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Discussion Guide Discussion guide Advance care planning Advance (Allina Health)

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ALLINA HOME & COMMUNITY SERVICES
Advance Care Planning
Discussion Guide
ALLINA HEALTH
Discussion guide
Advance care planning
TABLE OF CONTENTS
Introduction
Page 3
Our commitment to you
Page 4
Things to think about
Page 5
Discussion questions
Page 7
Health care directives
Page 14
Glossary
Page 18
Pocket card
Page 20
Health care agent card
Page 21
Any of us could think of a
time when we might be too
sick to communicate our
wishes. For example, after a
car accident or heart attack
we might need to depend on
others to make important
decisions about our care.
How can we guide our loved
ones so they feel confident
making decisions?
Advance
care
planning
Advance care planning helps your loved ones gain a better sense
of your values, preferences and wishes related to health care.
It provides information to others about your health care wishes in
case illness or injury prevents you from telling them yourself.
Advance care planning is a process to
UNDERSTAND: Learn about health care treatment options
and discuss these with your family and close friends.
CLARIFY: Talk through your health care goals with your family
and close friends so they understand your wishes.
WEIGH YOUR OPTIONS: Think about what kind of care and treatment
you would want, who you would want to care for you and where you
would want to receive care.
MAKE DECISIONS: Decide if you want to appoint a health care
agent. Decide if you want to put your wishes in writing in a health
care directive.
COMMUNICATE: Share your wishes and any documents with
your family and close friends, your health care agent and your health
care provider.
3
Allina Health is committed to you
Advance care planning is one way we support you as your partner
in health care. At Allina Health, we commit to being your partner in
health care throughout your life. We will:
•
Encourage you to have an advance care planning discussion with your
family and close friends.
•
Make sure your advance care plan is completed the way you want.
You may choose to have an advance care planning discussion, you
can assign a health care agent, and/or you can complete a health care
directive form (living will).
•
Make sure your health care wishes will be available wherever you
receive care at Allina Health. This is done through the electronic
health record. In addition, we recommend you share copies of your
plan with family, close friends and your health care agent.
When you have a health care directive, we will do our best to honor
your wishes and choices for medical care and treatment every step
of the way.
How to begin
• Use this guide and any other resources you may find.
•
Choose your health care agent(s).
•
Prepare for a discussion with your health care agent(s), family
members and close friends using the following discussion.
•
Attend one of our free advance care planning classes.
4
THINGS TO THINK ABOUT
Have you chosen the right person to be your
health care agent?
You can choose someone, called a health care agent, to make
health care decisions for you if you can’t communicate them on your
own. When deciding on a health care agent, choose someone who is at
least 18 years old and someone whom:
• you trust
• has similar beliefs and values about medical care and death or
dying or is willing to carry out your wishes even if they are different
than his or her own
• is not easily intimidated by family, close friends or health care
providers
• will be an advocate for you
• can make decisions under stress
• can cope with making dicult life and death decisions, including
making decisions that would allow you to die.
Allina Health offers free classes to assist you in having
advance care planning discussions and write a health
care directive. Call 612-262-2224 or 1-855-839-0005 to
register for a class.
Your health care agent will represent your wishes
and make your health care decisions ONLY if you are
unable to due to illness or injury. Your health care
agent will:
• Make choices for you about your medical care. This includes starting
or refusing tests, medicine and surgery. If treatment has already
started, your health care agent can continue it or stop it based on
your instructions.
•
Interpret any instructions you have made based on his or her
understanding of your wishes, values and beliefs.
•
Review and release your medical records as needed for your
medical care.
•
Arrange for your medical care and treatment in any location he or she
thinks is right, such as a nursing home or residential facility for long
term care.
•
Decide which health care providers and organizations provide your
medical treatment, including care and treatment for mental health
conditions.
• Make medical decisions if you are pregnant.
Portions of the health care agent information were developed by a group of professionals
with expertise in law, health care, life and death health care decision making, and plain
language materials development with the leadership of Marlene S. Stum, PhD, University
of Minnesota Extension (updated 2006).
6
Once you have chosen your health care agent and reviewed his or
her roles and responsibilities, talk to your agent about advance care
planning using the following discussion questions.
What do you hope to achieve in going through the
advance care planning process?
Think about what you want to talk about with your loved ones about
your health care wishes. For you, what makes life worth living or when
would life not be worth living? Plan to have this discussion when you
are feeling well, before a crisis or emergency.
7
Have you had past experiences with a family member
or friend, or heard of another situation where a
decision had to be made about a health care choice?
Think about the health care decisions that had to be made during these
dicult times. What would you want your loved ones to do on your
behalf if you were in a similar situation? Talking about this can help
your loved ones make health care decisions for you at an emotionally
dicult time.
8
What fears or worries do you have about possible
future medical care?
Some people worry about being a physical or financial burden to their
loved ones. Others have fear about pain and prolonged suffering. What
fears or worries do you have?
For discussion
You have suffered a head injury in an automobile accident that
left you in a permanent vegetative state.You would not be able to
communicate your wishes to your family. What would you decide
about health care for yourself in this situation?
What would you want for yourself if you were injured
or suddenly became ill and were unable to speak for
yourself?
For example, if you were in a serious car accident:
• Would you want life support treatment?
• Would you want medical treatments such as a ventilator/respirator,
feeding tube or cardiopulmonary resuscitation (CPR)?
• How long would you want to receive these treatments?
• What outcome would you hope for by having these treatments?

