Transcript of ©Gundersen Lutheran Medical Foundation Sharing Your Wishes Advance Care Planning Facilitator Course...
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- Gundersen Lutheran Medical Foundation Sharing Your Wishes
Advance Care Planning Facilitator Course GCC September 2006
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- Gundersen Lutheran Medical Foundation Advance Care Planning
Advance Care Planning Planning ahead for your last phase of life or
for an unexpected event, leaving you unable to communicate.
Planning ahead for your last phase of life or for an unexpected
event, leaving you unable to communicate.
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- Gundersen Lutheran Medical Foundation SHARING YOUR WISHES GRANT
This project is made possible by a grant from the Community Health
Foundation of Western and Central New York. The Community Health
Foundation is a non-profit private Foundation whose mission is to
improve the health and healthcare of the people of Western and
Central New York. This project is made possible by a grant from the
Community Health Foundation of Western and Central New York. The
Community Health Foundation is a non-profit private Foundation
whose mission is to improve the health and healthcare of the people
of Western and Central New York. Awarded to the Genesee County Long
Term Care Task Force.Awarded to the Genesee County Long Term Care
Task Force. Initial 2 year initiative with potential for 3rd
year.Initial 2 year initiative with potential for 3rd year. Six (6)
surrounding counties involved.Six (6) surrounding counties
involved. Targets frail elders and their caregivers.Targets frail
elders and their caregivers.
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- Gundersen Lutheran Medical Foundation The goal of the project:
Increase awareness in our community about Advance Care Planning
Using a holistic approach. Availability of care options and
services Importance of health care decision making Stimulate
communication Family Health care providers, Legal and spiritual
advisors Strengthen our system Process to access long term care
services is clear and accurate. To complete and effectively use
advance care planning documents
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- Gundersen Lutheran Medical Foundation SHARING YOUR WISHES
Objectives for Nursing Students SHARING YOUR WISHES Objectives for
Nursing Students Become familiar with the advance care planning
processBecome familiar with the advance care planning process
Become familiar with the care options and services available to
seniors and where to access informationBecome familiar with the
care options and services available to seniors and where to access
information Complete the Advance Care Planning Facilitator
courseComplete the Advance Care Planning Facilitator course
Complete a presentation on advance care planning to a group within
our communityComplete a presentation on advance care planning to a
group within our community Complete an ACP session with an
individual and their loved onesComplete an ACP session with an
individual and their loved ones
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- Gundersen Lutheran Medical Foundation Advance Care Planning
Facilitator Course Objective To provide the facilitator with the
necessary skills to assist an individual and their loved ones
through the advance care planning process, which includes long term
care needs and healthcare decisions. To provide the facilitator
with the necessary skills to assist an individual and their loved
ones through the advance care planning process, which includes long
term care needs and healthcare decisions.
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- Gundersen Lutheran Medical Foundation Participants will be able
to: Facilitate ACP for individuals and small groupsFacilitate ACP
for individuals and small groups Help complete written advance
directivesHelp complete written advance directives Make
presentations to groups about ACPMake presentations to groups about
ACP
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- Gundersen Lutheran Medical Foundation Group Exercise 1.) What
does quality of life mean to you? 2.)What does heroics mean to you?
Please take a few moments to answer these 2 questions
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- Gundersen Lutheran Medical Foundation
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- Session 1 From Advance Directives to Advance Care Planning
Gundersen Lutheran/ Respecting Choices Advance Care Planning
ModelGundersen Lutheran/ Respecting Choices Advance Care Planning
Model How do we get from Advance Directives to Advance Care
Planning?How do we get from Advance Directives to Advance Care
Planning?
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- Gundersen Lutheran Medical Foundation Respecting Choices An
Advance Care Planning System That Works Linking the Patient,
Family, Provider and Community Linda Briggs, RN, MSN, MA Assistant
Director, Respecting Choices & Ethics Consultant
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- Gundersen Lutheran Medical Foundation The Success in La Crosse
Suggests What is Possible The team approach to ACP: Collaboration
by major health organizations in 1991Collaboration by major health
organizations in 1991 Components:Components: Multiprofessional
approach and training Multimodal community education Organization
& community policies and practices Patients were routinely
approached about and assisted with ACP
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- Gundersen Lutheran Medical Foundation Gundersen Lutheran
Respecting Choices After 2 years of full implementation the project
had significant impact on end-of-life planning and decision
making.After 2 years of full implementation the project had
significant impact on end-of-life planning and decision making. Of
540 adult deaths studied from April 1995- March Of 540 adult deaths
studied from April 1995- March 1996 1996 -85% had written ADs. -85%
had written ADs. -96% had advance directives in their medical file.
-96% had advance directives in their medical file. -98% had
evidence that wishes were followed as -98% had evidence that wishes
were followed as death neared death neared Patients with AD:
Patients with AD: - were more likely to be admitted to long term
care - were more likely to be admitted to long term care (65%
vs.31%)& Hospice (29% vs. 11%) (65% vs.31%)& Hospice (29%
vs. 11%) -were less likely to die in the hospital -were less likely
to die in the hospital (31% vs. 68%) (31% vs. 68%)
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- Gundersen Lutheran Medical Foundation How do we get from
Advance Directives to Advance Care Planning? A cultural change will
be requiredA cultural change will be required Organizational &
community engagementOrganizational & community engagement
Commitment to learning new skills and practicesCommitment to
learning new skills and practices Development of new standards of
practiceDevelopment of new standards of practice
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- Gundersen Lutheran Medical Foundation A statement from the
Gundersen Lutheran model (the developers of Respecting Choices):
Gundersen Lutheran believes if incorporated as a routine component
of care with multiple professionals taking responsibility for
education and counseling, early in the course of an illness (or
ones life), advance care planning can truly become a process and
not an isolated event or signature on a document. The challenge is
to assist professionals ( and the people in our community) in
gaining the necessary knowledge and skills to attain competency in
advance care planning facilitation. Gundersen Lutheran believes if
incorporated as a routine component of care with multiple
professionals taking responsibility for education and counseling,
early in the course of an illness (or ones life), advance care
planning can truly become a process and not an isolated event or
signature on a document. The challenge is to assist professionals (
and the people in our community) in gaining the necessary knowledge
and skills to attain competency in advance care planning
facilitation.
