Clearly defining your healthcare wishes is an important part of receiving any kind of medical care, but it’s especially true in the context of end-of-life planning and hospice care. If you are facing a serious or life-limiting illness, chances are the topic of advance care planning, or “advance directives” has come up. Understanding what advance care planning is and why it matters will help you make sure your wishes and goals are honored at the end of life.
The Connection Between Hospice and Advance Care Planning
Advance care planning is a key part of hospice care. In fact, if you’re receiving hospice services, this is one of the first discussions you will have with your hospice team. Because people who have enrolled in hospice care have been found by a physician to likely have six months or less to live, it’s critical for these individuals to have discussions about end-of-life care and goals.
Types of Advance Directives
Simply put, advance care planning is a term used to describe the process of creating formal records, or written advance directives, of a person’s healthcare wishes. There are a few key documents that can be used to complete advance care planning:
Living Will
A living will is a document that details what kind of medical treatment you want, and in what situations you might not want certain types of care. It is a legal document that protects your wishes if you are unable to communicate for any reason.
Durable power of attorney for healthcare
Also called a medical power of attorney, healthcare power of attorney or healthcare proxy, this document names the person who you have chosen to make healthcare decisions on your behalf if you become unable to do so.
Do Not Resuscitate (DNR) Order
A DNR order is written by a person’s physician. It directs healthcare personnel to not provide CPR if a person’s heart stops beating or their breathing stops. Patients (or their healthcare power of attorney) must make this choice before the order can be written, and they can change their mind at any time.
POLST or MOLST Form
The Physician Orders for Life Sustaining Treatment (POLST) or Medical Orders for Life Sustaining Treatment (MOLST) form is written by your doctor or advanced practice provider. These forms create added medical orders, noting your doctor’s treatment plan for medical care based on your other advance directives. This creates a document that other healthcare providers can use in a health emergency to provide your care.
Each state has specific forms used to record these details. Your physician and healthcare team will have access to these and can guide you through the correct ones for your state.
What Happens if I Don’t Have an Advance Care Plan?
If you haven’t put advance care plan documents in place, you aren’t alone. Research shows that 54% percent of Americans haven’t completed their advance directives. Although it is best to do so well ahead of any major health conditions or changes, your hospice care team can help you with this process as part of your hospice care.
Without an advance care plan in place, sudden changes in your condition may mean you are unable to communicate your wishes clearly, leaving loved ones to make a best attempt to guess what treatment you would choose.
Even if you are able to make a healthcare choice on your own, it can be especially difficult to make these decisions at a time of medical crisis. Staying informed and having these conversations ahead of time can help you, your family and your healthcare team stay focused on the best care to meet your wishes at the end of life.
The Process of Advance Care Planning
You can start the process of advance care planning at any time, by having a conversation with your healthcare provider and your loved ones. If you are facing end-of-life decisions and have not set up your advance care plan, you’ll receive support and guidance through hospice care. In hospice care, advance care planning is a part of preparing for death, allowing you to put documentation in place to ensure your wishes are honored.
To complete your advance care planning during hospice care, you’ll need to make a few key decisions:
- Choose a healthcare power of attorney or surrogate decision maker.
- Discuss and document your medical preferences in a living will. This includes things like comfort measures through end-of-life pain management, what kinds of care you want to avoid such as returning to the hospital for treatment and more.
- Talk with your doctor about a DNR, which means your care will not be focused on aggressive life-saving measures if you stop breathing or your heart stops beating.
It’s also important that you share these conversations with your family and other loved ones. They are hard topics to bring up, but they can help those close to you understand and respect your wishes at the end of life, reducing stress for all involved.
Hospice Care: Compassionate Support When It Matters Most
Although as many as 71% of adults surveyed by the Kaiser Family Foundation shared that they believe a death without pain, stress and discomfort is more important than prolonging life at any cost, the opposite is often true when a lack of advance care planning causes confusion and uncertainty.
Hospice care aims to address the priority of a dignified death and through advance care planning and supports patients and their loved ones in sorting through decisions about end-of-life care.
Along with helping to create good advance care planning for patients, hospice care specializes in following through on advance care plans in a respectful way. Some ways that hospice can make sure advance care plans are followed are:
- A focus on comfort and quality of life
- Care in the patient’s home environment, wherever they call home
- 24/7 accessibility to care when needed
- Pain control and other symptom relief
- Emotional and spiritual support
- Bereavement support for families
- Assistance with daily tasks and personal care
- 100% of hospice costs covered by Medicare
If you are ready to take the next step to find out if hospice is right for you or a loved one, you can take our hospice quiz. Our team is ready to help provide support in all end-of-life care, including advance care planning.
