When Time Runs Out
April 25, 2017
By: Jody Moss
Email: mossjm1@dshs.wa.gov
They say you need to lead off an article with the main point, so I’m going to ask you to visit a website and fill out a survey – but let’s put a hold on that for the moment. (see the end of this article)
First of all…None of us gets out of this life without dying – just doesn’t work.
Way to start my first monthly article with a really dark topic!
Maybe I should introduce myself first…you may have noticed I am not Dawn Springgate – who is off and away on adventures with her husband. Good luck Dawn and thank you for the years of great writing and reading. I am Jody Moss, the Olympic Area Agency on Aging Director of Planning and Contracts Management – that’s a mouthful, I know.
Now back to the dark topic….None of us gets out of this life without dying – just doesn’t work.
When I imagine my last days which may be 25 years from now or may be tomorrow, I imagine being with my husband and kids, sharing memories, of a life well lived, and my husband and I peacefully go to sleep and that’s it. Cue the orchestra.
Okay, now I’m worrying about if my kids will know what to do next? And there is that horrendous closet and the nightmare work shop to clear out. So on my “plan” is cleaning the closet and the workshop.
More importantly, will they know what I want and need when I can’t tell them; where to find important papers; do they know we want to donate our organs: do they know that neither of us wants to be on extended life support? Does my doctor know?
I think they do, but I cannot get my 30 something children to talk about this. And honestly, I don’t think I’ve talked to my doctor about this. She probably won’t even be my doctor by then since we are the same age. Come to think of it, my husband and I have not really spoken in depth about this since we signed a living will more than 20 years ago. More thoughts for my “plan.”
Most of us, even if we haven’t expressed it have certain hopes around dying. Generally, most of us hope we die at home, not in the hospital, not in intensive care, not on life support, and not costing our families lots of money.
But we can’t count on this unless we take some action. Here is the reality:
o Nearly 40% of us will be in a hospital at the end of our lives, even though 70% of us want to stay at home to die
o If that happens our families are likely to incur high often staggering medical bills
o Our loved ones will experience increased stress, anxiety, depression – some studies have even reported that families can experience post-traumatic stress disorder when a loved one ends up in an intensive care unit at the end of their life
o Most of us want our doctors to talk with us about this kind of planning before we are in a critical circumstance but only about 17% of doctors actually do talk with us about this
o Most of us want to be comfortable and just improve the quality of our days at the end of life, but around a quarter of us will end up with invasive tests and treatments we didn’t really want
o Too many of us don’t know what our choices are, or how to make a plan that will be followed by our loved ones or our medical providers.
o For young people who experience a devastating health injury, an unrelated loved one (their significant other) who may know that person best in the world may be locked out of any decision making process.
So what’s this about making a plan? First I need to think about what I really want. What’s important to me? Hmmm. That takes some work. Maybe I should talk this over with my husband, and with my kids for sure.
I know that for that I am going to need some help. There is a very cool tool online called the Go Wish Game (www.GoWish.org) and click on the box that says Play the Online Version. This game can help me get ideas about what is most important to me and it can help my children understand that this is something we need to talk about. I plan to ask them to complete their own game and my husband too. Then we will have a gathering – and with my odd sense humor I may name it the casket ready weekend event. (To be honest, not my invention – I actually heard that one from the Port Angeles Senior Center.)
Now I am armed with some thoughts to begin the conversation. Now I need to make a plan, and by Plan I am talking about Advanced Directives. Maybe you have heard of this term.
Maybe you already have a plan in place – good for you! Do your kids know? Does your doctor? Is it in your chart? Is it in the electronic record? More complications.
A plan may have several different documents that you complete or it may have different tools all combined into one document. It may be helpful for some definitions at this point:
Durable Power of Attorney for Health Care: Also known as “durable medical power of attorney or health care power of attorney,” lets you name someone else to make decisions about your health care in case you are not able to make those decisions yourself. It gives that person (called your agent, surrogate or proxy) instructions about the kinds of medical treatment you want and do not want and stays in effect only for the period of time when you become incapacitated and unable to handle matters on your own.
Living Will/Health Care Directive: A living will or health care directive describes an individual’s health care wishes for the end of life when that individual is unable to communicate those wishes. So think of the Durable Medical Power of Attorney as the decision maker and the Living will as guidance in what decisions you want them to make.
Written personal statement. This is a summary of your values and goals of care relating to your end-of-life care wishes. It is a personal story that helps your family, your health care agent (see above), and health care providers understand you as a person apart from your illness and/or disability. This statement will help to fill in the gaps in health care decisions that may not be part of your living will.
Physician Orders for Life-Sustaining Treatment (POLST). Although not an advance directive, POLST is meant for individuals with serious illness or frailty, in instances where your life ending soon would not be unexpected. The POLST provides medical orders given by your doctor for current treatment to guide emergency medical personal and in-patient treatment decisions, but is not a replacement for a Living Will/Advance Directive.
Washington State Requirements – Different states have varying requirements for advanced directives, In WA state there are different requirements for different documents. But new this year are requirements for documents to be notarized. Some forms are not accepted in different states. The Olympic Area Agency on Aging has a link to some resources on the website.
So now you know the terms. Already did this? Great – feel good about it, and maybe revisit it and make sure your doctor knows about it.
Do you have to have one? No. Does it help you and your family and your doctor? Yes absolutely!
So here is more help: The Olympic Area Agency on Aging has just a few of the many Advance Care Planning tools linked to our website – www.o3a.org and click on the link in the 3rd paragraph which says: “Click here for some links to different advanced care planning resources.
There are many types of plans you can choose from to complete on your own, with family, or with your provider, or with friends. You can also talk with a lawyer if you prefer.
And if you decide not to, maybe just play the Go Wish Game with someone you love and compare notes so you know what each other is thinking is important. Do it over a cup of tea, a glass of wine or shot of whiskey and call it a “death café”. And before you ask, yes, a “death café” is a real thing – google it!
But before you do that…take the survey and make a plan.
Here is the survey information:
The Advisory Council of the Olympic Area Agency on Aging is working to help community members learn more about Advanced Care Planning. Advance Care Planning is making decisions about the health care you would want to receive if you become unable to speak for yourself.
These are your decisions to make, regardless of what you choose for your care, and the decisions are based on your personal values, preferences, and discussions with your loved ones and/or your medical providers. Our goal is to get survey results from a broad swathe of community members, old, and young, and in between, men and women and from all areas of our 4 county region. With your feedback we plan to design programs to introduce this topic to the community and to assist community members in learning more about what they tools and approaches are available to best meet your needs.
Would you be willing to:
1) Take a brief, anonymous survey to help us with this?
2) Share this survey with your clients, friends, and others who use a computer and email?
If yes, please visit our website at www.O3A.org and select the “Health Care & Decision Making Survey” link highlighted in blue on our home web site at. If you have any questions please contact our office at 360-379-5064 or 1-866-720-4863.
Thank you for taking this anonymous survey to help our agency improve local services. The survey does not ask for your; name, social security number or date of birth, and will take you approximately 15 minutes to complete.