Advance Care Planning
Advance Care Planning is the "process" of
assisting individuals in understanding their medical condition
and potential future complications; understanding the options
for future medical care as it relates to their medical
condition; discussing choices with family, loved ones, and
providers; and reflecting upon these choices in light of
personal values, goals, and religious or cultural beliefs. This
planning process is vitally important, not only for older
Americans or those who have a serious and/or progressive
illness, but also for healthy younger adults who may lose the
ability to speak for themselves because of trauma or a sudden
unexpected illness.
As such, it
demands guidance in uncovering the patient’s story and
facilitating shared decision making among patient, family,
provider and others. It emphasizes the personal relationships
embedded in making difficult choices for future medical care.
Embracing this definition of advance care planning acknowledges
that it is an ongoing process, not just the completion of one
document.
National
studies regarding end-of-life care for those who have not
prepared indicate that we are failing by not addressing these
issues early. According to the survey, most states received a
"D" grade in advance care planning.
Advance Directives
There are four legal documents that protect one's
right to specify the treatment one wants, or to refuse medical
treatment one does not want, in the event a person loses the
ability to make decisions.
1.
Texas Medical Power of Attorney
·
Lets you name someone to make decisions about your medical
care-including decisions about life support-if you can no longer
speak for yourself.
·
Your attending physician must certify in writing that you are
unable to make health care decisions, and file the certification
in your medical record.
2.
Texas Directive to Physicians and Family or
Surrogates
(Living Will)
·
Lets you state your wishes about medical care in the event that
you develop a terminal or irreversible condition and can no
longer make your own medical decisions.
·
Becomes effective when your attending physician certifies in
writing that you are in a terminal or irreversible condition.
3.
The Out-of-Hospital Do Not Resuscitate Order (OOH
DNR)
The OOH DNR program allows individuals to decide that they do
not want to be resuscitated if they stop breathing and their
heart stops beating. The program allows people to declare that
certain resuscitative measures will not be used on them. Those
resuscitative measures specifically listed in the OOH DNR
legislation are cardiopulmonary resuscitation (CPR), advanced
airway management, defibrillation, artificial ventilations, and
transcutaneous cardiac pacing.
4.
The Declaration for Mental Health Treatment
Lets you state your wishes about mental health treatment.
You are not
required to complete these documents should you choose not to do
so. They are not required for buying
health insurance or receiving medical care at a hospital,
nursing home or home health care agency. Please consult your
legal professional or health care provider if you have
additional questions about any of the information provided.
This information is provided
to comply with the State Advance Directives Act and the federal
Patient Self-Determination Act. Complaints concerning failure by
a hospital, nursing home or home health agency to follow federal
and state advance directive requirements may be filed with the
Texas Department of Health, Health Facility Compliance Division,
1100 West 49th Street, Austin, Texas 78756 (1-800-228-1570). You
are not required to complete these forms as part of patient
registration in a hospital, nursing home or home health care
agency, or at any time in the future should you choose not to do
so.
Communicating Your Medical Care Choices
Advance Directives Recognized in Texas
Medical Power of Attorney
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Now-Spanish
Directive to Physicians and Family or
Surrogates (Living Will)
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Download Now-Spanish
Out-of-Hospital Do-Not-Resuscitate (DNR) Order
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Now-English (Front)
Download
Now-English (Back)
Download Now-Spanish
Declaration for Mental Health Treatment
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Frequently Asked Questions about Advance Directives
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Information about Organ Donation
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Facilitating Your
Medical Care Choices
When you need medical care,
certain decisions need to be made involving the kind of care to
be given. These decisions may become harder if you become unable
to tell your doctor and loved ones what kind of medical care you
want. The law requires that patients be given enough
information to make an informed choice regarding whether to
consent (give permission) to medical care and treatment.
By law, an adult has
the right to be informed of the possible medical outcomes of
such refusal. Consent is not required to provide emergency care
to an adult who is unconscious or unable to communicate and is
suffering from an injury or illness that could result in
immediate death. Problems sometimes arise when an adult patient
needs medical treatment in a non-emergency situation but is
unable to give informed consent or tell the doctor his or her
desire for medical care.
