National healthcare Decisions day

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National healthcare Decisions day Community
outreach presentation

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Advance Care Planning Your Decisions Matter
Presented By Name Title Organization Date

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Do you know what healthcare treatments you would
and would not want if you could not speak for
yourself?Do other people know what your wishes
are?
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Today

• Discover the value of advance care planning
• Learn how to talk about your future healthcare
  decisions
• Understand how to document your healthcare
  decisions using advance directives
• Encourage others to honor National Healthcare
  Decisions Day

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Advance Care Planning

• Involves
• Learning about treatment options
• Thinking about your values
• Talking about your decisions
• Documenting your wishes

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Conversations That Matter SM

• Advance Care Planning
• Health Care Directives
• Thanks to Hospice Minnesota for use of their
  content in this presentation.

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Life Expectancy

• 1900 -- 47
• Most people died quickly from accident or
  infection.
• 2000 -- 78
• Most will die slowly from chronic disease.

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Your life expectancy is

• If you are 50. . .
• 81.8 (women)
• 77.9 (men)
• If you are 65. . .
• 84.2 (women)
• 81.3 (men)
• U. S. Centers for Disease Control and Prevention

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80-90 of deaths in U.S. . . .

• cancer pattern (20)--long illness with decline
  just before death
• dementia pattern (30)--grow progressively more
  frail over time, up to 10 years
• organ system failure (30-40)--series of
  hospitalizations over several years leading up to
  sudden death
• from Center to Improve Care for the Dying

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Where we die

• 63 die in hospitals.
• 17 die in long-term care facilities.
• Patients typically spend 8 days in ICU comatose
  or on a ventilator before they die.
• (Foley, 1995 Isaacs and Knickman, 1997)

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More Telling Statistics

• A 1999 study showed that. . .
• 70 of people in the U.S. face tough medical
  decisions at the end of life.
• Baby-boomers were more willing to talk about sex
  and drugs with their teens than about end-of-life
  care with an aging parent.
• National Hospice Foundation

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Health care planning involves...

• Learning
• Thinking
• Talking
• Putting it in writing

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Why plan ahead for health care?

• exercise your right to control your own care
• guide others in making decisions for you
• clarify your wishes in case of confusion or
  disagreement

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What is a health care directive?

• Document which. . .
• states your preferences about health care
• names someone to make decisions for you
• applies ONLY when you cannot make decisions or
  communicate your wishes

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A health care directive is NOT. . .

• a will or trust to distribute property and assets
  after death
• a power of attorney for financial affairs

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What happens if I dont have a health care
directive?

• You WILL receive medical care.
• Your family may struggle with tough choices.
• You will have no choice about who makes decisions
  for you.
• Decision-makers may disagree.
• You may not receive the kind of care you want.

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Health Care Directives in MN

• Living Wills (1989)
• Durable Power of Attorney for Health Care (1993)
• Minnesota Health Care Directive (1998)

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Minnesota Health Care Directive combines

• Naming an Agent
• (Durable Power of Attorney for Health Care)
• Health Care Instructions
• (Living Will)
• (may contain one or both)

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Minnesota law requires that a health care
directive...

• be in writing
• be dated
• state the persons name bear the persons
  signature or mark
• be verified by a notary or two witnesses
• include either health care power of attorney or
  health instructions or both
• be executed by person with capacity to do so

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Part I Choosing Your Agent(s)

• Talk to the person(s) before you make it official
• Explain your beliefs, preferences and
  expectations
• Make sure agent is willing to act on your behalf

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Choose an agent who is. . .

• at least 18 years old
• willing to act on your behalf and carry out your
  wishes
• not easily intimidated--a good advocate
• able to make difficult, possibly life-or-death,
  decisions
• physically near or available

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Primary and Alternate Agents

• Decide if agents will act
• alone or together.

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You may choose a direct health care provider as
your agent if

• You are related to that person
• or
• You state why you want that person to serve as
  your health care agent

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Powers of an Agent

• give permission for, refuse or withdraw a
  treatment, service or procedure
• select health care providers
• choose residence when related to health care
• obtain copies of medical records
• (Additional powers may be assigned.)

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Additional Powers of an Agent

• Make decisions even if Im able
• Carry out wishes about funeral, burial, etc.
• Make mental health treatment decisions
• Determine whether to continue pregnancy
• Continue even if marital status changes

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Part II Health Care Instructions

• Health care goals
• Feelings about specific treatments
• Religious and spiritual beliefs
• Beliefs about quality and length of life
• Wishes for care when dying
• Preferences about organ donation

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Common Treatment Decisions

• pain control
• ventilator/respirator
• nutrition support and hydration
• cardiopulmonary resuscitation (CPR)
• dialysis, medications (including antibiotics),
  surgery, chemotherapy

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DNR/DNI

• DNR - Do Not Resuscitate (use CPR or mechanical
  means to restart breathing or heartbeat)
• DNI - Do Not Intubate (insert tube and connect
  person to mechanical breathing device such as
  ventilator/respirator)

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DNR/DNI Orders

• are different and separate from a health care
  directive
• must be issued by a doctor
• are recognized in Minnesota

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Part III Making the Document Legal

• The document must be
• signed and dated
• witnessed by a Notary Public or two individuals
• Note limits on who can witness.

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Give copies of your directive to

• primary physician
• other health care providers
• health care agent(s)
• family members and close friends
• Keep a list of who has copies!

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Dont forget to...

• Talk to your family and doctor(s) about your
  wishes.
• Keep a current copy with you if you travel.
• Keep your directive up to date.

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Review your directive when...

• Your health status changes
• You move to another state
• Your agent is no longer able to act on your behalf

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To Change or Revoke your Directive

• Notify agent, family, doctor, and replace all old
  copies with new ones.
• Destroy all old copies.
• Your health care directive can be
• changed or revoked as long as
• you have capacity to do so.

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Some common questions

• Why should I complete a health care directive if
  I trust my family?
• Can I be required to complete a health care
  directive?
• What if Ive already completed a Living Will or
  Durable Power of Attorney for Health Care?
• Do I need an attorney to complete a health care
  directive?

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More common questions

• Will my health care directive be valid if I am in
  another state?
• Do I need a directive if I want all possible
  treatment?
• How can I be sure that my directive will be
  honored?

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Remember

• You do not have to complete all of the questions
  or blanks on the form.
• You may not have answers to some of the
  questions.
• There are no right or wrong answers.
• Starting the process is an important step.

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For more information about end-of-life health
care options

• Hospice Minnesota
• [phone]
• 1-800-214-9597