1. Systems of Care Initiative People & Organizations working together to improve healthcare
Jan Gillespie, MD
President, SOCI

2. Systems of Care Initiative
Local non-profit 501(c)3 organization; grant funded + donations
WE COME TO YOU—Home or Workplace visits
Medical Durable Power of Attorney
Living Wills
CPR Directives
MOST Form
Volunteer for Training Classes & become a Certified SOCI Coach
5 classes + one on one training
Expectation- Complete at least 20 advance directives
Developing Tools -Medical Education with CME on ACP for medical providers
One of SOCI’s goal is to have the majority of people in our community have signed ACD. Encourage and assist more people within our community to complete advance care directives.

3. What is an Advance Care Directive?
Why Should You Care?
The Story of
Tom Blasdell
What is an ACD and why should you care and why should you care now?

4. Systems of Care Initiative What Happens When You Can Not Speak for Yourself? What’s Your Plan? No Default Decision Maker in Colorado
Medical Durable Power of Attorney
All Interested Parties
Proxy-by-Statue
Guardian

5. Systems of Care Initiative Medical Durable Power of Attorney
3 People – a Primary & Two Alternates
Name, Address, Phone Number,
When to start – Now or when person cannot communicate
Notary/ Witneses – Not required, but notary required in other states

6. Systems of Care Initiative Medical Durable Power of Attorney
Instructions to Agent
If I do not know
who I am, where I am, or who I am with,
and this condition is permanent as confirmed by my physician who is reasonably certain,
I want to stop or withhold treatments that may prolong my life.

7. Living Will Terminal Condition or Persistent Vegetative State
Life-Sustaining Procedures
Artificial Nutrition & Hydration
Stop now or later- how many days? Or Goal?
Can MDPOA override these directions?
Communication
Allowed for People on the list
Who to notify; no decision making power

8. Living Will Requirements
2 physicians
48 hours wait period
Person is unable to communicate
Two witnesses & patient signature
Notary is optional

9. CPR Directive If your heart or breathing stops Withhold CPR
Signed by patient or Agent & physician

10. MOST Form For the terminally ill or frail person
Many detailed options –CPR or No CPR
Full Treatment
Selective Treatment: IV antibiotics, IV fluids, Airway
Comfort Focused Treatment Only
Effective immediately
Physician (or PA) & Patient Signed

11. End of Life Choices by Doctors
Doctors Die Differently By: Barbara Victor, MD, February 3, 2015
Doctor’s Personal End-of Life Resuscitation Preferences and Their Attitudes toward Advance Directives
Vyjeyanthi S. Periyakoil , Eric Neri, Ann Fong, Helena Kraemer
Published: May 28, 2014DOI: /journal.pone
How Doctors Die Ken Murray, November 30, 2011, Clinical Assistant Professor of Family Medicine at USC

12. End of Life Choices by Doctors
Physicians are unique not because of how much life-prolonging medical treatment they receive, but because of how little.
Physicians tend to face dying with acceptance and
minimal advanced life support.
88.3% of Doctors rejected aggressive life-savings measures for themselves at end of life when the chance of recover is uncertain.
Doctors choose "no code" or "do-not-resuscitate" orders.

13. End of Life Choices by Doctors
What was even more striking was how universally the doctors in the study rejected aggressive life-saving measures for themselves.
Doctors' attitudes have not changed significantly in the past 23 years. Doctors' gender, race and specialty did not influence their attitudes towards end of life decisions
Doctors choose "no code" or "do-not-resuscitate" orders.

14. Why are Doctors Different?
Doctors understand what aggressive life-saving measures mean. Doctors know CPR Outcomes Chronic illness – less than 5% survive Advanced Illness- less than 1% survive

15. How Do Americans Die? How about death in America:
Current Realities About Death in America:
50% of all Americans die in a hospital or nursing home
> 25% of hospice care is for three days or less, and 40 percent of these "latecomers" only arrive after an ICU stay
32% of Medicare dollars are spent on repeated hospitalizations in the last two years of life (aggressive end of life care).
Aggressive EOL care does not appear to improve outcomes for patients with chronic, life-limiting conditions like cancer and heart disease.
Research suggests that most Americans do not die the way they want to

16. So why do doctors continue to provide high-intensity care for terminally ill patients but personally forego such care for themselves at the end of life?
In the absence of instruction, the default is “doing everything” for the person even if it is not in the best interest of the person.
And it’s the family’s default decision, when they haven’t thought about it

17. Systems of Care Initiative Referral Line 970-449-6840 Email coaches@socicoaching.com