Here at the Blog, we’ve reviewed dozens of articles about advance care planning. That’s a catch-all term that describes what sort of medical intervention you will desire, and what you want to avoid, should you fall ill and need acute care. It’s essential that all of us spell out our desires in an advamce care plan, because too often a family has no idea what to do when a care crisis strikes.
Many of the articles we’ve read follow a helpful but predictable format. However, this article from NextAvenue takes a somewhat more creative approach to the process of preparing and evaluating an advance care plan. In the article, educator and patient advocate Ailene Gerhardt gives us an easy-to-remember four-step process to guide us through advance care planning She calls these “the four Ds.”
Want to know more? Read on.
Advance Care Planning Isn’t Just for Seniors
Gerhardt begins by reminding us of an often-overlooked fact: planning ahead for a health care crisis isn’t just for old people.
“Advance care planning is essential for every adult (anyone aged 18 and over), regardless of their marital / partner status, family support or health condition,” she asserts. “It ensures that your health care preferences are honored in the event of an unforeseen crisis.”
Sadly, that sort of unforeseen health crisis can happen to anyone at any time. Preparing for such an event is about much more than simply deciding who is empowered to act on your behalf. Unless you’ve clearly communicated your wishes, your so-called health care agent isn’t going to know what to do. This is a reality that Rajiv Nagaich reminds us about often.
Advance Care Planning is a Vital Component of Everyday Life
Gerhardt acknowledges how this type of advance care planning is typically dismissed as something only seniors need to do. “‘Traditional’ approaches often focus on estate planning and the designation of a health care proxy,” she writes, “but the reality is that the entire advance care planning process is critical for everyday life.”
When you think about the inherent dangers of daily living, this notion makes sense. “Whether you are involved in an accident (for example, while driving an auto, biking, rollerblading, skateboarding, hiking or playing a sport), affected by an act of nature (whether hurricane, earthquake, flood or fire) or experience a medical crisis, having a plan prepared ensures your health care preferences are known and respected,” Gerhardt states.
Gerhardt explains that advance care planning involves “making decisions about the health care you would want — and not want — if you become unable to speak or otherwise unable to advocate for yourself. These decisions are based on your personal values, priorities and preferences.” (The process is more fully explained in this information from the National Institute of Health website.)
The Importance of the Four Ds of Advance Care Planning
No matter what approach you take to advance care planning, there will be legal documents involved. “The process typically includes completing documents such as a HIPAA release and a Living Will/Personal Directive which allow access to authorized health care information, designate at least one individual to carry out your health care preferences on your behalf, and specify your preferences,” says Gerhardt.
(We posted this related article on thje Blog just a few weeks back.)
But to ensure a comprehensive and effective advance care plan – one that’s more than a stack of legal documents – Gerhardt recommends we follow four steps, each starting with the letter D. (She also calls this process “Advance Care Planning 4D.”) The four “D-steps” are Decide, Document, Designate and Discuss.
Step 1: Decide Based on Your Own Values and Priorities
The first step should be the most obvious, but it takes time and effort. Gerhardt challenges us to reflect on our health care values, priorities and preferences, and then to decide what types of medical treatment we might want or not want in various situations.
“Think about scenarios such as life-sustaining measures, resuscitation efforts and long-term care options,” she writes. “This decision-making process is deeply personal and should align with your values and beliefs about quality of life and medical interventions.”
Remember the old saying, “Not to decide is to decide.” If you don’t decide what kind of care you do and don’t want, someone else will decide for you.
Step 2: Document Your Wishes Clearly and in Detail
When we hear the phrase “advance care planning,” we usually envision a visit to the lawyer’s office. This reflects the second D: “Document.”
“Once you have made your decisions,” says Gerhardt, “it is crucial to document them clearly. This involves creating a living will or personal directive that outlines your health care preferences in detail. It provides specific instructions about the medical treatments you want and do not want, ensuring that your preferences are honored even if you cannot communicate them yourself.”
