Ron SmithPublished on Jun 1, 2023

A Little Bit More to Consider . . .Advanced Care Planning.

Last month I emphasized the need for planning during the third phase of our life. Although the article was a good overview regarding common planning needs, the confines of this space didn’t permit as much discussion as I wanted regarding end-of-life considerations. A very important part of end-of-life planning is starting the conversation with the ones that you love. A couple of very comprehensive advanced planning tools are available to Arizona Residents in both on-line and paper forms. Five Wishes (www.agingwithdignity.org) and PREPARE for Your Care (www.prepareforyourcare.org) have been used by millions of families nationwide. There is a small cost for the Five Wishes tool and no cost for the PREPARE tool. Both tools help to develop documents that meet the legal requirements for advanced directives in Arizona.

What’s the advantage of these tools? They’re written in everyday language and are easy to understand. They address personal, medical, spiritual and legal wishes in a way that facilitates the discussion with loved ones and care givers. The benefit is that these people will know exactly what you want and will be able to make decisions when needed and not have to guess your wishes. End-of-life decisions are difficult enough to start with, but combined with life threating scenarios they are very stressful. Clarity in your end-of-life decisions allows your loved one and care givers to focus on your needs rather than generating unnecessary animosity amongst themselves when they disagree.

A bit of a warning about advanced directives. Without discussion and participation with your family, an advanced directive might also not provide a complete picture. Check-marked decisions may not always fit the real-life medical scenario that you or your family members might encounter. For example, COVID-19 treatment might require the use of an incubator to assist your lungs for a period of time for your recovery. Choices in your advanced directive might preclude that treatment. f you discussed the choices with your family, they might have a better understanding of the context in which your choice was made. Sometimes a written narrative may be useful as an addendum to a prepared advanced directive. Having had the “talk” is really important to help decision making when choices aren’t necessarily clear. COVID-19 has reinforced the need for advanced directives to deal with sudden, unexpected life-threatening events requiring rapid decisions in complicated circumstances.

When preparing for the completion of advanced directive documentation, you might want to consider the following:

• Who do you want to be your health care proxy? This is the person that you will trust to fulfill your choices. It can be a family member, a friend, your lawyer or a friend from your house of worship. Hopefully they will share your views and values about medical decision and life. They should preferably live near enough to be able to respond quickly. And they should meet any legal requirements established by the state.
• You should establish a backup proxy or successor should your first choice be unable to serve in that capacity.
• You may also want to appoint a legal/financial agent to manage your will and finances.
• Of course, you need to speak with your medical team to better understand the implications of medical choices that you might make. You might want to also complete some additional forms known as MOLST (Medical Orders for Life-Sustaining Treatment) and POLST (Physician Orders for Life-Sustaining Treatment) for additional clarity.
• Plan on making multiple copies of your documents and storing them in a location where they can easily be found by your proxy. Also, keep in mind that advanced directive documents can be stored in the Arizona Healthcare Directives Registry which recently transitioned from the Secretary of State’s Office to Health Current, Arizona’s health information exchange.
• Plan on periodically reviewing and updating your documents with major changes in life events.

Your personal decisions should also be based upon self-reflection. As humans we are remarkedly talented to make decisions and handle diversity. We usually have a good idea of what gives our life meaning and what our values are. Sudden illness or incapacitation can definitely cloud that process. Therefore, writing down our wishes in preparation can help guide us through our thoughts and preferences. Take your time in order to help confront some difficult questions, such as (source: NCOA Aging Mastery Playbook, Firman & Stiles, p.83):

1. How long would I want to continue medical treatment in the face of terminal illness?
2. How long would I want to continue treatment in the face of dementia?
3. Am I willing to lose a critical ability (to walk, speak, eat, etc.) and continue living?
4. When would I want to begin palliative care?
5. Would I want to donate my organs?
6. Do I need to have all family members in agreement with my decisions?
7. How do my spiritual beliefs play a part in my decisions?

Many of your thoughts will come from prior experiences with family and friends confronting similar decisions. Once you have had time to consider your personal thoughts, it’s time to gather your family and use an attorney or one of the available advanced directive tools to start your conversations.

Ron Smith is an aging-in-place advocate, a Certified Aging-in-Place Specialist (CAPS) and a Certified Living in Place Professional (CLIPP)

This article appeared under a different title in the October 2021 issue of InMaricopa Magazine.