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ADVANCED HEALTH CARE DIRECTIVES

ADVANCED HEALTH CARE DIRECTIVES. For Health Care Providers at Glide. Historical Perspective . Patient Self Determination Act(1990) First legislation requiring health care organizations to provide adult clients with written information about their right to make medical treatment decisions.

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ADVANCED HEALTH CARE DIRECTIVES

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  1. ADVANCED HEALTH CARE DIRECTIVES For Health Care Providers at Glide

  2. Historical Perspective • Patient Self Determination Act(1990) • First legislation requiring health care organizations to provide adult clients with written information about their right to make medical treatment decisions. • Lead to the establishment of the Patient’s Bill of Rights and current advanced directive laws.

  3. Current California Law • Health Care Decisions Law (2000) • Consolidated California’s previous advance directive laws in order to make it easier for individuals to make their preferences known through written and oral communication. • Legally defines an “Advanced Health Care Directive.”

  4. What is an Advanced Health Care Directive? (AHCD)

  5. AHCD: Definition in California • AHCD is a document that provides an individual with the opportunity to express their wishes for future medical care. • Two broad categories: • Power of Attorney for health care • Instructional directives for health care *Best to have both types of AHCD, but may have one or the other.

  6. Power of Attorney for Health Care • Designates a person to make medical decisions for the client. • Usually specified to make decisions only when the client can no longer make decisions for themselves, but may be initiated at any time the client requests. • Also referred to as durable attorney for health care, health care agent, or health care proxy.

  7. Instructional Directives for Health Care • Written instructions describing what treatments the client would want or not want under certain circumstances. • Includes instructions on life-sustaining treatment (CPR, feeding tubes, breathing machines), pain medications, and organ donation. • Also known as “living wills.”

  8. What are the legal requirements for an AHCD?

  9. Current California Law • An AHCD is valid if it is: 1. Completed by a competent person over 18 years old. 2. Includes a persons name, signature, and the date executed. 3. Is acknowledged by a notary republic OR signed by two witnesses*. *A lawyer is NOT required to make the document legal and binding.

  10. Who can witness an AHCD? • At least one person must not be related or named in the will of the person. • Persons excluded include the: • Person’s physician/ health care provider or their employees. • Owner, operator or employee of a residential care home or facility that person is living in. In this situation, one witness must be a patient advocate.

  11. Why are AHCDs Important?

  12. Importance of AHCD • Ensures that an individual’s wishes are carried out with respect to their values and beliefs. • May prevent unwanted heroic measures or invasive procedures, which would conserve health care resources. • Encourages an open, clear dialogue between clients and their providers on what can be a difficult subject matter

  13. Who should initiate discussions around AHCDs?

  14. Role of the Primary Health Care Team • Surveys have indicated that most people would prefer to have advanced care planning discussions with a provider they have known over time. • Most say they look to the provider to initiate the discussion.

  15. When should advanced care planning begin?

  16. Ideally… • Clients will discuss AHCDs with their friends, families, and health care providers when they are healthy before the onset of a serious illness. • Clients with chronic illnesses, or those at the end-of-life need to be encouraged to set specific goals of care with their providers.

  17. What if clients want to change their AHCD?

  18. No problem… • A person who has cognitive capacity may revoke all or part of the AHCD at any time. • The revocation must be clearly documented by health care providers.

  19. Barriers to AHCDs • Only a small percentage of adults complete advanced directives - about 15% to 25%. • End-of-life discussions can be difficult, and emotionally charged for all involved. • Many clinics do not have user friendly forms readily available.

  20. Communication is Key • Open dialogue between health care providers and clients is essential to advanced care planning. • Set aside time within an appointment to discuss AHCD. • Educate client on what an AHCD entails, provide written form, and ensure that it is part of the medical record. • As the end-of-life nears, clarify the goals of care with the individual and family, reassess as needed.

  21. Resources • Barnes, S. (2003). The advanced directive: a fundamental communication. Journal of PeriAnethesia Nursing,18, 203-205. • California Coalition for Compassionate Care: http://www.finalchoices.calhealth.org/advance_health_care_directives.htm • Wissow, et al. (2004). Promoting advanced directives among elderly primary care patients. Journal of General Internal Medicine, 19, 944-951.

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