Advance Directives and End-of-Life Issues

1. Advance Directives and End-of-Life Issues This presentation is intended as a template Modify and/or delete slides as appropriate for your organization and community Delete this slide before use To view speaker notes and edit presentation, click 'Edit‘, then 'Edit slides'

2. Advance Directivesand End-of-Life Decisions (Add presenter name, organization’s name and contact information here) (Add your organization name and contact information on this slide) To assist in preparing for this presentation, refer to Caring Connections brochure, “Advance Directive and End-of-Life Decisions” . To download a copy at www.caringinfo.org, then “Advance Care Planning”, then “Resources”. To order copies for distribution, go to www.nhpco.org/marketplace. (Add your organization name and contact information on this slide) To assist in preparing for this presentation, refer to Caring Connections brochure, “Advance Directive and End-of-Life Decisions” . To download a copy at www.caringinfo.org, then “Advance Care Planning”, then “Resources”. To order copies for distribution, go to www.nhpco.org/marketplace.

3. Purpose Discuss advance directives and end-of-life care decisions Learn the different types of advance directives Recognize advantages and disadvantages of advance directives Identify resources that can help you complete your advance directives Purpose of our discussion today is to: Discuss advance directives and end-of-life care health care decisions Learn the different types of advance directives Recognize advantages and disadvantages of advance directives Know resources that can help you complete your advance directives Purpose of our discussion today is to: Discuss advance directives and end-of-life care health care decisions Learn the different types of advance directives Recognize advantages and disadvantages of advance directives Know resources that can help you complete your advance directives

4. Do you have a written plan stating what health care treatments you would or would not want if you could not speak for yourself? Before we begin talking about advance directives, do YOU have a written plan stating what kind of health care treatments you would want (or not want) if you could not speak for yourself? This is basically what advance directives are. If you do not have an advance directive, listen to one story that could change your mind about completing your documents.Before we begin talking about advance directives, do YOU have a written plan stating what kind of health care treatments you would want (or not want) if you could not speak for yourself? This is basically what advance directives are. If you do not have an advance directive, listen to one story that could change your mind about completing your documents.

5. Why Bother? (Use this photo and story as an example, or add your own slide and story as appropriate) Victor is a married business executive whose best friend was in a coma from a critical car accident. After his friend was in the intensive care unit for 4 weeks, he was diagnosed as “brain dead.” Victor witnessed the agonizing and difficult decisions his friend’s family had to make about whether to continue life-sustaining treatments or not. Victor’s friend had never talked about his end-of-life care wishes and had not completed his advance directives which left his family in a major crisis about what decisions to make. Victor knew that if he were in the same situation, he would not want to be kept alive on a ventilator and feeding tubes. Victor talked to his wife about what he would want if he were ever in a similar situation and completed his advance directives. Victor also discussed his advance directives with his primary doctor and gave him a copy to include in his medical records. Since Victor has talked about what health care he wants and does not want with his wife and doctor, he can now trust that his end-of-life care wishes will be honored. Victor’s example is one of many that highlights the need for all of us to think through and make a plan about our care at the end of life. (Use this photo and story as an example, or add your own slide and story as appropriate) Victor is a married business executive whose best friend was in a coma from a critical car accident. After his friend was in the intensive care unit for 4 weeks, he was diagnosed as “brain dead.” Victor witnessed the agonizing and difficult decisions his friend’s family had to make about whether to continue life-sustaining treatments or not. Victor’s friend had never talked about his end-of-life care wishes and had not completed his advance directives which left his family in a major crisis about what decisions to make. Victor knew that if he were in the same situation, he would not want to be kept alive on a ventilator and feeding tubes. Victor talked to his wife about what he would want if he were ever in a similar situation and completed his advance directives. Victor also discussed his advance directives with his primary doctor and gave him a copy to include in his medical records. Since Victor has talked about what health care he wants and does not want with his wife and doctor, he can now trust that his end-of-life care wishes will be honored. Victor’s example is one of many that highlights the need for all of us to think through and make a plan about our care at the end of life.

