LIZZIE MOORE: Hi, my name is Lizzie Moore
and I'm a clinical coordinator for Sutter Health,
and I am here with doctor Frank Mueller,
to talk about the basics of advanced care planning.
But before we do, I would like to say that the content is not
intended to be a substitute for professional medical advice,
diagnosis, or treatment.
You should always seek the advice
of your physician or other qualified provider
with any questions you may have regarding a medical condition.
The information provided in this presentation does not,
and is not intended to, constitute legal advice;
instead all information, content and materials presented here
are for general informational purposes only.
Information in this presentation may not
constitute the most up-to-date legal or other information.
So with that being said, I do want
to introduce doctor Mueller.
There's a picture of him here.
He is a fellow of the American Academy of Hospice
and Palliative Medicine.
He's also the medical director of palliative medicine Sutter
Santa Rosa Regional Hospital.
FRANK MUELLER, M.D.: Thank you, Lizzie.
So the purpose of an advance directive
is to pick someone, your agent, to speak for you if you're
too sick to speak for yourself.
And then to record on that form what is important to you
so your agent knows how to represent you.
Advance care planning is the term
we use when we encourage you to write down
what really matters to you.
We want you to tell your loved ones and us,
your health care team, what choices
you want us to make to keep you alive
if you lose the ability to decide or to speak
for yourself.
It tells others what trade offs you
are willing to make to your quality of life
in order to stay alive.
So for example, if you have that next round of cancer treatment
and that leaves you exhausted and bed-bound,
is that just what you wanted?
Is that the trade-off you would choose so you have
more time with your family?
A document called an advance directive
has been recommended for everyone over the age of 18
for a long time.
It appoints someone to speak for you
and make medical decisions if you can't make them yourself.
With the COVID-19 pandemic, many patients and families
are facing difficult treatment decisions
in our hospitals every day.
An advance directive helps to ensure
that if you get sick from COVID or really any other cause, then
you get just the care you want and avoid
treatments you don't want.
Some people are afraid to fill out the form.
We encourage you to do it, even if it feels scary.
I often give up the advanced health care form
and so often I see that they aren't completed.
People tell me, oh, I fill out this form,
like it's going to cause me to die
or I'll be acknowledging that I'm going to die.
We're all going to die at some point.
Sometimes we like to pretend that death is optional.
When couples are expecting, we recommend careful planning
and education for the birth and care of the baby.
Why shouldn't we educate ourselves and have
a plan for our own death?
That kind of a plan makes sense.
When you're in the final stage of your life,
having an advance directive in place
will help to ensure that your wishes are followed,
and it will make it easier for your loved ones
as they try to follow those wishes.
Filling out the form doesn't mean you're going to die soon.
Here are the steps you can take to complete an advance
directive.
Talk with your family, your loved ones, and your agent,
that person is going to speak for you,
and tell them about your wishes.
Sometimes I hear, gee, I didn't know
that Uncle Joe wanted me to be his medical decision maker.
I don't know what he would want.
Don't let that happen.
Make sure somebody knows what you want.
People sometimes have a way of thinking
about what happened to other family members
as a way of directing the kind of care they would want.
Remember when Mary was in the hospital
for so long at the end?
I don't want that to happen to me.
I'd rather be at home.
Or, I thought that the many weeks of care
that Mary got the intensive care unit was great
and really helped her.
I would want that too, even though it was hard.
So the second part is just to complete that form.
You need to have your signature witnessed or notarized.
If you have two people sign it, they can't be related to you.
They can't be one of the people you
need to be a decision maker for you.
There usually is a notary service
at mailing stores like UPS or FedEx,
or a mom and pop store, maybe even at your bank.
There are a lot of traveling notaries.
People who come to your home to notarize something.
Step three is providing that copy
to your doctor's office and or hospital,
so the document is available to your medical team when needed.
It will be a part of your medical record.
Give a copy to the person you have named as the decision
maker if you can't speak for yourself, known as your agent.
