Advance Care Planning: Your Decisions Matter

1. Advance Care Planning: Your Decisions Matter Expressing wishes for end of life care is important to people of all ages from all walks of life.

2. Images of Death We often imagine that we will die suddenly… but most people actually experience a slow, progressive loss of body function. Your Decisions Matter

3. We Anticipate and Plan for Important Life Events The process of dying is as natural as the process of being born. Pregnancy is a developmental state that prepares us for birth, dying is a developmental phase of “undoing” or “unwinding”. Both of these phases take time Both have observable changes in the body Your Decisions Matter

4. 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? Your Decisions Matter

5. Our Objectives for 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 health care directives Identify with whom to communicate your decisions Your Decisions Matter

6. Advance Care Planning Involves: Learning about treatment options Thinking about your values Decidewhat you want and do not want Choosing an Agent and talking about your decisions Documenting your wishes Your Decisions Matter

7. Your Rights You have a right to make your own health care decisions as long as you have the ability to: Understand and appreciate the nature and consequences of a health care decision Communicate a health care decision Understand your condition Your Decisions Matter Karen Quinlan

8. Patient Self-Determination Act You have a right to make your own health care decisions as long as you have the ability to: Understand and appreciate the nature and consequences of a health care decision Communicate a health care decision Understand your condition Your Decisions Matter

9. Death does not need to be resisted by every means. “ You can refuse medical treatment that only prolongs imminent death. Patient Self Determination Act “If I become terminally ill, I ask that I be told of this so I can prepare myself for death. I would like assistance with contacting my priest/pastor who will care for my spiritual needs.” Your Decisions Matter

10. Why Plan Ahead? Our lives can change in an instant…most of us are not able to predict when we might near death. Unable to speak for yourself Sudden illness or accidents Leave a guide for others Peace of mind for loved ones Your Decisions Matter

11. Questions to Discuss Take time to reflect on these questions. What do you want and not want at the end of life? Who should speak for you? What are your concerns? What gives your life the most meaning? What one thing do you want to be sure your doctors, family and friends know about your wishes? Your Decisions Matter

12. What are your wishes for physical, emotional or spiritual comfort? Be kept comfortable and minimize pain? Even if the medication impairs your thinking? Even if the medication might alter your breathing and shorten your life? Preserve life regardless of your physical or mental health? Make health care decisions with consideration for your religion and beliefs? Your Decisions Matter

13. What are your wishes related to life support? If there is no reasonable change to regain your life physically or mentally? If you have physical limitations but can relate to family and friends? If you cannot relate to family and friends? If you have brain damage or are in a coma? If you have confusion or dementia that will not improve? Your Decisions Matter

14. What are your wishes about how to live? Want to be healthy enough to care for yourself? Want to remain in your own home? Want to live without being dependent upon medical treatments to be kept alive? Want to die naturally without lingering? Want health care even if it exhausts personal finances? Your Decisions Matter

15. Talking About Your Decisions Valuable opportunity to reflect on what’s important with loved ones Discussion needs to happen before a crisis Can provide comfort to your loved ones Is up to YOU to initiate Meal time can be a good time to begin this conversation with your family members. Your Decisions Matter

16. Decisions that your loved ones may have to make CPR-Cardiopulmonary Resuscitation Artificial Breathing - Ventilator Life Saving Medications Artificial Food and Fluids (feeding tubes) Kidney Dialysis Tissue and Organ Donation It’s less stressful to think about these treatments ahead of time. Your Decisions Matter

17. Documenting Your Decisions Health care directives document healthcare decisions at the end of life-it is a tool to help you think through and communicate your choices Gives instructions about aspects of health care Designate an agent to speak on your behalf when you are unable to speak for yourself Can give instructions about other end-of-life wishes Your Decisions Matter

18. Healthcare Power of Attorney Document who makes medical decisions about your healthcare Authorized to speak ONLY if you can’t May also be called a: "healthcare proxy or agent" “healthcare surrogate” "durable power of attorney for healthcare" Your Decisions Matter

19. Your Healthcare Agent Is someone who: You trust Knows you well Will advocate in your behalf Will honor your wishes Can be anyone over the age of 18 Can be a family member, loved one or close friend Your Decisions Matter

20. Living Will States what you want and do not want for medical treatments at the end of life but does not identify someone to speak on your behalf May also be called: Directive to physicians Healthcare declaration Medical directive Your Decisions Matter

21. A Health Care Directive may permityou to do the following… State your health goals and values State preferences about making an anatomical gift (organ donation) Give instructions about where you want to die State funeral arrangement preferences The Five Wishes document is available in 26 languages and in Braille.

22. Important to Know This is not just an issue for the aging Your health care directive should reflect your wishes—only you can write your directive Lawyers are not needed Make sure your documents are legally valid in the state where you reside-a notary or two witnesses must sign in ND & MN A Health Care Directive does not expire and can be updated as needed—review it periodically Your Decisions Matter

23. What to do with the written document Give a copy to: Keep a copy: Where you live To bring with you if you travel Most states have reciprocity statutes that recognize health care directives completed in other states For another facility if care is transferred • Your Healthcare Agent • Primary provider (doctor) • Health Care Facility • Close family members • Others to consider: • Faith community leader • Attorney Your Decisions Matter

24. When an Health Care Directive is present, a Health Care Provider must: Read the document Validate the content Respect and follow patient choices If unable to follow or carry out, must provide for transfer of care to another provider/facility Your Decisions Matter

25. Key Points about Writing an Health Care Directive: Include your loved ones in the decision—this is a gift you can give to your family and loved ones Visit with your primary care provider at your annual visit Talk with your faith community leader or a parish nurse Don’t wait until you are sick to complete this important document Your Decisions Matter

26. Key Points about Writing an Health Care Directive: Make sure it is properly witnessed Make copies for family or health care agent Know that it can be changed or revoked at any time by you Must be in writing Your Decisions Matter

27. What happens if you don’t have an health care directive? State law determines who makes decisions when you cannot speak for yourself In North Dakota the order is: Court-appointed guardian or custodian if there is one Spouse Children Parents Adult brothers and sisters Grandparents Adult grandchildren An adult friend or close relative Your Decisions Matter

28. Your decisions matter… you have choices Talk to your loved ones “I learned today that my decisions matter. I want to take this opportunity to talk with you about my decisions for healthcare if I am ever in a situation where I can no longer speak for myself.” Get information that will help you make the best decisions for you then develop a written health care directive Encourage others to document their wishes and talk with their loved ones too Your Decisions Matter

29. Resources That Can Help Sanford Health Patient Representative or the House Administrator after 4:30 p.m. or on weekends Sanford Health website at www.sanfordhealth.org Health care Directives Information and forms can be found at Caring Connections at www.caringinfo.org/stateaddownload/ National Healthcare Decisions Day at www.nationalhealthcaredecisionsday.org ND Department of Human Services at http://www.nd.gov/dhs/ MN Department of Health at http://www.health.state.mn.us/ Your Decisions Matter

30. The art of living well and the art of dying well are one. Epicarus The future depends on what we do in the present. –Mahatma Gandhi Your Decisions Matter