CMSA Today - Issue 5, 2016 - 17

End-of-Life Care input from their health care providers will be a key component. We should all get comfortable with the excellent resources available. This article will focus on the various documents available to be completed and memorialized, thus allowing patients greater control over the various aspects of end of life care. These documents fall into the broad category of "Advance Care Planning," since patients should complete them in advance of the need occurring. As we have seen, the worst time to ask patients if they would like a ventilator is when they need one. One to the first types of "advance directives" was the "Living Will" developed in the late 1960s. It was dubbed a living will, as unlike traditional wills, it took effect before a person had died. It was used to give a voice to a person no longer able to speak due to a serious illness. A person who might already have a condition that was going to progress to a certain point where he or she might become incapable of communication wrote a living will. It could address specific healthcare choices and direct treatment decisions surrounding this condition. For example, a person with ALS or Lou Gehrig's disease might state that he or she would not want to have extraordinary measures implemented to keep him or her alive. People might state not wanting to be kept alive on machines. Those completing a living will could make a broad statement of their care desires or state specific circumstances and their preferences regarding the care desired. The terminology continues today to be relevant for most consumers, although later forms discussed are intentionally more specific. The next level of advance directive included a similar selection of broad choices and sometimes space for specific requests on treatment and something new. These new documents identified a surrogate decision maker whom you could appoint to act on your behalf if you became unable to speak for yourself. Powers of attorney for financial decision-making had been around since the beginning of the Common Law era. This document relating to healthcare decisionmaking capacity was commonly referred to as the Durable Power of Attorney for HealthCare. Having a document granting you authority by the incapacitated individual to make healthcare decisions for them now held legal weight over hearsay commentary by family and friends. For many it was very reassuring that someone could legally speak for them should they become incapacitated. So popular was this new document that it was codified into federal legislation in the Patient Self Determination Act of 1990 (PSDA). In 1991, every household in the United States received a copy of this document by mail with instructions on its use. Many saw this as a groundbreaking effort to ensure that their wishes would be upheld in the event they could not speak for themselves. In addition, the PSDA required healthcare institutions to promote and support the use of advance directives by education on admission to the institution for any reason. Frequently, this was met with confusion by patients coming in for scheduled surgery or other reasons, as they were advised that they had the right to refuse treatment at an odd time: admission. Many saw it as amounting to doing the right thing, in the wrong location, at the wrong time with the wrong person-usually an admissions clerk. Another common complaint of the durable power of attorney is the treatment decisions offered in the document were too broad to matter much to the surrogate decision maker. In the end, the primary goal was that it legally appointed someone who could act as if he or she had all the rights of the person now incapable. Simply having this in place avoided people from having to pursue conservatorship proceedings in order to act on the behalf of the person. Statespecific durable power of attorney/advance directive forms can be downloaded here: http://www.caringinfo.org. The next level of advance directive was developed out of an attempt to include the emotionally important needs, the nuanced position or wishes one might have at end of life. This document is referred to as the Five Wishes. It was developed with support from the Robert Wood Johnson Foundation and focused on the following five wishes: Wish 1: The Person I Want to Make Care Decisions for Me When I Can't; Wish 2: The Kind of Medical Treatment I Want or Don't Want; Wish 3: How Comfortable I Want to Be; Wish 4: How I Want People to Treat Me; Wish 5: What I Want My Loved Ones to Know. Many like the Five Wishes document especially, because it allows for individuals to include and express their feelings regarding the things that matter and may be especially important to them. Some examples include: who should or shouldn't visit, music, reading material and activities, frequency of bathing, applying lotion, makeup, etc. Basically, it outlines how care might take shape for a person during the course of a serious illness that could be seen as terminal. The Five Wishes document is available for a small fee online at w w w.agingwithdignity.org. This document has been translated into 28 languages. All of the documents discussed so far are for individuals over the age of 18 who have the cognitive capacity to complete the document with or without physical assistance. Each of them creates a legally binding document that potentially ensures the individual receives the care he or she desires, while at the same time forgoing unnecessary or unwanted care. The final document to be reviewed is one that has been around for a number of years. Initially started in the State of Oregon, it has now spread to 43 other states: the POLST. POLST stands for Physician Orders for Life Sustaining Treatment. It is also known as MOLST, MOST, and POST in different states. Each state-specific organization may have some slight variation on the content of the form and how it is designed. The common theme is that they all subscribe to the tenets of the National POLST Paradigm, which concludes that POLST is an approach to end-of-life planning that emphasizes that rich conversations are held between patients, family and healthcare professionals, there is Issue 5 * 2016 * DIGITAL CMSA TODAY 17 http://www.agingwithdignity.org http://www.caringinfo.org

Table of Contents for the Digital Edition of CMSA Today - Issue 5, 2016

President's Letter: Leading Through Change
Immediate Past President's Letter: Risks, Challenges and Progress
Association News
CMSA Corporate Partners
Normalizing End-of-Life Care with Rich Conversations
Personal Feelings/Professional Face: The Hidden Grief of the Helping Professional
INDEX OF ADVERTISERS
CMSA Today - Issue 5, 2016 - cover1
CMSA Today - Issue 5, 2016 - cover2
CMSA Today - Issue 5, 2016 - 3
CMSA Today - Issue 5, 2016 - 4
CMSA Today - Issue 5, 2016 - 5
CMSA Today - Issue 5, 2016 - President's Letter: Leading Through Change
CMSA Today - Issue 5, 2016 - 7
CMSA Today - Issue 5, 2016 - 8
CMSA Today - Issue 5, 2016 - Immediate Past President's Letter: Risks, Challenges and Progress
CMSA Today - Issue 5, 2016 - 10
CMSA Today - Issue 5, 2016 - 11
CMSA Today - Issue 5, 2016 - Association News
CMSA Today - Issue 5, 2016 - 13
CMSA Today - Issue 5, 2016 - CMSA Corporate Partners
CMSA Today - Issue 5, 2016 - 15
CMSA Today - Issue 5, 2016 - Normalizing End-of-Life Care with Rich Conversations
CMSA Today - Issue 5, 2016 - 17
CMSA Today - Issue 5, 2016 - 18
CMSA Today - Issue 5, 2016 - 19
CMSA Today - Issue 5, 2016 - 20
CMSA Today - Issue 5, 2016 - 21
CMSA Today - Issue 5, 2016 - Personal Feelings/Professional Face: The Hidden Grief of the Helping Professional
CMSA Today - Issue 5, 2016 - 23
CMSA Today - Issue 5, 2016 - 24
CMSA Today - Issue 5, 2016 - 25
CMSA Today - Issue 5, 2016 - 26
CMSA Today - Issue 5, 2016 - INDEX OF ADVERTISERS
CMSA Today - Issue 5, 2016 - 28
CMSA Today - Issue 5, 2016 - cover3
CMSA Today - Issue 5, 2016 - cover4
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