For discussion
You have had a stroke and cannot communicate with your family
about the kind of medical care you want.Your heart and other vital
organs cancontinue to function with medical care for years, even
decades. What type of treatment would you want?
For people with an illness: You will face making
choices about your medical care long before you are
at the end of life. If you became so sick from an illness
that you might die at some point in the future, what
kind of care would you want?
Think about:
• your wishes for the quality and length of your life
• your wishes for medical treatment, including pain control
• how successful the treatment might be and how easy or hard the
treatment may be for you.
What kind of side effects will you have with the treatments? How long
will you live with or without the treatment (such as antibiotics and
other medicines, blood transfusion, temporary or permanent tube
feeding/artificial fluids, temporary or permanent respirator, surgery,
radiation, amputation, dialysis, chemotherapy, cardiopulmonary
resuscitation – CPR)? Do you need more information about these
treatments before making a decision?

For discussion
Imagine in the future you are diagnosed with dementia.
Would you want to continue your life by artificial means?
If you cannot feed yourself, should a feeding tube be used?
Think about where and how you would want to spend
your final days.
What would your choices be for location (home, hospital, nursing
home) and type of care (hospice or palliative care), organ donations and
funeral arrangements?

For discussion
You have terminal cancer and need to decide if your goal is to live
your final days in comfort or to extend your life as long as possible.
What type of care would you want to receive? Where would you want
to spend your final days – at home, in a nursing home or at a hospice
residence?
What personal and religious/spiritual beliefs and values
shape how you make choices about health care?

