Grand Plans: September 26, 2024 (revised)
A semi-monthly newsletter from Grand Plans designed to normalize and celebrate our glorious geri-destiny through information, stories, real talk conversation, smart planning and shared experience.
Things I’m prattling on about today
One of the courses I’m taking in my master’s studies is Elder Law and I’m OBSESSED with this topic. Recently, we engaged in the topic of advance directives and I wanted to share some of the high points with you because they are just too darn important to keep to myself. Assembling your advance directives -- including a living will, healthcare power of attorney and DNR or POLST order -- is one of the most important steps you can take in designing a workable Grand Plan, both for yourself and the people you love. So, let's talk a quick minute about the whats and hows of why that is.
Let me first send you to the National Council of Aging's web page called "Getting Your Affairs in Order Checklist: Documents to Prepare for the Future." This is a really helpful place to begin the process. It will tell you all about the importance of advance directives and fill you in on a lot of other critical information including a handy checklist for getting your affairs in order, a list of documents you need to have in place, who can help you get your affairs in order and other decisions that can be tackled in advance, before crisis hits and the wheels fall off your bus.
The next thing you need to know about advance directives (something I did not understand before taking this course) is that you can draw up your own advance directives without the input or expense of an elder law attorney. You need a good lawyer on your side to design documents like a last will and testament, durable power of attorney and a trust, but you don't really need one to complete a healthcare power of attorney, living will or Do Not Resuscitate (DNR)/Provider Orders for Life Sustaining Treatment (POLST) documents. It may smart to work with an attorney to make sure your healthcare power of attorney and living will drafts meet the standards of the state in which you live, but it's not required. The DNR and POLST are actually prescribed by your physician, so definitely no lawyers needed for that!
Here are the key differences and applications of these four advance directive documents, according to my little ChatGPT friend who helps me decipher complex topics:
1. Living Will
Purpose: Specifies your preferences for end-of-life care, such as whether you want life-sustaining treatments like ventilators or feeding tubes.
Decision-Maker: No designated decision-maker. The document directly expresses your wishes.
Scope: Focuses mainly on specific treatments in terminal or irreversible conditions.
Activation: Activated when you are terminally ill, in a permanent vegetative state, or otherwise incapacitated and unable to communicate.
Flexibility: Less flexible. It only addresses the scenarios explicitly stated in the document and may not account for unforeseen situations.
2. Durable Power of Attorney for Health Care (Healthcare Proxy)
Purpose: Appoints someone to make healthcare decisions on your behalf if you are unable to do so.
Decision-Maker: Your appointed healthcare agent or proxy makes decisions for you.
Scope: Broad. It covers all healthcare decisions, not just end-of-life care, and includes decisions about treatments, doctors, and healthcare facilities.
Activation: Activated when you are incapacitated and unable to make decisions, regardless of whether the situation is life-threatening.
Flexibility: More flexible. The agent can make decisions in a variety of circumstances, including unforeseen medical situations.
3. Do Not Resuscitate (DNR) Order
Purpose: Instructs healthcare providers not to perform CPR or other resuscitation efforts if your heart stops or you stop breathing.
Decision-Maker: The order is typically signed by you and your doctor, but it does not appoint a decision-maker.
Scope: Limited to resuscitation measures (CPR, intubation, etc.). It does not address other medical treatments or conditions.
Activation: Activated when your heart stops or you stop breathing, typically during a medical emergency.
Flexibility: Very limited. It only covers situations where resuscitation is needed.
4. Physician Orders for Life-Sustaining Treatment (POLST)
Purpose: Medical orders that specify your preferences for a wide range of life-sustaining treatments, including resuscitation, intubation, feeding tubes, and more.
Decision-Maker: The form is filled out by you and your healthcare provider. It does not appoint a decision-maker.
Scope: Broad. Covers a variety of medical treatments and interventions for seriously ill or frail individuals.
Activation: Activated immediately once signed by your doctor, and it applies in all medical settings.
Flexibility: Less flexible. It is a medical order, so healthcare providers are required to follow it exactly unless it is formally updated.
Confused already? Don't be. This is the easiest, smart thing you'll ever do.
