Wednesday, August 16, 2017  

Advance Care Planning


Advance Care Planning describes the process by which people can state the kind of care they would like to receive in the event they are unable to speak for themselves due to a serious illness or injury. Advance Care Planning for medical treatment can include a number of other considerations, but stating your wishes for future care, particularly for end-of-life care, then communicating and documenting them, are the most important steps.
As you read the following information, keep in mind that advance care planning is a highly personal process. Its purpose is to provide a way for you to convey your specific thoughts, desires and values related to medical treatment. In its most basic form it is a discussion that all of us should think about and then share with our care 
providers, our families and our trusted friends.

Some Myths about Advance Care Planning

Randy J. Ferrance, MD
Internal Medicine/Hospitalist
Riverside Tappahannock Hospital

Sometimes the best way to get a sense of what something is includes looking at what it isn’t. In the case of Advance Care Planning I hope that looking at these common misconceptions and their realities can offer some insight into the process.

Myth #1: Advance Care Planning is only for 
the seriously ill and the frail elderly

The fact is, Advance Care Planning is something every adult should carry out even if they are young and in good health. While planning for the future makes sense for people with chronic illnesses or life-threatening diagnoses, it’s also a very good idea for all of us since a sudden injury or even a serious illness can’t always be predicted. My work over the years providing inpatient care as well as emergency treatment has made me a strong advocate for Advance Care Planning. By considering future possibilities at a time when you can 
make your wishes clearly known, you 
can avoid the kind of confusion and anxiety that can arise if you were unable to speak for yourself.

Myth #2: Advance Care Planning only covers the treatments you don’t want

The planning process gives you the chance to state your preferences for care, and for some people that can mean deciding against certain types of medical interventions in the event you are diagnosed with a life-limiting illness or have a sudden medical crisis. At the same time, Advance Care Planning offers the opportunity to decide what you would want in terms of available life-sustaining measures. Simply put, there is no built-in preference one way or the other and in either case your plan reflects very personal choices.

Myth #3: Advance Care Planning involves a discussion with a lawyer

One of the best places to talk about advance care is at the kitchen table with the people closest to you. You’ll also want to share your wishes with your primary care doctor but other than that, no one else needs to be involved when you’re going over your thoughts and plans. The subject of advance care isn’t one that we generally are eager to discuss, but it’s a very important conversation and one that I think is best carried out in comfortable and familiar environment.

The Difference between Advance Care Planning and Advance Directives

Gregg A. Shivers, MD
Internal Medicine/Hospitalist
Riverside Walter Reed Hospital

As Dr. Ferrance describes, Advance Care Planning is the process that centers on discussing and sharing your thoughts and wishes about the kind of care you would want to receive if you were unable to directly participate in medical decision making. Advance Directives refer to the actual written documents that provide specific guidelines for your wishes to be honored and carried out by loved ones and care providers.
Basically, there are two forms of Advance Directives: A Living Will that spells out your decisions for treatment and specific life-sustaining measures; and a Durable Power of Attorney for Health Care that names a proxy – a family member, close friend or someone else you trust to make choices for you when you are unable to make them for yourself. In Virginia, this person is usually referred to as your agent. Keep in mind that the Living Will has no relation to property or assets and is solely about your decisions for medical treatment.
For that reason, it’s a good idea to familiarize yourself with the kind of life-sustaining procedures that are available – including things like mechanical breathing equipment, tube feeding, cardiopulmonary resuscitation and other measures. In our state, neither the Living Will nor the Durable Power of Attorney for Health Care requires retaining an attorney, although some legal advice may be helpful if you have a complex health condition. What’s most important is that you take the time now to put these documents together. It doesn’t really take all that much time and what I’ve seen over the years is that most people agree that the peace of mind you gain from knowing that your preferences for care have been communicated is well worth the effort.

Take Advantage of the Available Resources and Take the Next Step

Carol Wilson
Director of Palliative Care 
and Advance Care Planning
Riverside Health System

Moving forward with Advance Care Planning, particularly because it can include end-of-life decisions, can be bit overwhelming at times. The good news is that you can count on a wide range of resources that can help answer your questions, provide the documentation you need and even assist you with putting the forms together.
A good example is the Advance Care Planning Coalition of Eastern Virginia. As a member of this partnership made up of the region’s leading health systems and agencies on aging, Riverside supports the As You Wish program which lets visitors to the website download needed documents and materials while also providing links to additional information related to Advance Care Planning. These same services are also available by phone.
Other helpful information, including a Discussion Guide and Workbook, is available at riversideonline.com/acp. Along with the As You Wish material, the Riverside site also includes an Advance Directive form that can be downloaded. In addition, adults 55 years of age and older can take advantage of Riverside’s Senior Care Navigation Program. This free service can help provide the information you need to make informed decisions on a variety of health-related issues and community related services.
I think one of the best ways to look at Advance Care Planning is to put it in the context of your overall approach to health care. The more control and involvement you take with your health and wellbeing, the better the outcomes. Planning now for a time in the future when you might not be able to make decisions gives you a strong and clear voice when you otherwise couldn’t make your wishes known. And at the same time, it has to the potential to bring a great deal of comfort to the people who love and care about you.