Herb Geary, MBA, BSN, RN, FACHE Vice President, Patient Care Services & Chief Nursing Officer

1. ADVANCE CARE PLANNING Understanding and Honoring Future Health Care Goals Estate Planning Council September 24, 2019 Herb Geary, MBA, BSN, RN, FACHE Vice President, Patient Care Services & Chief Nursing Officer Rebecca Simonitsch, MSGH, MAEd, CCLS Advance Care Planning Program Manager

2. What is Advance Care Planning?

3. ACP is for anyoneover age 18 ACP is making decisions now about medical care you’d want to receive in the future if you’re ever seriously ill or injured ACP is selecting a health care agent: a person who will speak for you and honor your health care goals ACP is communicating your health care goals in conversation and documenting them in an advance directive

4. Who Does ACP in Santa Barbara and the USA?

5. That includes: • Healthy people • People with early onset, stable health conditions • People with chronic illness • People who are seriously ill and may die within the next 18 months EVERYONE OVER AGE 18

6. MyCare Document Meets California Probate Code English and Spanish versions Required and Optional sections Legal in 42 states and DC. You also need a state form in: Alabama Indiana Kansas New Hampshire Ohio Oregon Texas Utah

7. MyCare Website | www.mycare.cottagehealth.org

8. Physician Orders for Life-Sustaining Treatment (POLST) • Medical order • Provides instructions regarding specific medical treatment • Legally binding across healthcare sites in CA • Valid only if appropriately signed • Can be signed by physician, nurse practitioner or physician assistant First responders will follow POLST because it is a medical order. An advance directive becomes active when patient arrives at hospital.

9. Advance Care Planning Services at Cottage Health • At admission, Patient Access staff ask patients about an advance directive and provide information • Social workers and case managers explain ACP staff to every patient, offer a MyCare, and make an ACP referral as appropriate • An ACP team member will meet with a patient and/or family individually to complete an advance directive or POLST form • Completed forms are scanned into electronic medical records and medical team has immediate access to forms

10. Two Key Steps of Advance Care Planning Those include: • Conversation • Documentation

11. Those include: • Burden on family to make decisions • Family conflict often occurs when there has been no conversation about a patient’s wishes • Without a document and experiencing many emotions during a medical crisis, a family may make different decisions from the conversation with their loved one about his/her wishes • Barrier when a patient chose a health care agent, but did not communicate with health care agent about his/her role or discuss wishes Challenges in the Hospital

12. 18 years or older • Knows you well • Agrees to accept this responsibility • Can be trusted to honor your values and health care goals • Can make difficult decisions in stressful situations • Can be calm and think clearly when talking with your medical providers, family, and friends • Can be contacted easily by your medical providers Who’s a Good Choice for a Health Care Agent?

13. If your heartbeat and/or breathing stop, CPR can be done to try to revive you. CPR may include: • Chest compressions • Medicine • Electrical Shocks • Breathing tube When CPR is performed, it can cause: • Broken ribs • Punctured lungs What is Cardiopulmonary Resuscitation (CPR?)

14. Code Blue in Hospital – Survival to Discharge

15. What are Life Sustaining Treatments? Life Sustaining Treatments Could Include: Ventilator:machine that breathes for you when your lungs aren’t working. A tube is put inside your mouth or an incision is made in your neck into your airway. The tube connects to a machine. This tube may feel uncomfortable, and the nurses may give you medicine to help you. You cannot talk or eat normally with a breathing tube. Feeding tube:a plastic tube that is put inside your nose or into your stomach through a small incision. This plastic tube gives you food and water. Dialysis machine:a machine that removes waste from your blood if your kidneys aren’t working.

16. Organ and Body Donation Everyone makes different choices depending on our individual beliefs, cultures, or religions Important:If you want to donate your body to science, it is important you plan details ahead of time because it is a complex process for a family and hospital to plan after death

17. Reflecting on Individual Values

18. What you hope for in your future? What’s most important to you? How you want to live? What you want your family and friends to know? What are your cultural, religious, or spiritual beliefs? If You Can’t Make Your Own Decisions, Who Will Know…

19. Next Steps for Community Members Have the conversation with your health care agent(s) and loved ones Give additional copies to: Your health care agent(s) Your family and close friends Your primary care physician and any specialists you see Your attorney • Mail, email, fax or deliver copies to Cottage Health: Advance Care Planning Services Cottage Health P.O. Box 689 400 W. Pueblo Street Santa Barbara, CA 93102 Email: MyCare@sbch.org Fax: 805.569.8364