Why people should think about end of-life issues Apr 21 2014

© Copyright John M. Cachat
Why People Should
Think About
End-of-Life Issues
John M. Cachat
jmc@directedmedical.com
Making your healthcare wishes known

Housekeeping
Phones are muted
Use the question
block for questions Copy of presentation
available upon request

3
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
Ask Yourself
What kind of
medical care
would you want
if you were too
ill or hurt to
express your
wishes?

5
Why?
I don’t want to
think about it
I don’t want to talk
about it
5

6
We do many things with
modern medicine because
“we can,” but it doesn’t
always follow a person’s
life values.

7
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
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
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
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
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
Illness Trajectories are Different

13
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
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
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
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
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
Reflect
Talk
Appoint
Act

19
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
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
Types of Documents
Durable Power of Attorney for Health Care
Do-Not-Resuscitate (DNR)
Living Will
Advanced Health Care Directive

22
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
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
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
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
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
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
The AHCD Process
DMS
App
Engine
Education
Creation
Authorization
Storage
Distribution
Maintenance
& Revisions

29
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
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
Summary
• You owe it to
yourself
• You owe it to your
family & friends
• You owe it to your
country

32
Why People Should Think
About End-of-Life Issues?
&
Contact:
John Cachat
jmc@directedmedical.com
Copy of Presentation
&
Request a Demo

Why people should think about end of-life issues Apr 21 2014

Empfohlen

Empfohlen

Weitere ähnliche Inhalte

Was ist angesagt?

Was ist angesagt? (20)

Andere mochten auch

Andere mochten auch (20)

Ähnlich wie Why people should think about end of-life issues Apr 21 2014

Ähnlich wie Why people should think about end of-life issues Apr 21 2014 (20)

Mehr von John Cachat

Mehr von John Cachat (20)

Kürzlich hochgeladen

Kürzlich hochgeladen (20)

Why people should think about end of-life issues Apr 21 2014