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Sharing Your WishesSharing Your Wishes™™ …..…..
Give Them Peace of MindGive Them Peace of Mind
Presented by Gina FedelePresented by Gina FedeleHospice Buffalo Hospice Buffalo
Where Hope LivesWhere Hope Lives
The Future depends on what The Future depends on what we do in the present.we do in the present.
- Mahatma Gandhi- Mahatma Gandhi
Unplugged
StatisticsStatistics
50-60% of Americans die in hospitals50-60% of Americans die in hospitals 25-30% more die in nursing homes25-30% more die in nursing homes
Most people want to die at homeMost people want to die at home Only 20-30% die at homeOnly 20-30% die at home
Who Decides When You Can’tWho Decides When You Can’t
Spokesperson (Agent)Spokesperson (Agent) Family/FriendsFamily/Friends StrangersStrangers The GovernmentThe Government
Family members in NY have no legal authority to consent or object to medical treatment for an incapacitated adult in absence of a signed health care proxy or other specific treatment instructions, such as a living will according to a 1988 ruling by the state’s highest court.
Advance Care PlanningAdvance Care Planning
A plan that assists individuals in understanding A plan that assists individuals in understanding their future choicestheir future choices
A process of shared decision makingA process of shared decision making
Chooses a spokesperson, who will speak on Chooses a spokesperson, who will speak on your behalfyour behalf
A written documentA written document
Living WillLiving Will
States what you want and do not want for States what you want and do not want for medical treatments at the end of lifemedical treatments at the end of life
Healthcare ProxyHealthcare Proxy
Documents who will make medical Documents who will make medical decisions about your healthcaredecisions about your healthcare Authorized to speak only if you can’tAuthorized to speak only if you can’t
The Best GiftThe Best Gift
Clarify values, beliefs Clarify values, beliefs
Choose a SpokespersonChoose a Spokesperson
Understand life-sustaining Understand life-sustaining treatmentstreatments
Practical issuesPractical issues
Compassion and Supportat the End of Life
Myths and TruthsMyths and TruthsMythsMyths
Something for the Something for the very old or sick very old or sick
Doing it will “bring on” Doing it will “bring on” my own death soonermy own death sooner
Needlessly worry Needlessly worry children or loved children or loved onesones
TruthsTruths Anyone can be Anyone can be
suddenlysuddenly severely severely injuredinjured
No more likely to die No more likely to die after talking about it after talking about it than to get sick after than to get sick after enrolling in a new enrolling in a new insurance companyinsurance company
Talking about wishes Talking about wishes relieves burden of relieves burden of making decisions in a making decisions in a time of crisistime of crisis
Who Should Have a Health Care Who Should Have a Health Care Proxy?Proxy?
Begin the Begin the conversation...conversation...
The BenefitsThe Benefits
Maintain control of what you wantMaintain control of what you want
Peace of mindPeace of mind
Wishes are honoredWishes are honored
How to Choose a SpokespersonHow to Choose a Spokesperson
Choose a family member or friend who is:Choose a family member or friend who is: TrustedTrusted Willing to accept responsibilityWilling to accept responsibility Willing to follow Willing to follow your wishesyour wishes and and
instructionsinstructions Able to make complex decisionsAble to make complex decisions Meets legal requirementMeets legal requirement
18 yrs or older, not your physician18 yrs or older, not your physician
Clarify Your Values and BeliefsClarify Your Values and Beliefs
Think aboutThink about What makes life worth living What makes life worth living What really matters to youWhat really matters to you What brings you joyWhat brings you joy
Life-Sustaining TreatmentsLife-Sustaining Treatments
Weigh benefits vs. burdensWeigh benefits vs. burdens Treatment Treatment CANCAN be refused or accepted be refused or accepted Can do time-limited trialsCan do time-limited trials Treatments Treatments CANCAN be discontinued be discontinued Will the treatment make a difference?Will the treatment make a difference? Is there hope for recovery?Is there hope for recovery? What does the patient value?What does the patient value?
