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