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- Gundersen Lutheran Medical FoundationSummary Sharing Your
Wishes is an important initiative to increase public awareness
about the ACP process, increase communication between elders and
their loved ones & medical providers, and to strengthen our
system to ensure a persons health care wishes are honored.Sharing
Your Wishes is an important initiative to increase public awareness
about the ACP process, increase communication between elders and
their loved ones & medical providers, and to strengthen our
system to ensure a persons health care wishes are honored. ACP has
proved to be successful in many other communities.ACP has proved to
be successful in many other communities. To get from Advance
Directives to Advance Care Planning our community requires a
cultural change with a commitment to learn new skills and develop
new practices.To get from Advance Directives to Advance Care
Planning our community requires a cultural change with a commitment
to learn new skills and develop new practices.
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- Gundersen Lutheran Medical Foundation Session 2 Services and
Care Options for Seniors in Genesee county Office for the
AgingOffice for the Aging Care Options for SeniorsCare Options for
Seniors
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- Gundersen Lutheran Medical Foundation Genesee County Office for
the Aging Provides a variety of programs and services to all county
residents who are 60 years of age and older Provides a variety of
programs and services to all county residents who are 60 years of
age and older 343-1611 343-1611 Monday Friday Monday Friday 8:30- 5
p.m.
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- Gundersen Lutheran Medical Foundation Genesee County Office for
the Aging Long Term Care Services Genesee County Office for the
Aging Long Term Care Services Nutrition: Meals on Wheels, Senior
meal programs, nutrition counselingNutrition: Meals on Wheels,
Senior meal programs, nutrition counseling Medical
TransportationMedical Transportation Nursing Home CounselingNursing
Home Counseling Home Care/ EISEPHome Care/ EISEP Assistance with
applications for benefits Ombudsman program Assessments for seniors
with financial needs
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- Gundersen Lutheran Medical Foundation Genesee County Office for
the Aging Information and referrals Housing for SeniorsHousing for
Seniors Adult Day CareAdult Day Care Home Health CareHome Health
Care RespiteRespite Nursing HomesNursing Homes Personal Emergency
Response SystemPersonal Emergency Response System Medical
ServicesMedical Services Social Security Benefits Weatherization
referrals Food stamps & Medicaid Alzheimers services
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- Gundersen Lutheran Medical Foundation Genesee County Office for
the Aging Information and Services CounselingCounseling Discount
servicesDiscount services Legal Services: POA, Living Will, HCP,
Medicaid eligibility, Long Term Care Insurance, Financial
PlanningLegal Services: POA, Living Will, HCP, Medicaid
eligibility, Long Term Care Insurance, Financial Planning Volunteer
Placement- RSVPVolunteer Placement- RSVP Recreation programs and
activitiesRecreation programs and activities Caregiver Resource
Center: counseling and support groups Community Education
Newsletters Tax Preparation Notary services Photocopying Voter
registration Site
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- Gundersen Lutheran Medical Foundation CARE OPTIONS FOR SENIORS
IN GENESEE COUNTY www.co.genesee.ny.us from the main menu select
:www.co.genesee.ny.us Care Options for Seniors Your Link to
Services in Genesee County
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- Gundersen Lutheran Medical Foundation Summary The Genesee
county Office For the Aging has many services and programs for
adults 60 years of age or older.The Genesee county Office For the
Aging has many services and programs for adults 60 years of age or
older.
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- Gundersen Lutheran Medical Foundation The Important Role of an
Advance Care Planning Facilitator Session 3 ACP Facilitator
definition ACP Facilitator qualifications ACP Facilitator roles and
responsibilities
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- Gundersen Lutheran Medical Foundation Advance Care Planning
Facilitator A person who is able to guide others to understand
through the advance care planning process. This includes reflecting
on life values and goals, examining support services, and
understanding the impact of future healthcare decisions.
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- Gundersen Lutheran Medical Foundation Facilitate To Guide To
Guide To Help To Help To Assist To Assist To Advance To
Advance
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- Gundersen Lutheran Medical Foundation Advance Care Planning
Facilitator Qualifications Can come from any background or
experience with a desire to enhance the quality of life for
seniors.Can come from any background or experience with a desire to
enhance the quality of life for seniors. Have good communication
skills and the ability to be an active listener.Have good
communication skills and the ability to be an active listener. Be
able to discuss sensitive issues.Be able to discuss sensitive
issues. Have the ability to respect cultural, spiritual and
personal differences.Have the ability to respect cultural,
spiritual and personal differences. Be able to remain
non-judgmental, non-prying and to respect an individuals choices.Be
able to remain non-judgmental, non-prying and to respect an
individuals choices. Maintain confidentialityMaintain
confidentiality Complete the Advance Care Planning facilitator
training programComplete the Advance Care Planning facilitator
training program
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- Gundersen Lutheran Medical Foundation Advance Care Planning
Facilitator Role and responsibilities Be knowledgeable in the
advance care planning process and services available to seniorsBe
knowledgeable in the advance care planning process and services
available to seniors Initiate advance care planning
discussionsInitiate advance care planning discussions Provide
education an the advance care planning processProvide education an
the advance care planning process Facilitate discussions of advance
care planning with seniors and their loved ones.Facilitate
discussions of advance care planning with seniors and their loved
ones. Assist seniors in the completion of advance directivesAssist
seniors in the completion of advance directives Make referrals for
other services when necessaryMake referrals for other services when
necessary
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- Gundersen Lutheran Medical Foundation Summary ACP facilitators
must have good communication skills and the abilities to discuss
sensitive issues while respecting cultural, spiritual &
personal differences.ACP facilitators must have good communication
skills and the abilities to discuss sensitive issues while
respecting cultural, spiritual & personal differences. ACP
facilitators need to be knowledgeable in the ACP process, services
available to seniors, and have the abilities to initiate and
facilitate ACP with seniorsACP facilitators need to be
knowledgeable in the ACP process, services available to seniors,
and have the abilities to initiate and facilitate ACP with
seniors
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- Gundersen Lutheran Medical Foundation You can make a difference
in the life of a senior by becoming a facilitator. by becoming a
facilitator.
