Why people should think about end of-life issues Apr 21 2014
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The document emphasizes the importance of end-of-life (EOL) planning, highlighting why many individuals avoid the topic despite its significance. It outlines legal frameworks, the benefits of advance directives, and practical advice on initiating family discussions about healthcare decisions. Additionally, statistics reveal a gap between the desire for living wills and their actual adoption, underscoring the need for better communication and documentation regarding personal healthcare wishes.
Why people should think about end of-life issues Apr 21 2014
- 1. © Copyright John M. Cachat Why People Should Think About End-of-Life Issues John M. Cachat [email protected] Making your healthcare wishes known
- 2. © Copyright John M. Cachat Housekeeping Phones are muted Use the question block for questions Copy of presentation available upon request
- 3. 3 © Copyright John M. Cachat Agenda Why People Do Not Spend Time Thinking About End of Life (EOL) The Benefits of EOL planning The Options State and Federal Laws Summary & Next Steps Q&A
- 4. 4 © Copyright John M. Cachat Ask Yourself What kind of medical care would you want if you were too ill or hurt to express your wishes?
- 5. 5 © Copyright John M. Cachat Why? I don’t want to think about it I don’t want to talk about it 5
- 6. 6 © Copyright John M. Cachat We do many things with modern medicine because “we can,” but it doesn’t always follow a person’s life values.
- 7. 7 © Copyright John M. Cachat Patient Self-Determination Act The PSDA simply requires that most health care institutions (but not individual doctors) do the following: Give you at the time of admission a written summary of your health care decision-making rights and the facility's policies with respect to recognizing advance directives. Ask you if you have an advance directive, and document that fact in your medical record if you do. Educate their staff and community about advance directives. Never discriminate against patients based on whether or not they have an advance directive. Thus, it is against the law for them to require either that you have or not have an advance directive
- 8. 8 © Copyright John M. Cachat Some Statistics 75% of aging population thinks living wills are a good idea, but less than 1/3 have them More than 25% of elderly patients become in capable of making end of life decisions Those that have directives, only 2% wanted aggressive care Only 1 in 8 nursing home residents want aggressive care
- 9. 9 © Copyright John M. Cachat Some $$ Statistics One medical community had 96% of its residents complete medical directives – the cost of care decreased from $26K to $18K 1/3 of developed nations annual healthcare spending goes toward medical costs for the last year of life • In the US, only 7% want life sustain treatment, but 68% will receive it due to lack of directives • Nearly 30% of Medicaid spending is for treatment during the last year of life
- 10. 10 © Copyright John M. Cachat Why People Do Not Think About EOL Planning for the end of life can be difficult I’m afraid to think of it It just makes everyone sad I’m too young to have to worry about it I’m healthy and take good care of myself I have to protect my loved ones from discussion Does it mean I am giving up hope? Will I disappoint those I love?
- 11. 11 © Copyright John M. Cachat Communication Is The Single Most Important Step In Health Care Planning No matter what your advance directive says, others will not fully understand your wishes. It will help you think about what you want. Others will ask you questions or tell you things that will make you think about your wishes in another way. It will help your loved ones make difficult decisions with less pain, doubt, and anxiety. It may save money. Sometimes families continue medical treatments long past the point where they are helpful, simply because they are unsure what their loved one would have wanted. It may even bring your family closer together.
- 12. 12 © Copyright John M. Cachat Illness Trajectories are Different
- 13. 13 © Copyright John M. Cachat Starting The Discussion “Do you remember what happened to so-and-so and what his family went through? 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.” “Neither Richard Nixon nor Jackie Kennedy was placed on life support. I wonder if they had living wills and made what they wanted clear in advance.” Blame it on your attorney “My lawyer, says that before I complete some legal documents, I need to talk over with you some plans about end-of -life medical care.”
- 14. 14 © Copyright John M. Cachat Resistance Is Common “Mom, I don’t see what good it does to talk about such things. It’s all in God’s hands anyway.” “Dad, I already know you don’t want any heroic measures if things are really bad. There’s nothing more we need to discuss about it. We’ll do the right thing if the situation arises.” “I just can’t talk about this. It’s too painful, and talking about it just makes it more likely that it will happen.”
- 15. 15 © Copyright John M. Cachat In Response to Resistance Be firm and straightforward “I know this makes you feel uncomfortable, but I need you to listen, to hear what I have to say. It’s very important to me.” “Yes, death is in God’s hands, but how we live until that moment is in our hands, and that’s what I need to talk to you about.” “If it is too overwhelming for you right now, I understand. But let’s make an appointment for a specific time to sit down together to discuss this. All right?”