Every adult of sound
mind has the right to decide what may be done to his or her
body. As a patient, you have the right to be told about your
condition, the proposed treatment, the risks of not having the
treatment and treatments available. This information helps you
make an informed decision about accepting or choosing not to
have the treatment your doctor has discussed with you.
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Medical Power of Attorney (formerly
known as Durable Power of Attorney for Health Care)
A Medical Power of
Attorney is a form that allows you to appoint someone (your
“agent”) to make health care decisions for you if you are no
longer able to make decisions for yourself. These decisions can
include (1) agreeing to or refusing medical treatment; (2)
deciding not to continue medical treatment; or (3) making
decisions to stop or not start life-sustaining treatment.
Points to
Remember -- The person you choose as your agent makes
decision for you only if you cannot make decisions
for yourself. Your agent may NOT make decisions regarding:
-
Voluntary
inpatient mental health services
-
Convulsive
treatment
-
Psychosurgery
-
Abortion
-
Withholding
treatment intended for comfort.
Discuss this advance
directive with the person you have chosen as your agent, your
physician and/or attorney before you sign it. Also, give these
individuals copies of your signed Medical Power of Attorney
form. You can change or cancel your Medical Power of Attorney at
any time for any reason. The Medical
Power of Attorney applies only to health care decisions. It does
not apply to financial matters.
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Directive to Physicians and
Family or Surrogates (Commonly referred to
as a Living Will)
A Directive to
Physicians and Family or Surrogates is a form that allows you to
instruct physicians to administer, withdraw or withhold
life-sustaining treatment when it has been determined by your
physician that you have an irreversible or terminal condition
and you are not able to communicate. Life-sustaining treatment
is a treatment or procedure that includes life-sustaining
medications and artificial life supports, such as mechanical
breathing machines, kidney dialysis and artificial nutrition and
hydration, that is not expected to cure your condition or make
you better, and is only prolonging the moment of death.
Points to
Remember -- This advance directive allows you to tell
doctors and those close to you what you wish to be done or not
done should you need life-sustaining treatment.
-
Discuss this
document with your physician, family, clergy, friends or
your attorney before you sign it.
-
You can
change or cancel your Directive to Physicians and Family
or Surrogates at any time for any
reason.
-
This advance
directive goes into effect only when you
have a terminal or irreversible condition and are unable
to make your own health care decisions.
-
This advance
directive applies only to health care decisions. It does
not apply to financial matters.
-
A copy of
this signed advance directive should be provided to your
physician, family members or significant others, the
person chosen as your agent to make health care
decisions and/or your attorney.
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Out-of-Hospital Do-Not-Resuscitate (DNR)
Order
An Out-of-Hospital
DNR Order is a form completed by an individual person and his or
her physician that allows the patient to refuse specific
life-sustaining treatments outside of a hospital inpatient
setting. An Out-of-Hospital DNR Order form or ID necklace or
bracelet will tell health care providers, including emergency
medical service personnel, not to use
cardiopulmonary resuscitation (CPR) and other life-sustaining
treatments.
Points to
Remember -- Any adult person who is capable of making
and communicating informed health care decisions can obtain and
complete an Out-of-Hospital DNR Order.
-
To show that
you have an Out-of-Hospital DNR Order, you must have the
original or a copy of your form with you or wear an
approved ID necklace or bracelet.
-
The
Out-of-Hospital DNR Order form and bracelet must be
obtained through a physician.
-
You may
cancel the Out-of-Hospital DNR Order at any time.
-
Discuss the
document with your physician, family, clergy, and/or
friends before you sign it.
You can consult
your family physician or legal professional for more information
about obtaining or completing an “Out-of-Hospital
Do-Not-Resuscitate (DNR) Order.”