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- Gundersen Lutheran Medical Foundation Session 4 Advance Care
planning: Understanding the concept How can we assist people?How
can we assist people? Why is it necessary?Why is it necessary? What
are the benefits?What are the benefits? For seniors For seniors For
loved ones For loved ones For medical providers For medical
providers For the work place For the work place Why is it avoided?
Why do we often fail? When is it successful? Local findings
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- Gundersen Lutheran Medical Foundation Advance Care Planning A
process of understanding, reflecting and communicating preferences
for future care, including care options and health care decisions.A
process of understanding, reflecting and communicating preferences
for future care, including care options and health care
decisions.
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- Gundersen Lutheran Medical Foundation Assisting with Advance
Care Planning Assisting with Advance Care Planning Encouraging
people to review their wishes and expectations with their loved
ones, health care agent, physicians, lawyers and spiritual
advisors.Encouraging people to review their wishes and expectations
with their loved ones, health care agent, physicians, lawyers and
spiritual advisors. Assisting people in completing the New York
State Health Care Proxy form, Living Will, DNR and Non-hospital DNR
forms.Assisting people in completing the New York State Health Care
Proxy form, Living Will, DNR and Non-hospital DNR forms.
Instructing seniors to review and updating these forms periodically
and after life changing events.Instructing seniors to review and
updating these forms periodically and after life changing events.
Emphasizing the importance of conducting ongoing conversations
about their wishes and expectations with their loved ones, health
care agent, physicians, lawyers and spiritual advisors.Emphasizing
the importance of conducting ongoing conversations about their
wishes and expectations with their loved ones, health care agent,
physicians, lawyers and spiritual advisors.
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- Gundersen Lutheran Medical Foundation ADVANCE CARE PLANNING Why
is it necessary? ADVANCE CARE PLANNING Why is it necessary?
Americans will live longer and healthier lives than ever before.
Life expectancy in one century has gone from 47 to 75
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- Gundersen Lutheran Medical Foundation Advance care planning
:Why is it necessary? Most people will experience chronic illness
or disability with complex health issues in the last phase of their
lives: complex health issues in the last phase of their lives: *8
out of 10 seniors 65 or older have at least 1 *8 out of 10 seniors
65 or older have at least 1 chronic condition chronic condition *5
out of 10 have at least 2 chronic conditions *5 out of 10 have at
least 2 chronic conditions *1 out of 2 people may require long term
care *1 out of 2 people may require long term care services
services *1 out of 2 people may be unable to make decisions *1 out
of 2 people may be unable to make decisions for themselves during
their dying process for themselves during their dying process
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- Gundersen Lutheran Medical Foundation Advance care planning
:Why is it necessary? Multiple changes and advancements in medical
technology, extending life. Health professionals typically treat
when uncertain. Most of us will die under the care of health
professionals.
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- Gundersen Lutheran Medical Foundation Advance care planning:
Why is it necessary ? To ensure clinical care is consistent with
the individuals wishes. Multiple changes have occurred in the
family structure. Loved ones have a significant chance of not
knowing a persons views without discussion. To reduce an
individuals concern regarding possible burden placed on family and
others.
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- Gundersen Lutheran Medical Foundation Advance Care Planning why
is it necessary? Currently under New York State law, no one, not
even a family member, has the legal right to make health care
decisions for a person if they become incapacitated.Currently under
New York State law, no one, not even a family member, has the legal
right to make health care decisions for a person if they become
incapacitated. Less than 25% of Americans have created some form of
plan outlining how they wish to be treated in the last phase of
their life.Less than 25% of Americans have created some form of
plan outlining how they wish to be treated in the last phase of
their life.
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- Gundersen Lutheran Medical Foundation Why is it necessary? How
the Majority of Americans Die How the Majority of Americans Wish to
Die Over 75% 80% Patricia Bomba, M.D. Vice President & Medical
Director, Geriatrics
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- Gundersen Lutheran Medical Foundation Advance care planning
affects many in our community 2000 Census County residents age
sixty plus: 11,095 (18.5% of total pop, 3.2% increase from 1990)
People 85+ increased from 860 to 1,101 (28% increase) By 2015:
People 85+ to increase to almost 1,400 NYS Office for Aging Project
2015
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- Gundersen Lutheran Medical Foundation The Aging Today and
Tomorrow Source: Policy Committee White House Conference on Aging
-- July 14, 2004
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- Gundersen Lutheran Medical Foundation Advance care planning
what are the benefits? Advance care planning what are the benefits?
For the patient.For the patient. For the family/loved onesFor the
family/loved ones For medical providersFor medical providers For
the work placeFor the work place
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- Gundersen Lutheran Medical Foundation Advance Care Planning:
Benefits Maintain Control Achieve Peace of Mind Can make difficult
transitions easier Assure wishes are honored when they are unable
to communicate them. For the senior, frail elder.