6. Why You Need Advance Directives Your wishes will be known Only used if you are unable to express your decisions This can happen to anyone – at any age Give your loved ones the gift of peace of mind – write down your wishes! Why YOU need advance directives: If you have a sudden accident or illness – your wishes will be known As long as you are able to express your decisions your advance directives will not be used You may lose the ability to participate in decisions about your own treatment Give your loved ones the gift of peace of mind – write down your wishes! Why YOU need advance directives: If you have a sudden accident or illness – your wishes will be known As long as you are able to express your decisions your advance directives will not be used You may lose the ability to participate in decisions about your own treatment Give your loved ones the gift of peace of mind – write down your wishes!

7. Interesting to note… Most Americans – 88 percent – feel comfortable discussing issues relating to death and dying* Yet only 42% have a living will* *National Survey on Death, Dying, and Hospice Care in America, VITAS Innovative Healthcare, 2004 According to a national survey done in 2004, Most Americans – 88 percent – feel comfortable discussing issues relating to death and dying, yet only 42% have a living will According to a national survey done in 2004, Most Americans – 88 percent – feel comfortable discussing issues relating to death and dying, yet only 42% have a living will

8. A written statement of your wishes, preferences and choices regarding end-of-life health care decisions A tool to help you think through and communicate your choices What are Advance Directives? Advance Directives: Are a written statement of your wishes, preferences and choices regarding end-of-life health care decisions List your wishes, preferences and choices regarding end-of-life health care decisions in the event you can not speak for yourself Are a tool to help you think through and communicate your choices Advance Directives: Are a written statement of your wishes, preferences and choices regarding end-of-life health care decisions List your wishes, preferences and choices regarding end-of-life health care decisions in the event you can not speak for yourself Are a tool to help you think through and communicate your choices

9. Advance Directives Written instructions about future medical care Only used: If you are seriously ill or injured, and Unable to speak for yourself Should include: Living will Medical (health care) power of attorney Note: Each state regulates the use of advance directives differently. Generally advance directives are: Oral and written instructions about future medical care Only used if you are seriously ill or injured AND unable to speak for yourself Two documents that make up an advance directives: Living will Medical power of attorney Note: Each state regulates the use of advance directives differently. Generally advance directives are: Oral and written instructions about future medical care Only used if you are seriously ill or injured AND unable to speak for yourself Two documents that make up an advance directives: Living will Medical power of attorney

10. What is a Living Will? A legal document with your wishes about medical treatment You choose: What you do want What you don’t want Your right to accept or refuse treatment is protected by constitutional and common law through a living will. A Living Will is a legal document with your wishes about medical treatment. You can choose what treatments you want and do not want. Your right to accept or refuse treatment is protected by constitutional and common law through a living will. A Living Will is a legal document with your wishes about medical treatment. You can choose what treatments you want and do not want.

11. What is a Medical Power of Attorney? A legal form that states who you want to make decisions about medical care The person is authorized to speak for you ONLY if you are unable to make your own medical decisions May also be called: "health care proxy or agent" “health care surrogate” "durable power of attorney for health care" Medical Power of Attorney can be used at anytime - Not only at the end of life! This is a legal form that states who you want to make decisions about medical care. The person is authorized to speak for you any time ONLY if you are unable to make your own medical decisions. May also be called: "health care proxy or agent" “health care surrogate” "durable power of attorney for health care" Gives a much broader scope of decisions than the living will document. Both forms are necessary to complete your advance directives and to protect your wishes for care at the end of life. Medical Power of Attorney can be used at anytime - Not only at the end of life! This is a legal form that states who you want to make decisions about medical care. The person is authorized to speak for you any time ONLY if you are unable to make your own medical decisions. May also be called: "health care proxy or agent" “health care surrogate” "durable power of attorney for health care" Gives a much broader scope of decisions than the living will document. Both forms are necessary to complete your advance directives and to protect your wishes for care at the end of life.

12. Advance Directives: Advantages You are in charge of making your own decisions Documents can be changed anytime You DO NOT need an attorney Documents can help you express your wishes Individual forms are available to download for FREE at www.caringinfo.org Advantages of advance directives are: You are in charge of making your own decisions Documents can be changed anytime You DO NOT need an attorney Documents can help you take initiative with family and doctor to express wishes Forms are available for FREE at www.caringinfo.org Advantages of advance directives are: You are in charge of making your own decisions Documents can be changed anytime You DO NOT need an attorney Documents can help you take initiative with family and doctor to express wishes Forms are available for FREE at www.caringinfo.org

13. Advance Directives: Disadvantages Advance Directives (AD) may not be available when needed Not readily available in patient charts Living wills: may not be specific enough may be overridden by a treating MD does not immediately translate into MD order Messages here: Discuss where to keep advance directives and not Make sure you give your health care agent a copy of your AD, plus family and doctor Always complete a medical power of attorney document, not just a living will!Messages here: Discuss where to keep advance directives and not Make sure you give your health care agent a copy of your AD, plus family and doctor Always complete a medical power of attorney document, not just a living will!