Gerhardt urges us to be as detailed as possible when documenting our chosen scope of care. For example, you need to specify your choices regarding resuscitation, mechanical ventilation, artificial nutrition and hydration and other life-sustaining treatments. She adds, “Clarity helps to prevent confusion and ensures that your health care proxy, health care team and support network understand your preferences.”
Step 3: Designate the Person to Make Your Health Care Decisi0ns
To “designate” means choosing a health care proxy, also known as a health care agent or medical power of attorney. Gerhardt calls this “a critical step.”
“This person will carry out your medical decisions on your behalf if you are unable to do so,” she writes. But don’t leave your chosen agent in the dark: “It is essential to talk with your proxies to confirm their willingness to take on this responsibility and their understanding of your preferences,” Gerhardt emphasizes.
Because this is such a vital role, your agent should have a back-up. “In addition to your primary health care proxy, consider designating an alternate,” says Gerhardt. “[T]his individual can step in and represent you if your primary proxy is unavailable or unable to serve.”
When Choosing a Health Care Proxy, Consider These Attributes
“When designating your health care proxy and alternate proxy,” Gerhardt writes, “it is important to choose individuals who embody certain key characteristics to ensure they can effectively advocate for you. Proxies should be persistent and unwavering in ensuring your preferences are honored. They must be ethical, acting with integrity and honesty in all situations.”
Your proxy may also have to make decisions under pressure. For that reason, Gerhardt adds, “The ability to figure things out and ask pertinent questions is crucial, because medical situations can be complex and change rapidly.”
She adds a few additional qualities that your agent should display. They have to be excellent communicators who can convey your preferences clearly and accurately. They have to possess the confidence to advocate for your rights and decisions. At the same time, your agent must remain objective, not imposing their own personal beliefs or values.
“It is also helpful if they are knowledgeable about death with dignity,” Gerhardt adds, “and grasp the nuances and legalities involved. By selecting someone with these qualities, you can have confidence that your health care proxy or proxies will act in your best interest at critical moments.”
Step 4: Discuss Your Plan Freely So Your Wishes Will be Honored
This final D – for “Discuss” – seems to us the step most often underemphasized. You may know your wishes, after all, but can the same be said for those closest to you?
“The last step is to discuss your advance care plan with the people involved in your care,” Gerhardt writes, “including your health care team and chosen members of your support network. Open communication is key to ensuring that everyone understands your preferences and is prepared to honor them. This discussion helps avoid misunderstandings and ensures your decisions and preferences will be respected.”
Y0u’ll want to distribute copies of your documented preferences to your proxies, members of your support network and health care providers. “Review the details of your plan, address any questions or concerns and make sure everyone is comfortable with their roles and responsibilities,” Gerhardt recommends.
Finally, bear in mind that this isn’t a one-and-done process. “Regularly revisit these discussions, as your preferences and circumstances may change over time,” the article suggests.
For a Well-Crafted Plan, Seek Professional Legal Advice
Gerhardt concludes by re-stating her earlier premise: for all of us, advance care planning is essential to ensure that our health care preferences are respected. This is particularly true in a crisis, when you may be unable to communicate or to advocate for yourself.
However, she says her approach can alleviate that danger. “With the 4D process, you can create a comprehensive and dynamic plan that provides clarity and peace of mind for you and support network,” she writes. This eliminates the uncertainty and emotional burden on your support network by clearly stating your medical preferences.
Her advice: seek professional help from your health care provider or an elder law attorney. As always, the team at Life Point Law welcomes the opportunity to assist you as you take proactive steps to ensure that your health care preferences are honored, whatever the situation.
Rajiv Nagaich – Your Retirement Planning Coach and Guide
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Through stories, examples, and personal insights, Rajiv takes us along on his journey of expanding awareness about a problem that few are willing to talk about, yet it’s one that results in millions of Americans sleepwalking their way into their worst nightmares about aging. Rajiv lays bare the shortcomings of traditional retirement planning advice, exposes the biases many professionals have about what is best for older adults, and much more.
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(originally reported at www.nextavenue.org)