Life Sustaining MeasuresLife Sustaining Measures
CPRCPR Intubation/ventilationIntubation/ventilation Nutritional supportNutritional support Kidney dialysisKidney dialysis AntibioticsAntibiotics IV hydrationIV hydration
CPR – Not Like You See on ERCPR – Not Like You See on ER
If a person’s heart stops and CPR is If a person’s heart stops and CPR is attempted:attempted: 56% are likely to die during the resuscitation 56% are likely to die during the resuscitation
effortsefforts Over half of survivors will die in next two daysOver half of survivors will die in next two days Chance of mental and physical disabilityChance of mental and physical disability
Those that get home are typically at home and Those that get home are typically at home and in good health prior to their CPR that took in good health prior to their CPR that took them to the hospitalthem to the hospital
Just Imagine…Just Imagine…
““With no family member legally authorized to With no family member legally authorized to speak for a patient, it is not uncommon for speak for a patient, it is not uncommon for invasive and painful treatment to be invasive and painful treatment to be prolonged unreasonably, while treatment prolonged unreasonably, while treatment that could make the final days more that could make the final days more comfortable is denied.”comfortable is denied.”
Important to KnowImportant to Know
Your advance directive should reflect your Your advance directive should reflect your wisheswishes
Lawyers are not neededLawyers are not needed Not all documents are legally valid in every Not all documents are legally valid in every
statestate A witness and a notary may be required if you A witness and a notary may be required if you
leave the stateleave the state AD does not expire and can be updated as AD does not expire and can be updated as
neededneeded
Your ChoicesYour Choices
How the Majority of How the Majority of Americans DieAmericans Die
How the Majority of How the Majority of Americans Wish to DieAmericans Wish to Die
Individual’s RightsIndividual’s Rights
You have a right to: You have a right to: Appoint an Agent (Spokesperson)Appoint an Agent (Spokesperson)
Not be discriminated against Not be discriminated against
Have your wishes honoredHave your wishes honored
Providers are legally responsible for Providers are legally responsible for honoring the individual’s wisheshonoring the individual’s wishes
If an individual feels their rights have been If an individual feels their rights have been denied call DOH @ 716-847-4532denied call DOH @ 716-847-4532
ChoicesChoices
Palliative and hospice carePalliative and hospice care Staying home and out of the hospitalStaying home and out of the hospital Enjoying your loved onesEnjoying your loved ones Minimizing financial burdenMinimizing financial burden
What to do with your What to do with your Health Care Proxy formHealth Care Proxy form
Keep a copy for yourselfKeep a copy for yourself Send to Assure Your Wishes databaseSend to Assure Your Wishes database Give a copy to yourGive a copy to your
Spokesperson/alternate spokespersonSpokesperson/alternate spokesperson Other family members/loved onesOther family members/loved ones Primary Care PhysicianPrimary Care Physician Physician Specialists (ex. Cardiologist)Physician Specialists (ex. Cardiologist) Spiritual AdviserSpiritual Adviser
Review and Update yourReview and Update yourHealth Care Proxy formHealth Care Proxy form
PeriodicallyPeriodically
Major life eventsMajor life events
Newly diagnosed illnessNewly diagnosed illness
Advancing illnessAdvancing illness
Why Have OneWhy Have One
Your Healthcare Proxy can be called upon Your Healthcare Proxy can be called upon
when:when:
You are unexpectedly incapable of making You are unexpectedly incapable of making
your own decisions your own decisions andand
It is clear you will have little or no recovery It is clear you will have little or no recovery andand
The injury or loss of function is significantThe injury or loss of function is significant
Health Care Agent’s Health Care Agent’s Rights and ResponsibilitiesRights and Responsibilities
Right to:Right to: Have access to the person’s medical Have access to the person’s medical
information and recordsinformation and records Responsibility to:Responsibility to:
Know what is important to the person, so Know what is important to the person, so decisions will be made according to the decisions will be made according to the person’s wishesperson’s wishes
To advocate for the individual to assure their To advocate for the individual to assure their wishes are honoredwishes are honored
Don’t Forget to ShareDon’t Forget to Share
Prevent avoidablePrevent avoidablesuffering suffering
Protect caregiversProtect caregivers Doctors are so scared of being sued that they often Doctors are so scared of being sued that they often
over treat over treat
Avoid financial ruin Avoid financial ruin
Give the perfect gift!Give the perfect gift!
Assure Your WishesAssure Your Wishes
For more information visit:For more information visit:
http://www.sharingyourwishes.orghttp://www.sharingyourwishes.org