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- Gundersen Lutheran Medical Foundation Advance Care Planning:
Benefits for family and loved ones Empowers and guides
family/significant others in making crucial health care decisions
for a loved one.Empowers and guides family/significant others in
making crucial health care decisions for a loved one. Helps avoid
family conflict over treatment options.Helps avoid family conflict
over treatment options. Aids in coping with grief if they are clear
that they have followed the wishes of their loved one.Aids in
coping with grief if they are clear that they have followed the
wishes of their loved one.
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- Gundersen Lutheran Medical Foundation Advance Care Planning:
Benefits for the medical providers Improves quality care by
matching provided treatment with an individuals preferences and
decreasing utilization of acute care services.Improves quality care
by matching provided treatment with an individuals preferences and
decreasing utilization of acute care services. Decreases
unnecessary stress on staff.Decreases unnecessary stress on staff.
Reduces the possibility of litigation.Reduces the possibility of
litigation.
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- Gundersen Lutheran Medical Foundation Advance Care Planning:
Benefits for the medical providers Guides physicians in decision
making.Guides physicians in decision making. Reduces the amount of
time in crisis management for the final phase of life
decisions.Reduces the amount of time in crisis management for the
final phase of life decisions. Reduces time spent in lengthy,
repeated family care conferences exploring whether to continue or
forgo medical treatment.Reduces time spent in lengthy, repeated
family care conferences exploring whether to continue or forgo
medical treatment.
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- Gundersen Lutheran Medical Foundation Advance Care Planning:
Benefits for the work place Reduce employee absenteeism Nationally,
1 in 4 employees is involved with Nationally, 1 in 4 employees is
involved with caring for an older adult caring for an older
adult
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- Gundersen Lutheran Medical Foundation ACP: Why is it avoided ?
ACP: Why is it avoided ? Many have not considered the importance of
ACP. Many have not considered the importance of ACP. Lack of
information or unsure where to get information. Lack of information
or unsure where to get information. It can be very personal and may
elicit strong emotional reactions. It can be very personal and may
elicit strong emotional reactions. It may be unclear how to start
the conversation. It may be unclear how to start the conversation.
It may raise issues that are difficult to resolve. It may raise
issues that are difficult to resolve. Many believe it is for elders
or the sick. Many believe it is for elders or the sick. May cause
worry to loved ones. May cause worry to loved ones.
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- Gundersen Lutheran Medical Foundation Why is ACP sometimes
avoided by health care professionals? Lack of professional,
training, skill and confidence. Lack of professional, training,
skill and confidence. Believe they are adequately addressing ACP
needs of their pt. Believe they are adequately addressing ACP needs
of their pt. Focused on completion of AD. Focused on completion of
AD. Perceived lack of time. Perceived lack of time. Lack of
reimbursement. Lack of reimbursement. No developed system. No
developed system.
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- Gundersen Lutheran Medical Foundation Ways we often fail:
People lack knowledge and understanding of services available to
them. People lack knowledge and understanding of services available
to them. Peoples values and preferences are not known. Peoples
values and preferences are not known. Written plans do not reflect
a persons preferences. Written plans do not reflect a persons
preferences. Written plans are often not available. Written plans
are often not available. Written plans are not clear or are
irrelevant. Written plans are not clear or are irrelevant.
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- Gundersen Lutheran Medical Foundation Advance Care Planning is
successful when: Future options are understood. Future options are
understood. Options are considered based on the persons values
Options are considered based on the persons values and goals. and
goals. Choices are discussed with loved ones and medical Choices
are discussed with loved ones and medical providers before a
crisis. providers before a crisis. A plan is formulated and
supported by loved ones. A plan is formulated and supported by
loved ones. Health care documents are accessible. Health care
documents are accessible.
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- Gundersen Lutheran Medical Foundation Local Findings In Genesee
County 4 community conversations with about 80 seniors were
conducted in July/August 2005, the results: KNOWLEDGE DEFICIT where
to go for information about care options and services available to
seniors.where to go for information about care options and services
available to seniors. terminology and definitions of advance
directives terminology and definitions of advance directives
advance health care planning as a process not a piece of
paperadvance health care planning as a process not a piece of paper
proper completion of forms/documentsproper completion of
forms/documents need to update forms periodicallyneed to update
forms periodically
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- Gundersen Lutheran Medical Foundation Local Findings LACK OF
COMMUNICATION between family, loved ones, spiritual advisors and
person completing forms.between family, loved ones, spiritual
advisors and person completing forms. between physicians and person
completing formsbetween physicians and person completing forms -
70% feel it would not be difficult to talk with their - 70% feel it
would not be difficult to talk with their physician about their
wishes for end of life. physician about their wishes for end of
life. -80% had not talked with their physician about -80% had not
talked with their physician about end of life care. end of life
care.
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- Gundersen Lutheran Medical Foundation Local Findings NEED TO
EDUCATE ABOUT : Services available to seniors in Genesee
countyServices available to seniors in Genesee county Terms and
definitions of advance directives Terms and definitions of advance
directives Advance care planning as a processAdvance care planning
as a process Proper completion of forms Proper completion of forms
Need to update forms Need to update forms How to have conversations
with families, loved ones, spiritual advisors, physicians and
medical providers. How to have conversations with families, loved
ones, spiritual advisors, physicians and medical providers.
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- Gundersen Lutheran Medical Foundation Ways facilitators can
improve the quality of life of people in our community Ways
facilitators can improve the quality of life of people in our
community Encouraging ACP as an ongoing process not a one time
event.Encouraging ACP as an ongoing process not a one time event.
Understanding the services and care options available for seniors
in Genesee County, referring individuals as
appropriate.Understanding the services and care options available
for seniors in Genesee County, referring individuals as
appropriate. Assisting an individual to become more informed about
their health & wellness, their diagnosis & prognosis and
the benefits & burdens of treatments.Assisting an individual to
become more informed about their health & wellness, their
diagnosis & prognosis and the benefits & burdens of
treatments. Guiding an individual to explore, clarify and document
their values, beliefs, goals and wishes. Including appointing a
Health Care Agent.Guiding an individual to explore, clarify and
document their values, beliefs, goals and wishes. Including
appointing a Health Care Agent. Informing seniors of the importance
of taking control of their own. lives. Informing seniors of the
importance of taking control of their own. lives.