HEALTH CARE DIRECTIVES
Putting your wishes in writing is the best way to help make sure
those wishes are followed if you can’t communicate because of illness
or injury. If you choose not to put your wishes in writing, your
health care agent and health care provider will make decisions based
on your spoken directions or what he or she considers to be in your
best interests.
FREQUENTLY ASKED QUESTIONS ABOUT HEALTH CARE DIRECTIVES
How do I create a health care directive?
There are forms for health care directives. You don’t have to use a form,
but your health care directive must meet the following requirements to
be legal:
• be in writing and dated
• state your name
•
be signed by you or someone you authorize to sign for you, when you
can understand and communicate your health care wishes
•
have your signature verified by a notary public or two witnesses
•
include a health care agent to make health care decisions for you and/
or instructions about your health care choices
•
before you prepare or revise your directive, talk about your health care
wishes with your doctor, health care agent, family and close friends.
What can I put in my health care directive?
You have many choices about what to put in your health care directive.
For example, you may include:
•
the person you choose as your primary agent to make health care
decisions for you (it is recommended you name an alternate agent in
case the first agent is unavailable)
• how you want your agent or agents to make decisions
•
your goals, values and preferences about health care
14
• the types of medical treatment you would want (or not want)
•
where you want to receive care
•
instructions about artificial nutrition and hydration
•
mental health treatments that use electroshock therapy or
neuroleptic medicines
•
instructions if you are pregnant
•
donation of organs, tissues and eyes
•
funeral arrangements
•
who you would like as your guardian or conservator if there is
a court action.
You may be as specific or as general as you wish. You can choose which
issues or treatments to deal with in your health care directive.
What can’t I put in my health care directive?
There are some limits about what you can put in your health care
directive. For example:
•
your agent must be at least 18 years old
•
your agent cannot be your health care provider, unless the health care
provider is a family member or you give reasons for the naming of
that person as your agent
•
you cannot request health care treatment that is outside of
reasonable medical practice
• you cannot request assisted suicide.
15
How long does a health care directive last?
Your health care directive lasts until you change or cancel it.
As long as the changes meet the requirements listed, you
may cancel your directive by any of the following:
•
provide a written statement saying you want to cancel it
•
destroy it
•
tell at least two other people you want to cancel it
•
write a new health care directive.
How often should I review my health care directive?
You should review and update or complete a new health care directive
form on a regular basis, at least every five years. We also recommend
you review your health care directive:
•
if there is a major family change, such as divorce or death
•
if you develop a serious health condition
•
ifyour health gets significantly worse, especially if you are unable
to live on your own.
Who should get copies of my health care directive?
Make sure to give copies of your health care directive to your
HEALTH CARE PROVIDER: At Allina Health, this becomes part of your
electronic health record and is accessible by Allina Health doctors and
staff who are part of your care team.
HEALTH CARE AGENT(S): Help them understand their responsibilities
and decision-making powers and your wishes.
FAMILY AND CLOSE FRIENDS: Tell them who you have named as
your health care agent and any other information you are willing
to share.
16
For information on state health care directives, contact your health
care provider, your attorney or visit the following websites:
MINNESOTA: health.state.mn.us/divs/fpc/profinfo/advdir.htm
IOWA: uihealthcare.org/otherservices.aspx?id=16035
NORTH DAKOTA: nd.gov/dhs/info/pubs/docs/aging/aging-healthcare-
directives-guide.pdf
SOUTH DAKOTA: finance.cch.com/tools/downloads/sdlivingwill.rtf
WISCONSIN: dhs.wisconsin.gov/forms/advdirectives/index.htm
US LIVING WILL REGISTRY: uslivingwillregistry.com/
Or call
OFFICE OF OMBUDSMAN FOR LONG TERM CARE
1-800-657-3591 or 651-431-2555
MINNESOTA BOARD ON AGING
1-800-882-6262 or 651-431-2600
17
GLOSSARY
ADVANCE CARE PLANNING: A process and discussion over time
where individuals clarify their goals and values, understand health
care choices and options of care and communicate future medical
treatment preferences, including end-of-life care.
HEALTH CARE DIRECTIVE (ADVANCE DIRECTIVE/LIVING WILL): Legal
forms you complete to describe choices for future health care if you
become unable to make these decisions yourself.
ANTIBIOTICS: Medicines used to treat illnesses caused by infections
and to relieve symptoms.
ARTIFICIAL NUTRITION AND HYDRATION: Liquid food and fluids
given through a tube put in your vein or stomach when you can no
longer eat or drink.
DECISION MAKING CAPACITY: The ability to take in information,
understand its meaning and make an informed choice using the
information.
CARDIOPULMONARY RESUSCITATION (CPR): A life-saving treatment
used to attempt to restore heart rhythm and/or breathing when they
have stopped. CPR uses rescue breathing (someone breathing into your
mouth) and chest compressions (someone pressing on your chest) to
try to revive you. In addition, you may need medicines and electrical
shock to the heart delivered from a defibrillator machine).
COMFORT MEASURES/COMFORT CARE: Medical care provided
with the primary goal of keeping a person comfortable rather than
prolonging life. Comfort measures are used to relieve pain and other
symptoms.
DIALYSIS: A treatment that removes waste from the body usually done
by your own kidneys. Dialysis is needed when your own kidneys can no
longer take care of your body’s needs.
18
HEALTH CARE AGENT (PROXY): Your agent is a trusted individual
chosen by you to make health care decisions on your behalf only if you
are unable to make decisions yourself.
INTRAVENOUS (IV) FLUIDS: A fluid given through a small plastic tube
(catheter) inserted directly into the vein.
INTUBATION/INTUBATE: Placing a tube down an individual’s windpipe
to assist in breathing. Intubation is needed for mechanical ventilation.
MECHANICAL VENTILATION: Mechanical ventilation is used
to support or replace the function of the lungs. A ventilator (or
respirator), is a machine attached to a tube inserted through the
mouth and into the windpipe, forcing air into the lungs. Some people
on long-term mechanical ventilation are able to enjoy themselves and
live a quality of life that is important for them. For the person dying
however, mechanical ventilation often prolongs the dying process until
some other part of the body fails. It may supply oxygen but it cannot
improve the underlying condition.
POLST (PROVIDER ORDER FOR LIFE SUSTAINING TREATMENT):
A brightly colored provider order form used to write medical orders to
honor life-sustaining treatment wishes for seriously ill patients.
TUBE-FEEDING (ENTERAL FEEDING): Delivery of fluids and/or
nutrition by way of a tube placed into the stomach or intestines.
On a short-term basis, the tube (nasogastric, or NG-tube) is placed into
the nose, down the throat and into the stomach. For long-term feeding
needs, the tube is placed directly into the stomach (gastric tube, or
G-tube).
19
PATIENT INFORMATION
Name
Address
Phone (home)
Phone (other)
I have a health care directive on file at:
CONTACTS
Doctor: Name, phone
Emergency contact: Name, phone
Health care agent: Name, phone, address
Health care agent (alternate 1): Name, phone
Pocket card
Trim at dotted line. Then fold in half and fold in half again.

Roles and responsibilities
of a health care agent
,
I have named you as my health care agent.
Thank you for agreeing to be my health care agent
and taking on this very important responsibility for me.
I have chosen you to be my health care agent because you
are at least 18 years old and, someone whom:
• I trust
• has similar beliefs and values about medical care and
death or dying or you are willing to carry out
my wishes even if they are different than your own
• is not easily intimidated by family members, close friends
or health care providers
• will be an advocate for my interests
• can make decisions under stress
• can cope with making dicult life and death decisions
including making decisions that may allow me to die.
In addition, as my health care agent you may need to
represent my wishes and make health care decisions on my
behalf due to illness or injury. I am giving you permission to:
• Make choices for me about my medical care. This includes
starting or refusing tests, medicine and surgery. If
treatment has already begun, you may continue it or stop
it based on the instructions I have discussed with you.
• Interpret any instructions based on your understanding of
my wishes, values and beliefs.
Trim at dotted line and keep for your records.
Name of health care agent
continued >

• Review and release my medical records and personal files as
needed to help you in deciding care needs.
• Arrange for my medical care and treatment in any location
you think is right, which may include the need to live in a
nursing home or residential facility for long-term care.
• Decide which health care providers and organizations
provide my medical treatment including care and treatments
for a mental health condition.
• Make medical decisions for me and my unborn child, if
I am pregnant.
In the future it will be important for us to have ongoing
advance care planning discussions so I can be assured
you are confident in your abilities to make decisions consistent
with my wishes on my behalf.
Name
Date
Roles and responsibilities
of a health care agent (continued)

Allina Health offers free classes to assist you in having
advance care planning discussions and write a health
care directive. Call 612-262-2224 or 1-855-839-0005
to register for a class.
Advance care planning checklist
understand your health situation
identify your health care agent(s)
have advance care planning discussions with your
health care agent
attend a free advance care planning class for assistance
with advance care planning discussion and/or help in
completing a health care directive when needed
complete the legal health care directive
distribute copies of your health care directive to your
family, health care provider, medical record, etc.
review your health care directive on a regular basis at
least every five years.

S410420A 110881 1214 ©2014 ALLINA HEALTH SYSTEM. TM – A TRADEMARK OF ALLINA HEALTH SYSTEM.
612-262-2224
1-855-839-0005
allinahealth.org/acp
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