (CPR) or other extraordinary measures
  • Dialysis

“Living wills can [also] address issues like pain management and palliative care,” says Candace Dellacona, an estate planning attorney at Offit Kurman, Attorneys at Law, in New York City. “I even include provisions like ‘I would prefer to die at home’ in a living will.”

“You want to provide as much information as you can to make sure that your proxy isn’t making the decision for you, [but] rather your wishes and words are moving through your proxy,” she says. “The more information you can provide in your living will to your proxy to illustrate for them the type of care that you’d want to receive or decline, the better.”

Living Will vs. Advance Directive: What’s the Difference?

“In New York, an advance directive is a category of documents that includes a power of attorney for financial decisions, a health care proxy and a living will,” says Dellacona.

The purpose of an advance health directive is to make sure your wishes for medical treatment and/or life-sustaining treatments are documented and carried out if you become incapacitated and unable to communicate those decisions for yourself. Depending on the state, definitions of documents known as advance directives may have some overlap.

“A living will is a subset of advance medical directive,” says Fearn-Zimmer. “It’s a legal document with the limited purpose of enabling the person who executes the document to control their end-of-life medical care. It helps avoid a tragic and frustrating situation by allowing the person who executes the document to choose ahead of time whether they want to be kept alive by means of medical treatments and technologies like a feeding tube or a ventilator.”

A living will is typically utilized in the event of:

  • Physical incapacity due to a terminal illness or injury
  • Mental incapacity due to Alzheimer’s disease or another form of dementia
  • Loss of consciousness

With an advance medical directive, such as a living will or a power of attorney for health care, the principal executing the document may consent to receiving all means necessary to remain alive, including artificial medical treatments like hydration, feeding and respiration using a tracheotomy and a respirator or ventilator, says Fearn-Zimmer.

Alternatively, the document may instruct the attorney-in-fact to decline consent to surgery or artificial and other medical treatments.

Living Will vs. Medical Power of Attorney: What’s the Difference?

Like a living will, the durable power of attorney for health care may also list measures for end-of-life treatments or instructions to withhold certain types of treatments. However, there are important differences between these two estate planning documents.

“The health care proxy names the person to make the decisions, and it often includes a Health Insurance Portability and Accountability Act (HIPAA) waiver,” says Dellacona. “The living will describes the type of care that the person may wish to have or avoid.”

“In New York and in many states, a living will and health care proxy are separate documents. Some states combine them into one advance health care directive, sometimes referred to as a medical power of attorney,” says Dellacona. New York refers to a medical power of attorney as a health care proxy.

The durable power of attorney for health care allows the health care proxy you’ve appointed to carry out your wishes for medical care should you become incapacitated and unable to communicate medical decisions for yourself. The health care proxy’s duties may include consenting to or declining treatments that could possibly lead to your recovery.

In addition to that power, the health care proxy named in the health care proxy document is also allowed to carry out the wishes outlined in your living will for receiving or declining life-sustaining treatments.

“Living wills can be a helpful document for the person you named as your health care proxy to read so that they understand your wishes, especially in a time of crisis,” says Dellacona.

Living Will vs. Last Will and Testament: What’s the Difference?

A living will and a last will and testament may sound similar, but these legal documents serve entirely different purposes. Like their names imply, both serve to carry out the “will” or wishes of the principal. However, that’s where the similarities end.

A living will comes into play while the principal is still alive but incapacitated and unable to communicate decisions about receiving or withholding life-sustaining treatments.

On the other hand, a last will and testament takes effect upon the principal’s death. The last will and testament instructs the executor of the principal’s estate on distribution of certain property and assets.

Why Living Wills Are So Important

In a medical crisis where there’s no hope for recovery or another end-of-life situation, a living will can ease the intense pressure placed on the principal’s health care proxy to make decisions in accord with their wishes.

“The living will can make it easier for the proxy to understand what those wishes are and advocate for you if you can no longer advocate for yourself,” says Dellacona “[The living will] is also helpful if the proxy is facing pressure from other family members or others who may think you have a different view of care.”

Living wills also provide clear instructions to emergency medical staff.

