How To Put Your Advance Care Plan in Place
National Healthcare Decisions Day – April 16th
Created in 2008 and today operated under the National Institute of Health and the Conversation Project, National Healthcare Decisions Day exists to inspire, educate and empower the public and providers about the importance of advance care planning. ADVault CEO Scott Brown says that “Such education is critical to dispel the misconception that ACP documents are only for seniors or those who have a terminal illness or a debilitating disease.”
By making sure that ACP documents are in place and readily accessible both consumers and caregivers empower a patient’s voice when they are unable to speak for themselves. In fact, “patients who inform their loved ones and health care providers of their end-of-life wishes find that those goals are carried out 90% of the time.” And 94% of decedents that had an ACP document in place did not receive unwanted treatments and interventions. Unfortunately, very few patients that arrive in the emergency room have an advance care plan or portable medical order in place to help guide the admitting medical team.
“Having an ACP document in place and easily accessible greatly increases the likelihood that the care delivered – or not delivered - will align with a patient’s wishes, values and priorities,” says Brown. “ACP documents benefit not only the patients themselves but family members and the entire healthcare ecosystem by removing some of the guesswork as to what the patient wants and doesn’t want.”
Who Needs an Advance Care Plan?
“Nobody can predict the future, and emergencies can happen at any time, potentially leaving you too injured or ill to communicate medical treatment decisions,” says Brown. “Everyone needs to have a plan in place reflecting their personal wishes regarding the medical treatments and interventions they would or wouldn’t want in an emergency. Fortunately, tools for patients, the healthcare providers who care for them, and even health plans and government agencies who pay for healthcare services, exist today to make that easier than ever.”
How Can I Get an Advance Directive?
Consumers can easily create a digital ACP document or upload a living will or other advance directive they already have by going to mydirectives.com, a free service that guides them through the process. Once complete, it is stored in the ADVault Exchange™, so it is always accessible to your medical team.
If you’ve already documented your wishes in a third-party, paper-based form such as Caring Conversations®, Five Wishes®, the VA form 10-0137 (U.S. Department of Veterans Affairs), or portable medical order (POLST) document, you can upload those documents into your account.
The ADVault Exchange is connected to electronic health record systems, so your medical care preferences can be shared with any of your healthcare providers and payers, anytime and anywhere you need to.
“At a time where health inequities still exist in our society, especially among communities of color, ACP documents are the ultimate empowerment of the individual by giving everyone the opportunity to express their personal preferences concerning location of care, life-sustaining treatments, CPR, organ donation and medical treatment goals,” says Maria Moen, ADVault’s Senior Vice President of Innovation & External Affairs.
What is the difference between an advance directive, advance care plan, and a POLST (MOLST, MOST, etc.)?
Let us give you the nickel tour, we hope this explains the differences:
1. Advance Directives
Advance directives are often very rigid, structured documents in terms of the format and requirements. Individual States, and other jurisdictions, may provide their own paper-based advance directives version. For example, the Catholic Advance Directive speaks to how organizations and jurisdictions approach the same problem but in different ways.
Typically, advance directives include things like a:
- Healthcare Proxy, Durable Medical Power of Attorney, or Healthcare Agent that is someone you designate to speak for you when you can’t communicate your wishes.
- Living Will, which details whether you want CPR, life-sustaining treatment, artificial nutrition, and sometimes a little more.
Advance directives often require a witness or notary signature, and don't go into much detail about you. They are intended to gather only what is critical in a life-threatening health crisis or emergency.
2. Personal Advance Care Plans
Personal advance care plans give you the opportunity to record more information about yourself, including:
- healthcare preferences,
- what is important to you to achieve a good quality of life,
- what you want others to know about your likes, dislikes, favorite things, important thoughts, and religious or spiritual priorities,
- who to call in case of an emergency, and
- even your instructions for "after death" such as cremation or burial, organ donation, autopsy preferences, and other information.
A personal advance care plan informs your medical care team and caregivers about your medical goals, treatment priorities, and care preferences so they can deliver more personalized care.
