DASH enrollment coordinator Jeanne West meets with a senior to discuss their options for Advance Directives.
Credit: David Bazemore.
Max and Mabel, aged 94 and 97, are a charming Santa Barbara couple who had made solid financial and legal plans. They’d written wills, and created trusts for their children and grandchildren. But as my nurse associate Jeanne West recounted to me, they didn’t formalize plans for their medical care – almost until it was too late.
Some people don’t want to talk about planning for medical problems. But it is critically important that these discussions happen, not just for the senior, but for their families as well. And not just for the very elderly, but for all adults.
This process can be made easier if you use one of the forms that have been developed recently, which are easily found online, and at most doctors’ offices and hospitals.You start with a discussion with family and loved ones to inform them of your wishes and values. Through this conversation, you give your family the gift of understanding how you want to be treated, so that if a time comes when you can’t speak for yourself, they can speak for you with confidence, rather than with doubt and uncertainty.
Here are two Advance Directives I recommend to my patients and their families to complete, ideally before they get sick.
First, a Durable Power of Attorney for Health Care (DPAHC) form allows you to designate a person to make medical decisions for you if you cannot speak for yourself. There many DPAHC forms available – one of the best is the Five Wishes, available at www.agingwithdignity.org. If you need help completing the 5 Wishes form, The Alliance for Living and Dying Well is a local group that can assist you.
Second, the POLST form stands for Physician Orders for Life-Sustaining Treatment, and is designed for people with chronic progressive illnesses, serious health conditions, or who are medically frail. It is a newer, improved version of the old DNR (Do Not Resuscitate) form. You can get help with a POLST form from groups like Visiting Nurses, DASH, or your Primary Care Physician – who must sign the POLST once it is completed.
So where did Max and Mabel go wrong? They almost waited too long to do this planning. In fact, on the very day that the POLST was completed, Max became ill and was taken to the hospital by ambulance.
Luckily, Jeanne, the nurse who had helped him fill out the form and got it signed by his doctor, was able to rush to the ER and hand that physician the POLST. It clearly outlined the care choices that Max had made. Max ended up treated the way he wanted, with his wishes honored, and with comfort and dignity in his home.
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Michael Bordofsky, MD, is a primary care physician and partner in Palliative Care Consultants of Santa Barbara, a medical group that provides consultation, education, and clinical services in hospital, hospice, and community settings. His group created DASH, and he serves as its executive program manager.