“In an emergency life-or-death situation, every minute counts,” says Fearn-Zimmer. “The emergency medical team needs to know instantly whether to act in an emergency situation. The living will is short and sweet—maybe only one or two pages—and tells them what they need to know and who will give the authorization quickly in an emergency situation.”

Studies show both health care providers and family members experience increased anxiety and stress after making these decisions for their patients and loved ones. The presence of a living will can help provide them not only a sense of direction, but also welcomed relief.

How to Write a Living Will

An estate planning or elder law attorney can prepare a living will according to your instructions. Alternatively, you can use software purchased from legal document websites or certain state bar associations to prepare the living will yourself. Hiring an attorney to prepare your living will ensures the document complies with your state’s laws.

Many (but not all) states require two witnesses and notarization of your signature to execute the living will. You can revoke or revise a living will at any time.

To get a general idea of your state’s laws for living wills, you can look up state requirements at FindLaw. Make sure to double-check state statutes yourself on your state legislature’s website for accuracy.

The URL for the official website for your state legislature ends in “.gov.” If you’re preparing your own living will, make sure it meets the requirements listed on the official state website.

Lastly, remember a person’s wishes and values often change over time, particularly as illness arises and advances and one approaches their end-of-life journey. Therefore, a living will shouldn’t be a static document, but rather one that’s readdressed every few years to ensure it reflects a person’s current care preferences.

Complete Article HERE!

Why End-of-Life Conversations Can Be Difficult for Sexual and Gender Minority Patients

Carey Candrian, PhD, helped lead a study to understand how fear and discrimination affects advance care planning.

by Greg Glasgow

Advance care planning — thinking about what kind of care you want and whom you want by your side at the end of your life — can be difficult under any circumstances. But for sexual and gender minority (SGM) patients — including individuals who identify as lesbian, gay, bisexual, asexual, transgender, queer, or intersex — those conversations are often made even more difficult due to stigma, fear, and discrimination.

Carey Candrian, PhD, associate professor of internal medicine at the University of Colorado School of Medicine, is senior author on new research, published in JAMA Network Open, that finds that SGM patients’ experiences of discrimination affect their selection of clinicians and cause concern about whether their end-of-life preferences will be honored.

Candrian and her fellow researchers collected survey data from SGM and non-SGM participants and conducted qualitative telephone interviews with SGM participants across the country, asking them about their end-of-life discussions with clinicians.

“These conversations are hard for everyone, because you’re talking about things like death and dying and serious illness and diagnosis,” Candrian says. “When you add in all these other factors that we know exist for SGM people — less likely to have a traditional family, more likely to have experiences with discrimination or mistrust in the health care system — it makes those conversations even harder. We’re really trying to really understand what is happening and how these conversations impact it.”

Fears of disclosure

Advance care planning discussions can happen at any stage in a patient’s medical journey, not just when they are diagnosed with a serious illness. Doctors may ask the patient’s preferences on care measures such as ventilators, CPR, and artificial feeding, and whom the patient wants to speak or make decisions for them if they are unable to speak for themselves. Those conversations are often difficult for SGM patients who are not in heteronormative, legally recognized relationships or who have not disclosed their sexual or gender preferences to their parents or siblings.

“It can be a double bind — they don’t feel comfortable in the health care system, and they also are not comfortable disclosing it to their family,” Candrian says. “The big tension that we found is, ‘How can I actually have a meaningful conversation if I am so worried about disclosing this core part of myself in terms of who I am, who I need by my side, and what I want?’ How can you ensure they’re getting the care that they need if they can’t disclose this critical information?”

Part of that worry for SGM patients is making such a disclosure part of their medical record, where it can be seen by other doctors if the patient has an accident or needs emergency care out of state. Many survey respondents had experienced discrimination based on their gender or sexual identity in other aspects of health care and were reluctant to share that information in care planning discussions.

Critical conversations

The paper notes that “more SGM-specific patient-centered care might better support these discussions within the health care system,” and that clinician sensitivity training may also help as well. Other paths to more constructive conversations could include indicating support for SGM patients — through a rainbow flag or other means — and changing standard questions from, for example, “Are you married? Do you have kids?” to “Do you have a partner? Do you live with anyone?”

