Editor’s note: This article originally appeared in Sound Publishing’s The Time of Your Life, Spring 2015.
BY BETTY HERMAN
As outreach coordinator for Martha & Mary, I begin most of my talks about end of life decisions by handing out a 9-inch by 12-inch white envelopes to each participant. With a brightly colored marker, I instruct participants to address the envelope with “To:” and “From.” Inside this envelope, they will be placing a great gift.
What is this gift? It is directions for decision making on saving your life, or care when life is ending.
It’s a gift because anyone who you’ve selected to be responsible for carrying out your end-of-life decisions needs to have the information that is unique to you so they will represent your wishes. Simply put, you wouldn’t ask anyone to make care decisions without telling them what you want.
Families who have muddled through, guessed at or argued about care of a loved one will affirm how important it is to have these directions. The person you are asking to make care decision for you is known as a health care agent.
One of the documents your health care agent will want is a a Physician’s Order for Life Sustaining Treatment, or POLST. It is important to have a detailed Health Care Directive. This document outlines choices many people make and allows you to add or delete your individual choices on issues such as the kind of medical treatment you want or don’t want; pain management and possible side effects on mental clarity; how you want people to treat you; and what you want your loved ones to know.
The document provides a form for appointing a health care agent, along with a backup person. Once completed, the form must be witnessed by two people.
The POLST gives immediate information to the Emergency Medical Technicians when 911 is called.
This is a bright green form that is in your home, usually on the refrigerator, that paramedics will refer to until your health care agent arrives or is contacted. The POLST must be discussed with and signed by your physician to be legal. It is just like the prescription you take to the pharmacist, which is signed by the doctor telling the pharmacist that it is OK to dispense a particular medicine. The POLST form tells the EMTs what they can and can’t do if you are unconscious and can’t make decisions for yourself.
There are many guides to help direct your thinking about short and long term health care. One tool is the Five Wishes Document. (Five Wishes is a trademark name and program of Aging with Dignity. For more information go to www.agingwithdignity.org or call 850-681-2010.)
Most of the time I find that few people are prepared.
They haven’t had “the conversation” about end of life decisions because either their doctor won’t initiate it, or the kids bring it up and they reject it, or they bring it up and the kids reject it. It’s emotional.
Sometimes people put off writing things down because they know they will most likely want to make changes down the road.
It’s important to remember to update your information with your health care agent and as life circumstances change. Updates can be done at anytime. Making sure you’ve specified what you want is crucial. It can always be changed later if needed.
In selecting a health care agent, to whom you will be addressing the envelope, choose someone who will be able to say that it is time to end your life if needed. Choose someone who will be able to handle the family dynamics.
That person must be 18 years old or older, who clearly understands your wishes, and who can be assertive, should the need arise. It cannot be your physician or anyone affiliated with a health care facility where you are a patient at the time you sign your advance directive.
Other documents that are essential are a financial will that dictates what will happen to your stuff, who will inherit the what portion of your money, what will happen to real property, who gets which pieces of jewelry, etc.
It is important that this document be drawn up with the advice of a lawyer and sometimes a financial advisor, too. There are legal and tax implications to divesting your assets and getting good advice is critical to minimizing the paperwork and potential family conflicts after one dies.
A third document you want in the envelope is a list of current accounts and such things as user names and passwords for bank accounts. It is important that this be kept up to date and include the location of documents such as wills and insurance policies.
In taking control of your end-of-life decisions, everyone should have a Durable Power of Attorney for Health Care, the Physician’s Order for Life Sustaining Treatment, a Health Care Directive, and a financial will that have been reviewed by an attorney, signed, notarized, and are on file with an attorney, with copies in the hands of your health care agent.
If your Health Care Agent is different than the executor of your estate, then you may want to keep your financial will separate from the POLST and Living Will.
Copies of Five Wishes are available from most Hospice locations and online. Other resources include “My Personal Planner,” by Margie Jenkins; “You only Die Once,” by Margie Jenkins, and “Grandma’s Yellow Pie Plate” by Marlene S. Sturn, which addresses decisions about who gets what and how to avoid conflict.
About the author
Betty Herman is a certified senior adviser and outreach coordinator for Martha & Mary throughout Kitsap County. She hosts informational sessions about end of life decisions periodically. For more, email her at bherman@marthaandmary.org.
Martha & Mary can play a key role in the end of life process for families in the West Sound region. They provide Long Term Care, Memory Care and Rehabilitation services at their Poulsbo campus and work closely with Hospice providers both at the Health Center and in client homes.