You can also give a copy to other important loved ones.
Keep a copy for yourself.
Many people like to keep a copy in a safe deposit box,
but that's the one place you can't get to when you need it.
It's important that you give a copy
to your doctor or other provider to put in your medical record.
Why?
If your a medical team and loved ones
can't find the document when they need it,
it's not going to help.
Be sure members of your family have copies, too.
You can change an advance directive form at any time.
As your life changes, so can your advance directive plan.
Your age, your health, your life situation
may have changed since you filled out the last one.
Review your advance directive periodically
or after a major life change, like a change
in your health or a divorce.
Change it as needed.
Be sure to provide a copy of the new one to your loved ones
and to your doctor to replace the old one.
Giving an advance directive that will help your doctor the most.
You know, your attorney may have included an advance directive
at the end of your will or trust.
Sometimes the language in an advance directive like that
can be pretty stiff and doesn't really
tell us what is really important to you.
If you have an advance directive prepared by an attorney,
you may want to consider completing a new one that
includes more detail and uses words that
are better at telling your medical team what
is important to you.
If you fill out a new form, the new form
will take precedence over the old one just based on that date
alone.
Here are a couple of options for where you
can find an advanced directive.
I really likes these two.
Prepare For Your Care, and My Directives.
Sutter patients can use My Health Online
to access a new form that we're using called Wiser Care.
This is a step by step in-depth electronic advance directive.
It walks you through those important choices.
This Wiser Care module results in a legal advance
directive which you can then have witnessed or notarized.
You can go back to My Health Online and change it any time,
and each time you make a change, your doctor
will be notified of those changes.
So this slide tells you exactly how
to access Wiser Care advance directive online
through My Health Online.
So we're not really focusing on a POLST
during this presentation.
But I did want to give you a brief, overview
of what POLST is and how it's different from an advance
directive.
Sometimes people confuse the two,
but they do work very well together.
POLST stands for physician's orders for life
sustaining treatment.
Unlike an advance directive, which sort of gives us
a general outline of your wishes,
a POLST is actually a physician's orders.
This usual bright pink form you place
on the front of your refrigerator,
tells first responders what type of level of care
you would want in a 911 emergency.
POLST is best used in people who are sick enough
that we would not be surprised if they
died within the next year.
POLST first asks whether you would
want pressing on your chest and broken ribs and a tube
down your mouth and into your windpipe connected
to a breathing machine if you are found with no pulse,
and not breathing.
Most people who are found with no pulse and are not breathing
would be said to be dead.
The second part of the POLST form asks what level of care
you would want if you were alive but seriously ill.
Full treatment would say, pull out all the stops.
I want to be kept alive no matter how burdensome it
is for me or for my family.
The comfort care choice would say, just keep me comfortable.
Whether I live longer is not important to me now.
And then there is middle choice which says,
selective treatment.
Well, if I have something that's easy to treat,
and treating it won't make me feel too bad,
and have a good chance of getting better,
I want to be treated.
The third part of the form asks whether he
would want artificial feeding if you lost your ability
or desire to eat.
If you and your doctor determine that this form is needed,
it should be completed, given to your doctor
so it can be placed in your medical record,
and then it should appear on the front of your refrigerator
so first responders can find it.
That's where they are taught to go to look for it.
Your doctor can give you a copy of a POLST form.
It can also sometimes be filled out online with your doctor
at the office or at the hospital.
Let's review the main points of this presentation.
Everyone 18 or older should have an advance directive.
It helps you appoint someone to speak for you if you can't
speak for yourself, and helps to tell
your agent what is important to you they know what to say.
You can get an advance directive form
at the resources I just listed.
Fill it out, have your signature witnessed or have it notarized,
and be sure to have a copy given to your doctor,
the person who you name as your decision maker,
and any other loved ones you feel should have one.
A lot of times once people come to this forum
they feel a sense of relief.
They don't have to worry about it until it's time
to review it again.
Thanks for your attention.