- 16. 16 © Copyright John M. Cachat In Response to Resistance Point out the possible consequences of not talking now “If we don’t talk about this now, we could both end up in a situation that is even more uncomfortable. I’d really like to avoid that if I could.” Ask someone to be your spokesperson If you are able to connect well with one family member or friend, ask this person to initiate and lead the discussion with other family members or your doctor. This may make your job of explaining, clarifying, and answering questions easier.
- 17. 17 © Copyright John M. Cachat The Benefits of EOL Planning But by deciding what end-of-life care best suits your needs when you are healthy, you can help those close to you make the right choices when the time comes
- 18. 18 © Copyright John M. Cachat Reflect Talk Appoint Act
- 19. 19 © Copyright John M. Cachat What Should Be Documented? What concerns do you have about making decisions for yourself later in your life? What concerns do you have about your health or future healthcare? Where do you want to receive care? Who do you want to be with you?
- 20. 20 © Copyright John M. Cachat Why Can't I Just Tell My Doctor? Both legally and practically, it is far better to do a written advance directive. The written advance directive will carry more weight and is more likely to be followed, especially if it supports and affirms your continuing conversation. Be aware of state specific laws
- 21. 21 © Copyright John M. Cachat Types of Documents Durable Power of Attorney for Health Care Do-Not-Resuscitate (DNR) Living Will Advanced Health Care Directive
- 22. 22 © Copyright John M. Cachat What is a Power of Attorney? Another form is a specific type of power of attorney or health care proxy, in which the person authorizes someone (an agent) to make decisions on their behalf when they are incapacitated. People are often encouraged to complete both documents to provide comprehensive guidance regarding their care. Note: Needs to follow state laws
- 23. 23 © Copyright John M. Cachat What is a DNR? A "do not resuscitate" or "DNR", sometimes called a "No Code", is a legal order written either in the hospital or on a legal form The DNR request is usually made by the patient or health care power of attorney Over simplification of the myriad of options
- 24. 24 © Copyright John M. Cachat What is a Living Will? A living is generally a philosophical statement of your goals. “If I suffer an incurable, irreversible illness, disease, or condition and my attending physician determines that my condition is terminal, I direct that life-sustaining measures that would serve only to prolong my dying be withheld or discontinued.”
- 25. 25 © Copyright John M. Cachat Standard Forms versus a Process Standard Forms Provide very limited options Have no concept of time – it is either Yes or No Hard to find / retrieve when needed Processes Are a interactive thought process Have the ability to apply time restrictions Can be easily updated Provide many ways to access quickly when needed
- 26. 26 © Copyright John M. Cachat What is an Advance Directive? Summarize preferences for life-sustaining treatment and surrogate decision- maker in the event that one loses decisional capacity and requires medical care
- 27. 27 © Copyright John M. Cachat Advanced Health Care Directive • A comprehensive process that combines the living will and the health care power of attorney into one document. • You may include any other directions, including organ donation or where and how you prefer to be cared for. • Because it is more comprehensive and more flexible than the other tools, it is the preferred legal tool. • Includes knowledge of local federal & state rules
- 28. 28 © Copyright John M. Cachat The AHCD Process DMS App Engine Education Creation Authorization Storage Distribution Maintenance & Revisions
- 29. 29 © Copyright John M. Cachat Re-examine Whenever Any Of the “Five D’s” Occur Decade – when you start each new decade of your life. Death – whenever you experience the death of a loved one. Divorce – when you experience a divorce or other major family change. Diagnosis – when you are diagnosed with a serious health condition. Decline – when you experience a significant decline or deterioration of an existing health condition, especially when it diminishes your ability to live independently.
- 30. 30 © Copyright John M. Cachat Other Terms / Documents MOLST - medical orders for life-sustaining treatment MOST - medical orders on scope of treatment POLST - physician orders for life-sustaining treatment POST - physician's orders on scope of treatment ACP - advanced care planning ADIL - Advanced Directive Intervention List COLST - Clinician Orders For Life Sustaining Treatment MAD - medical advance directives PAD - psychiatric advance directive TOPP - transportable physician orders for patient preferences DNH - Do not hospitalize
- 31. 31 © Copyright John M. Cachat Summary • You owe it to yourself • You owe it to your family & friends • You owe it to your country
- 32. 32 © Copyright John M. Cachat Why People Should Think About End-of-Life Issues? & Contact: John Cachat [email protected] Copy of Presentation & Request a Demo