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- Gundersen Lutheran Medical Foundation Summary ACP is an ongoing
process that includes understanding, reflecting, discussing and
formulating a plan.ACP is an ongoing process that includes
understanding, reflecting, discussing and formulating a plan. ACP
effects everyone in our community.ACP effects everyone in our
community. ACP provides many benefits to the individual, their
loved ones, medical providers and spiritual leaders.ACP provides
many benefits to the individual, their loved ones, medical
providers and spiritual leaders. ACP is successful when care
options are understood & considered based on a persons values
and goals, a plan is developed and supported by loved ones, and the
healthcare documents are accessible.ACP is successful when care
options are understood & considered based on a persons values
and goals, a plan is developed and supported by loved ones, and the
healthcare documents are accessible.
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- Gundersen Lutheran Medical Foundation Session 5 Advance
Directives: Understanding the language and tools Types of ADTypes
of AD Living WillLiving Will Power of AttorneyPower of Attorney
Health Care AgentHealth Care Agent Health Care ProxyHealth Care
Proxy Non-hospital Do Not ResuscitateNon-hospital Do Not
Resuscitate MOLST formMOLST form
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- Gundersen Lutheran Medical Foundation An Advance Directive
is... a plan, indicating preferences for future health care
decisions if a person becomes unable to speak for themselves.
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- Gundersen Lutheran Medical Foundation Types of Advance
Directives I.Oral II.Written A. Formal (signed, dated, witnessed)
1. Meets statutory requirements B. Informal 1. Physicians note 2.
Personal letter
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- Gundersen Lutheran Medical Foundation Advance Directives can be
changed or revoked at any time either in writing or verbally. An
Advance Directive only takes effect when a person becomes unable to
make their own decision due to illness or injury. When can an AD be
changed?
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- Gundersen Lutheran Medical Foundation Session 5 Making Choices
Video and discussion about the importance of Advance Care
Planning
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- Gundersen Lutheran Medical Foundation Session 6 An Overview of
Law, Ethics & Medicine, related to Advance Health Care Planning
Right to Refuse Medical TreatmentRight to Refuse Medical Treatment
Patient Self- Determination ActPatient Self- Determination Act
Ethical basis for ACPEthical basis for ACP Life-Sustaining
Treatments *Benefits and Burdens of Treatments *CPR, including
outcomes *Nutritional Support *Hydration Comfort Care
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- Gundersen Lutheran Medical Foundation Right to refuse medical
treatment Competent adults have a right to refuse medical/surgical
treatment at any time. Competent adults have a right to refuse
medical/surgical treatment at any time. This right continues even
if the person is This right continues even if the person is
incapable. incapable. The most that a state can require is clear
and convincing evidence of an adults choices. The most that a state
can require is clear and convincing evidence of an adults
choices.
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- Gundersen Lutheran Medical Foundation Patient
Self-Determination Act A federal statute that requires health
organizations: -To ask adults about advance directives at
admission. -To provide written information about rights to refuse
treatment and to have an AD. -To provide education to staff and
community about ADs.
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- Gundersen Lutheran Medical Foundation Ethical Basis for ACP
Successful ACP promotes: -Respect of patients values and wishes.
-Respect for right to self-determination.
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- Gundersen Lutheran Medical Foundation Decisions Should be
Guided by: -Determining the persons goalsboth medical and
non-medical. -Considering the benefits and burdens for the person
of particular options or choices.
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- Gundersen Lutheran Medical Foundation Advance Health Care
Planning: creates an environment of shared decision-making among
individuals, loved ones, and health professionals.
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- Gundersen Lutheran Medical Foundation Life-sustaining
treatments: Any treatment or intervention that is used to sustain
or prolong life. Any treatment or intervention that is used to
sustain or prolong life.
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- Gundersen Lutheran Medical Foundation A treatment may be
beneficial if it is... -Effective in prolonging life. -Effective in
restoring/maintaining function. -Promotes goals/values of patient.
-Consistent with religious/cultural beliefs.
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- Gundersen Lutheran Medical Foundation A treatment may be
considered burdensome if... Results in more or intolerable pain.
Results in more or intolerable pain. Damages the body image or
function. Damages the body image or function. Psychologically
harmful. Psychologically harmful. Does not conform to their quality
of life. Does not conform to their quality of life. Cost is
unacceptable. Cost is unacceptable.
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- Gundersen Lutheran Medical Foundation Choices about
life-sustaining treatments When to start. When to start. When to
forgo (may choose limited time trials of treatment). When to forgo
(may choose limited time trials of treatment). How and when to
maintain comfort. How and when to maintain comfort.
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- Gundersen Lutheran Medical Foundation Mixed Management Allows
for choices to extend life as well as choices that prepare for
death and provide comfort.
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- Gundersen Lutheran Medical Foundation Understanding the
potential goals, benefits/burdens, and outcomes for life-sustaining
treatments is important. CPR CPR Intubation /ventilation Intubation
/ventilation Nutritional support Nutritional support IV hydration
IV hydration
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- Gundersen Lutheran Medical Foundation What is Resuscitation?
Life-Sustaining Treatments What is Resuscitation? Life-Sustaining
Treatments If your heart stops: Electrical shock to the heart and
injection of medications. If your breathing stops: mechanical
ventilation. Common Life-Sustaining TreatmentsCommon
Life-Sustaining Treatments CPR: Group of treatments used when
someones heart or breathing stops Mechanical Ventilation: Use of a
machine attached to a tube inserted through nose or mouth that
forces air into the lungs Artificial Hydration and Nutrition:
Artificial means of giving food or water
- Slide 76
- Gundersen Lutheran Medical Foundation CPR Outcomes The success
rate of CPR is often thought to be much higher than it actually is.
