Advanced Health Care Planning: Please Don’t Delay It

Advanced health care planning is something most Americans don’t think about, but they should. You don’t want to get to old age and not be prepared to handle health issues in your senior years. You never know when a health crisis may suddenly occur.

Planning for health care in the future is an important step toward making sure you get the medical care you want. Your immediate family should also be involved and make decisions, if you are incapacitated.

The National Institute on Aging (NIA) has set forth a list of guidelines that will help you and your family make the right decisions.

Knowing who you want to make decisions on your behalf will insure that you get the best care possible.

Advanced Health Care: Planning Ahead Is Smart

Advanced care planning involves learning about the types of decisions that might need to be made. Involve your family and/or close friends in case you are not able to make decision(s) yourself.  Put your preferences into an advance directive, a legal document that goes into effect only if you become incapacitated and can’t speak for yourself. Always have a back up crew to help you.

Advanced Health Care: Decisions

Sometimes decisions must be made about the use of emergency treatments to keep you alive. Doctors can use several artificial or mechanical ways to try to do this. Decisions that might come up at this time relate to:

• CPR (cardiopulmonary resuscitation)
• Ventilator use
• Artificial nutrition (tube feeding) and artificial hydration (IV, or intravenous, fluids)
• Comfort care

Comfort care is anything that can be done to soothe you and relieve suffering while staying in line with your wishes. It includes managing shortness of breath; limiting medical testing; providing spiritual and emotional counseling; and giving medication for pain, anxiety, nausea, or constipation.

Advanced Health Care: Plan Ahead

Start by thinking about what kind of treatment you do or do not want in a medical emergency. It might help to talk with your doctor about how your current health conditions might influence your health in the future. For example, what decisions would you or your family face if your high blood pressure leads to a stroke? You can ask your doctor to help you understand and think through your choices before you put them in writing. Medicare or private health insurance may cover advance care planning discussions with your doctor.

Also, even if you don’t have any medical issues now, your family medical history might be a clue to help you think about the future. Talk with your doctor about decisions that might come up if you develop health problems similar to those of other family members.

Conclusions

In considering treatment decisions, your personal values are key. Is your main desire to have the most days of life? Or, would your focus be on quality of life, as you see it? What if an illness leaves you paralyzed or in a permanent coma and you need to be on a ventilator? Would you want that?

What makes life meaningful to you? If your heart stops or you have trouble breathing, would you want to undergo life-saving measures if it meant that, in the future, you could be well enough to spend time with your family? Would you be content if the emergency leaves you simply able to spend your days listening to books on tape or gazing out the window?

But, there are many other scenarios. Here are a few. What would you decide?

• If a stroke leaves you unable to move and then your heart stops, would you want CPR? What if you were also mentally impaired by a stroke—does your decision change?
• What if you are in pain at the end of life? Do you want medication to treat the pain, even if it will make you more drowsy and lethargic?
• What if you are permanently unconscious and then develop pneumonia? Would you want antibiotics and to be placed on a ventilator?

For some people, staying alive as long as medically possible, or long enough to see an important event like a grandchild’s wedding, is the most important thing. An advance directive can help to make that possible.

Moreover, it allows you to provide instructions for these types of situations and then to change the instructions as you get older or if your viewpoint changes.