Planning for Your Evolving Needs
Advance Directives 101
By Linda Ziac
November 27, 2018
The Caregiver Resource Center
Making my healthcare choices known with written advance directives.
What would happen if a medical emergency left you unable to speak or communicate?
This nightmare can happen to anyone of any age; as the result of a sports injury, fall, car accident, stroke, heart attack or illness.
As a board certified case manager, I experienced one family’s living nightmare when an ER staff member suggested the family call me. Their father had just been wheeled into the ER unresponsive, and immediate decisions needed to be made following a car accident with head trauma.
When I arrived at the ER, family members were all arguing with each other. Their father was in serious condition and some decisions needed to be made, but the family couldn’t agree on which of the options the doctors presented should be taken. Unfortunately, prior to the accident, their father hadn’t taken any steps to make his wishes known or to complete advance directives.
A PERSONAL EXPERIENCE
I still remember the morning my client cancelled their 10:00 appointment, so I decided to stop by to surprise my mother.
You can imagine the flood of emotions I experienced when I opened the door to hear my mother’s slurred speech and jumbled use of words. Fortunately, I recognized the signs, and with some preliminary screening, I got my mother to the emergency room as quickly as possible.
When we got to the emergency room, my mother was unable to speak.to the hospital staff, to explain what had happened, or to express her wishes to receive care.
Fortunately, I had spoken with my mother well in advance of this situation, and we had taken steps to ensure that my mother had all her advance directives in place.
An Advance Directives consists of written statements of the person's wishes regarding medical treatment, often including a living will, made to ensure those wishes are carried out should the person be unable to communicate them to a doctor.
YOUR RIGHTS TO MAKE HEALTH CARE DECISIONS
To follow is a summary of Connecticut Law prepared, in large part, by the Office of the Attorney General for the CT Department of Social Services.
• You have the right to make health care decisions about the medical care you receive. If you do not want certain treatments, you have the right to tell your physician you do not want them and have your wishes followed.
• You also have the right to receive information from your physician to assist you in reaching a decision about what medical care is to be provided to you.
• There may, however, come a time when you are unable to actively participate in determining your treatment due to serious illness, injury or other disability.
WHAT ARE ADVANCE DIRECTIVES
An “advance directive” is a legal document through which you may provide your directions or express your preferences concerning your health care and/or to appoint someone to act on your behalf. Physicians and others use them when you are unable to make or communicate your decisions about your medical treatment.
Advance directives are prepared before any condition or circumstance occurs that causes you to be unable to actively make a decision about your health care.
IN CT, ADVANCE DIRECTIVES INCLUDE:
1. My Appointment of A Health Care Representative
A “health care representative” is a person whom you authorize in writing to make any and all health care decisions on your behalf including the decision whether to withhold or withdraw life support systems. A health care representative does not act unless you are unable to make or communicate your decisions about your medical care.
The health care representative will make decisions on your behalf based on your wishes, as stated in a living will or as otherwise known to your health care representative. In the event your wishes are not clear or a situation arises that you did not anticipate, your health care representative would make a decision in your best interests, based upon what is known of your wishes.
2. My Living Will or Health Care Instructions
A “living will” is a document that may state your wishes regarding any kind of health care you may receive. Should you be in a terminal condition or permanently unconscious, the living will can also tell your physician whether you want "life support systems" to keep you alive or whether you do not want to receive such treatment, even if the result is your death.
A living will goes into effect only when you are unable to make or communicate your decisions about your medical care.
3. My Document of Anatomical Gift
This is a document in which you make a gift of all or any part of your body to take effect upon death.
Any adult may make an anatomical gift in writing, including through a will, a donor card or by a statement imprinted or attached to a motor vehicle operator's license. An anatomical gift may be made for the purpose of transplants, therapy, research, medical or dental education, or the advancement of medical or dental science. If you do not limit the gift's purpose to one or some of these uses, the gift can be used for any of these purposes.
You may select who receives the gift – a hospital, physician, college, or an organ procurement group. You may also specify that the gift be used for transplant or therapy for a particular person. If no one is named to receive the gift, any hospital may do so.
4. The Designation of My Conservator of The Person For My Future Incapacity
What is a “conservator of the person”?
A "conservator of the person" is someone appointed by the Probate Court when the Court finds that a person is incapable of caring for himself/herself including the inability to make decisions about his or her medical care. A person who is conserved by a court is known as a “ward”.
The conservator of the person is responsible for making sure that the ward’s health and safety needs are taken care of and generally also has the power to give consent for the ward’s medical care, treatment and services.
If a conservator is later appointed for you, he or she must follow your health care instructions, either as expressed in a living will or as otherwise known to your conservator, made while you were able to make and communicate health care decisions.
Further, a conservator cannot revoke your advance directives without a probate court order.
CT ADVANCE DIRECTIVE LAW – 10/1/16
The new CT law, effective October 1 2016, states that all Power of Attorneys executed after that date will be "durable" UNLESS you expressly state otherwise.
