Advance Directives – Part 1

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This is the first of a two part series that will shed a little light on what an advance directive is and how they can be effectively created, stored and applied.

Welcome to The Senior Circle, where we hope to inspire and help others by providing valuable, relevant information related to caring for an elderly loved one. Hi, my name is Dawn Neely and I’ll be your host. Thank you for joining us.

As the owner of a private duty home care for seniors, I’m responsible for doing in home assessments prior to commencing services. One of the questions that I always ask is whether or not the person we will be caring for has advance directives in place. Many times, there’s not a clear understanding of exactly what an advance directive is.

An advance directive is a legal document. It tells your doctor and family what kind of medical care you want and the event you can’t tell them yourself. This could happen for example, if you are in a coma, you’re seriously injured, you’re terminally ill, you have severe dementia or if you suffer a stroke or a heart attack.

A good advance directive describes the kind of treatment you would want depending on how sick you are. It could describe what kind of care you want if you have an illness that you’re unlikely to recover from. It could also describe the care you want if you’re permanently unconscious. Advance directives usually tell your doctor that you don’t want certain kinds of treatments or may say that you want a certain treatment no matter how ill you are.

There are a few things that could be included in an advance directive. For example,

A Living Will. A living will is a written legal document. It describes the treatments you would want if you were terminally ill or permanently unconscious. These could be medical treatments or treatments that will help you live longer. A living will doesn’t let you select someone to make decisions for you.

It could include a Durable Power of Attorney for Healthcare. A durable power of attorney for health care is another kind of advance directive. It states whom you have chosen to make healthcare decisions for you. It becomes active anytime you are unconscious or unable to make medical decisions. A durable power of attorney is generally more useful than a living will, but it may not be a good choice if you don’t have another person you trust to make these decisions for you. Laws about advance directives are different in each state, and while they’re legal in most states, they may not be officially recognized by the law in yours. They can still however guide your loved ones and your doctor if you’re unable to make decisions about your medical care.

An advance directive could also include a Do Not Resuscitate order or a DNR. Hospital staff or first responders try to help any patient whose heart has stopped or who has stopped breathing. They do this with cardiopulmonary resuscitation or CPR. A DNR is a request not to have CPR if your heart stops or if you stop breathing. Your doctor can put the DNR order in your medical chart. Doctors and hospitals in all States accept DNR orders. They do not have to be part of a living will or another advance directive.

Other possible end of life issues that may be covered in an advance directive may include

  • Ventilation, if and for how long you’d want a machine to take over your breathing,
  • Tube Feeding, if and for how long you’d want to be fed through a tube in your stomach or through an IV.
  • Palliative care or comfort care. This keeps you comfortable and manages pain. It could include receiving pain medication or dying at home.
  • Organ donation, specifying if you want to donate your organs, tissues or body for other patients or for research.

Creating an advance directive is a good idea. It makes your preferences about medical care known before you’re faced with a serious injury or illness, and frankly will spare your loved ones the stress of making decisions about your care while you’re sick. Most people consider an advance directive something that only a senior citizen would have in place, but really any person 18 years of age or older can prepare an advance directive.

People who are seriously or terminally ill are more likely to have one in place. For example, someone who has terminal cancer might write that they don’t want to be put on a respirator if they’re not breathing. This action could reduce their suffering, it can increase their peace of mind and give them more control over their passing.

Even if you’re in good health, you might wanna consider writing an advance directive. An accident or serious illness can happen suddenly. If you already have an assigned advance directive, your wishes are more likely to be followed.

In part two of this series, we’re going to discuss how one goes about writing an advance directive and what needs to be done with it once it has been established. Until then, if you have any questions, please feel free to contact Seniors Helping Seniors at 248-969-4000. We’d be happy to assist you in any way that we can.

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