“Several participants had really great ideas on how to improve these processes in terms of how to find forms and how to make them more accessible for people who don’t fit the standard checkboxes,” Candrian says. “We need to collect this information in a way that doesn’t perpetuate discrimination, but actually opens the door to having a really critical conversation with SGM people.”

The study data were collected between October 2020 and March 2021, and the authors note that in the wake of the Supreme Court’s decision that overturned Roe v. Wade and concerns about the future of the legal status of same-sex marriage in the U.S., the fears and concerns expressed by SGM participants about advance care planning may be more pronounced now and in the future.

“Now, perhaps more than ever, we need to bring more voices into the conversation around advance care planning than have been included before,” says lead and corresponding author Amanda Reich, PhD, MPH, an investigator at the Center for Surgery and Public Health at Brigham and Women’s Hospital in Massachusetts. “Clinicians have the opportunity to re-open how we talk about end-of-life care to be more inclusive and to understand why our patients may be fearful or hesitant to have these critical and deeply personal conversations.”

Complete Article HERE!

11 Important End of Life Documents Everyone Needs

By

11 End of Life Documents for Mesothelioma & Cancer Patients

Although patients can outlive a prognosis and even reach remission, mesothelioma remains one of the worlds most deadly conditions. This is why mesothelioma patients should take as many measures as possible to ensure their personal finances and responsibilities are covered. Many people have a will prepared, but there are several other end of life documents that are essential family members or patients dealing with mesothelioma. Without these kind of documents, loved ones will have to make difficult decisions on your behalf with no guidance. Although it may be difficult to discuss, Mesothelioma Hub feels it is still necessary to prepare for the worse. Here is our list of eleven essential documents that all families should prepare while dealing with a mesothelioma prognosis.

1) Letter of Competency

A letter of competency is one of the first end of life documents to complete during your planning. A letter of competency is a statement from a mesothelioma doctor or specialist stating that a person is capable of making informed, stable decisions. This end of life document could apply to health care, finances, or estate. A common side effect of mesothelioma treatment is memory loss, confusion, and brain fog. Therefore, it is essential to obtain a letter of competency if applicable.

2) Living Trust End of Life Document

A living trust is another essential piece of end-of-life paperwork. A trust is created and funded during a patient’s lifetime that they can amend or revoke as time goes on. A living trust appoints a person or corporation to act as a “trustee” after their passing. The document also designates the “beneficiaries,” aka the people who receive income or other property from the trust. This trustee manages the trust property for the benefit of the beneficiaries.

The average lifespan for a mesothelioma patient after receiving a diagnosis is 4 – 18 months. A living trust is an end of life document that you should assemble as quickly and efficiently as possible during your end-of-life preparation and especially during the more advanced terminal stages.

3) Last Will and Testament

A last will and testament is the legal end of life document specifying a patient’s last wishes pertaining to assets and dependents after death. Although similar to a living trust, the last will controls property directly under the control of the individual and does not include jointly owned assets whereas a living trust controls all assets. Details included in the last will and testament include what to do with possessions, and what will happen with their responsibilities including dependents and management of financials.

4) Letter of Intent

Although not a legal document, a letter of intent can be beneficial for your executor and family members. A letter of intent can act as an end-of-life checklist for your loved ones for wishes not covered in a will. The document can include the location of important legal end of life documents, names and contacts, care for pets, and many more details. It should remain a high priority for those with wishes that can’t be fully explained within other documents.

5) Financial Power of Attorney

The purpose of a financial power of attorney is to designate an agent to handle financial affairs. This person has the legal ability to make decisions about a person’s finances when someone is ill, disabled, or physically not present. The agent should make arrangements in line with the person’s wishes but has full authority to make autonomous decisions until their authority is challenged or revoked by the law.

Many people on their life journey were negligently exposed to asbestos and developed mesothelioma. This is where your a financial power of attorney can come in and assist with the legal side of things and even pursue legal help and compensation.

Need to Obtain End of Life Documents?

