Hello, my name is Teressa Vaughn, and I am an
advance care planning consultant for Sharp HealthCare.
Today, I will be talking with you about advance care planning.
So, what is advance care planning?
We see advance care planning as a gift to your loved ones.
It allows your loved ones to make difficult decisions on
your behalf if ever there is a time you can't
speak for yourself.
It relieves the emotional burden of them having to make a
decision on your behalf.
So why is advance care planning important?
Because it puts you in the driver's seat of your
health care journey.
With this plan in place, it helps others speak on your
behalf and say what you would have wanted to say.
We never want to think about the "what ifs," but there are
times when we need to have this discussion and we create this
important tool that your loved ones can use down the road.
It's also important because it helps protect against
those backseat drivers.
Does anyone know any backseat drivers?
Completing an advanced health care directive allows you to
put your wishes and orders, your health care wishes, in order.
What are some benefits to advance care planning?
Well, a person's voice can be heard even if they can't
speak for themselves.
Their family or health care agent can be relieved of the
moral guilt of having to make a decision for them;
instead they'll just be speaking what the person have
already said they want.
A person's wishes and preferences can align with the
treatment that they actually receive, and a
reliable document can be stored and retrieved when necessary.
So why are people hesitant to begin this process?
Well there are many reasons.
Oftentimes people say, "Oh, I'm not that sick."
"Oh, it's too confusing."
"I've already talked to my lawyer."
"Oh, nothing won't happen to me."
"It might be bad luck."
Or they may say, "I'm sure that my loved ones already know what I want."
They may even think "I don't want to talk
about my mortality" or "I don't like difficult conversations."
And some people are just plain old procrastinators
such as myself.
But some things we want to consider when we're completing
our advance health care directive
are aging considerations.
What would I want as I age?
What would my loved ones need to provide for me and speak on
my behalf as I age?
What if I have dementia or some other cognitive decline?
What if there's a chronic illness such as
congestive heart failure,
diabetes, cancer, COPD?
Or what if there's a functional decline, if I can
no longer walk, can no longer use my hands?
Some other considerations might be a car accident,
something tragic, a sudden illness that no
one's thinking about, like a pandemic -- we never
saw that coming.
One thing that happened during the pandemic,
some hospitals had to consider a universal do-
not-resuscitate order.
What would you have wanted during this time?
Have that conversation with your loved ones.
So you want to choose a health care agent very carefully and
this person should know what's most important to you;
what your goals, values and beliefs are;
where you desire to live or die;
when medical decisions should be continued or discontinued;
and what resources are available to use, such as a
long-term care insurance policy or any veteran benefits.
And the person you select should be someone you can talk
to to discuss your goals and values with.
If someone doesn't want to talk about these things, you may not
want to select them.
This person should be willing to accept the responsibility.
So you want to ask them first.
They should be able to follow your wishes and they're able to
make decisions in stressful situations.
So there are many health care directives out there.
There's nothing magical about any document, but you do
want to play close attention to the witnessing requirements.
In the state of California, the requirements are two
witnesses or a notary, and you have to sign that document in
front of either the two witnesses or the notary.
We always recommend that you color outside the line so you
don't necessarily have to just say whatever is on the form,
but you can add extra things, whatever is important to you.
And we recommend using a wallet card.
You can review and update your plan.
We say every 6 D's if there is every decade or so, every 10
years or so, you want to maybe review that document.
We say pull it out, blow the dust off, and see if
it still honors your goals and your wishes.
If there's a death, you want to review your document because
it's pretty hard for a person to speak on your behalf if
they're no longer living.
If there's a divorce, you want to review your document and maybe update it.
If there is a new diagnosis, just pull that document out to
see if that document still honors what you would want.
If there is a pandemic, we didn't see this coronavirus
coming our way, but you want to have that conversation:
What would I want in this season of life?
Or if there is a decline, if there is a decline, you want
to have a conversation to see if your goals and wishes still
are reflected in your advance health care directive.
But as long as you have decisional capacity,
you can change your advance health care directive
at any time, and as long as you have decisional capacity,
the health care team will come directly to you to ask you what
you would want.
This document only comes into play when you can no longer
speak for yourself.
And if you have a more serious illness, you want
to consider a more detailed document that will explain how
your disease will likely progress.
So have a conversation with your physicians early so you
can document that.
Have you ever heard of the POLST?
The POLST is a supplementary document that comes alongside
the advance health care directive, and it
stands for the physician's order for
life-sustaining treatment.
It is a medical order.
It's a pink document that's portable,
it transfers from one location to another.
So if a person is at a hospital and they go to a skilled
nursing facility and back to home,
it transfers with them.
It's recognized throughout the state of California.
Not everyone would fill out a POLST.
The POLST is typically filled out by someone with a chronic,
progressive or serious illness,
maybe someone who is medically frail or someone who just does
not want an attempt at resuscitation.
So there are many parts to the POLST document.
Part A stipulates if I no longer have a pulse and
I'm not breathing, which means the person has passed away
because we don't know anyone walking around without a pulse
and not breathing.
We're not talking about our zombie movies of course.
But if we don't have a pulse and we're not breathing,
that means we've passed a natural death.
Would you want an attempt at resuscitation?
And in the resuscitation process,
we have to exert 100 to 125 pounds of pressure to the chest
to get about two inches deep to get the good ol'
heart going again.
And remember, the person who fills out a POLST is someone
who's chronically ill, medically frail.
So that person may or may not want that attempt, may not want
that amount of pressure to their chest.
So then they could say, "Yes, I want an attempt at
resuscitation" or "No, I do not want an attempt at resuscitation."
There are many applications to Part A, is only when a person
has no heartbeat and they're not breathing.
It doesn't mean do not do anything.
We will do something if you do have a pulse
and you're breathing, or breathing, we will get to that
in Part B.
But we have careful communication when we're
completing this document so that's why it is a physician's
order to be discussed with your physician.
We talk about the success rate of CPR because many people
think that it looks like it does on the television when
actually it does not.
So we say, "What does CPR look like in real time?"
"What's the success rate in real time?" And then Part B of
that document says, let's say I come in and I have a pulse,
or I am breathing but I'm non responsive.
What type of medical intervention would I want?
Would I want what we call aggressive full treatment,
meaning I want to be intubated, ventilated and
placed in the ICU in the hospital?
And then you can select maybe just a trial period of that,
or would I want just a selective treatment or comfort-
focused treatment?
And Part C of that document addresses artificial nutrition
and artificial hydration.
Then this document is signed by the physician and the patient
or the medical decision-maker.
It can be updated at any time.
Do you know the difference between palliative care and
hospice?
Palliative care is comfort care provided during any phase
of disease process.
Any phase a year out, two years out, five years out,
you can receive palliative care to manage symptoms
for chronic illness.
Hospice care is palliative care also, which is
comfort care but is provided when the prognosis is six
months or less, and it's also to manage symptoms.
You typically tend to have a more robust team with
the hospice benefit.
So it looks a little bit like this.
If a person is diagnosed with a chronic illness, they receive
more curative care and less palliative care, and that
as they go along the trajectory of the disease process,
they receive a little bit more palliative care, a little
less curative care, and when they have a prognosis of six
months or less, then they're offered the hospice benefit.
Thank you for joining us and have a great day.