Some people want them witnessed or notarized because they believe that makes them more acceptable to a medical team. But it's important to know that doctors and nurses care more about treating you in a way that is consistent with WHO you are than whether the document was witnessed or notarized. Your medical team wants to honor your wishes and these plans help everyone do the right thing.
3. POST, MOLST, MOST, POLST and Other Portable Medical Orders
Portable medical orders are formal physician orders written when a person is nearing the end of their life to document delivery of life-sustaining treatment. Depending on your state, these include Physician Orders for Scope of Treatment (POST), Medical Order for Scope of Treatment (MOST), Medical Order for Life-Sustaining Treatment (MOLST), or Physician Order for Life-Sustaining Treatment (POLST) documents.
When you work with your doctor to prepare these orders, you’ll know your medical team will have to follow that order. This includes ambulance services, emergency medical service personnel, firefighters, and anyone who responds to life-threatening emergencies and must provide urgent treatments.
As you approach the end of life, you may decide you don’t want specific life-sustaining measures that may cause further pain or damage. If so, you can ask your doctor to create one of these medical orders. For example, you can have your doctor write down whether you want CPR administered. If CPR isn't appropriate because you’re still breathing and have a pulse, your physician can document whether you want:
- "Full treatment to prolong life by all medical means,"
- "Selected treatments that are not burdensome or invasive," or
- "Comfort-focused treatment that maximizes comfort and relieves pain/suffering.”
Start With a Healthcare Agent
Putting together an advance care plan can for end-of-life decisions can be intimidating. At a minimum, we encourage everyone to at least select a Healthcare Agent.
What is a Healthcare Agent?
A healthcare agent is a person you designate in your advance care plan to make medical treatment decisions for you if you ever become too sick or injured to make or communicate those decisions for yourself.
Do I need to tell my Healthcare Agent what is in my plan?
It's important to talk to your healthcare agent about the medical treatments you would want, those you would decline, how aggressively you want to be treated, and under what circumstances. It’s also a good idea discuss how and where you want to spend your last days and what you want done with your body if you pass on. These final details are all important.
But it's just as important that your healthcare agent knows what you consider an acceptable quality of life. When your healthcare agent knows these very personal details about you, then they can make medical treatment choices that are aligned with your wishes.
ACP Tools for Healthcare Providers
Moen says healthcare providers can play a vital role in this process by using National Healthcare Decisions Day as an opportunity to assist in the development of ACP documents with their patients while also ensuring these documents are accessible when seconds count and minutes matter. In particular, providers in long-term care, skilled nursing homes, home health/hospice, and chronic care management play a critical role in understanding a patient’s changing physical or mental state, which makes them uniquely positioned “to have important, compassionate discussions with their patients regarding end-of-life care.”
An increasing number of professional caregivers, chronic care management companies, and palliative care organizations have turned to digital ACP tools to document these discussions and ensure they are accessible beyond the current care setting to the broader healthcare delivery system. ADVault’s MyDirectives for Clinicians™ is a low-cost solution that uses an intuitive Q&A format to guide conversations, document treatment choices, and designate a healthcare agent or proxy. Caregivers can also help patients upload existing documents they may already have. Once completed, the ACP documents and portable medical orders are securely stored in ADVault’s registry and repository and are readily accessible through existing electronic health record systems across all points of care.
A Good Idea – National Healthcare Decisions Day
From a public policy perspective, Brown would like to see National Healthcare Decisions Day serve as the impetus for the Centers for Medicare and Medicaid Services to require Medicare Advantage Plans to offer ACP services to all of their members. “Knowing that plan members have documented their goals of care and stored them where they can be securely and seamlessly accessed in an emergency is vital to ensuring the care delivery that respects and honors the individuals these Medicare Advantage plans are dedicated to serving. Clarifying what the person wants and doesn’t want leads to more personalized medical care and has also shown to decrease avoidable and unwanted costly hospitalizations and undesired medical interventions.”