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6) Health Care Power of Attorney

If a patient is unable to make medical decisions for themselves, they may choose to have a health care power of attorney. A health care agent should be someone trustworthy and noble as they can:

  • Accept, withdraw, or decline treatment
  • Agree to admit or discharge a patient from any medical center or institution
  • Access medical and mental health records and share them with others
  • Carry out plans or make decisions about the body or remains

Throughout the mesothelioma journey, several health-related decisions will need to be made. Whether you are going through treatment or are staying in an assisted living home, a health care power of attorney can assist you in these decisions and maintain important end of life documents.

7) Living Will End of Life Document

A living will is a vital facet of a patient’s end-of-life plans. This document declares a patient’s desire to have death-delaying procedures withheld after being diagnosed with a terminal illness. This end of life document can assist doctors and loved ones if a decision needs to be made about withholding death-delaying procedures.

The medical community considers mesothelioma a terminal illness. If you are interested in death-delaying procedures being withheld, you should complete a living will.

8) Organ Donor Care

Those interested in donating their organs should complete a health care directive stating their wishes. If arrangements have already been made, specifying an end of life document should include all necessary information. If a patient has a health care agent, they can also make the decision with guidance from the patient.

9) HIPAA Release

Health care information of everyone is not accessible by others before or after their death. However, a HIPAA release form shares otherwise protected health information with other individuals or organizations. Patients should file a HIPAA release form if they would like their health care agents or loved ones to have access to their important end of life medical details.

10) DNR Order End of Life Document

A health care provider will typically begin CPR and life-saving activities if the heart or breathing stops, however, people can choose to not receive care under these circumstances. A do not resuscitate (DNR) order states that a patient prefers to not receive CPR in the case that the heart or breathing stops.

Many mesothelioma patients that pass, developed the condition due to negligence. The patient’s loved ones may be eligible to file a wrongful death suit against the individual or company believed to be responsible for negligence. Thats why it’s so important for to keep all your family members end of life documents secured and organized.

11) Digital Asset Instructions

Nowadays, the average person has almost 200 digital accounts including bank, investment, insurance, cryptocurrency, and social accounts. Some of these accounts, if not all, will need attention after a person passes. If these accounts are password protected, a patient should assemble a list of login information. Patients can even assign a digital executor to manage online accounts after they pass.

Complete Article HERE!

Advance Directives

— What You Need To Know

By Jennifer Lagemann

Only one in three U.S. adults has an official plan in place for end-of-life care, according to research in Life Affairs. Formalizing these details when you’re able to do so can make a world of difference for you and your loved ones down the line.

Read on to learn about advance directives, including what they are, why they’re important, what challenges may arise and how to ensure your or your loved one’s wishes are in writing so they’re more likely to be honored if and when the time comes.

Advance directives are written instructions regarding what a person wants in terms of health treatment and care should they lose the capacity to voice these desires. Samantha Winemaker, M.D., a palliative care physician and co-host of the Waiting Room Revolution podcast, defines advance directives as “an expression of someone’s values and wishes based on what’s most important to them in their life.”

Advance directives were first introduced in the U.S. in 1967 as a component of advance care planning. Reaching a step beyond informed consent, they help people prepare for inevitable and unpredictable life events that can impact a person’s ability to direct their own care. These documents provide space in which patients can wield more power and autonomy in shaping their health care experiences, particularly as it relates to end-of-life care, says Dr. Winemaker.

Types of Advance Directives

There are several types of advance directives, including (but not limited to) living wills, health care powers of attorney, do-not-resuscitate (DNR) orders and physician orders for life-saving treatment, says Ferdinando Mirarchi, D.O., chief medical officer of the Institute on HealthCare Directives.

Physician orders for life-saving treatment (POLSTs) outline a plan of end-of-life care that reflects the patient’s care preferences as well as their health care provider’s judgment based on a medical evaluation. This advance directive is only valid once agreed upon and signed by both parties.

A living will is a written document that outlines a person’s health care wishes for end-of-life care in the event that something prevents them from voicing their own values, wants, wishes and needs for whatever reason and they cannot make such decisions on their own. Living wills typically tell health care providers what treatments the person does or doesn’t want when the individual no longer has the competency to make such decisions, and some include religious preferences as well.

“They are [written] documents that provide a way to express your wishes if you can’t speak for yourself,” adds Dr. Mirarchi.

