In our last newsletter, we focused on Degrees/Level of Intervention. This month we take a step back to talk about Advanced Care Planning in general.
Why should you do advanced care planing? Because if you don’t, and you become unable to make decisions on your own due to a physical or cognitive impairment, someone else will make decisions for you. You might have approved of, or agreed with their decisions. Or you may not, but by the time they make them, you have lost that control. Another reason to consider and make your choices clear is it can help family members avoid discord. Finally, it spares your family having to make painful decisions such as what kind of care you need and whether or not they should end medical interventions. These are precisely the kinds of decisions family members often have to make at a time of crisis–and it is difficult to make any decisions while in crisis. It is even more difficult to have to make decisions about someone we love.It eases the burden of responsibility considerably when we know that, as we act in crisis, we are fulfilling the decisions of our loved ones.
While advanced care planning is often thought of in terms of life support at the end of life, it is actually much more than that. It is about decisions that may have to be made before end of life is a consideration. Further advanced care planning is not just about what decisions, but also who, how, when, and where.
Who will make decisions for you? Which decisions will they make? What process will they use and who will they consult? What will “trigger” for someone make (or start to make) those decisions for you? For example who will determine if you become cognitively impaired, who will determine that you can no longer make decisions? Will it be your doctor? A Social Worker? Your children? If there is disagreement about what action to take,how will those disagreements be resolved?
Advanced care planning should also take in to account your assets and income. How do you want your money spent and on what? Do you want your home sold to pay for your care, or do you want to use a line of credit or reverse mortgage or other financial product? Do you want the same person to make your financial and care decisions, or do you want to divide those responsibilities?
Advanced care planning can take time. Ideally, It should entail conversations with more than family. You might want to consult with your physician, your financial advisor, and of course, your lawyer. Most jurisdictions allow for the creation of a document which declares and legally protects our care and financial choices. In B.C., this document is called a Representation Agreement.It is the only legal document that protects you choices ( aside from an enduring power of attorney. The enduring power of attorney protects financial decisions only. It does NOT give someone the right to make care decisions for you.) In other provinces and in the U.S. there are other legal documents.
Once made, advanced care plans should reflect not only what you want, but the spirit and values under which you want decisions to be made for you. After you have completed you advanced care plans, let others know about them, including your doctor , children, and maybe grandchildren and a close friend . These people should also know where they can find a copy of the plans.
The basic concerns (the “whats”) to be considered for a time when you might become unable to make decisions for yourself include:
- Housing, e.g. staying home vs. seniors housing
- Life sustaining medical treatment, such as ventilators, feeding tubes, dialysis,
- Cardio pulmonary resuscitation
- Pain relief
- Funerals and burial
- If you should have a psychiatric illness, when should someone take over
- Donation of your organ
Professionals: If We Don’t Ask, They Won’t Tell
We recently had a discussion with a financial planner who told us he doesn’t ask his older clients, or middle aged clients with parents, about issues in aging. He will only discuss financial concerns.. His feeling was that “such personal matters” are private matters, and people are sensitive about them.
Our belief is that if a client seeks a professional’s advice to protect their interests (and that can be a lawyer, a financial planner, an accountant, as well as a doctor), then that professional has the responsibility to ask some pertinent and contextual questions. If done with sensitivity these questions are often welcomed. Far too often, issues in aging are avoided, or not picked up on. It can be a relief for people to be able to talk about something with someone if they have concerns.
Questions can start with a disclaimer– “I don’t want to intrude, so tell me if I should mind my own business, but I was wondering if….
- ” You are doing ok?””You have made some advanced directives?”
- “You have spoken to your parents/children about….?”
- “You are having any pain?”
- “There is something bothering you, because you seem…”
Professionals who provide resources and support for their clients find that it is helpful to their business and strengthens their relationship with their clients. Have the names of companies or resources that can meet their needs or that can point them in the right direction.