Caring House The Smarties Series Advance Care Planning 1. Twelve - PDF document

Caring House The Smarties Series Advance Care Planning 1. Twelve Reasons Advance Directives Fail and How to Avoid Them. (Sep 12) for Smarties 2. Who Ya Gonna Name? Plus Advance Directives October 3, 2017 101. (Sep 19) 3. What Ya Gonna Tell Em? (Sep 26) I’ve Been Named: How Do I Do 4. I’ve Been Named. How Do I Do an an Amazing Job? Amazing Job? (Oct 3) Providing peace, comfort and 5. Care Lingo Decoded. Plus California’s End of Life Option Act. (Oct 10) support to men and women at the ends of their lives Background Handouts, Slides and More  Ellen Gorbunoff, RN  Ed Long, JD You can get all class materials and be notified about future classes by signing up at  Handouts  Time YourCaringHouse.org/materials  Questions Aging Preparedness Advance Care Planning* 1. Power of Attorney for Health Care* 1. Power of Attorney for Health Care* 2. Think and Communicate With 2. Think and Communicate With Helpers* Helpers* 3. Power of Attorney for Financial Matters 4. Your Estate Plan Advance care planning is for all adults – not just those who are older than I am. 5. Your Plan for Long-Term Care 6. Your Plan for Funeral and Burial Based on H.E.L.P .’s Your Aging Preparedness Kit Nuts & Bolts Guide Page 1

8 Core Concepts Keep Score / Up to Date 1. You have a right to decide whether to  Agent selection -- start,  Documentation -- decline or  What’s Important -- stop  Communication available medical treatment (“care decisions”). Copies at 2. You have a right to name another person yourcaringhouse.org/scorecard to make care decisions for you. 11 Legal Lingo  Principal  The person signing the advance directive naming others to make decisions for them.  Agent  A person named to make decisions under an advance directive. Star Trek Prime Directive Page 2

16 Agent’s Prime Directive Starfleet personnel 1. Follow the Principal’s wishes shall not interfere with the internal development of 2. If not known, follow the Principal’s values alien civilizations. and views 3. If not known, use Agent’s best judgment and act in the Principal’s best interests Agent’s Top Duties Principal’s Top Duties 1. Speak for and make care decisions for 1. Communicate wishes, values and view to the Principal the Agent 2. Communicate with the Principal to learn 2. Strengthen and support the Agent wishes, values and views 3. Keep up to date 3. Keep up to date 20 Agent’s Part of the Conversation Communicate  Listen Two monologues  Ask questions do not equal  Echo back in your own words a dialogue  Confirm that you both understand Principal’s wishes, values and views Page 3

Let’s Vote Would you be comfortable saying “I don’t understand” to a doctor? 1. Yes 2. No 24 Agent’s List of Tasks Task #01  See your handout  Let’s create a list of tasks Regularly communicate with the Principal and others. Task #02 Task #03 Get educated about how to do an Be available when needed. awesome job. Page 4

Task #04 Task #05 Let the healthcare team know that Establish who will be the “MD you are the Agent. Quarterback.” 34 Task #06 Task #07 Ask questions until you have Understand the context. enough information. Context Task #08  Just getting started vs. ODTAA Syndrome Set and revise Goals of Care.  Progressive illness? What stage?  Exhaustion?  Looking for a cure vs. Peace Time Page 5

42 Goals of Care Task #09 Return to Create a Good Health Good Death Make decisions. Peace and Combat or comfort Slow Illness See Your Way page 11 Two Hands Up? Two Hands Up?  Question #1 -- Pursue Would the the treatment if treatment be medically helpful?  Question #2 -- Don’t pursue Would the Principal the treatment if say “Yes” to the treatment? 49 Task #10 Task #11  Set time limits  Hours, days, weeks Keep family informed. Page 6

53 Task #12 About Caring House  The first and only non-medical home in Los Angeles County totally focused on Self-care. end-of-life care  An IRC 501(c)(3) nonprofit  Volunteer originated, professionally staffed, volunteer supported  Revenues from resident/family payments and community donations John’s Story 58 Where to Find Help Additional Resources  Doctor  Your Way, A Guide to Help You Stay in Charge of Decisions About Your Medical Care ,  Nurse from H.E.L.P .  Social worker  Hard Choices for Loving People , by Hank  Spiritual care Dunn.  Bioethics committee  End-of-Life, Helping with Comfort and Care ,  Family and friends from NIA & NIH  Being Mortal , Atul Gawande, book and Frontline documentary Page 7

Kanako is the Principal 66 You are the Agent  Woman, age 76  Dementia, not recognize family for 2 years  In hospital for urinary tract infection  Can no longer swallow  Feeding tube is proposed 76 Agent’s Prime Directive Deciding on Feeding Tube 1. Follow the Principal’s wishes  What wishes, values and views of Kanako would tell you 2. If not known, follow the Principal’s values and views  Yes on feeding tube?  No on feeding tube?  Time limits on feeding tube? 3. If not known, use Agent’s best judgment and act in the Principal’s best interests Page 8

82 Caring House Five Guiding Principles 1. Know Principal’s wishes, values and views Coming Next 2. Gather information October 10, 2017 3. Set goals of care 1 PM 4. Decide on care/treatment with time Care Lingo Decoded limits Plus CA End of Life Option Act 5. Re-evaluate and return to #1 Providing peace, comfort and support to men and women at the ends of their lives Handouts, Slides and More You can get all class materials and be notified about future classes by signing up at YourCaringHouse.org/materials Page 9