The word "durable" means that the Power of Attorney will still be good even if you become legally "incapable." The powers you give to your agent will remain effective even though you, the principal, are no longer able to give your agent instructions.
Pursuant to Public Act 06-195, An Act Concerning Revisions To Department of Public Health Statutes, the Office of the Attorney General released official forms that should be used by hospitals to update their advance directives and patient self-determination materials.
Please note: All forms executed prior to October 1, 2016 are still valid.
Source: CT Hospital Association 3/11/17
WHY IS AN ADVANCE DIRECTIVE NEEDED
If you don’t have an Advance Directive and you become incapacitated, a court may have o name someone to make medical decisions on your behalf.
This process can be long and complicated. It also may create undue stress on your family in a time of crisis, especially if family members disagree as to what course of treatment is best, or what course of treatment you have wanted.
With an Advance Directive, you can name in advance who you want to make decisions for you, and your family, and the court will not have to guess about your wishes.
Moreover, you can also specify exactly what kind of health care you wish to receive. Without an Advance Directive, health care providers or others will make decisions about your health care that you may not have wanted.
Advances in medical science allow doctors to keep patients alive much longer than they once could; sometimes prolonging life in this way is hopeful, but other times it means that people are kept alive when they are no longer able to live a fulfilling and conscious life.
If there is an Advance Directive, patients decide what kind of health care they receive, and how long they want to receive it.
DECISIONS TO MAKE
As you make up your Advance Directive, you will need to evaluate your wishes, concerns and fears so that you can make rational choices about what to include in your specifications.
Here are some of the things you will need to consider:
• What kind of medical treatment do I want or you do not want to receive?
• Do I want to receive life-sustaining treatment? If so, under what conditions?
• Who do I want to be my healthcare agent and make health care decisions when I am unable to do so for myself?
• How comfortable do I want to be?
• In what ways do I want to be treated?
• What do I want my family and loved to know?
HOW TO MAKE AN ADVANCE DIRECTIVE
Different states have different laws about medical directives. Typically, there is a special form to fill out, and most states require two witnesses when you sign this form.
In some cases, it will also need to be notarized.
Give close family members a copy of your Advance Directive, including the person you name as an agent, your physician and any other people who may be affected by the Advance Directive.
As long as you are able, you can at any time change your specifications in your Advance Directive; you must simply destroy old copies and follow the proper procedures for preparing a new one. If you do make changes, make sure that you replace everyone’s copy of the old one with the new one.
Be sure to go over a copy of your Advance Directive with your physician, your family and the person you name as your agent.
This section source: Parlay International
The following resources offer Advance Directives information and templates.
CT HOSPITAL ASSOCIATION
CT DEPARTMENT OF SOCIAL SERVICES
CT ATTORNEY GENERAL’S OFFICE
CT Advance Directive Laws & Forms
U.S. LIVING WILL REGISTRY
Advance Directive Form by State
AGING WITH DIGNITY
Aging With Dignity states that the Five Wishes document meets the legal requirements in
42 states (including CT and NY) and the District of Columbia.
OTHER AVAILABLE RESOURCES
NATIONAL HOSPICE & PALLATIVE CARE ORGANIZATION HELPLINE
ABA COMMISSION ON LAW & AGING
Consumer Tool Kit FOR Advance Care Planning
CT AREA AGENCIES ON AGING
CUIDANO CON CARNIO, COMPASSIONATE CARE HELPLINE
Photo by Microsoft
The information in this article is provided as an information resource only, and is not to be used or relied on for any diagnostic or treatment purposes. This information is not intended to be patient education, does not create any patient provider relationship, and should not be used as a substitute for professional diagnosis and treatment.
Please consult your health care provider for an appointment, before making any healthcare decisions or for guidance about a specific medical condition.
Linda Ziac is the owner and founder of The Caregiver Resource Center. The Caregiver Resource Center is a division of Employee Assistance Professionals, Inc. which Linda founded in October 1990. The Caregiver Resource Center provides a spectrum of concierge case management and advocacy services for seniors, people with special needs and families.
Linda’s professional career spans more than 40 years in the health and mental health field as a CT Licensed Professional Counselor, CT Licensed Alcohol and Drug Counselor, Board Certified Employee Assistance Professional, Board Certified Case Manager, and Board Certified Dementia Practitioner. In addition, Ms. Ziac has 15 years of experience coordinating care for her own parents.
Linda assists seniors, people with special needs and their families; in planning for and implementing ways to allow for the greatest degree of health, safety, independence, and quality of life. Linda meets with individuals and family members to assess their needs, and develop a Care Team, while working with members of the Team to formulate a comprehensive Care Plan (a road map).
Once a plan is in place, Linda is available to serve as the point person to monitor and coordinate services, and revise the plan as needed. This role is similar to the conductor of an orchestra; ensuring that there is good communication, teamwork, and that everyone remains focused on the desired goal.