Having an Advance Care Plan in Place


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The United States population is rapidly aging. According to the Centers for Disease Control (CDC), by 2030, the number of Americans aged 65 and older will more than double to 71 million older Americans, comprising roughly 20 percent of the U.S. population.

Many chronic diseases unfortunately can eventually exhaust all reasonable medical approaches and the patient and family must then navigate this final but important stage of life. Heart failure is one of those chronic diseases which can lead to the need for end-of-life discussions including an advance care plan. The Heart Failure Society of America (HFSA) has put together information on advance care planning to provide not only grace and dignity for the patient, but to help ease the burden of the family.

A good place to start is with an understanding of what such a plan entails. It is basically a written document that helps you ensure that your health care is customized to reflect your personal preferences and health needs, as well as meet your social, cultural and religious requirements. Important things to consider include:

• Whether you want to be resuscitated if your heart stops beating;

• If you want to be placed on a ventilator if you can’t breathe on your own; and

• How you want pain relieved if it develops.

“Discussing end of life issues is not exactly something any of us wants to bring up, but telling people what you want before you become incapacitated ensures that your wishes will be carried out, and protects your family from having to deal with the burden of second guessing whether or not you’d agree with their decisions,” says Barry H. Greenberg, MD, president, Heart Failure Society of America (HFSA), a non-profit organization of health care professionals and researchers who are dedicated to enhancing the quality and duration of life for patients with heart failure and preventing the condition for those at risk.

The HFSA has put together a booklet (Advance Care Planning) focusing on end-of-life issues. This information, which targets heart failure patients, can also be applied to other chronic medical conditions. The booklet explains, in easy to read and understand detail, the various components of an advance care plan, and how to put one together. These include:

• An advance care directive — This document will provide clear evidence of your wishes regarding treatment and can include a living will, a durable health care power of attorney and a statement about organ donation.

• A do-not-resuscitate order — This directive made by you or your family in consultation with the doctor, tells doctors, nurses and other rescue personnel what they should or should not do when a person stops breathing or when their heart beats so irregularly as to threaten life or stops beating entirely. A do-not-resuscitate order can include instructions on whether to use different types of methods to revive a person.

• A living will — This legal document lets a person who is unable to participate in decisions about their medical care to express their wishes about life-sustaining treatment. A living will is usually used during a terminal illness when a person is unable to communicate; it lets you set limits on what is done to you regarding the use of medical treatments such as CPR, blood transfusions, mechanical breathing, surgery, antibiotics, kidney dialysis and invasive measures to provide nutrition and fluids.

• A health care power of attorney — This allows someone you designate to make all heath care decisions for you, including the decision to refuse life-sustaining treatment if you are unable to make the decision for yourself. You can give someone a general power of attorney or you can limit their decision-making to certain issues by including instructions about your care. For example, you can specify preferences regarding particular treatments such as tube feeding, intravenous fluids and organ donation if you have not covered those subjects in a living will.

• A financial plan — You and your family may have concerns about paying for medicines, doctor and hospital bills and other types of health care. A financial plan can help you deal with these issues and also provide for your family.

Once you’ve pulled these materials together, you may wish to consult a lawyer to help you ensure that the plan meets your individual wishes and state legal requirements. And be sure that your family knows and understands your wishes for care.

Discussing these issues now will make implementing them easier when that becomes necessary. To order a copy of the brochure, or access any of the other educational materials put together by the Heart Failure Society of America, log on to Abouthf.org.

Article courtesy of ARAcontent

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