The success rate of CPR is often thought to be much higher than it
actually is. Approximately 15% of hospitalized patients survive and
return to previous function. Approximately 15% of hospitalized
patients survive and return to previous function. Success rates in
some populations are much lower, e.g., in long term care, advanced
cancer, the success rate is < 2%. Success rates in some
populations are much lower, e.g., in long term care, advanced
cancer, the success rate is < 2%.
- Slide 77
- Gundersen Lutheran Medical Foundation CPR Outcomes For those
who do survive the CPR attempt, complications include:For those who
do survive the CPR attempt, complications include: Prolonged ICU
stay on mechanical ventilation Decreased mental functioning Rib
fractures
- Slide 78
- Gundersen Lutheran Medical Foundation Artificial Nutrition and
Hydration When a person can no longer take food or fluid by mouth,
a feeding tube can sometimes be used.When a person can no longer
take food or fluid by mouth, a feeding tube can sometimes be used.
-Nasogastric tube -Nasogastric tube -Gastrostomy tube -Gastrostomy
tube Or intravenously nutrition can be administered.Or
intravenously nutrition can be administered. -Total Parenteral
Nutrition -Total Parenteral Nutrition
- Slide 79
- Gundersen Lutheran Medical Foundation Points about Nutritional
Support Nutrition delivered by tubes is a medical treatment
Nutrition delivered by tubes is a medical treatment With a terminal
illness, the body often can not process food normally and forcing
nutrition will not prolong life. With a terminal illness, the body
often can not process food normally and forcing nutrition will not
prolong life. Naturally in the dying process there is decreased
appetite and thirst. Naturally in the dying process there is
decreased appetite and thirst. The word starvation is an
emotionally charged word that does not describe the cause of death.
The word starvation is an emotionally charged word that does not
describe the cause of death.
- Slide 80
- Gundersen Lutheran Medical Foundation Comfort Care No
aggressive or life prolonging treatments, symptom control measures
only.No aggressive or life prolonging treatments, symptom control
measures only. Providing optimal pain control and comfort
measures.Providing optimal pain control and comfort measures.
Providing physical, emotional and spiritual support to the
terminally ill person and their family.Providing physical,
emotional and spiritual support to the terminally ill person and
their family. Allowing natural death to occur.Allowing natural
death to occur. Comfort Care does not mean dont treat ! Comfort
Care does not mean dont treat !
- Slide 81
- Gundersen Lutheran Medical Foundation Summary All Adults have a
right to refuse treatments.All Adults have a right to refuse
treatments. Decisions for care options and treatments should be
guided by a persons preferences and goals, while considering the
benefits and burdens of treatments.Decisions for care options and
treatments should be guided by a persons preferences and goals,
while considering the benefits and burdens of treatments. Life
sustaining treatment is any treatment used to prolong life.Life
sustaining treatment is any treatment used to prolong life.
Decisions can be made about when to begin and forgo treatment &
when to provide comfort care.Decisions can be made about when to
begin and forgo treatment & when to provide comfort care.
- Slide 82
- Gundersen Lutheran Medical Foundation Session 7 Problem Solving
Scenarios Please break up into groups of 3
- Slide 83
- Gundersen Lutheran Medical FoundationSession 8Advance Care
Planning: Facilitating the Process Basic skills at initiating ACP
discussions Basic skills at initiating ACP discussions Facilitation
skills with different groups:Facilitation skills with different
groups: - the healthy adult - the healthy adult the adult with
incurable, progressive disease the adult expected to die within 12
months or those in long term care those in long term care the adult
with new, serious conditions
- Slide 84
- Gundersen Lutheran Medical Foundation Basic Skills at
Initiating ACP Affirm relationship; support, timeAffirm
relationship; support, time Introduce the conceptIntroduce the
concept Explain ACPExplain ACP Explain ACP Assesses motivation,
knowledge, beliefs Encourage reflection and discussion
- Slide 85
- Gundersen Lutheran Medical Foundation Basic Skills at
Initiating ACP Explore statements, preferencesExplore statements,
preferences Encourage loved ones involvementEncourage loved ones
involvement Assist in choosing an appropriate agentAssist in
choosing an appropriate agent Provide information, worksheets Make
referrals Develop a follow up plan
- Slide 86
- Gundersen Lutheran Medical Foundation Introduce the Concept Id
like to give you some information that you can take with you to get
started thinking about the kinds of choices you might want to make
for your future care.
- Slide 87
- Gundersen Lutheran Medical Foundation Explain Advance Care
Planning This is called Advance Care Planning and it is a good idea
to take some time to understand whats involved, think about your
choices, what your goals and values are and then discuss them with
loved ones and others as needed. If you have questions about your
medical condition, you can talk with your MD.
- Slide 88
- Gundersen Lutheran Medical Foundation Encourage Reflection and
Discussion If you want to complete a document now, we can have
someone help you. However, we often encourage people to take these
materials home, review them with loved ones and begin to discuss
the issues, choices and questions you may have.
- Slide 89
- Gundersen Lutheran Medical Foundation Develop a Follow-up Plan
When you and your loved ones are ready to learn more or complete a
written plan, please call me and we will schedule a time that I can
assist you in any way you need.
