Transcript SYW for Funeral Directors

Sharing Your Wishes™
Give Them Peace of Mind, Not Tough Choices
Enhanced Pre-Need Planning
Helping Families with Health Care Directives
© 2008. Human Services Coalition of Tompkins County. All rights reserved.
Sharing Your Wishes
How Advance Care Planning provides Peace of Mind
For Older Clients and their Families
Finger Lakes Funeral Directors Association
May 8, 2008, Ithaca, New York
Presentation by:

Lisa Kendall, Family and Children’s Services, Home Care
Program, Caregiver Counseling and Respite Services, Ithaca, NY

Beverly Hammons, SYW Coordinator
Supported by the Human Services Coalition of Tompkins County, Ithaca, New York
Overview

Why Advance Directives are necessary

Various legal documents and statutory
requirements

Sharing Your Wishes Planning Guide

Advance Directives as a part of Pre-need
Planning Services
Note: Advance Health Care Planning is also referred to as
Advance Care Planning (ACP).
Why advance care planning
is important:




Most people will die while under the care of
health professionals after experiencing a chronic
or life-threatening illness.
Up to 50% of persons cannot make their own
decisions when they are near death.
Health professionals typically treat when
uncertain of a patient’s wishes.
Without discussion, loved ones have a significant
chance of not knowing a person’s views.
©GLMF, Gundersen Lutheran Medical Foundation
“Cancer” Trajectory, Diagnosis to Death
High
Cancer
Function
Possible hospice
enrollment
Low
Onset of incurable cancer
Death
Time
-- Often a few years, but decline
usually < 2 months
15% of deaths
Joanne Lynne, The Washington Home, Center for Palliative Care Studies
Organ System Failure Trajectory
High
Function
(mostly heart and lung failure)
Low
Death
Begin to use hospital often,
self-care becomes difficult
Time
20% of deaths
~ 2-5 years, but death
usually seems
“sudden”
Dementia/Frailty Trajectory
High
Function
Low
Death
Onset could be deficits in ADL,
speech, ambulation
Time
Quite variable up to 6-8 years
Over 50% of deaths
Do they really need a
document?
 Isn’t
just talking enough?
 Won’t
the doctors just ask
my closest relative?
Current Practice

Hospitals, nursing homes, home care
agencies and other providers are mandated
to ask if a patient has a health care proxy.

Doctors discuss with certain patients.

Hospicare and Palliative Care Services may
require advance directives.
American Hospital Association site: www.putitinwriting.org
Choices???
How the Majority of
Americans Die
Over 75%
How the Majority of
Americans Wish to Die
80%
Patricia Bomba, M.D. Vice President & Medical Director,
Geriatrics, Lifetime HealthCare Companies
Advance Health Care Planning
“A process of assisting individuals in
understanding, reflecting and discussing
preferences for future medical care, including
end-of-life decisions.”
The Advance Directive is the legal document.
It is only one step in the ACP process.
Different Roles
Different professionals
have different roles
in helping
individuals with
advance care
planning.
People involved include
Nurses
Office for the Aging
Home Care
Individual
Lawyers*
Doctors
Anyone who works with
seniors………….
Faith Leaders
Funeral Directors
*Note that an attorney is not needed to complete Advance Directive documents
Capacity

A clinical term recognized by law

The ability of a patient to make informed
decisions as determined by clinical
assessment
*GLMF
Four Steps to Advance Health
Care Planning
(contained in the SYW Planning Guide)
1)
Think about what’s important to you.
2)
Select an “agent” to speak for you.
3)
Talk about your wishes.
4)
Put your choices in writing using the New
York State Health Care Proxy form.
Individual
Values and Beliefs
SYW encourages people to speak with:
Health Care Agent
Family
Spiritual Advisor
Physician
About Their
Values
Personal beliefs
Spiritual beliefs
Hopes and wishes
What makes life worth living?
What really matters?
True or False?
Advance Directives may be in the form of
a personal letter…
Types of Advance Directives
Legal in New York State

Health Care Proxy Form (most common)

Do Not Resuscitate forms
a. in-hospital/nursing home
b. out-of-hospital

MOLST (Medical Orders for Life-Sustaining Treatment) not widely used

Clear and Convincing Evidence (a judge would decide)
Living will form
Physician’s note
Personal letter
Other evidence
Common misperceptions
Senior counselor:
“Some people think that being the health care
proxy leads to the money. They confuse living
will with a will for distributing assets. Some
health care proxies ask for financial
information because they think that being the
HCP entitles them to it.”
Clarifying Confusing Language



Will

Living will

Power of attorney for health
care

Health care agent, proxy, or
representative

Death proxy
Power of attorney
Legal guardian
Recent NYS Form

Appointment of Agent to Control the
Disposition of Remains
(Section 4201 of the NYS Public Health Law)
We are suggesting that people check with their
funeral director for more information.
Basic Standards for
Communication

Written plans are best.

