Now Is the Time to Consider Advance Care Planning

April 16 is National Healthcare Decisions Day, a time to inspire, educate, and empower the public and healthcare providers about the importance of advance care planning. Frederick Regional Health System (FRHS) is joining healthcare organizations across the country to celebrate this national movement, in hopes of helping others to make, discuss, and document future healthcare wishes and decisions.

Imagine for a moment that you’re terminally ill or injured and unable to communicate your wishes regarding healthcare. Would your loved ones know what to do? How would they feel about making such monumental decisions on your behalf?

Too many people are dying in ways they wouldn’t choose for themselves—and too many of their loved ones are left to cope with the loss, guilt, and uncertainty of deciding for them. By talking early about end-of-life care with the people you love and planning your advance directive, together you can make these difficult situations easier—and ensure that both your wishes and those of your loved ones are heard and respected, if or when the time comes.

What is Advance Care Planning?

“An advance directive is a gift a person gives to their family and loved ones because it tells them what you want, so they don’t have to struggle with these decisions at a very stressful time for all,” says Rachel Mandel, MD, vice president of medical affairs at Frederick Memorial Hospital.

Advance care planning is making decisions about the type of care you’d like if you were ever unable to speak for yourself. It’s Your Life, Your Plan. To put it simply, an advance directive states which medical interventions you would want and those you would not want if you were in any of these conditions and unable to communicate your wishes:

• End-stage condition: a progressive state caused by injury, disease, or illness. A person suffers severe and permanent deterioration that can be accompanied by incompetence and complete physical dependency. To a reasonable degree of medical certainty, treatment of this irreversible condition would be medically ineffective.

• Terminal condition: an incurable state caused by injury, disease, or illness that makes death imminent. Even if life-sustaining procedures are used when an individual is close to death, there is no reasonable expectation of recovery.

• Persistent vegetative state: a condition in which a person is permanently unconscious, unaware of their environment, and unable to interact with others. There is no reasonable expectation of recovery. It’s important to note that a persistent vegetative state is not the same as a temporary coma.

It doesn’t matter how old or young you are, or the current state of your health, now is the time to have conversations and complete documents that identify your wishes, values, and beliefs. This caring act will relieve your loved ones and healthcare providers of the stress and heartache that comes with guessing what you would want during such a tragic time.

How Do I Complete an Advance Directive?

Before you get started, review this checklist for advance care planning.

Every advance directive legal document includes two parts: Selection of Healthcare Agent(s) and a Living Will.

• Part 1: Selection of Healthcare Agent(s)

This section assigns a person(s) to assist the medical team in making healthcare decisions on your behalf if you’re unable to make decisions for yourself.

When selected, your agent can consult with your doctor, view medical records, and give consent for treatment. Your agent is bound to make decisions according to your known wishes; however, the advance directive does not afford your agent the ability to conduct financial business on your behalf.

• Part 2: Living Will

This section provides instructions for your future medical treatment when you cannot decide for yourself, including inpatient treatment and/or end-of-life care. This does not require an attorney or notary in Maryland, nor does it guide EMS personnel.

To be effective in the state of Maryland, your advance directive must be voluntarily executed and made in writing, dated and signed by you, and signed by two witnesses who are both 18 years or older. Neither witness can include your healthcare agent(s), nor can your witness benefit financially or otherwise from your death.

It’s recommended that you complete your advance directive once you turn 18 years of age. You should do so regardless of your current health conditions or need. Accidents, natural disasters, or health crises can happen at any time—it always seems too early until it’s too late!

Once your advance directive is complete, you should give a copy to your:

• Healthcare agent(s)
• Hospital
• Doctors and specialists
• Family and/or loved ones that may be contacted in the event of an emergency

You should also keep a copy in your vehicle’s glove compartment, with your dated list of medications, and in your Red Folder.

What Is a Red Folder?

A Red Folder is a special place to keep important healthcare paperwork organized and in easy access. In it, we recommend including copies of not only your advance directive, but also your Medical Orders for Life-Sustaining Treatment (MOLST) form, a current list of your healthcare providers and medications, and a recent photo.

The folder is bright red for easy identification and has magnetic strips on the back so that you can attach it to your refrigerator, too. Emergency responders (including paramedics, firefighters, and police officers) are trained to look for this folder on refrigerators when responding to a medical crisis.

What Is a MOLST Form?

Your MOLST form designates medical orders for current treatment. It’s intended to stay with you as you move in and out of various healthcare facilities and settings (e.g., assisted living, home with HHC, nursing home, hospital, hospice). A treating physician, nurse practitioner, or physician’s assistant must sign the MOLST form. It does not guide EMS personnel, it should replace an old DNR form, and it does not expire but should be reviewed during transitions of care.

This form designates an agent who will conduct business on your behalf if you should become unable to do so. This includes transactions such as paying bills or selling your property, for example. The same person can be your financial power of attorney and your healthcare agent. An individual with the capacity to decide for themselves must complete this form. It is generally recommended that this form is completed with an attorney present. The form does not automatically apply to making healthcare decisions.

Start the Conversation Today

According to a 2013 national survey by The Conversation Project, a nonprofit that works in collaboration with the Institute for Healthcare Improvement to help people talk about their end-of-life care wishes, about 90 percent of people say that talking with their loved ones about end-of-life care is essential. However, only 27 percent have done so.

It’s never too early to talk about your wishes for end-of-life care. The Conversation Starter Kit (click here to download for FREE) is a useful tool to help you have important conversations with your family members and other loved ones about your end-of-life wishes.

Whether you’re getting ready to tell someone else what you want, or you want to help someone else prepare to share their wishes, this starter kit will guide you in talking openly and honestly with your loved ones, before a medical crisis happens. While the kit doesn’t answer every question you or your loved one may have, it will help you gather your thoughts and then begin the conversation together.

How Can You Get Help with Advance Care Planning?

Do you have an advance directive? If not, it’s time to get started on one. FRHS can help. Our staff can support you in completing your advance directive and deciding the best options for your needs. We’re with you every step of the way, so you never feel alone.

Appointments with licensed social workers are available free of cost to the community. For questions, more information, or to set up a personalized appointment or presentation, please contact Michelle Ross, LGSW, at 240-651-4541 or mross1@fmh.org, or visit fmh.org/ACP.