If you're feeling ready to get this advance directive chore off your to-do list, then your next stop should be this AARP web page on Advance Directive forms. It links you to advance directive forms and rules for your state. As a resident of Jacksonville, FL I clicked on the state of Florida and got to a page managed by CaringInfo, a program of the National Hospice and Palliative Care Organization (NHPCO), a national consumer engagement initiative to improve care and the experience of caregiving during serious illness and at the end of life. The editable PDF package includes Florida-specific advance directive forms and instructions for preparing an advance directive that meets state requirements. Follow the directions for witness signatures and notarization, and you'll be set with your advance directives!
Neither my course, nor this post, mentioned the completion of an ethical will, which is not a legal or healthcare document but one I believe is also very important. An ethical will is just a common sense, conversationally written, your voice document explaining your thinking about your estate, will and any other directives. This can help add a gentle, loving voice to documents that can sound abrasive
The last step is probably the most important one however, and that is to communicate your wishes to your family, friends and medical providers -- especially the people you may have named in these directives! -- during ongoing, loving and direct conversation. Make sure everyone is on the same page about what you want when you can't articulate it for yourself. This is critical, so I'll say it again: TALK TO YOUR PEOPLE. Make it very clear your intentions so there's no grey area to muddle through when you're hooked up to a machine and people are freaking out.
And one final thought: put these documents in a safe, portable, easy to locate place and TALK TO YOUR PEOPLE about where they can find them. These documents won't do any good if no one knows where they are. More specifically, these documents should not be stored in a lock box. Don't do it! My professor specifically warned us about the challenge of getting legal access to a lock box that indicates who has access. So, no lock boxes! With the DNR, POLST and living will forms, make sure they are scanned into your medical record or are on file with the hospital where you are being treated.
Drawing up, communicating and safely storing your advance directives are among the most loving, generous acts you can do for your people. Plus, it's pretty easy to do if you have a computer and enjoy talking to friends and family. Do it today!
News you can use
Will, or wontcha, read the latest Grand Plans piece in Sixty & Me, which reaches more than 500,000 60-plus-ers around the world? This piece is about some other important documents to write up before it’s too late.
And here’s another Sixty & Me piece I wrote recently about being young at heart and connecting with the cool kids.
But wait…there’s more! You can read the latest Grand Plans piece in agebuzz, an online source reaching more than 50,000 folks around the U.S. It’s about purging our sense of self and our stuff, not exactly acts of advance directive but important to our end game nonetheless.
Lastly, get down with some Grand Plans column action in First Coast Senior Living, one of the most beautiful, informative magazines in Jacksonville!
Make sure you’re connected to Grand Plans on social media (Instagram, Facebook, YouTube and LinkedIn) so you don’t miss a thing! GerontoloGeeWhiz! is the latest little ditty out there on the line. Enjoy!
Grand Plans Podcast
I welcome any podcast guest suggestions! This season we’re talking to people who have been there done that. We’re talking about our experiences and lessons learned. The first podcast is out on the line and it is awesome! What an honor to speak with Kari Bell and Sarah Dymond from River Garden. They have some fantastic wisdom to share! Let me know if you want to be part of the conversation and sharing. I’d love to host you on the podcast.
Shelf life
I am very excited to begin this book, The Second Fifty, by the AARP’s Dr. Debra Whitman. The flap write-up describes the book as a “roadmap for navigating and celebrating the second half of life. Drawing on compelling stories from her own family and people across the country, interviews with experts and cutting-edge research, she shares insights on brain health, the contributions and concerns of an older workforce, caregiving, financing retirement and more.” Sounds like it’s right up the Grand Plans alley!
And of course, it’s also smart to remember to order a copy of Grand Plans and the Grand Planner for all your friends. Let’s hold each other accountable?
Some golden gedunk and goods
Get yourself another few copies of Grand Plans: How to Mitigate Geri-Drama in 20 Easy Steps and the Grand Planner for all the people who like getting gifts in your life! Visit www.mygrandplans.com for links to purchase on Amazon.
And… Check out our Grand Plans merch in our Etsy storefront.
