Approaching Advance Directives

This month we asked some of our Virginia colleagues for advice on advance directives. Below is what they said. We hope you find it helpful as you approach these often difficult but important conversations with your family and friends.

 

Charlotte Arbogast, MSG
Dementia Services Coordinator
Virginia Department for Aging and Rehabilitative Services
Division for Aging

If you have a question that you think our colleagues ought to answer, please submit it through the Contact Us section.


 

David Hominik, Legal Services Developer, Virginia Department for Aging and Rehabilitative Services

 

hominickThe National Healthcare Decision Day (NHDD) organization (http://www.nhdd.org) states that 90% of adults know about advance directives (ADs) but less than 30% have one. AD educational efforts must continue. But the focus must be to get individuals to act – to prepare the AD itself.

To begin, view – alone, with a family member, or in a group setting — the brief NHDD video: It’s Time to Start the Conversation, available at NHDD’s and the Virginia State Bar’s (VSB’s) websites (http://www.vsb.org/site/public/healthcare-decisions-day). It addresses the need for ADs and the consequences of not having one.

Virginia Advance Directives (VAD) website (http://www.virginiaadvancedirectives.org) contains another kick-start video. It stresses that ADs are a gift to yourself, assuring that your wishes are followed, and a gift to your loved ones, removing the difficult, uncertain decisions that you would leave to them without an AD.

Next, express your AD wishes in concrete terms. VSB’s Advance Directive Tool Kit, at the VSB webpage, contains seven AD tools, covering topics from medical preferences to healthcare agent selection. The Tool Kit’s step-by-step process, when completed, provides the basis for the AD itself.

If questions remain, VSB and VAD websites offer FAQ sections. Even those without questions would benefit from reviewing these.

Finally, prepare the AD itself. VSB and the VAD websites have free forms, ranging from the very basic to those where health or personal preferences require more. Although AD preparation does not require an attorney, if concerns remain, individuals should seek legal advice. If you have or know an attorney, tell them you want a review of your AD document or preparation of one. Other seniors can contact their local Area Agency on Aging office (see http://vaaaa.org/agencies/); low-income individuals can contact their local legal aid office (see http://www.valegalaid.org/find-legal-help/directory); and anyone can contact the VSB Lawyer Referral Service (one 30-minute consultation for $35 with a local attorney who handles ADs):  http://www.vsb.org/vlrs/ or call, 804-775-0808.

Warning: ADs are not just for those with advance years or serious medical conditions. We are all just an accident away from needing one – from our families and loved ones needing us to have one. If you plan to speak with someone about why they should have an AD, first you should have one yourself. But if you do not have one, you should still speak with the individual in order to prepare ADs together.


 

Julie Bayly, Riverside Health System

 

It is often challenging to think and discuss personal wishes around end of life care at any age and at any stage of life.  However, it is my personal and professional experience that it is important to periodically have these conversations with our family and loved ones.  All too often this decision is automatically delegated to family members.  Family members frequently express suffering from guilt when having to make uniformed end of life care decisions.  In this scenario you want to focus on making the decision based on the person you are representing and not your own personal values.

How do you know what a person’s wishes around end of life care are if you have never had the discussion?  Reflect on someone’s past in order to understand their decision making.  Was another family member in a similar health situation?  Did you ever hear comments about friends or family health care and end of life experiences?  You can learn someone’s personal preference by listening to their comments.  Think about the individual’s personality.  For example, a risk taker may be more apt to try a high risk medical procedure.  Was family and socialization important?  If family and socialization is important, it may be more appropriate to consider health care options in the home where you can be surrounded comfortable by friends and family.  Make sure you are informed of religious preferences.  Many religions offer guidance around health care decisions.


 

Heather Zelle, JD, PhD, Post-Doctoral Research Associate, University of Virginia Institute of Law, Psychiatry, and Public Policy

 

zelleKnow that advance directives are about a lot more than just end-of-life care.

The tools available for health care planning have evolved.  In Virginia, you can pick a health care agent for and give instructions about general medical care, mental health care, and/or end-of-life care all in one advance directive document.

Just like for other activities, planning in advance for health care is a lot better than waiting until a problem arises.

Planning for your care in advance can help avoid health crises, direct care if a crisis does arise, and manage care coordination.  Planning in advance also means that your “voice” will continue to be a part of health care decisions even when you cannot make the decisions needed.

Virginia does not require that a lawyer or notary be involved.

The cost of completing an advance directive for most people comes down to the cost of paper, ink, and the time they spend on it.

Spend some time thinking about what you would like to say about your health before looking at any paperwork.

Forms can sometimes seem daunting.  Thinking about your health care values and wishes and talking with loved ones and health care providers will help you have a sense of what you want when it comes time to write things down.  You can work on an advance directive in parts.  Also, it is easy to add or update something in the future.  Even when you are “done”, plan to revisit it every 6-12 months to see if you need to update anything.

Make your advance directive accessible.

Advance directives are only helpful if loved ones and health care providers have them.  Make copies of your advance directive and give them to loved ones and providers.

 

For more information and resources: www.VirginiaAdvanceDirectives.org