A health care power of attorney, also called a health care proxy or health care agent, is someone a person appoints or designates to advocate for them in the event that they can no longer advocate for themselves.

The importance of choosing a power of attorney cannot be overstated. Dr. Winemaker describes the role as a culmination of all the previous conversations they’ve had with the person about what they value and the tradeoffs they’re willing to make. They need to pick what the person they’re advocating for would want and put their wishes in the context of the given situation. A power of attorney is only as good as how well they know their role, says Dr. Winemaker.

Do-not-resuscitate (DNR) orders are medical orders written by a doctor explicitly instructing health care providers not to use cardiopulmonary resuscitation (CPR) should the patient’s breathing stop or heart stop beating. “Depending on the state, these orders can also be written as a cardiopulmonary arrest,” Dr. Mirarchi.

Various guidelines for each of these advance directive documents are outlined in state laws and often templated by specialized attorneys. You may also create similar documents on your own. The more specific a person is with the information they include in an advance directive, the more closely their wishes will be followed when the time comes.

Why Are Advance Directives Important?

Advance directives are essential for patient autonomy. They empower a person to have their wishes honored in the event that they’re no longer able to speak for themselves.

What’s more, the use of advance directives is linked to higher utilization rates of palliative care (health care for people living with a serious illness), reduced stress toward end of life, improved communication between health care teams and patients’ families, and reduced health care costs, according to research in the Journal of Gerontological Nursing.

It’s important to understand the broader context of how advance directives play a role in how people experience health care. “We have to [acknowledge] that 90% of us will end up with some condition that will result in multiple [health care] decisions,” says Dr. Winemaker. “We have to [be ready to] make [these] decisions for ourselves and [others]. It’s not ‘if’— it’s ‘when.’”

Coordinate with your or your loved one’s health care team to keep time on your side, advises Dr. Winemaker. “Don’t put yourself at a disadvantage or work in crisis mode. This is a part of life, and just like with everything else, planning is the best medicine,” she says.

Dr. Winemaker also explains that it’s important for patients to play a more active, consumerist role in their health appointments by expressing person-centered requests.

“The health care system is all about bi-directional sharing—it helps diagnose an illness and treat the illness,” she says. Often, the goal is to keep people going for as long as possible and keep the illness quiet as long as possible. However, quality of life is often superseded by the pursuit of longevity. So, it’s crucial to be open, honest and proactive with your care team so they can make recommendations and treatment plans that best suit your specific situation and personal preferences.

In fact, the point of an advance directive and participating in advance care planning is to go against the health care conveyor belt—you won’t get what you need unless you’re vocal about your wishes, says Dr. Winemaker. Your treatment plan should reflect who you are.

When Should You Make Advance Directives?

There’s no “best” time to file advance directives, but Dr. Winemaker says the sooner they’re in place, the better. And remember care planning is not a one-off conversation, but rather a series of discussions with your loved ones and yourself about what suits you best.

“When you’re healthy, reflect on what movies you watch on Netflix,” suggests Dr. Winemaker. “Think of ‘The Notebook’ or ‘Still Alice.’ What would you do in either of those situations? Think of yourself in multiple scenarios and what you’d want, and share those [details] with people around you as soon as possible.

Meanwhile, there are certain points in life when it can be advantageous to update advance directives, says Dr. Winemaker, which include (but aren’t limited to):

  • When you become a partner or spouse
  • When you become a parent
  • When you lose someone important to you
  • When your contact information (telephone number, physical address, email address, etc.) changes
  • When your selected health care power of attorney is deceased or you want to select another person in their place

Generally, advance care plans or advance directives should be updated and reviewed annually similar to how you schedule an annual health care appointment with your primary care physician.

When Are Advance Directives Implemented?

Each type of advance directive serves a unique purpose and is implemented in certain situations.

POLSTs are implemented once both the patient and their health care provider agree and sign off on a medical treatment plan as it relates to the person’s current health status.

Living wills go into effect when the person enters any of the conditions listed in their living will document. At this point, the document becomes operative and is followed by all care team members, explains Dr. Mirarchi.

