Advance Directives- any suggestions on how to have that conversation?

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My mother in law, 93, has had several ER visits, a hospitalization with surgery and a stint at rehab so far this year. Each time she is asked if she has Advance Directives and she always says she does not want to be resuscitated, but we don’t have a formal document. Once in the ER, when they kept her overnight, a geriatric NP brought in a DNR form which my mother in law signed. It traveled with her up to the hospital room but apparently was only good for that one admission. My MiL is adamant about not wanting to be resuscitated, but I know there are other medical interventions to weigh in on in Advance Directives, like antibiotics, IV fluids, feeding tubes. I mentioned it to her one time but she seemed overwhelmed and merely stuck to her one request for DNR. When she had an outpatient procedure recently, the admission nurse asked about Advance Directives and when my MiL claimed No Resuscitation, the nurse said it doesn’t count if you don’t have a legal document. So- we’ve been “meaning to get around to it”, but dear MiL only mentions such things when she is sick or in some sort of medical crisis, which is a terrible time to bring out forms and documents, then when she is feeling better, that also seems like a bad time to bring up end of life choices. I’m probably in some sort of avoidance mode. But I welcome advice from those who have already dealt with this. She has an appt with her PCP in a couple of weeks and that seems like a good time to address the issue. I just want to be prepared. Thanks in advance.

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Good advice at
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Reply to joemat
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MaryBee Aug 30, 2018
Thank you joemat, I will look into this.
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Thank you fantasmagorical. I was not familiar with the Five Wishes. How wonderful that your mom had this in place at the end and that she had you to honor her wishes. Great idea.
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You do need something documented. My mom ended up in a memory care unit. And they have questioned my refusal of certain care, and I can say go back to her wishes. What I have learned is the care facility does not like the Five Wishes. I think it is because no lawyer is involved. I showed them on the back it is a legal document in most states, some require notarization. So as was mentioned in an another post is to have a POLST. This the family doctor can give you the form. ERs and ambulance services will abide by it where they may question the wording of other advanced directives. I do really like the Five Wishes because it also talks about how the person would like to be treated by family and friends, ex. Do they want visitors at the end or would they rather be just with loved ones. Also talks about funeral wishes. It gave my mom the opportunity to tell me she wanted my siblings to handle things in a manner that we remain close after her death and that she wanted her grand children to know each of them was special to her and she loved them all, equally.
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Reply to fantasmagorical
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Conversations with family members are more important than Advance Directives. Step 1 is to get you MiL to think about outcomes (as Maggiebea says), not proceedures, i.e., resuscitation. What quality of life is unacceptable to her? She needs to think this through, and tell all family members he end-of-life wishes. Try playing this game of cards with her, on line. gowishcards.org. (or buy the cards).
Secondly, she needs to designate someone to speak for her should she not be able to (power of attorney for health care). This means an advance directive is necessary, properly executed for her state. In it, she can exclude anyone that doesn't agree with her, based on the conversations. I disagree with Countrymouse. DON'T LET THINGS BE.
There are on line resources for getting the conversations started (i.e., the conversationproject.org).
Bill finalexodus.org
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Reply to willsim
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Even if you do know your MOL’s intentions, it can be very difficult if the doctors aren’t on side. I remember only too vividly witnessing a serious argument in the hospital corridor outside my mother’s room between her physician and her oncologist, with the oncologist going for resuscitation at all costs irrespective of her known wishes.

Advanced Care Directives differ in different places. Where I am, they now cover pages and pages of complex decisions. However you don’t have to fill in all those pages. You can put in the beginning ‘not to be resuscitated’, nominate who can make other decisions, and cross the rest out. The details are for people who really want to be specific. Cynics would say that most of the medical profession is quite happy that they discourage people from making their own decisions because the form looks too intimidating. My mother’s form was ‘invalid’ at the relevant time because we had previous legislation that was challenged and overturned courtesy of the medical profession and the Catholic church. It's at least better now.

Check that 'simple lines' are the same where you are, and have another try.
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Reply to MargaretMcKen
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If money is not an issue, I would strongly advise you make an arrangement with an attorney (at your expense) to come visit your mother with the necessary forms to complete her advance directives. There is a lot more that should be done than simply the DNR. My attorney had different scenarios available in which I had to indicate what I would want done in particular situations. We will be adding another section in the next few months that will deal with what I want done if I develop dementia and begin to contradict the advance directives I've made when I was competent. At the same time, since it appears that your mother has not set up a POA, that could be done at the same time. Again, there are some choices to be made. While it's definitely possible to do all of these things without a lawyer, I learned that what I had done on my own was not adequate. Finally, as another writer suggested, your mother needs to have an at-home DNR set up (there are forms to do this; you put the info on the refrigerator door) so that emergency medical personnel will not have to resuscitate her against her wishes would that situation ever to occur.

I realize you cannot just spring this on your mother, but you may be able to frame this in terms of the concerns of you and your siblings, and also to indicate that you are gifting the services of a lawyer to her.
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Reply to caroli1
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I saved some money and used RocketLawyer.com; did did a couple other firms as well. It cost only $40. The website first asks your state as requirements vary state by state. Of course before you are able to fill out the.the paperwork, you will have to have the conversation. With my dad I simply said, It's a long way off but if something unexpected happens I want to make sure that I everyone does exactly as you want.

Good luck. Its tough to to start that conversation. 
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Reply to Goldilocks
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A starting point could be, "You know, Mom, when you went in the hospital last time, they had questions about what kind of care you wanted if you became unable to speak for yourself. Maybe we should have a talk so we all know what you want us to do. If it's put down in writing, then everyone will be sure we are telling the doctors what you want."
If you feel the necessity of guilting her into it: "We don't want to have to wonder if we are making the choice you would want, especially if we're not sure and someone else disagrees with us." That could be family, medical professionals, etc.
When she is visiting her PCP, they will probably be happy to help.
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Reply to Agingmyself
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Quite frankly, at that age, you will not get much if any resistance from the medical staff. They are geared towards convincing people who want resuscitation to go DNR. There's no point at that age. They are in enough pain, why add a broken ribcage to that?

Everytime they ask me at the hospital, I say DNR. They all just nod and occasionally say that's the best choice. So unless you have a family member there screaming to do all they can, there won't be an issue.

Now where it is a problem is if you call 911. The EMTs are required to resuscitate unless ordered otherwise. Even a advanced health care directive won't stop that. You need to have a POLST form. That's a medical order and not just a request like a heath care directive. They have to follow that.
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Reply to needtowashhair
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Tell her all of the family love her & you hope she loves the family too - it could be shown by setting up an appointment to sign these sort of things with a lawyer or a senior centre - take her to a special lunch afterwards to celebrate - tell her she can pick who will drive her so she doesn't feel it is just 1 person pushing her -

This will allow her wishes to be made the highest priority the family can do - have her think about what else like pain meds etc she would like/not like & even if there is no form for that write it out and have her sign it - then thank her for her courage to look at things clearly & that it one of the most loving things she could do for the family - maybe other family members do it at same time [to paraphrase ... a family that does medical directives together stays together]

Make sure everyone is aware & even have several copies made so that whoever takes her to hospital will have one on hand - this is best done when no crisis is looming
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