How to Begin Creating an Advanced Care Plan

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According to the
CDC, 70% of Americans have no advance care plan. Advance care planning is simply a future healthcare plan between you, your family, and healthcare agents. When a detailed plan of your desires is written out, you get the care you want, and your family gets the relief they deserve.

Not sure where to start? We’ve consulted some experts to help you take the first steps towards this important aspect of healthcare for older adults.

Appointing a Health Care Agent

Sara Stephens is founder and CEO of Sara C. Stephen’s Medical Advocacy & Planning. Stephens is passionate about supporting her patients through life’s challenges. Stephens is also on the Board of Directors for San Francisco’s Laguna Honda Hospital Volunteers, a nonprofit that works to improve the quality of life for patients.

Stephens discusses why advance care planning is so important.

Sara-StephensUsing Advance Care planning, an individual is educated about decision-making for life-threatening medical problems. Issues addressed include a patient’s cultural and spiritual beliefs as these can have direct effect on treatment options. Finally this process is important as it enables medical professionals and designated health care decision-makers to make better decisions that align with their patient’s wishes.

Choosing someone to act as your health care decision-maker is an important one. Ask yourself some questions before you appoint the role.

Is this person willing to assume this role? Do they know you well? Are you comfortable speaking with this person and they with you? How does this person function under stress, and can this person’s function in a stressful situation in a hospital/medical setting? Does this person’s cultural or spiritual beliefs align with yours? If not, can they respect yours? Do they have emotional attachments to you that would prevent them from supporting your wishes?

Be sure to be objective when choosing your health care agent, as it may not always be the person closest to you.

Living Will vs. Advance Care Directive

Nearly two decades ago, Paul Malley began his work as the president of non-profit organization Aging with Dignity. Malley is a popular speaker at healthcare conferences.

Malley explains the difference between advance directive and living will.

Paul-MalleyThe terms “advance directive” and “living will” are often used interchangeably, but they’re different. The doctor will want to speak with a living person for medical decision-making, versus simply referring to a sheet of paper, which would be the living will. Many living wills just ask about life support treatment in end-of-life scenarios. Ideally, the living will should guide the health care agent in making decisions for you.

Malley’s organization, Aging with Dignity, created the Five Wishes advance directive, the most popular document used in creating an advance care plan.

An advance directive like Five Wishes contains both a durable power of attorney for health care (Wish 1) and living will (Wish 2). Some people do not have someone they trust to make their medical decisions, so they simply fill out a living will and be sure their doctor has a copy. It’s not ideal, but it’s better than having nothing to guide medical decision-making.

Today there are more than 19 million copies of Five Wishes in circulation.

Don’t Wing It!

Jim Sarlis is an attorney who specializes in estate planning, will preparation and advance directives. Sarlis has been a guest lecturer at New York Law School and taught for the City University of New York. His law office is in Queens, NY.

As an attorney, Sarlis highly recommends not leaving your future care to chance.

Jim-SarlisPutting Advance Directives in place, rather than leaving it to chance or the default of the particular state you may end up in (imagine an accident far from home, or a statute that says something different than your wishes) is the best way to go. And seek the help of a knowledgeable expert rather than trying to wing it on your own.

What happens if you leave it up to chance? Sarlis tells who will make your decisions for you.

Some states have statutes that list the categories of people who would be able to make such decisions in descending order of priority, like spouse, child, parent, etc.

In the absence of such a default statute or in the event of uncertainty or conflict among the members of a given category, the only alternative would be to bring a guardianship proceeding in court for the authority to make such decisions. In an emergency, a temporary guardian with narrow powers may be appointed in the meantime, until a full hearing is held. Having a Health Care Proxy in place can help alleviate these concerns.

Be prepared and make sure you have trusted legal counsel help with the planning.

Dealing with Disagreeing Family Members

Thomas Harter is an Ethics Consultant focusing on ethical issues within business and medicine. Harter works for Gundersen Health System and teaches bioethics college courses. His work with Gundersen includes improving end-of-life care in advance care planning.

Harter shares about how to deal with a family member who doesn’t agree with your plan.

Thomas-HarterIt is not uncommon that family members and other loved ones have different treatment preferences, beliefs, and values that might clash with one another. It is important for the person doing ACP to identify health care agents who are willing to make decisions as the person doing the planning would, based on that person’s known wishes, values, and beliefs.

It is also important for the person doing the planning to communicate his or her wishes especially to family members or loved who might struggle or simply disagree with the person’s preferences. These can be difficult conversations and may require scheduling family meetings or get-togethers to discuss the individual’s preferences in depth.

When it comes to having these hard conversations, Harter says it is best not to wait.

The earlier these conversations begin to take place, the more likely it becomes that family members will come to understand and respect the decisions even if they personally disagree with them, and the less likely it will become that family members who disagree with the decisions will attempt to intervene at the bedside.

It may be difficult when not everyone in your family is on the same page when it comes to your care. But you can’t please everyone. Remember that this is about your desires and wishes and it will help your family members in the long run by knowing what you want.

Plan Today

A study from the National Hospice and Palliative Care Organization showed that the number one reason why a person doesn’t have an advance directive is lack of knowledge. Don’t leave your life up to chance. Get started on your advance care plan and keep your family in the loop. One of the best gifts you can give your loved-ones is peace of mind.

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