Recommend the document that best meets
the needs of the individual.

Strive for clarity, accuracy and
completeness.
©GLMF, Gundersen Lutheran Medical Foundation
Nutrition and Hydration –
Need to specify on form

People MUST indicate on the form that they have
discussed their wishes about artificial nutrition and
hydration with their agent.

If this is not documented, the agent cannot decide
for the individual and artificial methods (tubes, etc.)
are likely to be used.

The form in the SYW Planning Guide already has
this printed on it; people can cross this out if they
prefer.
"Won't doctors just do
what the family wants?"
Signatures for Health Care Proxy

Individual must sign and date the form.

Two witnesses must also sign and date.


Witnesses must be 18 or over
Cannot be a physician who is treating the patient
(unless the physician is a relative.)

Cannot be the person who is appointed as agent
Practical Issues: Accessibility

Keep a copy

Provide a copy to:

Health Care Agent

Alternate Agent, if designated

Family members / loved ones

Primary care physician

Other health care providers

Primary hospital

Faith leader / spiritual advisor
Hospital admissions coordinator:
“If it falls apart at the last moment because
you can’t find the form, all the planning
doesn’t matter.
If the paper is not there when needed,
lawsuits are possible either way.”
On-line Registry
for advance directives
In New York State some counties are
participating in this free, secure, on-line
program; check to see if your county
participates.
AssuringYourWishes.org
Storage by Hospitals
Some hospitals provide electronic storage of
records; check with your local institutions.
In Tompkins County:
Cayuga Medical Center at Ithaca
Scans forms into electronic medical record
(Even if not a CMC patient)
Review and Update
 Periodically
 Major life events
 Newly diagnosed chronic
illness
 Advancing chronic illness
 After complicated lifesustaining treatments
 If agent no longer available to make decisions
Update - continued

To ensure continued accuracy

If you move – every state recognizes some form of
advance directive though terminology may differ
from state to state.

When wishes change
You can always alter your proxy and living will
documents at any time.
Funeral Directors
can help!
Hospices
For more info and to find the Hospice nearest you:
Hospice and Palliative Care Association
of New York State
www.hpcanys.org
Tompkins County: Hospicare and Palliative Care Services
607-272-0212
www.hospicare.org
Online Resources

www.agingwithdignity.org Five Wishes

www.compassionandsupport.org

www.putitinwriting.org American Hospital Assoc.

www.nhpco.org National Hospice and Palliative
Care
Organization
(Many focus on just end-of-life care, rather than the longer
last-phase-of-life care).
Legal perspective
NYS Attorney General Guide

www.oag.state.ny.us/health/health_care.html
American Bar Association Consumer’s Tool Kit
 www.abanet.org/aging/toolkit/home.html
Other States?
For state-specific documents, go to
www.caringinfo.org
Maintained by
Caring Connections,
a program of the
National Hospice and Palliative Care Organization
Sharing Your Wishes™
The Community Health Foundation of
Western and Central New York has an
EXCELLENT website:
www.sharingyourwishes.org
It includes:

Downloadable materials for clients
(Planning Guide, Information Booklet, Note Card for Agent)

SYW Toolkit for organizations
interested in promoting advance
health care planning in their
community.
Sharing Your Wishes™
Give them Peace of Mind, not Tough Choices.
Copyright, 2008. Human Services Coalition
of Tompkins County, Inc. All rights reserved.
100 W. Seneca Street, Ithaca, NY 14850
(607) 273-8686
www.hsctc.org
[email protected]
The People Behind the Package
Educators
 Lisa Kendall, LCSW, CSW-G, Family and Children’s Services, Home Care



Program, Caregiver Counseling and Respite Services, Ithaca, NY
Marilyn Kinner, BS, Ithaca College Gerontology Institute
Christine Klotz, MHA, Community Health Foundation of Western and Central NY
Tom DeLoughry, EdD, Niagara Caregivers Network, Health Association of
Niagara County, Inc, NY
Human Services Coalition staff
 Betty Falcão, MPH, Director, Health Planning Council
 Beverly Hammons, MPS, SYW Coordinator
Instructional Media Developer
 David M. Coleman, MyOnlineLearning.com, Owner