Advance Care Planning is the process of planning for future medical care in
the event that the individual is unable to make his or her own decisions and to identify your health care choices so that they can be communicated to your family and your health care providers. It is a process of exploring, discussing, articulating and documenting those preferences, based on the person’s values and goals about health and medical treatment. Some people may not be certain of their values and goals. It is here that you can provide valuable support and guidance. You are uniquely qualified to speak to the religious and spiritual issues that are an important part of shaping one’s values and life choices.
Armed with a clear understanding of personal values and goals, the planning process allows the person to identify the levels and intensity of medical care he or she would like, or not like, to receive in a variety of clinical situations. As we go through this section, we will provide you with tools to help the you and your loved one come to a clear understanding of his or her personal values. First, we would like to go over the documents used in the care planning process.
Advance Care Planning Means:
- Understanding possible future health choices
- Thinking about these choices in light of what is important to you
- Talking about your decisions with loved ones and your doctors
- Putting your plans in writing so they will be ready if they are needed
- It is the process of planning for future medical care.
- It is based on clarification of values and goals.
- It outlines choices if someone else must make medical decisions.
Advance Directives
The documents used in advance care planning are called “Advance Directives.” They fall into two categories: (1) those that provide instructions regarding medical care and (2) those that designate someone, known as a “proxy” or “surrogate,” who is empowered to make decisions for the person who is ill. The health care surrogate instruments deal with health decisions. A Durable Power of Attorney expands decision-making power to other areas.
States have differing laws governing advance directives and forms that are recognized within that state.
Why are Advance Directives important for hospice patients?
Advance Directives can be provided to family and physicians to advise them of a patient’s care preferences. They include a Living Will, a Medical Power of Attorney, and a Do Not Resuscitate (DNR) order. Ask our Glory Hospice & Palliative Care social worker to talk with you about the benefits and risks of each type of directive.
Hospice programs do not require these directives. However, they support the right of patients to make their own decisions about care. Advance Directives give patients the control and legal ability to state how they want to be cared for and who they want to make decisions for them if they ever become unable to communicate their wishes. These directives specify the types of medical support wanted by the patient including the use of feeding tubes, breathing machines, and provision of cardiopulmonary resuscitation (CPR).
Advance Directives are prepared at the patient’s request and must be signed by him or her before they are given to the hospice care team. The patient decides what will be included in each document. If he or she becomes unable to clearly communicate his or her wishes for care, certain family members can complete these documents on the patient’s behalf.
If Advance Directives have not been completed at the time of hospice admission, and the patient would like to complete them, a staff member of Glory Hospice & Palliative Care can help to arrange for and finalize these documents. Each option will be clearly explained so that the patient can make informed decisions. Advance Directives and DNR orders can be changed or cancelled by the patient at any time.
Advance directive forms that are approved for your State of Georgia can be downloaded at www.caringinfo.org
What is a living will?
A living will is a type of Advance Directive in which you put in writing your wishes about medical treatment should you be unable to communicate at the end of life. Your state law may define when the living will goes into effect, and may limit the treatments to which the living will applies. Your right to accept or refuse treatment is protected by constitutional and common law.
Do Not Resuscitate Order (DNRO)
The DNRO is a physician’s order not to resuscitate if a person goes into cardiac or pulmonary arrest. It is part of the prescribed medical treatment plan and must have a physician’s signature. It is also signed by the patient and the health care surrogate or power of attorney. It is the legal document that instructs the hospital or emergency medical service to not resuscitate a person in cardiac or pulmonary failure.
What is a medical power of attorney?
A medical power of attorney is a document that enables you to appoint someone you trust to make decisions about your medical care if you cannot make those decisions yourself. This type of Advance Directive may also be called a “health care proxy” or “appointment of a health care agent.” The person you appoint may be called your health care agent, surrogate, attorney-in-fact, or proxy. In many states, the person you appoint through a medical power of attorney is authorized to speak for you any time you are unable to make your own medical decisions, not only at the end of life.
Why do I need an advance directive?
Advance Directives give you a voice in decisions about your medical care when you are unconscious or too ill to communicate. As long as you are able to express your own decisions, your Advance Directives will not be used and you can accept or refuse any medical treatment. But if you become seriously ill, you may lose the ability to participate in decisions about your own treatment.
What laws govern the use of advance directives?
Both federal and state laws govern the use of Advance Directives. The federal law, the Patient Self-determination Act, requires health care facilities that receive Medicaid and Medicare funds to inform patients of their rights to execute advance directives. All 50 states and the District of Columbia have laws recognizing the use of advance directives.
The Division of Aging Services provides free information forms on the Georgia Advance Directive for Healthcare. For more information, contact the Division of Aging Services at 404-657-5319 or go to the Division’s website at www.aging.dhr.georgia.gov and click on Publications on the left. Please click on the following link to take you directly to the Georgia Advance Directive for Healthcare document Georgia Advance Directive for Healthcare
Funeral Planning
Funeral planning is a difficult process involving emotional stress, financial decision making and uncertainty. Without some guidance, the options and information surrounding funerals and arrangement planning can seem overwhelming at an already complicated time.
Here are some guidelines to help caregivers plan the funeral of an elderly loved one. Many of these items can be arranged prior to death, to lessen the stress for the family at a time when they are grieving their loss.
Pre-Arrangements
You can choose and pre-arrange:
- Information for an obituary
- A funeral director
- Burial or cremation
- The casket or cremation container
- A crave marker and inscriptions
- The location for the service
- Type of service (memorial, wake, military, Jewish ceremony, etc.)
- Flower arrangements
- Photos that will be displayed
- Funeral music and songs
- What the deceased will wear
- Scripture to be read
- Memorial register or memorial cards
- Transportation and funeral cars
- Who will perform the eulogy
- Who will read the scripture
- Pallbearers
Final Planning
Other items cannot be pre-arranged, but must be taken care of following a loved one’s death:
- Ambulance transfer from place of death
- Death certificate
- Burial permit
- Time and date for the service
- Embalming and body preparation
- Submit obituary
Funeral Costs
The FTC has mandated that the funeral providers must give you a statement of all costs of the funeral goods and services that you select. This is called a General Price List (GPL). In addition, the law enables consumers to select and purchase only the goods and services they want, rather than having to accept an entire package
Funeral costs can be divided into three basic categories:
- The basic service fee: Funeral providers are allowed to charge this, and it can’t be declined by the family. This fee covers services common to all funerals including the use of the home, the services of the funeral director and funeral home attendants, burial arrangement coordination (with a cemetery or other), securing permits, etc.
- Optional service charges: Some optional services include transporting the body, embalming, times for viewing (or wakes), use of a hearse or limousine, burial container, cremation and interment.
- Cash disbursements: This covers goods and services that the funeral home buys on your behalf, with your consent. It may include the purchase of flowers, clergy services, obituary notices, pallbearers and other service providers such as soloists or musicians.
A great resource for planning a funeral can be found on the following link:
A Guide to Funeral Homes, Crematories and Cemeteries
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