Wednesday, August 12, 2009

Advance Medical Directives - 2

Hello, Readers!
I'm back from a short break. I spent some time at the North Carolina Outer Banks, a great place to watch the ocean and regain perspective on what's important in life. Hope you all had a good week.

In my last regular post, we began to discuss the Advance Medical Directives document. We talked about the types of decisions that you might be called upon to make, and the importance of knowing what each procedure stated in the Directives involves. Let's look at some other things to keep in mind for the Directives.

Forms for an Advance Directives Statement
The following sources will have forms available. Contact any one of these:
• A lawyer; particularly one specializing in elder law (see July's post on Eldercare Attorneys)
• The social worker at a hospital, hospice, home health agency, nursing home, or long-term care facility;
• The Attorney General’s Office in the state where your parent lives; or
Caring Connections, a website created by the National Hospice and Palliative Care Organization (NHPCO), a national consumer and community engagement initiative to improve care at the end of life.

The Spiritual Side
In caregiving, especially in long-distance caring, there is a possibility that you, or your family, may not be with your parent at the end. Although not part of the standard wording, you may want to add a statement in the Advance Directives about honoring a person’s religious practices—calling a minister, rabbi, imam or priest, arranging for rituals that might bring comfort to your parent. The Directives are reviewed by health care staff regularly, and the staff will try to follow any reasonable request.

The Directives In Use
You must be an advocate for your parent’s wishes, whether you live close or far away.
• If your parent is admitted to a health care facility, request that the Advance Directives be filed on the top of your parent’s medical records chart. This will mean that every time a nurse or doctor looks at the chart, he will see your parent’s wishes first. When you visit the facility, check that your request has been fulfilled to your satisfaction.
• Make sure that the facility personnel understand your parent’s wishes. Speak personally with every member of your parent’s health care team.
• Every time a new doctor (usually a specialist) enters the treatment process for your parent, reiterate your parent’s wishes verbally and note that the Advance Directives are with the medical chart.
• Check your state's regulations or ask your parent's doctor. Some states require that the physician call the caregiver regularly to ask about Directives. In some states, this call must be made even at the time of intervention, such as before administering CPR.

In a crisis situation, the doctors and nurses may NOT refer to your parent’s chart for Advance Directives information. You might have heard of people being resuscitated even though they had written orders to the contrary. This is why it is important to mention those decisions regularly and keep those Directives at the front of the minds of the health care staff caring for your parent.

In my next post, I'll finish up with some special issues about the Directives and resources for further reading.

Blessings on your caregiving day!

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