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Make Your End-of-Life Health Care Choices Known

July 03, 2012

Plan Ahead with Washington Hospital's Advance Care Planning Services

It's difficult to sit down with loved ones and talk about dying and your end-of-life wishes. But it's nothing compared to the difficulty we may face if we don't.
"Families end up standing at the bedside of their loved one struggling with the decisions that have to be made, wondering what that loved one would have wanted, possibly experiencing conflict with other family members about decision making or living with guilt about whether they made the right choices," says hospice nurse Ellen Cuozzo, R.N., CHPN. "It happens all too often when end-of-life plans aren't put in place."

Cuozzo is determined to spare others that pain with Washington Hospital's new Advance Care Planning program, a free service aimed at helping community members make informed decisions about their end-of-life health care.

Once a month beginning this month, Cuozzo, director of hospice services, will be available in the Washington Community Health Resource Library to answer questions about advance care planning, provide the necessary documents to complete an Advance Directive or POLST, and help get those documents implemented.

Advance directives - easier than you think

"Advance care planning is about deciding treatments tailored to patient's health care goals; what medical care you want and don't want at the end of your life, and writing those wishes down," says Cuozzo. That written document is known as an advance directive.

"It's a legal document that allows you to speak when your voice is absent, for whatever reason," explains Cuozzo.

"People have a tendency to be fearful of this document," she says. "I tell them what a gift it is for those who have to make decisions for you when you're no longer able to. It's so much easier to make those decisions when you have your loved ones wishes, in their own words."

In addition to stating your health care wishes, an advance directive allows you to name two people as agents to speak on your behalf - a process known as appointing a power of attorney for health care. However, when an advance directive is created, no attorney involvement is required.

"People tend to think this is a much more complicated process than it is," notes Cuozzo. "The biggest challenge is getting all the elements to come together - having the form in hand, the time to think about your wishes, and a resource available to answer any questions about end-of-life health care choices and treatments. All those opportunities come together here."

Who will speak for you?

Cuozzo sits down with visitors and goes through the advance directive document section by section. She explains what the patient needs to fill out, discusses their values and goals for end-of-life care, and answers any questions about general medical procedures or life-prolonging treatments that might be used. Patients needing more detailed or specific information about their own medical condition are referred to their doctor.

She also explains what the role of the agent is, if the person chooses to name an agent.

"I ask people who would be the best advocate for you and your wishes?" says Cuozzo. "Who would uphold your values? Who would stand up and ask the questions that you would ask and make the decisions that you would make, if you could still speak for yourself?"

Typically the patient then takes the document home to think through everything, talks with their potential agents to make sure they would honor their wishes and desires, then fills out the form and gets it signed by two witnesses. The witnesses must sign an advance directive the same day it is signed by the individual completing it.

"It's difficult to get the form witnessed here in the library because health care employees can't legally serve as witnesses," notes Cuozzo. "I recommend asking two good friends or neighbors."

Once an advance directive is implemented, it should be easily accessible and taken with you when you go to the hospital or medical appointments. Copies should be given to your agents and doctors. Cuozzo recommends carrying a small card in your wallet stating you have an advance directive and where it can be found.

"Finally, keep in mind your advance directive can be changed any time your health care wishes change," she stresses.

Doctor's orders

The new program also offers help with another end-of-life planning tool known as the POLST form, or Physician Orders for Life-Sustaining Treatment.

The POLST form goes a step beyond an advance directive by turning your health care wishes about life-sustaining treatments - such as resuscitation if your heart stops or whether or not you want a feeding tube - into specific medical orders that should be followed by health care professionals. The form is signed by you and your doctor based on your wishes about the end-of-life health care you do and don't want.

"The POLST form is meant for someone who is critically, chronically or terminally ill, who may intermittently be in and out of the hospital (on a regular basis) and transported by emergency responders," explains Cuozzo.

The two-sided, hot pink form is easily recognizable and easily portable from one care setting to the next.

Start the conversation

Once the subject of end-of-life health care is broached, Cuozzo sees a transformation in people from "I can't do this" to "I have to do this."

"They see how practical advance care planning it is, and what a gift it is to those we leave behind," she says.

"Life is fragile," adds Cuozzo, "Anything can happen to anyone at any time. We can be up and alert and able to speak for ourselves one moment, and lose that ability in the next. I encourage everyone over the age of 18 to plan ahead and make your end-of-life health care choices known today, for yourself, and your loved ones."

Learn more about Washington Hospital's Advance Care Planning program

The Advance Care Planning program will be held once a month in the Washington Community Health Resource Library. Walk-ins are welcome, or you can schedule an appointment by calling (510) 791-3496.

When: Third Tuesday of the month, 3 to 5 p.m.
Upcoming Dates: July 17, August 21, September 18, October 16, November 20, December 18
Location: Washington Community Health Resource Library
Washington West (2500 Mowry Avenue) first floor
For more information, visit www.whhs.com/hospice.
For more information about advance directives, visit www.whhs.com/advance-directives.

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