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Declaration for Mental
Health Treatment
The Declaration for
Mental Health Treatment is a document that allows you to tell a
hospital providing mental health services what kinds of mental
health treatment you want, in the event you become mentally
incapacitated. A Declaration for Mental Health Treatment form
indicates the kinds of mental health services you do or do not
agree to (including such options as psychoactive medications,
convulsive treatment and preferences for emergency treatment
such as restraint, seclusion, or medication).
Points to
Remember -- You should consult a lawyer if you have
questions about how the Declaration for Mental Health Treatment
works and under what circumstances your decisions can be
overridden.
-
For the
Declaration for Mental Health Treatment to become
effective, a judge must find that you are incapacitated
because you lack:
-
(1) the
ability to understand the nature and consequences of
a proposed treatment, including the benefits, risks
and alternatives to the proposed treatment, and;
-
(2) the
ability to make health care treatment decisions
because of impairment.
-
The law
defines “incapacitated,” and the court determines
“incapacitation” in one of only two ways:
-
(1) in a
guardianship proceeding, or
-
(2) in a
hearing to consider the forced administration of
psychoactive medication.
-
The
Declaration for Mental Health Treatment is generally
valid for only three years from the date it is signed.
-
You may
change or cancel your Declaration for Mental Health
Treatment at any time as long as you are mentally
competent.
-
You may
obtain forms for the Declaration for Mental Health
Treatment from a psychiatrist, psychologist, licensed
social worker, other mental health provider or an
attorney.
-
A copy of the
signed document should be provided to your physician,
family members or significant others, the person chosen
as your agent to make health care decisions and/or your
attorney.
Note:
People who need
inpatient mental health services and present to a facility that
does not provide mental health services will be examined to
determine whether an emergency medical condition exists. If an
emergency medical condition exists, appropriate stabilizing
treatment will be provided and then the patient will be
transferred to a facility that provides inpatient mental health
services.
You can consult
your family physician or legal professional for more information
about obtaining or completing a “Declaration for Mental Health
Treatment.”
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Frequently Asked Questions about Advance
Directives
Where should I keep my
advance directives?
You should keep the
advance directive forms that you sign and give a copy to your
regular doctor and others who are likely to be with you if you
become seriously ill. Give a copy of your living will and your
medical power of attorney to the person you have chosen as your
agent. You should keep a record of everyone who has a copy.
Remember, you can change or cancel an advance directive at any
time. If you wish to cancel an advance directive while you are
in the hospital, tell your doctor, family, health care agent,
and others who need to know.
Do I have to
have an advance directive?
No one may force you
to sign an advance directive. No one may deny you medical care
or insurance coverage because you choose not to sign one. You
are not required to complete advance directives as part of
patient registration in a hospital, nursing home, or home health
care agency. If you do sign one, it will not affect any other of
your rights to consent to or refuse medical treatment.
What if I
don’t have an advance directive?
If you have not signed an advance
directive and you become ill and cannot state your wishes, your
attending physician and certain family members can make
decisions about your care.
What are your
agency's policies about consenting to medical treatment?
Homestead Health Care
Services, Inc. is committed to honoring a patient’s rights
to make his or her own medical decisions, including the right to
refuse treatment. Our Agency have
adopted formal policies to respect your right to make an
informed decision concerning your medical care to the extent
permitted by law. In addition, the policies acknowledge a
patient’s right to have advance directives and to honor
treatment decisions made by a patient’s medical power of
attorney. The policies describe the ways to inform patients
about advance directives. If you would like to have more
information about these policies, contact your nurse or doctor.
When should I complete
these forms?
It is never too soon
to talk about serious illness and what treatments you would
desire if you were too sick or unable to state the treatment
choices you would want to make. This topic is important for
everyone to:
For Help
For help with filling
out an advance directive, ask our staff member to assist you further. If you have an
advance directive and you believe it is being ignored, please
contact the administrator on duty for access to the agency’s
ethics committee as applicable. You may also contact the Texas
Department of Health, Health Facility Compliance Division, 1100
West 49th Street, Austin, TX 78756 (1-800-228-1570) regarding
your concerns.
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