88% say they want to die at home

20% actually die at home

Source: Teno, JM et al. Family perspectives on end of life care at the last place of care. JAMA. 2004;291:88-93

It can be be VERY tough

Autonomy

YOU!

Plan ahead

Have conversations with your loved ones

Write down your values and wishes

Living willPower of Attorney for Health Care

◦ (Durable Power of Attorney”)Other written documentation of your

wishes/valuesConversations with your loved ones

Living Wills (state specific)

POA for Health Care (usually part of LW)

Other documentation of your values and wishes (see ABA toolkit, Caring Conversations, Five Wishes)

MOLST form (?)

Will Living Will

May address:

Resuscitation (CPR) Ventilator Artificial Nutrition &

Hydration Antibiotics Transfusions Dialysis Invasive Procedures Organ Donation

***May instruct YES or NO

Allows you to name someone to make decisions for you, if you are unable to make them yourselfDoesn’t take effect UNTIL you are unable

(“springing”)Usually has space for 2 decision-makers, in

case one is unavailablePick the right person

Knows your wishes Strong advocate Available, willing

Can act for you ONLY if you are UNABLE TO

MAKE DECISIONS for yourself.

MUST make decisions IN AGREEMENT WITH YOUR DESIRES as stated in your Living Will or as otherwise known to the agent.

If your wishes are unknown, they must make decisions “in the patient’s best interest”

You do NOT need an attorney You do NOT need a notary in DE/PA/NJ/MD You DO need two witnesses, not related to

you, who will not inherit from you, who don’t work for the facility where you live.

Make copies and distribute Family Physician POA’s Keep several copies yourself and take to

hospital or facility if you go Copies have the same force as an original

Each state has a hierarchy of decision makers. In Delaware—

1. Spouse

2. Adult Child

3. Parent

4. Adult Sibling

5. Adult Grandchild

6. Adult Niece or Nephew

7. Guardian: Adult who has exhibited special care and concern—IF none of above are available AND if appointed by the court.

DE

PA

NJ

MD

If you do more than 1, make sure they all agree

Living Will

Only when a patient is

terminally ill or in a persistent

vegetative state

Medical POA

Whenever a patient is

incapable of making or

communicating a choice.

engagewithgrace.orgThe One Slide

Project

1. On a scale of 1 to 5, where do you fall on this continuum?

2. If there were a choice, would you prefer to die at home, or in a hospital?

3. Could a loved one correctly describe how you’d like to be treated in the case of a terminal illness?

4. Is there someone you trust whom you’ve appointed to advocate on your behalf when the time is near?

5. Have you completed any of the following: written a living will, appointed a healthcare power of attorney, or completed an advanced directive?

1 2 3 4 5

Don't give up on me no matter what, try any proven and unproven

intervention possible

Let me die in my own bed, without any medical intervention

Family disagrees with LW

Not all family members are “ready to let go”

Physician feels “we have to do something”, and family goes along

Cannot find LW/have not talked about it

Living will is unclear in present situation.

PLEASE . . . Think about your values and wishes for the

end of lifeDocumentHave a conversation with your loved ones

It’s may be difficult now, but it will save bigger difficulties later

EMS Providers will honor a new form called

Medical Orders for Medical Orders for Life Sustaining Life Sustaining TreatmentTreatment (or (or MOLST)MOLST)

All adults are encouraged to complete a living will and power of attorney.

MOLST—only for people with a terminal illness who do not want to be resuscitated in an emergency.

MOLST—intended to be used in the last year of life.

MOLST