Advance Care Planning for Health Care, Is It Right For You?

Let me begin by saying that I’m a dietitian who has expanded into wellness and sometimes this wellness piece takes me into unchartered territory.  Advance Care Planning was definitely one of those trips up the river with a missing oar and a hopelessly misaligned boat at times.   I live in Western Michigan and our new community goal is that everyone, 18 years of age and older, completes an Advanced Care Directive for Health Care.  When I was approached about leading a team at our hospital, my response was “Sure I’m game, but I’m not a very touchy-feely person. It kind of sounds like this project calls for it, so I’m just telling you going in, that’s not me. Teach me the program and let’s start getting people checked off.”

When peers asked me how “death” fit into my wellness role, I responded that it was a natural fit into the spiritual and emotional health bucket. Widget is to hole as nut is to bolt. Just as I teach Financial Peace by Dave Ramsey to enhance our colleague’s financial health, Advanced Care Planning for Health Care has the potential to enhance one’s spiritual and emotional health.  When asked “Why now? You’re young and healthy,” (literary licence taken.) I  likened it to creating a retirement planning or writing a will.  Advanced Care Planning for Health Care was something that was better done on your own terms and timeframe as opposed to when a doctor tells you “it’s time to get your affairs in order.”  Throughout the planning I was gently hand slapped by the steering committee that my tendency to treat this as a “one and done” was not the preferred approach. Rather the end goal was to facilitate intentional and meaningful conversations with individuals and their selected patient care advocates, so that each individual’s values, beliefs and preferences on health care were honored should they not be able to speak for themselves.

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Gunderson Health

During the training sessions our implementation team was asked to reflect on the people in our lives who had been hospitalized and or died.  What did it feel like? What would we do the same or differently? What did they know about their chronic illness or condition? How might we respond in a similar situation?  Gut check. Time warp back to this summer.  My dad had a stroke while we were on vacation.  Our vacations are always jinxed, Boston Marathon bombing, my husband’s brother died, don’t get me started because it’s a joke at work that you don’t want to travel with me.

Unbeknownst to all this is my dad’s second stroke.  He is now a survivor of both a left and a right side stroke.  He is in a hospital bed being kept alive by a feeding tube, IV and ventilator and becoming progressively more unresponsive.  My dad is a control freak, a workaholic and a perfectionist.  At age 72 he still builds beautiful homes in our community, with cracked, scarred, callused hands and arthritis that has caused him to slow down but never stop.  He is humble but very proud of everything he creates and he continues to teach himself new building skills. He is an old dog with new tricks.  He is a thoughtful, gentle man who is an incredibly great listener and a wise counsel throughout many times in my life and others.  I am his appointed patient care advocate.  I struggled to draw each breath out of my lungs as the two doctors explained his prognosis.  My three aunts and uncle, his brother and life partner look to me as the medical staff directs their conversation about prognosis and ultimate decision to me.  I shrink beneath their gaze with the weight of the decision but draw strength from my father.  He gave us a final gift, he had the conversation with each of us.  While not easy, ever, we all knew exactly what he wanted done.  We clearly understood what “living well,” meant to him and we were able to honor his wishes even though he was unable to speak for himself.

An advanced directive is a document that specifies the type of medical care you want in the future and who you want to make decisions for you if you are unable to speak for yourself.  Is it right for you?Absolutely, everyone over 18 years should complete one.
A serious illness or injury can happen at any time.

  • Do your loved ones know what to do and who takes the lead if you unable to do so?
  • Can they make decisions about your healthcare without regret, remorse or anxiety because they know how you would have answered life dependant healthcare questions?
  • Could they have these conversations in a way that binds the family together rather than tearing them apart?

Think of advanced care planning as your final gift to your loved ones and to yourself.  It’s your personal insurance policy that your values, beliefs and preferences are honored despite your inability to direct your own health care.

You can find information on advance care planning at The Centers for Disease Control and National Institute for Health.  If you live in Michigan, Making Choices Michigan also has great resources.  Your first step is to select a patient advocate. Someone who

·      Knows your values and beliefs

·      Is over the age of 18

·      Need not be a family member

·      You can trust to honor your values and beliefs in what oftentimes maybe a stressful and difficult situation.

Your second step is to have a facilitated conversation (smile, yes I get it now.)  Just completing the forms does not insure that your patient advocate has a good understanding of your values and beliefs so have the talk.  During this session you will discuss how you define “living well.”

One individual in our group reflected that her definition of “living well” was “being able to be an active participant in my life.  If the only reason my body is living is because of a feeding tube and IV, that’s not my definition of living well. “

Another person defined “living well” as being able to ride in their golf cart and shoot the last putt on each hole of the golf course every night.”

Some people said they would be fine on a ventilator while others said it would cause too much anxiety and the burden would be too much.  Everyone’s definition of “living well” was a little different so it became very clear to me that this conversation was an important one.

So in my newest role, I now help people create plans that improve their nutritional health, their wellness and death.  A well-planned life includes Advance Care Planning because it’s part of a life well lived!



Categories: Nutrition & Wellness

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