Advance Directive for Healthcare

Over the past few months, the experience of enduring the impact of COVID-19 on the health and lives of many people has highlighted the importance of planning for the unexpected. The good news is that we can learn from this current environment to help us put our house in order.

In the next two blog chapters, we discuss the legal documents to empower others to act on your behalf, when you are temporarily or permanently, unable to do so.

• Advance Directive for Health Care and/or Medical Power of Attorney

• Power of Attorney for Finance

• Will

Advance Directive through Advance Care Planning

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—both your family and your healthcare providers—about your preferences. These preferences are often put into an advance directive, a legal document that goes into effect only if you are incapacitated and unable to speak for yourself. This could be the result of disease or severe injury—no matter how old you are. It helps others know what type of medical care you want.Without this, you may have some conflicting ideas among your loved ones as to the course of treatment for you.

Federal law requires health-care facilities, such as hospitals receiving Medicare funds, to ask patients at the time they are admitted whether they have an Advance Directive; if they do, the facility must keep it on file. Many health systems allow the electronic storing of your directive, so it will be retrieved upon your admittance. The Commonwealth of Virginia hosts a Registry for Advance Health Care Directives, so that the document can be retrieved by providers. However, to ensure the power of this document:

• Give a copy or the original to your agent or proxy.
• Give a copy to your physician(s).
• Give a copy to family and friends.
• Bring it to the hospital with you.
• Register a copy at Connect Virginia (or your home state), and make sure your agent or proxy (the person you appoint in the directive) has access.
• If you travel frequently, there is also a US Advance Care Plan Registry, however, if you spend significant time in another state, then it would be prudent to create and register a duplicate Directive for that state too.

While impossible to determine what specific situations might trigger an advance directive, it is vital for you to determine whether you would wish to have your life sustained by artificial means, such as a ventilator, medications, artificial feeding or other life-prolonging treatments. The decision can be helped by consulting with family, clergy, or an experienced professional. Regardless, the person you identify to represent you in a medical emergency, should know your wishes.

Medical professionals may also suggest to patients suffering from life-threatening conditions or who become seriously ill or frail and are toward the end of life that they complete a POLST form (Physician Order for Life Sustaining reatment). A POLST form gives medical orders (written by a physician) to emergency personnel based on your current medical situation. In Virginia, the form is called a POST, or Physician Order for Scope of Treatment. POLST or POST forms and Advance Directives are both advance care plans, but they are not the same.

An Advance Directive will not stop emergency personnel from performing CPR, however a POLST will, in addition to other treatments outlined in the order. Another physician order, a DNR (Do Not Resuscitate) order will also stop emergency personnel from performing CPR and is restricted to CPR only (chest compression, ventilation, electric shock, or drugs).The video links following this post do a good job of illustrating how each of these documents work. 

Research shows that advance directives can make a difference, and that people who document their preferences in this way are more likely to get the care they prefer at the end of life than people who do not.

Additional resources for education on this topic at the Virginia Bar website, and at non-profit Virginia Advance Directives website. In addition, almost all health systems will have examples of advance directives on their website. The National Institute on Aging at NIH has some excellent resources too, as does the National POLSTsite. Also, please review the attached document "Understanding Advance Care Planning" for good explanation of how these documents work together.

You can also talk with us here at Aging Consultants Group, and we can assist you in creating this and other important estate documents for your planning purposes. In the next blog we will review POA for Finance and Wills.

Videos: