Understanding Advance Directives

What are advance directives?

“Advance directives” are legal documents that allow you to plan and make your own end-oflife wishes known in the event that you are unable to communicate. Advance directives consist of (1) a living will and (2) a medical (healthcare) power of attorney. A living will describes your wishes regarding medical care. With a medical power of attorney you can appoint a person to make healthcare decisions for you in case you are unable to speak for yourself.

What is a living will?

A living will is an advance directive that guides your family and healthcare team through the medical treatment youwish to receive if you are unable to communicate yourwishes. According to your state’s living will law, this document is considered legal as soon as you sign it and a witness signs it, if that’s required. A living will goes into effect when you are no longer able to make your own decisions.

What is a medical power of attorney?

A medical power of attorney is the advance directive that allows you to select a person you trust tomake decisions about yourmedical care if you are temporarily or permanently unable to communicate andmake decisions for yourself. This includes not only decisions at the end of your life, but also in other medical situations. This document is also known as a “healthcare proxy,” “appointment of healthcare agent” or “durable power of attorney for healthcare.” This document goes into effect when your physician declares that you are unable to make your own medical decisions. The person you select can also be known as a healthcare agent, surrogate, attorney-in-fact or healthcare proxy.

Who should I select to be my medical power of attorney?

You should select someone you trust, such as a close family member or good friend who
understands your wishes and feels comfortable making healthcare decisions for you. You
should have ongoing conversations with this person to talk about your wishes at the end of life. Make sure yourmedical power of attorney feels comfortable and confident about the type of medical care you want to receive.

Most state laws prevent your doctor or any professional caregiver from being assigned as your healthcare agent. You can also select a second agent as an alternate in case your first healthcare agent is unwilling or unable to serve.

Understanding Advance Directives

What do I need to know about end-of-life decisions to prepare my advance directive?

Learn about life-sustaining treatments

Life-sustaining treatments are specific medical procedures that support the body and keep a person alive when the body is not able to function on its own. Making the decision about whether or not to have life-sustaining treatments can be a difficult decision depending on your situation.

You might want to accept life-sustaining treatments if they will help to restore normal
functions and improve your condition. However, if you are faced with a serious life-limiting condition, you may not want to prolong your life with life-sustaining treatment. The most common end-of-life medical decisions that you, family members or an appointed healthcare agent must make involve:

Cardiopulmonary Resuscitation (CPR)

Do Not Resuscitate Order (DNR)
Do Not Intubate Order (DNI)
Artificial Nutrition and Hydration

What is cardiopulmonary resuscitation (CPR)?

Cardiopulmonary resuscitation (CPR) is a group of procedures used when your heart stops
(cardiac arrest) or breathing stops (respiratory arrest). For cardiac arrest the treatment may include chest compressions, electrical stimulation or use of medication to support or restore the heart’s ability to function. For respiratory arrest treatment may include insertion of a tube through your mouth or nose into the trachea (wind pipe that connects the throat to the lungs) to artificially support or restore your breathing function. The tube placed in your body is connected to a mechanical ventilator.

What is a Do Not Resuscitate (DNR) order?

A Do Not Resuscitate (DNR) order is a written physician’s order that prevents the healthcare team from initiating CPR. The physician writes and signs a DNR at your request or at the request of your family or appointed healthcare agent if you do not want to receive CPR in the event of cardiac or respiratory arrest. The DNR order must be signed by a doctor otherwise, it cannot be honored. DNR orders:

Can be cancelled at any time by letting the doctor who signed the DNR know that you
have changed your decision.

Remain in effect if you transfer from one healthcare facility to another. However, consult the arrival facility’s policy tomake sure. Also, theDNRmay not be honored if you are discharged fromthe facility to your home if your state does not have an out-of-hospital DNR policy.

May not be honored during surgery but this is something very important to discuss with your surgeon and anesthesiologist before surgery so your wishes are honored.

Should be posted in the home if that is where you are being cared for.

If there is noDNR order, the healthcare teamwill respond to the emergency and perform CPR.

The teamwill not have time to consult a livingwill, the family, the patient’s healthcare agent or the patient’s doctors if they are not present.

What is a Do Not Intubate (DNI) order?

When you request a DNR order, your physicianmay ask if you also wish to have a “do-not-intubate” order.

Intubation is the placement of a tube into the nose or mouth in order to have it enter your windpipe (trachea) to help you breathe when you cannot breathe adequately yourself. Intubation might prevent a heart attack or respiratory arrest.

Refusal of intubation does notmean refusal of other techniques of resuscitation. If you do notwantmechanical ventilation (breathing), youmust discuss intubation because itmay be included as part of a DNR order. Even if you have completed a DNR order that does notmean that you have refused to be intubated. If you do not want life mechanically sustained, youmust discuss your decision about intubation with your doctor.

What is artificial nutrition and hydration?

Artificial nutrition and hydration are treatments that allowa person to receive nutrition (food) and hydration (fluid) when they are no longer able to take them by mouth. This treatment can be given to a person who cannot eat or drink enough to sustain life. When someone with a serious or life-limiting illness is no longer able to eat or drink, it usuallymeans that the body is beginning to stop functioning as a result of the illness.

How can I prepare my advance directive?

You can fill out a living will and medical power of attorney formwithout a lawyer. The National Hospiceand Palliative Care Organization, your state hospice organization, local hospitals, public health departments, state bar associations or state aging offices provide state-specific forms and instructions.

It is very important that you use advance directive forms specifically created for your state so that they are legal. Read the forms carefully and make sure you follow legal requirements determined by your state. You may need to have a witness signature and get the forms notarized (signed by a notary public.)

Keep your completed advance directive in an easily accessible place and give photocopies to your primary medical power of attorney and your secondary, alternate agent. This document stays in effect unless you cancel it or decide to complete a new one with changes.

Understanding Advance Directives

Can healthcare professionals refuse to honor my advance directive?

Some healthcare professionalsmay choose to ignore what is written in your living will if they believe that what is written is against your best interest or for moral or religious reasons. In some cases there may be a misunderstanding of the law, medical ethics or professional responsibilities. It is important for you to know if your doctor will honor your request. Bring your completed living will to your next healthcare appointment and ask your doctor if he or she has questions or concerns.

Who would decide about my medical care if I did not complete an advance directive?

If you are unable to make decisions, healthcare professionals must consult your family
members. Some states have decision-making laws to identify individuals who may make
decisions on your behalf when you do not have an advance directive, such as your spouse, parents or adult children.

Does my advance directive include my wishes about organ donation,
cremation or burial?

Some states may include your wishes about whether you want to be an organ donor as part
of the advance directive. If it is not included, you can still write down your decision about organ donation. However, you should fill out a specific form for that purpose. You should also let your loved ones know if you wish to be buried or cremated.

How to Talk with Your Loved Ones

Remember, it’s up to you to take the initiative and express your wishes. Your family or loved ones are not likely to raise the issue for you. Talking about end-of-life issues can be difficult for anyone. One way to approach the subject is to talk about why you have decided to talk about these issues.
For example:

Did a particular event cause you to make the decision?

Did an article in the newspaper or something that happened to a family member make you think about it?

What is motivating you to take these actions now?

Sometimes sharing your personal concerns and values, spiritual beliefs, or views about what makes life worth living can be as helpful as talking about specific treatments and circumstances.

For example:

What aspects of your life give it the most meaning?

How do your religious or spiritual beliefs affect your attitudes toward dying and death?

What is your attitude towards death?

Sharing your end-of-life care decisions with your loved ones will also help them ensure your wishes are followed. Decisions may include answers to the following questions:

How important is it to you to be physically independent and stay in your own home?

Would you want your healthcare agent to take into account the effect your illness has on any other people?

Would you prefer to die at home if possible?

Reassess your decisions over time. These are not simple questions and your views may change. It is important that you review these issues and discuss your choices as your personal health or circumstances change your life.

Initiative 1029

On November 4, 2008 the Washington voters passed initiative 1029. The initiative requires the Department of Health (DOH) and the Department of Social and Health Services (DSHS) to develop the home care aide profession. Under the initiative, certain long-term care workers will have 150 days from the day they start working to be trained and certified as a home care aide. DSHS will do background checks on applicants and set the training curricula. DOH will develop and administer a written and skills examination and credential applicants. Both agencies will complete the rulemaking process for the initiative. The agencies will be able to share information on background checks, training, continuing education, and credential status.The initiative requires this work be completed by January 1, 2011.

If you have any questions or concerns, please contact us at Homecareaides@doh.wa.gov.

Lifeline Service

Living at home for as long as possible is a goal that most of us share, but as we age, changes occur in our ability to function mentally and physically, making it a challenge to remain at home. These changes often necessitate thinking through next steps and taking action, such as installing safety devices and getting support when needed.

Developing a plan for the future can be difficult, but not having a plan can be more costly, and cause more heartache. That’s why Philips Lifeline is sponsoring the Independent Living Assessment for older adults and their families to plan for the future while continuing independent living at home.

Philips Lifeline, the #1 medical alert service, is easy-to-use and designed to reduce the risk of living alone. In the event of a fall or an emergency, help is available at the push of a button. The Lifeline Personal Help Button connects you to a trained Personal Response Associate who can send help quickly - 24 hours a day, seven days a week.

Call Lifeline now for more information 1-800-380-3111

New Home Care Assessment

The Personal Touch, LLC is now offering low cost home care assessments. This assessment is for family caregivers, to assess the needs for their loved ones. We will give professional suggestions on making caregiving easier for the family members. Please call for your low cost assessment or more information, please call (360) 895-3980.

The Personal Touch, LLC coming soon to California......When quality of care is your number one priority.

Now order your medical supplies

The Personal Touch, LLC is now offering quality medical supplies that can be delivered to your home. We are a home care agency committed to personal service and quality products. We care for your loved ones as we would care for our loved ones.

When the quality of care for your loved one is your number one priority, call for your free assessment at (360) 895-3980.

Baby Boomers

Due to the abundance of excellent health care available in Washington State, California and the surrounding area, we are living longer than ever anticipated. But as seniors age, some may need help if they want to continue to live independently. More often than not, it is the already overscheduled children of the baby boomer generation that are called upon to assist their parents to age with dignity.

On a recent visit to your parent's home you notice the mail is three days old in the mailbox, medication is scattered haphazardly over the kitchen table, the refrigerator is empty and neither parent has apparently bathed since your last visit. Your parents are adamant that "everything is fine".

How do you identify when your loved one needs help and how do you help without taking away their autonomy? The following may be helpful in your conversation and observation of your parents:


Be Honest. If you are concerned about their needs, say so. State this in an "I" message. Example, "I am concerned about your diet, you seem to be loosing weight." Or "I noticed that you call me often and forget we have just talked, are you concerned about your memory?". "I am ...".
When parents call you frequently and complain about vague symptoms, sometimes they are telling you that they are scared or lonely. Try to get to what the underlying issue is and don't focus so much on the vague symptoms.

All medical complaints need evaluated by a health care professional.

Tell your parent(s) that you respect their autonomy. Wanting them to be independent and to support their independence, you need to know a few important items to help them when and if an emergency presents itself:

What kind of legal planning have they done? If they become disabled could you or another party take over without going to the court system? This means they have a Durable Power of Attorneys for both Health and Finances in place.

Talk about their finances. What is their monthly income? Where does the income come from? What are their assets? Get a list of bank accounts and brokerage accounts. Is the income sufficient to meet their needs? They could be entitled to some governmental programs if they are low or even middle income.

What is their medical insurance and what numbers are associated with those policies. What is their social security number? Do they have life insurance policies or long term care policies? If they have this insurance get the names and phone numbers of these companies.

Have they pre-paid for funeral and/or burial expenses? Where have they done this? What are the phone numbers of the mortuary and/or cemetery?

Who are their doctors? What medications are they currently taking? List all the medications and determine what they are taking them for. Ask them if they take any over the counter medications or vitamins or herbs.

How often do they see friends? Do you have the names and phone numbers of their friends?

Ditto for their religious community.

Are they drinking alcohol? If yes, how much?

Are they driving safely? Do they have convenient transportation?

Identifying when your loved one needs help is not difficult when a medical emergency of accident occurs. However, the slow progression of dementia or depression might not be apparent through telephone calls or short visits. If both of your parents are alive, the well spouse often compensates for the other's failing and may deny anything is wrong. It is a good idea to think proactively when caring for aging parents.

Below is a list of "Red Flags" to watch for when visiting your aging family member:

Change in weight

Change in short term memory

Change in usual routine

Change in speech and/or ambulation

Bills not being paid

Entering contests

Refusing to go with friends on outings or going to church

Refusing suggestions as well as agreeing with everything without giving consideration to consequences

Mood swings, getting angry quickly

Refusing to see medical providers

Inability to take care of activities of daily living: cooking, dressing, bathing, housekeeping to name a few.

Once you have decided to become proactive in helping your aging parents, your next step is where do you go for help?

If you are in a crisis mode, or do not have the luxury of time to gather this information options like The Personal Touch, LLC for Elder Care is available to work closely with your siblings, other relatives and parents to design the most cost and care effective plan. (options for eldercare)

Call today for a free assessment 1-877-896-3980

5th Annual Private Duty Leadership Summit

Private Duty Homecare Association would like to invite you to attend the 5th Annual Private Duty Leadership Summit & Exposition, January 24-26, 2010 in Phoenix, Arizona.
Point Hilton*Tapatio Cliff Resort
Visit www.nahc.org

Thank you for considering the Personal Touch, LLC for your home care needs.Our experienced caring staff ensures reliable and professional services. We are looking forward to exceeding your expectations.
Personal Assistance and Home Care Services
Office Hours Monday - Friday 8:00 a.m. - 5:00 p.m.
(360) 895-3980
The Personal Touch LLC
P.O. Box 1996Port Orchard, WA 98366
Providing the personal touch in home services to care for you and your loved ones.

Some of our services include: (but not limited to) Home Care:(hourly and live-in services available)
Companionship
Personal Care
Respite Care
Meal Preparation
Transportation
Medication Reminders
Homemaker Services

Personal Assistant:

Travel Arrangements
Shopping
Errands
Flight Reservations
Household Managers

Time Out Program

Maybe you just need a break?Husband on deployment? Need time for yourself? Ask about our 'Time-Out'
Professional Services:

AFH / Attestation verification

We also provide staffing for adult family homes, nursing homes, retirement & hospice centers, hospitals and private individuals.

Now accepting Veteran Administration Benefits

Our staff members are:
Insured Licensed Registered Nurses and certified aides
Trained, reliable and professional
Caring and compassionate
24 hour on-call emergency staff
(360) 895-3980