In recognition of National Health Care Decisions Day, importance of advance care planning conversations stressed

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In recognition of National Health Care Decisions Day on April 16, the Aging Inspired Advance Care Planning Coalition of Lebanon County encourages everyone to have a conversation with their family or loved ones.

It always seems too early, until it’s too late.

Advance care planning is not just about old age. At any age, a medical crisis could leave you too ill to make your own health care decisions. Even if you are not sick now, making health care plans for the future is an important step toward making sure you get the medical care you would want based on your goals, values, and wishes. Advance care planning guides doctors, as well as family members, loved ones, and other important people in your life, who may need to make decisions on your behalf when you cannot speak for yourself.

As a local doctor shared recently: “As the trusted partner in my patients’ health, it’s my responsibility to help them understand why it’s important to think about advance care planning and inform family members of their decisions. Research shows that patients want their physicians to talk with them about end-of-life decisions but few of them have.” 

Another physician shared: “I’d rather be fifteen years too early with an advance care planning conversation with my patients than 15 minutes too late.”

The first place to start is with yourself. Explore why you are thinking about this topic. Is it due to a particular event in your life or someone close to you? For instance, a car accident that left someone in critical condition or a friend dying suddenly. What else is motivating you to have a conversation with your family or loved ones now? You might also want to explore your basic principles, values, and how they would still apply near the end of your life, whenever that may come. If you can answer these questions for yourself, you will be better prepared to have an advance care planning discussion with loved ones.

Now that you are clear on what you want, and have started discussions with your family or close friends, then it is time to make sure all your wishes are covered. An advance care planning discussion is never held just once since there are various phases of your health and life circumstances that might trigger a conversation with your family.

At the end of any advance care planning conversation you should have these “five wishes” clearly understood by your family:

1. Who do you want to represent you when you can’t make health care decisions for yourself due to your medical or mental condition? Your answer should include at least two people, and preferably three, so you have your primary decision-maker and two people as resources and back-up in case your primary decision-maker cannot be available. 
2. What extreme measures do you wish to have taken to prolong your life if death seems imminent? These measures can include CPR and other aggressive life support treatments, such as intubation/ventilation, dialysis, tube feeding, and pain management.
3. How comfortable do you wish to be when you are near death? How can Hospice Care enable you to lead a longer, higher quality end-of-life experience and support your caregivers in this journey?
4. How do you want people to treat you? Do you wish specifically to die at home?
5. How you will share your stories with those you love, and what do you want your family to do for arrangements once you die?

Knowing these answers ahead of an end-of-life crisis helps reduce the stress and guilt on a family, loved ones, or those people most important to you who are trying to make the right decisions for you as their loved one. It can also reduce the severe conflicts that can occur from not knowing what you would want.

Once you have decided to create an advance care plan, and discussed your wishes with others and your physician, then it is time to document. This is known as the “3 Ds” of advance care planning: DECIDE, DISCUSS, DOCUMENT.

Keep in mind that a conversation with no documentation is more valuable than supporting documentation in the absence of a conversation. A family may not remember the contents of a signed document, but they will remember words their loved ones have said to them. It is very important though to take the next step of effective advance care planning and document your wishes by completing a living will and a power of attorney for healthcare form. 

The planning doesn’t end once you’ve documented your wishes. Make sure you share your documents with your primary care physician and local hospital, if appropriate. This will ensure that your advance care planning documents become a part of your electronic medical record. Also, share the documents with the family member or friend who will speak for you as your legally determined health care agent when you cannot. Make sure they do not have any questions. As your life changes, revisit your conversation and documents on a regular basis.

Advance Care Planning involves learning about the types of decisions that might need to be made, considering those decisions ahead of time, and then letting others know about your preferences. No one can escape death. You should plan for it. You and your family will be glad you did when the inevitable happens.

For more information about Aging Inspired Initiative and the Aging Inspired Advance Care Planning Coalition’s programs and events, please contact Nicki Gray, Executive Director of the Community Health Council of Lebanon County at communityhealthcouncil.com/aging or at 717-270-7935.