No family likes having difficult conversations surrounding end-of-life decisions and death — but discussing these topics in advance offers necessary clarity and peace. April 16 is National Healthcare Decisions Day, and the perfect time to start the conversation is now.
“Making healthcare decisions in calmer times is wise and loving, instead of in the middle of a health crisis or impossible situation,” said Dr. Steven Katzman, National Medical Director for Heart to Heart Hospice. These legal healthcare documents help outline deeply personal preferences that reflect the patient’s values, beliefs, and goals as they approach life’s inevitable ending.
During the initial hospice intake, patients and caregivers help create a flexible care plan with goals and end-of-life wishes, along with hospice support. These range from physical (like pain management and nutrition) to spiritual (guidance and counsel based on a patient’s desires and traditions) to psychosocial (caregiver burnout, mental health issues, and relationships). One goal regarding advance directives, for example, is setting a deadline to finish important paperwork.
Types of Healthcare Documents
Acceptance and grief often come in waves for families and terminally ill patients on hospice, many of whom are facing the reality of a life expectancy of six months or less. Curative treatments are discontinued and vital healthcare conversations between patients, families, and hospice providers are an imminent necessity.
Hospice experts help families navigate these difficult conversations and provide step-by-step assistance for important documents. “Advanced directives” is a broad term that covers a set of instructions outlining healthcare wishes. Not limited to terminal illness, advanced directives cover those who are medically incapacitated for any reason. For hospice, the most common healthcare documents include:
A living will (also called an advanced directive) outlines wishes for end-of-life care or when a patient is unable to communicate wishes. For example, a hospice patient may include the following:
- Direct life-sustaining measures to discontinue if they prolong dying, such as feeding requirements, breathing treatments, or others.
- Do-not-resuscitate (DNR) orders, such as no life-saving CPR or external defibrillator, or do-not-intubate (DNI) orders.
- Religious preferences and funeral planning may also be included.
A healthcare Power of Attorney (or healthcare proxy) is someone you trust to act as your decision maker if you are physically or mentally unable to do so yourself. Choosing a healthcare agent is an important task and CaringInfo outlines these suggestions. Pick someone who:
- Knows you well.
- Is calm in a crisis.
- Understands your wishes or the spirit of your wishes if not specifically outlined.
- Is not afraid to ask questions and advocate for you to doctors or other loved ones.
- Can communicate and reassure your family.
Your healthcare power of attorney legal document is often separate from your advanced directive. It is certified and enacted once the patient’s physician determines the patient is unable to make healthcare decisions. If a patient regains their ability to make decisions, they can regain decision-making power.
Tips for Official Healthcare Documents
You don’t have to wait for a chronic or terminal illness in order to create your healthcare plan. Read these helpful tips regarding advance directives from the National Hospice and Palliative Care Organization (NHPCO):
- Laws vary between the states regarding witnesses, notarization, and other specifics. Plus, advanced directives may have different titles from state to state. Download your state’s advanced directive form for free to ensure you comply with your state’s law.
- In the U.S., advanced directives are legally binding. A lawyer is not required to create one and it is legally binding when signed in front of required witnesses (see your state’s laws for details).
- One of the goals of hospice is to prevent hospitalizations, so outlining specific wishes is important. Families can call the 24/7 hospice line to triage and provide instructions for medications or symptom relief and evaluate if a nurse visit is needed.
- Advanced directives don’t expire. If you create a new one, it replaces and invalidates the previous version.
- To ensure the document stays current to your wishes, review it periodically. Create a whole new document if you want to make changes.
- Provide copies to your healthcare proxy, loved ones, caregivers, and physicians. Keep the papers easily accessible in the home and vehicle.
- You may want to consider other important end-of-life conversations, like funeral and estate planning, and have official documents for those as well.
With experts like those at Heart to Heart Hospice, difficult end-of-life conversions and filling out the necessary legal documents don’t have to be overwhelming. Your compassionate team can help you feel empowered and prepared, reduce conflict, and foster peaceful communication. Start making your healthcare decisions today; you’ll be grateful you did.