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Advance Directives ERIE’S ORIGINAL HOSPICE 202 EAST 10TH ST. ERIE, PA 16503 Living Will – A written statement of your personal desires regarding life-sustaining treatment and other care. POLST (physician’s order for life sustaining treatment). Similar to a L.W. but done with your Doctor and it is viewed as a physician order for healthcare professionals to follow. A health care agent is a person you choose in advance to make health care decisions for you in the event that you become unable to do so. A health care agent can help make medical decisions on your behalf at the end of life or any other time you are not able to communicate, such as if you are severely injured in an accident. A health care agent also may be called a health care proxy or surrogate or an attorney-in-fact. Healthcare Representative – The health care representative in most cases will be selected by the statute, not by the patient himself or herself. Healthcare providers, physicians or there staff may not sign for a patient they are treating. H.C. providers may assume that an AD presented to them is valid. Executing an advance directive Adults (18 and over) of sound mind An advance directive must be in writing, dated and signed by the patient or an individual acting on the patients’ direction. Witnessed by 2 individuals who are 18 or over Advance directives are only enacted when: A Physician has documented: a) You are incompetent b) You are permanently unconscious c) You have a life limiting diagnosis or are at the end stage of a medical condition Definitions Incompetent: Generally means that the patient is not able to understand, make and communicate health care decisions, even when provided appropriate information and aids. Permanently Unconscious: A medical condition in which the patient has total and irreversible loss of consciousness & capacity for interaction with the environment, such as irreversible vegetative state or an irreversible coma. End stage medical condition: An incurable & irreversible medical condition in an advanced state caused by injury, disease, or physical illness that will result in death despite the introduction or continuation of medical treatment. Note: there is no maximum life expectancy parameter. The condition needs to be advanced. Living Wills focus on life-sustaining treatment & other end of life care. A health care agent may be given authority as broad as the patient would have if competent. In contrast to living wills, health care agents are not restricted to end of life decision making 3 A health care agent when duly authorized generally may direct the provision, continuation, withholding, or withdrawal of all forms of medical care from the patient. PENNSYLVANIA: Unless a patient designates a HCPOA the following is the statutory order accordingly: 1) Spouse 2) Adult child 3) Parent 4) Adult grandchild 5) Close friend As is the case of a health care agent, a health care representative generally may direct the provision, continuation, withholding or withdrawal of medical care including life sustaining medical care. Living Wills are not required to be notarized in Pennsylvania if you travel amongst other states please verify each states law regarding living wills. Emergency professionals may disregard living wills, if you have a signed and completed POLST form (on the proper pink paper) your wishes may be honored. Challenges: Modified rules apply to withholding or withdrawal of artificial nutrition & hydration. There is a “rebuttal presumption” that the patient would want this treatment in the absence of the 4 patient specifically stating otherwise in writing. Generally, speaking, the presumption may be overcome if the patient clearly expressed wishes to the contrary or it is clear from the patients’ preferences & values that the patient would not want the artificial nutrition & hydration. A direction to withhold or withdraw life sustaining treatment generally does not prohibit the provision of comfort care or other beneficial care. Special restrictions apply to withholding or withdrawing lifesustaining treatment from pregnant women. Prescribed decision making process for health care agents & representatives includes requirements to protect against discrimination of patients because of a disability. If providers refuse to follow the withdrawal of nutrition/hydration then the patient can/may be transferred to another facility 5 Hospice Care 6 Hospice Care •Specialized care focusing on improving ones quality of life. By providing relief from symptoms, pain and stress of serious illness. •Palliative care is for people with serious illness and/or chronic disease. •Services provided by doctors, nurses, and other healthcare specialists Diseases (not all inclusive) Congestive Heart Failure Cancer COPD Chronic heart disease Kidney failure Alzheimer’s (late stage) Parkinson’s ALS MS And many more (discuss your chronic condition with your physician) Controllable symptoms Pain Shortness of breath, Fatigue Nausea or loss of appetite Constipation or diarrhea Difficulty sleeping 7 Depression Symptoms affecting your quality of life Additional benefits of hospice care Close communication with your healthcare team Expert management for symptoms Help navigating the healthcare system Guidance with difficult & complex treatment options Emotional & spiritual support for you and your family Hospice 8 Life expectancy of 6 months or less Care is provided when treatment options are exhausted Care is provided in the patients home (private residence, nursing home, assisted living etc) Paid by Medicare, Medicaid, private insurance Assists with paying for medications, equipment and other services necessary for the comfort of the patient and management of the terminal disease. No homebound requirement Palliative Starts at time of diagnosis Can be provided in conjunction with curative treatments Most often provided in the hospital but is starting to be accessible in the community Limited funding sources for this care No reimbursement for additional services. www.hospiceerie.org (814) 456 6689 Hospice of Metropolitan Erie 202 East 10th St. Erie, PA 16503 9