Meanwhile, a health care power of attorney can be utilized at any point in a person’s life when they aren’t able to make a health decision for themselves, be it due to an acute health emergency or progression of a chronic illness.

And DNR orders become active when a person stops breathing or their heart stops beating, at which time the care team isn’t allowed to perform CPR to resuscitate them.

What Happens if You Don’t Have Advance Directives?

Without advance directives, the specific outcomes of your care are more uncertain. “From a health care perspective, there are times when the health care team can act in an emergency in the patient’s best interest, but that’s reactive care—not proactive care,” says Dr. Winemaker. You or your loved one likely wants to be in a position of control over their care, which requires having a plan.

“If it’s not an emergency situation, [the health care team has] to try to find people who are in the person’s life. Ultimately, if a decision needs to be made, they can also go to a higher-level attorney or representative,” explains Dr. Winemaker. There are various contacts the health care system can use to make a legal decision on a patient’s behalf.

Unaware of what a patient wants, the health care team and family members they’re able to contact are often left to make decisions based on what they think they know about the patient. Naturally, a lack of advance directives in such circumstances can cause undue stress and burden for loved ones who, even with good intentions, might make the wrong decisions for the person in need of care.

Common Challenges With Advance Directives

According to Dr. Mirarchi, one common challenge with advance directives is something he refers to as “medical stranger danger.” Advance directives are documents often written with the help of attorneys and then interpreted by health care professionals, explains Dr. Mirarchi, so it’s not surprising that misunderstandings that can turn into medical errors occur. More specifically, his research shows advance directives can “get prematurely misinterpreted as a DNR order, and DNR orders can get misinterpreted as do-not-treat orders.” However, he adds that while most people in medicine are “medical strangers” to you, your doctors are often people who actually know you well enough to make informed decisions as it pertains to your care.

The goal is for the health care team to make decisions that honor what a person says they want, says Dr. Winemaker. There’s a process to override someone if they’re not making a fit or good decision, but you typically don’t have to escalate a situation to that level. And often, a person’s decision is coming from a good place.

There’s no time like the present to get started on your advance directives if you haven’t already— and encourage your loved ones to do the same. Once you have them in place, remember to review them at regular intervals as well to make sure they still represent your wishes and desires.

Complete Article HERE!

Advance directives: A new look at future health care wishes

An advance directive is a voluntary, legal document that articulates an individual’s wishes regarding future medical care and treatment.

By Gloria Brigham, EdM, MN, RN

As highlighted during the COVID-19 pandemic, individuals have preferences about their life and future. These preferences arise from values, cultural norms, knowledge and available information. They are influenced by past experiences and the consequences of previous decisions. Periodically, preferences change.

Health care planning for the future is important to ensure that your wishes are known and followed when you are unable to speak for yourself. Sharing what matters to you most (in writing) is one way to clearly communicate with loved ones and health care providers.

What is an advance directive?

An advance directive is a voluntary, legal document that articulates an individual’s wishes regarding future medical care and treatment. It is valid from the time of completion until the end of life. In Washington state, there are two types of advance directive that can be completed by adults 18 and older:

  • Durable power of attorney for health care – The durable power of attorney for health care is also called a medical power of attorney or health care agent. This is an individual that you choose to make health care decisions (on your behalf) if you are unable to make them for yourself. The health care agent cannot be under 18 years old, your health care provider or an administrator/employee of a health care facility where you receive care or live.
  • Health care directive – A health care directive is also referred to as a living will. This written document includes the type of medical care and treatment that you wish to have near end-of-life, if any. This document informs health care professionals of your preferences in the event of an accident or life-threatening illness when you are unable to speak for yourself.

Who should complete an advance directive?

It is advised that everyone over the age of 18 have an advance directive. The reality is that no one knows when an event might occur that renders us incapable of making our own decisions.

How is an advance directive completed?

Fill out advance directive forms found on the Honoring Choices Pacific Northwest website1. An attorney is not needed for an advance directive. Once your advance directive forms are complete, they are legally valid when notarized or signed by two “disinterested” witnesses. Witnesses must be 18 years of age and cannot be related to you by blood or marriage and cannot be your attending provider or an employee of your provider or the health care facility where you are a patient or receive care.

