Advance Directive

Your Advance Directive Always Seems Too Early…
Until It’s Too Late!

This is the theme for  the 2016 National Healthcare Decisions Day’s (NHDD), and will be the “catch phrase” for all the NHDD activities on and around April 16th. It was developed and suggested by one of our newsletter readers, Kathy Saldana of MidMichigan Health. It is an extremely appropriate statement.

Not Now?

I hear it all the time. I’m too young, not sick enough, not old enough or I hear that people will get to it when they really need it, e.g. not now. And what happens is that their advance directive is not in place when the need arises. If a person can no longer speak for themselves or communicate their wishes, you have missed the window of opportunity. I am always hopeful that they have at least had “the conversation” with loved ones but frequently that is not the case.

Afraid of Death?

Why do we continually deal with this issue like ostriches with our heads in the sand? Most often, it is because we are afraid: afraid of death, afraid that if we put it in writing it will happen, afraid that death will happen too soon and we won’t be ready.

I do appreciate that reluctance. My husband and I went through the drill of updating our legal trust this past year. Like you and advance care planning, I knew it needed to be done as we had put it off far too long and I knew how important it was to complete. But, the process dragged on because it was easier to deal with the activities of the day than to deal with the potentiality of the future. Yet, what a mess it would have been if something had happened to us and we did not have it inked and in place.

Why Hurt Those You Love Most?

It would have been problematic for those people whom we love most: our executor and our heirs. We had to continually remind ourselves that we weren’t doing this for us but for them. That is what needs to be done with advance care planning. Remember the positive impact having a plan in place will have for both you but particularly for those you love who will be left behind.

It’s NEVER Too Early

It is never too early once you have reached majority at 18. Everyone should take the time to speak with their loved ones and share their beliefs, preferences, and values. Everyone should explain what they mean by “heroic measures” or “futile treatments”. Being specific is much more helpful than using platitudes for which there are many definitions.

Don’t Wait…Act Now

Don’t wait for the crisis. Go to the NHDD web page and download their materials so you can help yourself and others.

Contributing author:  mjmarkley.com

By |March 12th, 2016|Categories: Advance Care Planning, Advance Directive, Advance Directives, Death, NHDD|Tags: , , , , , |Comments Off on Advance Directive

Are Your End-Of-Life Care Wishes Clear

End-of-Life Care

Are Your End-of-Life Care Wishes Clear?

As acceptance of end-of-life planning grows in the U.S., new concerns are emerging about how well patients and their doctors understand the forms they are signing about the care they want in their final days.

In September, the Institute of Medicine’s “Dying in America” report called for a national effort to improve medical and social services for end-of-life care, both to improve quality of life and to help reduce the outsize costs of unwanted care at the end of life.

Some health plans are reimbursing doctors who help with advance care planning, and the federal government is weighing doing the same for doctors who talk to Medicare patients about options. A growing number of states are starting programs known as Physician Orders for Life Sustaining Treatment, or Polst, a form offered to patients who might die within a year so they can document their wishes in a medical record, signed by the doctor.

Read more of Laura Landro‘s article in the Wall Street Journal by clicking here.

By |December 14th, 2014|Categories: Advance Care Planning, Advance Directive, Advance Directives, end of life, end-of-life planning, End-of-Life-Care|Tags: , , , , , |Comments Off on Are Your End-Of-Life Care Wishes Clear

Death is Not Failure

Death is Not Failure

As I am preparing this newsletter, I am awaiting a call from a longtime colleague with the knowledge that it will be the last time we have a chance to talk.  Recently diagnosed with multiple brain tumors that are inoperable she has chosen to let her life run its course and to enjoy what quality time she can for as long as the tumors allow.  Tragic, sad, emotional; you bet, but not a failure, as far as we can tell, on anyone’s part.  Remember I said before, death is not an option.  Fortunately, her healthcare providers understand this type of terminally ill planning.