14. Medical Terms for End-of-Life Care Decision Making Life-Sustaining Treatment Artificial Nutrition and Hydration (tube feeding) Cardiopulmonary Resuscitation (CPR) Do-Not-Resuscitate Order (DNR) Palliative Care Hospice Describe definitions of each. Go to www.caringinfo.org, then ‘Advance Care Planning’, then ‘Glossary’ for definitions.Describe definitions of each. Go to www.caringinfo.org, then ‘Advance Care Planning’, then ‘Glossary’ for definitions.

15. Resources in Our Community List your local resources here Insert name of your hospice/coalition/agency and any other relevant resources – invite people to call you.Insert name of your hospice/coalition/agency and any other relevant resources – invite people to call you.

16. www.caringinfo.org • 800.658.8898 www.caringinfo.org is a national consumer website, sponsored by NHPCO, with specific information on: Advance care planning Caregiving Pain Financial Planning Hospice and palliative care Grief Plus a consumer helpline number is available to answer your questions. Will mail advance directives for FREE www.caringinfo.org is a national consumer website, sponsored by NHPCO, with specific information on: Advance care planning Caregiving Pain Financial Planning Hospice and palliative care Grief Plus a consumer helpline number is available to answer your questions. Will mail advance directives for FREE

17. FREE Resources Available from Caring Connections State-specific advance directives Advance care planning Web resources Brochures to download or order: Advance Directives and End-of-Life Decisions Health Care Agents: Appointing One & Being One Conversations Before the Crisis You Have Filled Out Your Advance Directive… Now What? Ask Tough Questions The FREE resources available from Caring Connections are: State-specific advance directives Advance Care Planning information Some of the brochure topics available to download or order: Advance Directives and End-of-Life Decisions Health Care Agents: Appointing One & Being One Conversations Before the Crisis You Have Filled Out Your Advance Directive…Now What? Ask Tough Questions The FREE resources available from Caring Connections are: State-specific advance directives Advance Care Planning information Some of the brochure topics available to download or order: Advance Directives and End-of-Life Decisions Health Care Agents: Appointing One & Being One Conversations Before the Crisis You Have Filled Out Your Advance Directive…Now What? Ask Tough Questions

18. It’s About How You LIVE! Learn about your options, choices and decisions Implement your advance directive plans Voice your decisions Engage others to complete their advance directives Overall – IT”S ABOUT HOW YOU LIVE! Think about how you want it to be for yourself, your loved ones and your community and decide what actions you need and want to take when you walk out the door. You can Learn more about your options and choices about advance directives and your end-of-life decisions by visiting the Caring Connections website – www.caringinfo.org You can Implement a plan to ensure your wishes are honored by completing your advance directives and other plans for future health care. FREE advance directive forms are located on the Caring Connections website as we mentioned before. You can Voice your decisions by talking to your loved ones and doctor about your advance directives You can Engage in personal or community efforts to improve end-of-life care by helping others to complete their advance directives We are here to help you take that next step with whatever you decide. To contact us…… Thank you for your time. Overall – IT”S ABOUT HOW YOU LIVE! Think about how you want it to be for yourself, your loved ones and your community and decide what actions you need and want to take when you walk out the door. You can Learn more about your options and choices about advance directives and your end-of-life decisions by visiting the Caring Connections website – www.caringinfo.org You can Implement a plan to ensure your wishes are honored by completing your advance directives and other plans for future health care. FREE advance directive forms are located on the Caring Connections website as we mentioned before. You can Voice your decisions by talking to your loved ones and doctor about your advance directives You can Engage in personal or community efforts to improve end-of-life care by helping others to complete their advance directives We are here to help you take that next step with whatever you decide. To contact us…… Thank you for your time.