How is POLST different from an advance directive?

According to the Washington State Medical Association, Portable Orders for Life-Sustaining Treatment (POLST) is a medical order that addresses emergency care wishes for seriously ill individuals. POLST is not for everyone. It is intended for individuals in poor health who want to have the choice not to pursue selected treatments in response to a health emergency2.

Inspiring individuals to complete an advance directive supports individual choice and autonomy regarding personal care preferences at end of life. Once complete, advance directive copies are provided to the people close to you, such as your health care agent, loved ones, and your health care providers. If advance directive changes are necessary, share those changes and provide an updated copy of the advance directive to those that matter to you. For additional information visit www.honoringchoicespnw.org.

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Preparing Yourself or a Loved One to Die at Home

by Ray Burow

Death is not a fun topic, but failing to talk about end-of-life plans results in a lack of preparation and exacerbates emotional strain when a loved one passes away at home.

If your loved one opts to live out their final days in their house, or if you care for an elderly spouse or parent who’s in the advanced stages of Alzheimer’s disease, they could die at home. Are you prepared? What are your loved one’s end-of-life wishes? Would they choose to pass away at home? Is hospice care an option, or is a hospital setting a better choice for your circumstances? Medicare often pays for hospice care.

Why some people prefer to die at home

Passing away at home is often preferred by critically ill or older individuals. According to the Stanford School of Medicine, studies indicate that 80% of Americans would choose to pass from this life surrounded by what’s familiar to them, preferably at home. However, many don’t get their wish. Only 20% of Americans die at home, while 60% die in acute care hospitals and 20% die in nursing homes.

People prefer to die at home for various reasons, but perhaps control is a primary contributor. The family can manage who comes and goes, providing an opportunity to gather, reminisce, and properly say goodbye. Caregivers administer palliative care in a comfortable, familiar environment rather than one that is foreign and starkly sterile.

Hospice care will assist with pain management, and no heroic actions are taken to resuscitate the patient, who is allowed to slip away. Depending on the laws in your state, you may be able to keep the body at the house for a period of time, and some families may choose to have the funeral at home, too.

How to prepare for a death at home

Preparing to die at home is a process that must occur before the person’s final days. If you or a loved one has been diagnosed with dementia, it is essential to decide in the early days of the condition, while the decision is still yours to make. Caregivers and loved ones, acting as surrogates, can carry out your wishes, but only when they know what they are.

Advance directive

An advance health directive is crucial to securing end-of-life wishes. It’s a legal document containing the patient’s desires. If the patient is incapacitated, the document expresses their values regarding end-of-life processes. These include whether first responders and healthcare professionals will administer CPR, if the patient will donate organs, and what comfort measures will be in place during the dying process.

When a person dies at home unexpectedly and without an advance directive, first responders typically can’t pronounce them dead, as required by law. Paramedics transport the remains to the nearest hospital emergency room, where a doctor will pronounce them. If hospice is in place, the hospice nurse can pronounce the person’s death at home, and the family arranges for a funeral home to remove the remains.

Without hospice, a living will, or an advance directive, the family must call emergency services when their loved one dies at home. Paramedics, possibly firefighters, and police officers will arrive at your home, but only a doctor or coroner can pronounce death.

Understand that without the proper documents in hand, paramedics have to follow protocol and will often begin administering emergency procedures and transport your loved one to a hospital where a doctor with authority to pronounce can do so. There are exceptions to this rule depending on where you live, and in some cases, paramedics are permitted to pronounce.

Following death

Some states require an autopsy when a person dies at home. If the deceased was advanced in age, an autopsy might not be necessary. In either case, you must make arrangements for transportation to a funeral home or crematorium. Don’t be shy to ask about cost. Funeral homes are required by law to provide that information when requested.

There is much more to preparing for death at home than what we can briefly discuss in this column, including the emotional and spiritual aspects and mourning through the grieving process. Mourning is necessary and healthy, and it’s futile to try and skip it. Grief will rise to meet you in unexpected places and at random times. A grief counselor, pastor, trusted friend, or family member can help you through the mourning process. You don’t need to mourn alone.

Complete Article HERE!