- Slide 90
- Gundersen Lutheran Medical Foundation Skills to Engage people
in Advance Care Planning Discussions
- Slide 91
- Gundersen Lutheran Medical Foundation Eliciting the persons
perspective Take time to listen Take time to listen Ask for persons
story about end-of-life care Ask for persons story about
end-of-life care Attempt to determine the persons current health
status and their understanding of it. Attempt to determine the
persons current health status and their understanding of it. Start
with a focus on goals and what it might mean to live well at this
point or in future circumstances Start with a focus on goals and
what it might mean to live well at this point or in future
circumstances
- Slide 92
- Gundersen Lutheran Medical Foundation Before Developing a Plan,
Address: Expressed fears Expressed fears Misunderstandings about
basic facts or processes Misunderstandings about basic facts or
processes Gaps in knowledge Gaps in knowledge
- Slide 93
- Gundersen Lutheran Medical Foundation Next, Explore and Clarify
What do you value most about your physical and mental well
being?What do you value most about your physical and mental well
being? What gives your life meaning and purpose?What gives your
life meaning and purpose? What are your religious or spiritual
beliefs?What are your religious or spiritual beliefs? What are your
hopes and wishes for the final phase of your life? What are your
hopes and wishes for the final phase of your life? Have you thought
about living arrangements as you age and become more frail?Have you
thought about living arrangements as you age and become more
frail?
- Slide 94
- Gundersen Lutheran Medical Foundation Common Misunderstood
Expressions Common Misunderstood Expressions No Heroics No Heroics
Dont keep me alive if I am a vegetable. Dont keep me alive if I am
a vegetable. Dont keep me alive on machines. Dont keep me alive on
machines. If I am terminal, let me go. If I am terminal, let me
go.
- Slide 95
- Gundersen Lutheran Medical Foundation Explain qualifications
for surrogate Willing and available. Willing and available. values
and preferences. values and preferences. Understands what is
important to you.Understands what is important to you. Will talk
about sensitive issues now.Will talk about sensitive issues now.
Will listen to your wishes.Will listen to your wishes. Can separate
his/her feelings from yours.Can separate his/her feelings from
yours. Willing to speak on your behalf.Willing to speak on your
behalf. Would honor and act on your wishes.Would honor and act on
your wishes. Able to handle challenges during difficult times.Able
to handle challenges during difficult times.
- Slide 96
- Gundersen Lutheran Medical Foundation Facilitation Skills with
Different Groups of Adults Basic skills with all adultsBasic skills
with all adults Adults with chronic, progressive diseaseAdults with
chronic, progressive disease Adults expected to die within 12
months or those in long-term careAdults expected to die within 12
months or those in long-term care
- Slide 97
- Gundersen Lutheran Medical Foundation What to discuss with all
adults Are you familiar with the different long term care services
available to you? Are you familiar with the different long term
care services available to you? Do you know where to go for
information about the services? Do you know where to go for
information about the services?
- Slide 98
- Gundersen Lutheran Medical Foundation What to discuss with all
adults Who would you want to make decisions if you couldnt? Who
would you want to make decisions if you couldnt? What would be the
goals of treatment if you permanently lost the ability to know who
you were, who you were with, or where you were? What would be the
goals of treatment if you permanently lost the ability to know who
you were, who you were with, or where you were? Do you have any
religious, personal, or cultural views that would affect treatment
choices? Do you have any religious, personal, or cultural views
that would affect treatment choices?
- Slide 99
- Gundersen Lutheran Medical Foundation What to discuss with
adults with a chronic, progressive illness The same issues as a
healthy adult, plus Goals and benefits/burdens of
initiating/forgoing treatment most likely needed to attempt to
sustain life Goals and benefits/burdens of initiating/forgoing
treatment most likely needed to attempt to sustain life Desires for
comfort care for specific illness Desires for comfort care for
specific illness
- Slide 100
- Gundersen Lutheran Medical Foundation What to discuss with
adults who may die in the next 12 months The same issues as a
healthy adult as well as an adult with a chronic, progressive
illness, plus The same issues as a healthy adult as well as an
adult with a chronic, progressive illness, plus Review the persons
medical and non-medical goals. Review the persons medical and
non-medical goals. Make decisions about CPR, hospitalization,
nutritional support, etc, if not already made. Make decisions about
CPR, hospitalization, nutritional support, etc, if not already
made. Review options for comfort care and life closure. Review
options for comfort care and life closure.
- Slide 101
- Gundersen Lutheran Medical Foundation What to Discuss with all
Adults: Explore What is Most Important and How They Want to Receive
Care What makes your day worthwhile?What makes your day worthwhile?
What experiences are most important for you to live wellWhat
experiences are most important for you to live well at this time
and in the future of your life? at this time and in the future of
your life? How does your faith impact your health care decision
making?How does your faith impact your health care decision making?
What gives you strength or sustains you in difficult times?What
gives you strength or sustains you in difficult times?
- Slide 102
- Gundersen Lutheran Medical Foundation Explore What is Most
Important and How They Want to Receive Care What fears or worries
do you have about your illness or medical care?What fears or
worries do you have about your illness or medical care? Have the
illnesses or deaths of loved ones influencedHave the illnesses or
deaths of loved ones influenced your view of the medical system?
your view of the medical system? What are your goals for care and
where would you like to receive care?What are your goals for care
and where would you like to receive care? Are there circumstances
under which you would refuseAre there circumstances under which you
would refuse or discontinue treatment that might prolong your life?
or discontinue treatment that might prolong your life?
- Slide 103
- Gundersen Lutheran Medical Foundation Some Other Things to
consider in Pre-Planning: Completion of a Will: a legal document
used to divide assets and property after death.Completion of a
Will: a legal document used to divide assets and property after
death. Organ donation.Organ donation. Burial arrangements.Burial
arrangements.
- Slide 104
- Gundersen Lutheran Medical Foundation Summary Skills at
initiating ACP conversations must be learned and incorporated as
routine care. Skills at initiating ACP conversations must be
learned and incorporated as routine care. Different facilitation
skills are required for different groups of adults. Different
facilitation skills are required for different groups of adults.
Facilitation skills require practice and experience to develop.
Facilitation skills require practice and experience to
develop.
