Advance Directives

We plan our vacations. We plan for our retirement. We plan for our children’s college education. And yet we are typically reluctant to plan for our own end-of-life health care. Almost everyone has to make decisions about their medical care as they age. Unfortunately, for more than 25% of Americans, these decisions must be made on their behalf by someone else because they are no longer able to speak for themselves.

When an individual’s preferences have not been spelled out, their families are faced with the difficult decision of determining what they think their loved one would have wanted. This is a tremendous burden to place on those closest to us. In many situations, someone who has no knowledge of the patient’s preferences is placed in the role of decision maker, or sometimes families are unable to reach a common decision on the best course of action. As a result, significant and lingering family disputes arise and end-of-life treatments that are not in line with what the patient wanted are implemented.

The best way for you to ensure that your medical treatment is in accordance with your wishes is to take a proactive approach. No matter what your age or your current state of health, now is the time to prepare! Everyone needs to create a health care roadmap for guiding decisions related to their health care. The goal of advance care planning is for you to live well, in a way that is meaningful to you, for as long as you live.

Advanced Care Planning Involves

  1. Being aware of, and understanding, possible future health care choices
  2. Deciding what types of treatment you would or would not want if you are faced with a life limiting situation
  3. Talking about your decisions with your loved ones and your physician
  4. Putting in writing what treatments you would or would not want to receive
  5. Identifying someone to make medical decisions on your behalf if you are unable to do so
  6. This will likely be an ongoing process that requires more than one conversation.

Important Facts about Advanced Care Planning

  1. You do not have to have an Advance Directive to be admitted to hospice – We do encourage individuals and their family/caregivers to participate in decisions regarding care and treatment including documenting the patient’s Advance Directives.
  2. You do not need a lawyer to prepare your Advance Directives. Completing your Advanced Directives is free – forms to assist you are available from a number of sources (some resource links are provided below).
  3. Your values and beliefs are important guides. Think about your health care choices in light of what is important to you – physically, emotionally, spiritually and financially.
  4. You can change your Advance Directives at any time
  5. An advanced directive does not expire. It remains in effect until you change it.

Consider the 5 D’s

The 5 D’s are the 5 times in your life when you should review and make desired changes to your Advance Directives.

All of the following events may affect how you think about future health care decisions for yourself. Whenever necessary you should also update addresses and contact information for your agent, alternate agent and other people such as potential medical guardians whom you may have identified in your Advance Directive.

The 5 D’s are:

  1. Decade birthday
  2. Diagnosis
  3. Deterioration
  4. Divorce
  5. Death of someone close to you or that affects you.

One state’s advance directive does not always work in another state. If you spend a significant amount of time in more than one state, the best solution is to complete the Advance Directive for each state.

Make several copies of your Advanced Directives and be sure copies are readily accessible. Make certain that your loved ones and your physician have a current copy. If you are hospitalized, be sure to take a copy of your Advanced Directives to the hospital.

Documents You Should be Aware of

Medical Durable Power of Attorney (MDPOA) – This document gives authority to the person you have selected to make medical and health care decisions on your behalf should you become unable to do so. This document does not have to be notarized or witnessed and it does not have to be completed by an attorney. Be certain that you have talked with your decision maker about their role and your general wishes.

An MDPOA can be chosen in addition to or instead of a living will. Having an MDPOA helps you plan for situations that cannot be foreseen, like a serious auto accident.

Five Wishes – This is an advance directive form that helps you document personal, emotional, and spiritual needs. This form also allows you to document who you have chosen to make health decisions on your behalf if you are unable to make them yourself.

Power of Attorney – This is a notarized document that assigns authority to another adult allowing them to make decisions regarding your money or property. This document ceases to be in effect at the time of death.

Durable Power of Attorney – This is a notarized document that assigns authority to another adult allowing them to continue making decisions regarding your money or property even if you become incapacitated, disabled, or incompetent. This document ceases to be in effect at the time of death.

Living Will – This is a document that allows you to explain in writing which life sustaining procedures are to be withdrawn or withheld if you have a terminal illness or are in a coma or persistent vegetative state with no reasonable likelihood of recovering. Depending on individual state law, this document may also be called a “Directive,” “Physician Directive” or “Declaration.”

Do Not Resuscitate Oder – This is a physician order that states that cardiopulmonary resuscitation (CPR) will not be started if your heart stops. If you and your doctor decide that a DNR order is appropriate, that order will be documented in your medical record and routinely reviewed.

Physician Orders for Life Sustaining Treatment (POLST)

The POLST form complements your Advance Directive and is not intended to replace it. It is a medical order indicating your wishes regarding treatments that are commonly used in a medical crisis. Since it is a medical order, emergency personnel can follow its directive. Without a POLST, paramedics and EMTs responding to emergency calls are required to provide every possible medical treatment to sustain life. It is important the POLST shows what treatments you want NOW, in your current state of health. POLST forms are not recognized in all states. Check with your health care provider to see if your state recognizes this form.

Still Not Sure?

What happens if you have no advance directive or have not made plans and you become unable to speak for yourself? In this situation, the medical caregivers will look to the following members of your family to speak on your behalf. In the order of priority, the following people can consent to treatment for you:

  1. Your spouse
  2. Your adult child, with the waiver and consent of all other qualified adult children
  3. The majority of your children
  4. Your parents
  5. An individual clearly identified to act on your behalf before you became incapacitated, your nearest living relative, or a member of the clergy.

A Quick Guide to Helping You Select a Medical Power of Attorney

Select someone who:

  1. Knows you well
  2. Is calm in a crisis
  3. Understands how you would make the decision if you were able
  4. Is not afraid to ask questions and advocate to doctors
  5. Can reassure and communicate well with your family

Topics to review with your MDPOA

  1. What treatments you particularly want to receive or refuse? (mechanical ventilators, feeding tubes, renal dialysis, etc.)
  2. What are your views about artificial nutrition (food) and hydration (fluids)?
  3. Would you want to receive treatments such as those above for a time, but have them stopped if there was no improvement in your condition?
  4. What are your guiding principles regarding continued medical treatment in the face of a significantly altered mental status or physical status? What conditions would you be willing to endure to remain alive?
  5. What is your position on long-term placement in a skilled nursing facility?
  6. Do you have particular life goals that you wish to reach if at all possible (a wedding/wedding anniversary, loved one’s graduation, etc.)?

Please fill out our contact us form or call us at 210-444-2244 to learn more about how Alamo Hospice can help you and/or your loved ones, today. We have hospice offices in San Antonio, New Braunfels, Castroville, Boerne, Kerrville, Conroe and Livingston and serve many surrounding counties.

About Alamo Hospice

At Alamo, we take our commitment to providing care at the end of your life or your loved one's life as seriously as if you were our own family member. We believe your journey should be focused on living each of your days fully, however you define that. Our promise: No one dies alone, afraid or in pain.

Explore this site to see the impact our care has had on others at the end of their life. Discover our exceptional care to Veterans, check out who will care for you, including our complimentary alternative therapies, or give us a call for further information. We look forward to being of service to you on this most sacred of journeys.

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Alamo Hospice, San Antonio
3201 Cherry Ridge Street
Suite C313
San Antonio, TX 78230
Phone: (210) 444-2244
Fax: (210) 444-1144