Let’s Talk About ADVANCE CARE PLANNING Sharing Your Wishes Let’s Talk About ADVANCE CARE PLANNING

Sharing Your Wishes The Human Services Coalition of Cayuga County is one of six community coalitions to receive funding for the Sharing Your Wishes project Sharing Your Wishes is supported by the Community Health Foundation of Western and Central New York Sharing Your Wishes Goals: Increase awareness of advance care planning and advance directives Help you plan ahead for your health care so you will receive the care you want Help give your loved ones peace of mind, not tough choices

Agenda What is Advance Care Planning? Why is Advance Care Planning Important? What are Advance Directives? Did You Know? Questions and Answers

What is Advance Care Planning? Advance Care Planning is the process of thinking about, talking about and writing down your health care wishes. Advance Care Planning is the best way to ensure that your wishes are known, understood and respected.

Noah began building the ark before it started raining! All I Really Need to Know, I Learned from Noah… Noah began building the ark before it started raining! PLAN AHEAD!

What Are Some of the Benefits of Advance Care Planning? Advance Care Planning Helps You: Keep control over your care Receive the care you want but not the treatments that you don’t want Keep your dignity Advance Care Planning Gives Your Loved Ones: Peace of mind, not tough choices The ability to make the decisions you would want

Why is Advance Care Planning Important? Planning helps you avoid the worst case scenarios: Family stress & conflict Treatments that you don’t want Involvement of lawyers, judges and others who don’t know your wishes Care decisions made by courts or by the State

WHAT’S NEW? Good News: We are living longer lives and we have many choices! But, we are more likely to live with chronic conditions, more likely to need help with some activities of daily living and more likely to need someone to speak for us to make health decisions.

Advance Care Planning In Four Easy Steps Think about what is important to you and how you want to receive care. Select someone to speak for you if you are ever unable to speak for yourself. Talk about your health care wishes. Put your choices in writing.

Advance Care Planning: Step One THINK ABOUT WHAT IS IMPORTANT TO YOU & HOW YOU WANT TO RECEIVE CARE. What makes your day worthwhile? How does your faith impact your decision-making? How have the illnesses or deaths of loved ones influenced your view of the medical system? What are your goals for care? Are there circumstances under which you would refuse or discontinue treatment that might prolong your life?

Advance Care Planning: Step Two SELECT A PERSON (health care agent) TO SPEAK FOR YOU IF YOU ARE UNABLE TO SPEAK FOR YOURSELF. Legal Requirements of a Health Care Agent: Minimum of 18 years of age Mentally competent Not your attending physician

… Selecting a Health Care Agent continued Other Important Considerations for Selecting a Health Care Agent Does he/she know me well and understand what is important to me? Will he/she talk to me now about sensitive issues?

Other Considerations Will the person I’ve selected follow my wishes, even if he/she doesn’t agree with them? Is he/she a strong advocate – willing to ask questions and demand that my wishes are followed? Will he/she be available when I need help? Note: Your health care agent cannot be your doctor or an employee of a health care provider responsible for your care, unless he or she is a family member. Note: You may also select an “alternate agent” who will act if your primary agent is unavailable.

When Does My Health Care Agent’s Authority Begin? When two doctors agree that you are unable to make medical decisions for yourself (when you “lack capacity”), the person that you have selected as your health care agent will begin to speak on your behalf regarding medical care.

Health Care Agent Rights and Responsibilities If/When you lack capacity, your health care agent will have access to your medical information and records to help him/her make informed medical decisions. Your health care agent will have the authority to accept, forgo or discontinue treatments that may otherwise prolong your life. Your health care agent will also be able to make decisions about medical tests, treatments or surgeries.

Advance Care Planning: Step Three HAVE A CONVERSATION REGARDING YOUR HEALTH CARE WISHES WITH YOUR HEALTH CARE AGENT (AND ANYONE WHO IS LIKELY TO BE INVOLVED IN YOUR FUTURE HEALTH CARE). This conversation is very important to ensuring that your wishes are known, understood and respected.

Step Three continued The conversation is the heart of the advance care planning process. The most important thing for you to do is have conversations about the things that are important to you. This way, your health care agent will know the kinds of decisions you want them to make on your behalf.

Step Three continued Where will you be comfortable having a sensitive conversation? Who should be present for and included in these conversations? (health care agent, family, friends, spiritual advisors, doctors, other) Consider step one of the process and share what is important to you and share your health care wishes.

How Do I Start the Conversation? “I’d like to talk with you about how I would like to be cared for if I become unable to speak for myself. Is that okay?” “As I become older and face more health problems, I am concerned that you don’t know what kind of care I would like. Could we talk about his now? It would make me feel better now, and might help you feel better later.”

Conversation Starters continued “Do you remember what happened to Aunt Mary when she was in the nursing home and couldn’t feed herself? None of us knew what she would have wanted. I don’t want you to have to go through that with me. That’s why I want to talk about this now, while we can.”

Advance Care Planning: Step Four PUT YOUR CHOICES IN WRITING The most important document to complete is the Health Care Proxy. Health Care Proxy – a document that allows you to name a health care agent. This person will make health care decisions for you if you are unable to make them yourself.

Step Four continued If you want to put more of your wishes in writing, you can also complete other advance directives documents: Living Wills Do Not Resuscitate Orders (DNR) MOLST Ethical Wills

Living Will – a document that enables you to leave written instructions regarding your health care wishes for life-sustaining treatments. Do Not Resuscitate Order (DNR) – a document that allows you to state that you do not want cardiopulmonary resuscitation. A DNR is a medical order requiring a physician’s signature.

MOLST (Medical Orders for Life Sustaining Treatments) – a document containing medical orders regarding life sustaining treatments. This document is meant for frail persons near the end of life. Non-Formal Documents – Some people wish to write letters or an “Ethical Will” for loved ones. This is a way of sharing values, life lessons, hopes for the future or forgiveness with friends and family.

“I didn’t say I loved him” video slide

After Advance Care Planning What do I do with my advance directives now that they are complete and I’ve shared my wishes? Keep the original in an accessible place Provide copies to your health care agent, your doctors, your spiritual advisor and your loved ones

Keep Talking! People, situations and wishes change! Keep the lines of communication open! Revisit the conversation whenever one of the five D’s occur: Divorce (or other life changing events) Death (of a loved one) Diagnosis Decline Decade (we look at the world differently in our 60’s, 70’s, 80’s or older) Be sure to update your document whenever you need to make a change.

DID YOU KNOW? The Truth About Advance Care Planning and Advance Directives You have a right to participate in the planning of your health care even if you lose the capacity to make decisions. Advance directives documents are most successful when they are coupled with ongoing and thoughtful conversations about your wishes.

The Truth continued Health care professionals are legally and ethically bound to follow directives. You do not need a lawyer or a notary to complete valid advance directives.

The Truth… continued In New York State, no one – not even your spouse or next of kin – has the legal authority to speak on your behalf if you have not designated him/her as your health care agent using the health care proxy form. A health care proxy, living will or DNR Order only come into play when you are unable to speak for yourself.

Sharing Your Wishes Give Them Peace of Mind, Not Tough Choices.

Long Term Care Access Office Questions and Answers Monica Scott, LMSW Long Term Care Access Office 149 Genesee Street Auburn, NY 13021 315-253-1102 Monica.Scott2@dfa.state.ny.us