- Slide 105
- Gundersen Lutheran Medical Foundation Session 9 Respecting
Choices: The Facilitation Process with a Healthy Adult video and
discussion
- Slide 106
- Gundersen Lutheran Medical Foundation Session 10 Creating an
Advance Directive Communicating the Plan
- Slide 107
- Gundersen Lutheran Medical Foundation Basic Standards for
Communication Written plans are best. Written plans are best.
Recommend the document that best meets the needs of the individual.
Recommend the document that best meets the needs of the individual.
Strive for clarity, accuracy, and completeness. Strive for clarity,
accuracy, and completeness. Encourage the agent and loved ones to
be a part of the conversations when ever possible. Encourage the
agent and loved ones to be a part of the conversations when ever
possible.
- Slide 108
- Gundersen Lutheran Medical Foundation Living Wills are Limited
Living Wills are Limited Only give instructions for a limited
number of circumstances Only give instructions for a limited number
of circumstances Often do not apply to needed decisions Often do
not apply to needed decisions No surrogate to make decisions No
surrogate to make decisions
- Slide 109
- Gundersen Lutheran Medical Foundation Health Care Proxys are
typically best A person can make decisions with MD in real time. A
person can make decisions with MD in real time. May provide a wide
range of instructions. May provide a wide range of instructions.
Applies to a wide range of health decisions. Applies to a wide
range of health decisions.
- Slide 110
- Gundersen Lutheran Medical Foundation Statutory Requirements
Review Health Care Proxy form Review Health Care Proxy form Review
Living Will form Review Living Will form
- Slide 111
- Gundersen Lutheran Medical Foundation Summary Summary Assist
individuals in selecting a communication plan Assist individuals in
selecting a communication plan Understand/clarify terminology
Understand/clarify terminology Know statutory requirements Know
statutory requirements
- Slide 112
- Gundersen Lutheran Medical Foundation Current Education of
health care professionals Focused on completion of advance
directives Focused on completion of advance directives No developed
system to practice or work No developed system to practice or work
No defined responsibilities or competencies No defined
responsibilities or competencies Inadequate or conflicting teaching
resources Inadequate or conflicting teaching resources Little or no
management or review of practice Little or no management or review
of practice Studies of professionals knowledge of end-of-life
issues reveal a lack of awareness of ethical & legal rulings,
but also continued dissatisfaction and discomfort when placed in
these situations
- Slide 113
- Gundersen Lutheran Medical Foundation The Role of the RN as an
ACP Facilitator Assess the need for informationAssess the need for
information Initiate conversation when cues arriveInitiate
conversation when cues arrive Provide accurate information on
medical condition or refer to MDProvide accurate information on
medical condition or refer to MD Listen/ClarifyListen/Clarify Make
appropriate referralsMake appropriate referrals Provide emotional
supportProvide emotional support Communicate choicesCommunicate
choices Follow organizational policiesFollow organizational
policies
- Slide 114
- Gundersen Lutheran Medical Foundation Session 11 The Four Steps
for Success in Advance Care Planning
- Slide 115
- Before a crisis occurs or a treatment option is considered take
time to explore your: Health & wellnessHealth & wellness
Diagnosis & prognosisDiagnosis & prognosis Treatment
benefits & burdensTreatment benefits & burdens Options
& available servicesOptions & available services
- Slide 116
- Gundersen Lutheran Medical Foundation The Four steps for
success in Advance Care Planning The Four steps for success in
Advance Care Planning 1. REFLECT Consider your personal values and
spiritual beliefs. Think about what is important to you and how you
want to receive your care. Consider your personal values and
spiritual beliefs. Think about what is important to you and how you
want to receive your care.
- Slide 117
- Gundersen Lutheran Medical Foundation The Four steps for
success in Advance Care Planning The Four steps for success in
Advance Care Planning 2. CHOOSE Select the best person to speak for
you if you become unable to speak for yourself. Select the best
person to speak for you if you become unable to speak for
yourself.
- Slide 118
- Gundersen Lutheran Medical Foundation The Four steps for
success in Advance Care Planning The Four steps for success in
Advance Care Planning 3. TALK Start the conversationshare your
wishes with your loved ones, health care agent, medical
professionals, lawyers and spiritual advisors. Continue the
conversation throughout your life. Start the conversationshare your
wishes with your loved ones, health care agent, medical
professionals, lawyers and spiritual advisors. Continue the
conversation throughout your life.
- Slide 119
- Gundersen Lutheran Medical Foundation The Four steps for
success in Advance Care Planning The Four steps for success in
Advance Care Planning 4. WRITE Put your health care wishes in
writing and give a copy to your loved ones, health care agent,
physicians, lawyers and spiritual advisors. Keep copies on you at
all times. Put your health care wishes in writing and give a copy
to your loved ones, health care agent, physicians, lawyers and
spiritual advisors. Keep copies on you at all times. Update the
forms periodically. Update the forms periodically.
- Slide 120
- Gundersen Lutheran Medical Foundation Imagine If.SYW Vision A
majority of frail elders in Genesee County knew what kind of
last-phase-of-life care they wanted; Were able to talk about this
with their family members and medical providers and spiritual
advisors; Had their wishes clearly expressed in a legal document;
The document was accessible and used to direct and guide their
medical care and support services to improve their quality of life
during the last years of their life.
- Slide 121
- Gundersen Lutheran Medical Foundation Conclusion Thank you for
your participation! Conclusion Thank you for your participation!
Questions?Questions? Comments?Comments? Please complete a course
evaluationPlease complete a course evaluation A certificate of
completion for this course will be mailed to you in the near
future.A certificate of completion for this course will be mailed
to you in the near future. Contact Cathie Plaisted at The Office
for the Aging 343-1611for any questions or for literature and
materials for your presentations.Contact Cathie Plaisted at The
Office for the Aging 343-1611for any questions or for literature
and materials for your presentations.