FIVE WISHES: Advance Care Planning Initiative Tammy Stokes, BSN, RN

What is Advance Care Planning? Advance care planning is a process that provides individuals with peace and assurance that their wishes and preferences are known when a health care crisis or life-threatening illness occurs It is not a “One Size Fits All” process

Advance Care Planning is about preparing for the “what if’s” in life Waiting for a tragedy or serious diagnosis is the wrong time to discuss a patient’s preferences or wishes Pre-planning allows the patient to make informed decisions about end of life wishes and choosing an appropriate surrogate when unable to speak for themselves Time to have the conversation is when you are healthy not when you are being wheeled into the ER on a gurny. Advance directive is your gift to your family. I can’t tell you how many times I’ve witnessed families being torn apart because no one knew what the patient wanted. Having a document is important but having a conversation with your familiy about your decisions is critical

Did You Know….. Most people say they would prefer to die at home, yet only about one-third of adults have an advance directive expressing their wishes for end-of-life care (Pew 2006, AARP 2008). Only 28 percent of home health care patients, 65 percent of nursing home residents and 88 percent of hospice care patients have an advance directive on record (Jones 2011). Even among severely or terminally ill patients, fewer than 50 percent had an advance directive in their medical record (Kass-Bartelmes 2003). Between 65 and 76 percent of physicians whose patients had an advance directive were not aware that it existed (Kass-Bartelmes 2003).

Reasons Why We Don’t Plan Ahead? Don’t won’t to talk about death….. What if I Change my mind? Don’t won’t to upset my family What you expect is what you elect

Benefits of Planning Ahead Alleviates unnecessary suffering Improves quality of life Provides better understanding of the decision-making challenges for the patient and their loved ones Relieves stress on the family Aids healthcare professionals when providing care

What is Five Wishes? Legal Document Advance Directive Addresses emotional, spiritual and personal needs as we approach the end of life User Friendly document Addresses the whole person

Wish One: The person I want to make decisions for me if I can’t Choose someone whom you trust can respect your wishes and honor them if a difficult situation arises This person may or may not be a spouse or child if you feel they will be too emotionally involved to stand up for you and your wishes. This person also needs to be at least 18 years or older and should not be your doctor or employee of your doctor. Person who will speak for you when you are unable to speak for yourself. Someone close by is helpful

Wish Two: The kind of medical treatment I want or don’t want Allows you to decide what you want well before the time there is a medical emergency. This is your time to voice your desires when it comes to life support treatment, CPR and whether you would want to live in a coma like state. You have lines avaliable to be specific regarding medical treatment options.

Wish Three: How comfortable I want to be Many cultures and people view pain and comfort differently. It is important for you to make your wishes known as to what brings you peace and comfort. Some find comfort in certain types of music, in their faith or don’t want to experieince pain. I want to be in my home. I want to ask hospice to be invovled.

Wish Four: How I want people to treat me This wish addresses issues like whether a patient wants vistors, to die at home and if you would want hospice involved.

Wish Five: What I want my loved ones to know How much you love them, Encourages conversations with our families. I love you thank you im sorry Encourages us to reconcile brokeness . It also address whether you would want traditional burial or cremation. How do you want to be remembered?

Final Thoughts: Notary or Two Witnesses Give copy to loved ones, health care providers and hospital Empower yourself Challenge others to consider their wishes