Understanding Advanced Directives and Long-term Care

Introduction

Have you ever found yourself in a situation where you were asked if your parent had an advanced health care directive, and you thought, “We really need to get that done, but I’m not quite sure what it is or how to fill it out”? This blog is here to help you with just that. In this comprehensive guide, we will cover everything you need to know about advanced health care directives, how to complete them, and why they are crucial for long-term care planning. By the end of this article, you will have all the information needed to help your parent (or yourself) complete an advanced health care directive.

What is an Advanced Health Care Directive?

Basic Definitions

There’s a lot of confusion surrounding advanced health care directives, so let’s start with some basic definitions:

Advanced Care Planning: This is a process in which you learn about different medical decisions that might arise in the future and decide what you would want based on your unique values and circumstances. It involves informing others of your wishes in advance.
Advance Directive: This is a legal document that informs others about your wishes regarding medical care if you are unable to communicate them yourself. It can come in various forms, such as a living will, a pre-hospital Do Not Resuscitate (DNR) order, or a Physician Orders for Life-Sustaining Treatment (POLST).

Advanced Health Care Directive Form

The most commonly used type of advance directive is the advanced health care directive form. It is legally recognized in every state and is both comprehensive and easy to complete. This form allows you to do two main things:

Appoint a Health Care Proxy: You designate a person (agent, representative, or surrogate decision-maker) to make medical decisions on your behalf if you are unable to do so.
State Your Wishes: You can specify your preferences for medical treatments and interventions, which is known as a living will.

Importance and Legalities

Having an advanced health care directive ensures that your wishes are carried out even if you cannot communicate them. It’s a legal form that does not require an attorney to complete. It simply needs to be signed by the person creating it (the principal) and witnessed or notarized, depending on state requirements.

Common Forms of Advanced Directives

Living Will

A living will outlines the types of medical treatments and life-sustaining measures you want or do not want, such as resuscitation, mechanical ventilation, and artificial nutrition and hydration.

Do Not Resuscitate (DNR) Order

A DNR order instructs healthcare providers not to perform CPR if your heart stops or if you stop breathing.

POLST or MOLST

POLST (Physician Orders for Life-Sustaining Treatment) and MOLST (Medical Orders for Life-Sustaining Treatment) are medical orders indicating your preferences for treatments in an emergency.

How to Complete an Advanced Health Care Directive

Step-by-Step Guide

Download the Form: Forms are available online and are state-specific. You can find them on websites like CaringInfo.org.
Fill Out Personal Information: Include your name, date of birth, and contact information.
Appoint a Health Care Proxy: Choose someone you trust to make decisions on your behalf.
State Your Wishes: Specify what treatments you do or do not want under certain conditions.
Sign and Date: The form must be signed and dated by you.
Witnesses/Notarization: Depending on your state, the form may need to be witnessed by two people or notarized.

Witnesses and Notarization

Each state has specific requirements for witnessing or notarizing the form. For example, in California, the form needs to be witnessed by two people who are not named on the form as agents and who are not related to you by blood or marriage.

Where to Keep the Form

Once completed, make multiple copies and distribute them to your doctor, your appointed agents, and keep a copy with you whenever you go to the hospital. Do not store it in a safety deposit box where it’s inaccessible.

Why You Need an Advanced Health Care Directive

The Importance for All Ages

While many associate advanced directives with older adults or those with serious illnesses, they are essential for everyone. Unforeseen events like accidents or sudden health crises can happen at any age, and having an advanced directive in place can alleviate the burden on family members during critical moments.

Real-Life Scenarios

Without an advanced health care directive, the nearest family member becomes the default decision-maker. This might not align with your wishes, and family members might feel guilt or pressure to choose all possible medical interventions, which could lead to prolonged life support that you might not want.

Making Decisions: CPR, Mechanical Ventilation, and Artificial Nutrition

Cardiopulmonary Resuscitation (CPR)

CPR is an emergency procedure used to restart the heart and breathing. It can save lives but also has risks, especially for older adults or those with serious health conditions. It’s important to consider whether you would want CPR under various circumstances.

Mechanical Ventilation

Mechanical ventilation involves using a machine to help you breathe when you cannot do so on your own. It can be life-saving but also comes with significant considerations regarding quality of life and long-term outcomes.

Artificial Nutrition and Hydration

This involves providing nutrients and fluids through a tube when you cannot eat or drink. Deciding whether or not to receive artificial nutrition can be complex and depends on various factors, including the likelihood of recovery and overall health goals.

Having Difficult Conversations

Preparing for the Talk

Talking about advanced directives and end-of-life care with your parents or loved ones can be challenging. It’s important to approach these conversations with empathy and clarity.

Tips for Effective Communication

Choose the Right Time: Find a quiet, private time to have the conversation without distractions.
Be Honest and Clear: Explain why you are having the discussion and the importance of planning ahead.
Listen Actively: Encourage your parent to share their thoughts and feelings about their care preferences.
Use Resources: Utilize guides and resources to help structure the conversation and provide information.

Advanced Directives in Long-term Care

Role of Long-term Care Facilities

For residents in long-term care facilities, having an advanced health care directive is crucial. It guides the facility’s staff in providing care that aligns with the resident’s wishes.

Involving the Long-term Care Ombudsman

If your parent is in a nursing home or similar facility, the form may need to be witnessed by the long-term care ombudsman. The facility’s social worker can assist with this process.

Integration with Care Plans

Advanced directives should be integrated into the overall care plan for residents in long-term care facilities. This ensures that all staff members are aware of and respect the resident’s wishes.

Conclusion

Recap of Key Points

Understanding Advanced Directives: These legal documents ensure your medical wishes are known and respected.
Importance for Everyone: Regardless of age, everyone should have an advanced directive.
Comprehensive Planning: Include decisions about CPR, mechanical ventilation, and artificial nutrition.
Effective Communication: Have open and honest discussions with loved ones about their wishes.
Long-term Care Integration: Ensure directives are part of the care plan in long-term care settings.

Final Thoughts

Creating an advanced health care directive is a critical step in planning for your future health care needs. It not only ensures that your wishes are respected but also provides peace of mind for you and your loved ones. By taking the time to complete this document and having these important conversations, you can help ensure that your care preferences are honored in any situation.

Resources

For more information and state-specific forms, visit CaringInfo.org. Additionally, consider watching the full video series that inspired this blog to gain a deeper understanding of each aspect of advanced health care directives and long-term care planning.

Feedback and Engagement

If you have any questions about advanced health care directives or would like to share your thoughts, please leave a comment below. Your feedback is valuable, and we are here to help you through this process.

This blog aims to provide a thorough understanding of advanced health care directives and their importance in long-term care planning. By following the steps outlined and utilizing available resources, you can ensure that your or your loved one’s health care wishes are clearly documented and respected.