CREATING AN ADVANCE DIRECTIVE
HEALTH
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It is a good idea to speak with your loved one’s doctor about any potential future health risks. Including their physician also ensures that everyone is on the same page for long-term care decisions. It is worth noting that talking with the doctor about advance care planning during a wellness visit is covered by Medicare.
The most important things to take into consideration before making any specific decisions are your loved one’s personal values.
How do we want to be treated when we get to the end of our lives? What decisions would we like made on our behalf if we are unable to make them? Life is uncertain. It’s important to have a plan in place.
An Advance Directive is a document to let family and medical professionals know your desires should something happen. Work with your loved one to get these documents drafted while they are still able to speak clearly about their choices. Work together, instead of assigning it to them as a task, to ensure that you understand clearly what they want.
As a part of the Advance Directive, your loved one will often appoint someone as their healthcare proxy. This is the person that, if your older adult cannot make a medical decision themselves, will make the decision in accordance with their wishes. If you do not feel like you agree with the decisions that they are making in the Advance Directive, steer them to choose someone who might be more in line with their values. If there is a trusted medical professional in your family, perhaps this person might be better suited for this role.
Source: Death with Dignity
Where to Draft Your Advance Directive
The laws governing how a state will honor your Advance Directive vary from state to state. Often, one state will not honor an Advance Directive created in another state. If your loved one travels or resides in several states, it is recommended that you create an Advance Directive in each location.
Source: Death with Dignity
Some questions to consider:
- Is it important to them to be able to be mobile, so paralysis or coma may not be acceptable?
- Do they need the ability to speak to their loved ones or do they feel they could communicate in other ways should speech be impaired?
- Would they want pain medications at the end of life if it meant that they were drowsy and lethargic all the time?
- If in a facility, is it important to them that their pets and grandchildren can visit or be with them?
Source: National Institute on Aging and The Conversation Project – Institute for Healthcare Improvement
Additional Resources:
https://www.clearcareonline.com
https://deathwithdignity.org/learn/end-of-life-resources/
https://www.nia.nih.gov/health/advance-care-planning-health-care-directives
https://theconversationproject.org/
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Some of the Many Things to Think About for an Advance Directive:
- Are they open to the use of CPR?
- Are they willing to be put on a ventilator or other life sustaining mechanical apparatus? If so, for how long?
- What level of feeding/hydration is acceptable?
- What level of comfort care and pain medications are acceptable?
- Have they filled out an organ donation card?
- Do they want to live their last days in a hospital, in hospice, or at home?
- What if they require blood transfusions or organ transplants?
Many organizations offer online templates for Advance Care Directives that can be used as a starting point. Many hospitals will require the directives to be notarized.
Source: National Institute on Aging and The Conversation Project – Institute for Healthcare Improvement
What is a DNR (Do Not Resuscitate) Order?
A DNR order is a document that indicates to emergency and medical responders that the person does not want CPR or other life-restoring measures should their heart or breathing stop. In the moment, it may be hard to honor this wish. It is easier to have a clear directive and a healthcare proxy willing to make this decision on their behalf.
If your senior has indicated that they would like to donate their organs, they will need to note that the desire to donate supersedes the DNR since there may be a need to keep the heart beating until the organs can be taken for donation.
Source: National Institute on Aging
Additional Resources:
https://www.clearcareonline.com
https://www.nia.nih.gov/health/advance-care-planning-health-care-directives
https://theconversationproject.org/
Adapted from the original PDF document: “0721-MM-AdvanceDirective.pdf”