In this day and age so many healthcare providers feel like they have failed if they are unable to cure their patients.  They frequently continue to offer alternative treatments when they know that the chances of doing anything truly helpful are miniscule.  They talk about end of life planning matters extending life, but not about the quality of that life.  They are also confronted by patients and/or loved ones who want “everything” done.   They offer treatments that they themselves would not take were they in the same condition.  The healthcare professionals’ role in life has always been to make people better, to cure them, and when they can’t they feel inadequate or like they have failed so they keep trying even as hope wanes.  It is a reasonable response considering their training focuses on the cure.  But, death is just a part of life and it is sometimes best to accept.

As you might guess, the call came before I had finished this.  I was floored.  In fact my friend was ecstatic when I spoke with her.  Hard to believe isn’t it?  She kept telling me how wonderful it is to have time to talk with people who love her and who share with her what a difference she has made in their lives.  She said that this truly has been the best experience of her life and she is so pleased that her life will be ending this way because she never really thought that she had made a difference in anyone’s life.

She’s living fully in the moment.  She is making plans for the “celebration” of her end of life, when she is gone and where to scatter her ashes.  And given the advent of the Internet and advanced technology tools today, there are many new memorial technology options for cremations.  She has made peace with what is happening to her and is embracing the experience better than anyone I have ever met.  Surely there are down times but to everyone with whom I have spoken who has spoken with her they all are getting the same vibe.

Death for her is not a failure but truly is an experience she is cherishing.  Talk about acceptance!  And yes, she has her advance directives in order.

The bigger question is when will you:  Have ‘The Conversation’ And Give ‘The Gift’

Courtesy of M Jane Markley Consulting 

 

Advance Directives and Advance Care Planning

Advance Directives

Are We at a “Tipping” Point?

How is it that 24 years after the Patient Self-Determination Act went into effect we have not made significant progress in increasing the percentage of people who have Advance Directives?  Death has been hidden behind hospital doors for almost a century, new funeral and memorial technology has advanced, and people still seem to think that death is optional and prefer to avoid the end of life discussion.

Current research shows that only about 25% of the population has completed Advance Directives, yet 80% of the population states that they wish to die at home.  Many of us have talked till we are blue in the face, much money has been spent, and many different initiatives have been started but the number hasn’t budged.

All of this may seem discouraging but there are several different moves afoot that may open the subject up and bring it into the mainstream.  Things like:

  • Respecting Choices – an advance care planning model that has been inculcated into the fabric of the community in La Crosse, WI and has been around long enough to demonstrate significant community, personal, and financial impacts that are being noticed and shared.
  • Institutes of higher learning have started and/or increased their emphasis on end of life care and Advance Directives in their medical and nursing school curriculums planting the seed for better communications with patients in the future.
  • Accountable Care Organizations and Medical Home models are being encouraged by Health and Human Services to collect and report data on the advance care planning, that they are providing to seniors, which will eventually impact their reimbursements.
  • Ever increasing numbers of people, bothered by the lack of discussion and emphasis placed on the needs of people at the end of life, have taken the initiative to develop electronic tools on the internet to guide and help people address these issues before the need arises.
  • And, as I referred to in last month’s newsletter, Death and Dying Cafes and Dinner Parties are becoming increasingly popular in the U.S. as the underlying need to talk about death and our beliefs about it are being met through this informal yet growing medium.

Making advance care planning and Advance Directives a part of the mainstream of American life, where it is considered inappropriate not to discuss our thoughts and feelings on these issues, will go a long way towards increasing percentages in the future.  With the pace of change upon us we may just be at the beginning of that tipping point.  More people will be willing to have “the conversation” and give “the gift”.

Contributed by M Jane Markley LLC, www.mjmarkley.com

By |March 17th, 2014|Categories: Advance Directives, Death, death cafes, death dinner parties, end of life, Memorial Technology|Tags: , , , , , , |Comments Off on Advance Directives and Advance Care Planning