Advance Care Planning
What is Advance Care Planning?
Advance care planning involves preparing for one's future medical care if that person becomes seriously ill or unable to communicate his or her wishes. Having meaningful conversations with loved ones is the most important part of advance care planning. Many people also choose to complete advance directives, legal documents that provide instructions for medical care and only go into effect if a person is unable to communicate his or her own wishes.
Advance care planning is not only for people who are ill or very old. At any age, a medical crisis could occur, leaving a person unable to communicate his or her health care decisions. Setting up advance directives sooner rather than later can help individuals plan for their future health care needs, ensure that they will receive the care that they want, and give them peace of mind knowing that someone they trust has been elected to make those decisions.
It is important to note that being someone's "Power of Attorney" does not necessarily equate to having the authority to make health care decisions on that person's behalf. The authority to make healthcare decisions must be specifically written into the legal Power of Attorney document. Similarly, a person's emergency contact in his or her medical records is not automatically that person's Health Care Representative. This, too, must be spelled out in writing.
Types of Advance Directives
A living will is a legal document that tells doctors how a person wants to be treated if he or she cannot make their own decisions about emergency treatment. In a living will, individuals can can say which common medical treatments or care they would want, which ones they would want to avoid, and under which conditions each of those choices applies.
Durable Power of Attorney for Health Care
A durable power of attorney for health care is a legal document that identifies a health care proxy, a person who can make health care decisions for someone if that person is unable to communicate on his or her own. A proxy, also known as a representative, surrogate, or agent, should be familiar with the person's values and wishes. A proxy can be chosen in addition to or instead of a living will. Having a health care proxy helps a person plan for unforeseen circumstances, such as a stroke or a serious vehicle accident.
Do Not Resuscitate (DNR) Order
A DNR becomes part of a person's medical chart to inform medical staff in a hospital or nursing facility that he or she does not want CPR or other life-sustaining measures to be attempted if his or her heartbeat and breathing stop. This document may also be referred to as a Do Not Attempt Resuscitation (DNR) order or an Allow Natural Death (AND) order. Even though a living will might state that CPR is not wanted, it is still helpful for individuals to have a DNR order in their medical file if they go to a hospital. Having a DNR posted next to one's hospital bed would minimize confusion in an emergency. Without a DNR order, medical staff will attempt every effort to restore a person's breathing and heart rhythm.
Do Not Intubate (DNI) Order
A DNI informs medical staff in a hospital or nursing facility that a person does not want to be on a ventilator.
Do Not Hospitalize (DNH) Order
A DNH indicates to long-term care providers, such as nursing home staff, that a person prefers not to be sent to a hospital for treatment at the end of life.
Out-of-Hospital DNR Order
An out-of-hospital DNR alerts emergency medical personnel to a person's wishes regarding measures to restore breathing and heartbeat if he or she is not in a hospital.
Physician Orders for Scope of Treatment (POST)
A POST form is a direct physician order for a person with at least one of the following:
1. An advanced chronic progressive illness.
2. An advanced chronic progressive frailty.
3. A condition caused by injury, disease, or illness from which, to a reasonable degree of medical certainty there can be no recovery and death will occur from the condition within a short period without the provision of life prolonging procedures.
4. A medical condition that, if the person were to suffer cardiac or pulmonary failure, resuscitation would be unsuccessful or within a short period the person would experience repeated cardiac or pulmonary failure resulting in death.
In consultation with you or your legal representative, your physician will write orders that reflect your wishes with regards to cardiopulmonary resuscitation (CPR), medical interventions (comfort measures, limited additional interventions, or full treatment), antibiotics, and artificially administered nutrition. The POST form must be signed and dated by you (or your legal representative) and your physician to be valid. The original form is your personal property and you should keep it safe.
Completing Advance Directive Forms
Do I need a lawyer to create advance directives?
An attorney is not required to complete an advance directive. As of January 1, 2023, Indiana law permits any form or documentation for an advance directive. To ensure their legality, they need to be signed by the patient and witnessed by either two people or one notary. The witnesses cannot be the named Health Care Representative, and only one can be a relative.
Can I change my mind after I sign an advance directive?
A person may change or cancel his or her advance directive at any time as long as the person is of sound mind. Anytime someone changes or cancels an advance directive, they must tell their family, health care representative, power of attorney, and health care providers. It may be necessary to present that cancellation decision in writing for it to become effective. People should always talk directly with their physician and tell him or her their exact wishes.
What if I need help filling out the forms?
Case managers at Golden Apple are trained in completing advance directive forms. If you are a client of Golden Apple and you would like to set up an advance directive, please reach out to your case manager or call the main office at 260-602-6287.