Advance care directives help ensure that the elderly parent you care for has a voice in the kind of medical treatment that they receive if they become incapacitated and are unable to make decisions or let their wishes be known.
It's a good idea for caregivers to ask their person they are caring for to draft an advance care directive. You might want to do so for yourself as well. Elders value their ability and freedom to make choices, especially about the kind of medical treatment they receive.
But what if your elderly parent become incapacitated and is unable to make decisions or let their wishes be known?
Advance care directives can help ensure that your mom or dad's voice is heard in these circumstances. They allow your parent to specify their wishes for health care and life-sustaining measures and to name a person who will make health care decisions for them in the event that they can't do it for themselves.
The types of situations that a health care directive covers are:
- The use of equipment such as or ventilators (breathing machines) dialysis (kidney) machines.
- "Do not resuscitate" (DNR) orders (instructions not to use CPR if breathing or heartbeat stops); in some cases, this also includes life-sustaining devices such as breathing machines.
- Whether you would want fluid (usually by IV) or nutrition (tube feeding into your stomach) if you couldn't eat or drink for yourself.
- Whether you want treatment for pain, even if you aren't able to make other decisions (this may be called comfort care or palliative care).
- Whether you want to donate organs or other body tissues.
When to get Advance Care Directives
It is impossible to know the exact circumstances in which the advance directives are used. When you create the document, it is also impossible to know what medical options will be available, and how the ailing person's feelings might change. For these reasons, the person signing an advance care directive should select an agent who can be trusted to make judgments guided by an understanding of wishes as explicitly as possible. Mulling over end-of-life care with the healthcare agent can help a person sort out his or her feelings, preferences, and values.
Advance directives go by different names in different states, but two common ones are: Living Will and Durable Power of Attorney. A living will states the person's medical wishes that will guide health care if a person becomes mentally or physically unable to make decisions. A durable power of attorney for health care, or health care proxy form, designates a person to act on an ill person's behalf when necessary.
As you prepare these documents, it's a good idea to discuss all health care wishes and decisions with the doctor who is providing care.
Also, because state laws vary, make sure the advance directive complies with current state law. You can use an attorney to draft an advance care directive. Or check with a local hospital or seniors' organization. They may have staff members who can help your parent or family member prepare an advance directive.
Talking to Parents About What Medical Treatments They Want
If you're selected as your parent's health care agent, try to get as much information as possible about his or her preferences for medical treatment.
In the absence of clear directions, medical personnel are legally required to undertake some fairly extreme measures that many people would prefer to forgo. If you're worried about how to broach the topic, consider the following suggestions.
Find opportunities to talk. One of the hardest parts is figuring out how to start the conversation. Find an example, such as a newspaper article about advance care directives, or the experience of a friend or relative. This can create opening for a conversation about medical wishes. Or try mentioning that you are considering an advance care directive for yourself.
Ask a doctor to help. Medical professionals, especially those who deal with older or seriously ill patients, are often well versed in discussing these matters with their patients. Ask for help and ask the doctor to raise the topic. Talking with their doctor openly and honestly about possible medical scenarios can help your elderly parents make decisions.
Don't Overlook A Crucial Step
Desires for healthcare and end-of-life care cannot be followed if they haven't been clearly communicated to key people. As a caregiver, check that the following steps are taken: Ask the parent to discuss their healthcare wishes with a doctor before writing the directive. If a directive has already been prepared, talk with the doctor to make sure the person's wishes are understood and can be followed.
- Provide all doctors caring for the patient with a copy of the advance directive. Keep a copy handy yourself.
- Make sure anyone named as agent in a health care proxy has a copy of that document and knows the goals for medical care.
- Explain the person's healthcare wishes to other family members.
- Realize that more than one discussion with doctors and family is warranted. Revisit the advance directive annually or whenever big changes occur in your loved one's health to be sure the document still reflects his or her needs.
When a person is admitted to a hospital, ask the doctor primarily responsible for the care of your family member to look at a copy of the directive and put it in the medical chart. Sometimes people ask the primary nurse caring for the person to do this. In some hospitals, however, this won't ensure that the doctors giving care will be aware of the directive.