Senior Health And Wellness

Advanced Care Planning

Advance care directives are legal documents that explain your wishes about medical care to your loved ones and healthcare team in case you’re unable to speak for yourself. Creating clear instructions ahead of time ensures your values are respected during a medical crisis or end-of-life care.

Your advance care directive can include the following documents:

  • Living will. This document describes your preferences regarding pain management, invasive surgery, artificial life support, organ or tissue donation, long-term care due to Alzheimer’s disease, and more. Make sure to keep your living will somewhere your loved ones can easily find it. A living will is not a medical order and can guide people about your wishes.
  • Health care proxy or power of attorney. A healthcare proxy is who you appoint to make healthcare decisions when you can’t. Your health care proxy should be someone who knows your wishes and would be able to convey them in a difficult situation.
  • MOLST (Medical Orders for Life-Sustaining Treatment) The New York State Department of Health has approved a physician and nurse practitioner order that can be used in any healthcare setting. A MOLST is all-encompassing and is intended for patients with serious health conditions who:
    • Want to avoid or receive any or all life-sustaining treatment
    • Reside in a long-term care facility or require long-term care services

This form does not replace your other directives. Instead, it serves as doctor-ordered instructions — not unlike a prescription — to ensure that, in case of an emergency, you receive the treatment you prefer. It can include orders to avoid CPR or intubation. A MOLST, typically bright pink in color, stays with you and is posted near your bed or prominently displayed where emergency personnel or other medical team members can easily find it.

  • Do Not Resuscitate (DNR). This form instructs your health care team not to perform CPR and other life-saving measures if your heart stops beating. The document can be added to your medical record.

To view, print or download the above forms go to: caremountmedical.com/patient-resources

 

When do I need to create an advance care directive?

The best time to create an advance directive is before you are sick — when you have a clear understanding about your options and can communicate them to your loved ones and your doctor.

Who would I want to be involved in any complex healthcare decisions that I make?

You should select a trusted individual, willing and able to accept this responsibility who will follow your values and instructions.

How should I start the conversation?

Having a conversation about advanced care planning can be uncomfortable.  You can ease into the discussion by saying, “I know that this isn’t easy to talk about, but if I get sick or have an accident — and can’t make medical decisions for myself — I’d like to share what would be important to me, so you could be my decision maker.”

What questions should I ask my healthcare team?

  • What is likely to be ahead for me with my illness?
  • If I decide not to undergo further treatment, what would that entail?
  • What types of symptoms and problems could I experience as my disease progresses?

What questions should I consider and discuss with my healthcare agent and healthcare team?

  • If my health situation worsens, what are my most important goals? What outcomes are unacceptable to me? You may want to think through whether or not you want certain treatments to relieve pain/other symptoms; spiritual help; being at home instead of at a healthcare facility.
  • How much am I willing to endure for the possibility of gaining more time?  Do I want to pursue all possible treatments or are there some I would prefer to forego because of the potential impact they could have on my quality of life?   Consider which, or whether any life support treatments are part of your treatment plan.  These include antibiotics, cardiopulmonary resuscitation (CPR), dialysis, intravenous (IV) fluids, tube feeding, and others.  You may also want to decide how long you’d like to continue these treatments if there is no medical benefit or recovery.

What do I need to do?

COMMUNICATE:  Talk to your loved ones and your healthcare team about your choices.

DOCUMENT:  Work with the team to complete appropriate forms that honor your decisions.

SHARE: Place copies of forms in a visible location at home and provide a copy to your loved ones and your designated healthcare agent.