The Talk We Fail to Have: Advance Care Planning

Advance Care Planning for Elder PeopleWhat is advance care planning? Why is it important? Why do so many people resist it? Our Life Care Planning Law Firm is there to help when it's time to have "The Talk."

The statistics are sobering. Two-thirds  of American adults haven't completed an advance health care directive, a legal document that outlines a person's wishes if they become incapacitated and can't make their own health care decisions, particularly near the end of life.

In my experience as both a social worker and elder law attorney, I have found that families put off these discussions as long as possible.

When confronted with families in denial, I ask questions that help me assess the family's structure, values, and roles. Drilling down is hard but I have to find out who can deal with reality so we can structure a plan that will work with the family unit.

Coaching a family who doesn't want to talk takes finesse. I consider myself a social worker in lawyer's garb, but it's all in service of an important goal: to get clients to a point where they can have a good death.

A Life Care Planning Law Firm strives to involve the family as much as possible in an elderly loved one's dying process. Many elderly clients tell me that their most important goal is for the kids to still talk to each other after they're gone. For that to happen, we have to find the cracks in the armor, then put the cracks on the table to talk about them. It's not always comfortable.

It can even be harder to talk about advance care planning when you're younger. You never know when something's going to happen that would make it impossible for you to make your own healthcare decisions.

Advance care planning involves the same steps for everyone, young and old. The easiest place to start is to think about whom you would trust to make health care decisions on your behalf if you were unable to. 

Advance Health Care Directives for Dementia

Most Advance Health Care Directives from other offices that I've seen offer brief, checklist forms. The standard advance directive tends to focus on things like a 'permanent coma' or a 'persistent vegetative state.' Most of the time, they apply to a person with less than six months to live.

Our office offers a dementia-specific advance directive. It maps out the effects of mild, moderate and severe dementia, and asks clients to specify which medical interventions they would want - and not want - at each phase of the illness.

Clients stumble into the advanced stage of dementia before anyone identifies it and talks to them about what's happening. Although it's a terminal disease, dementia often intensifies slowly, over many years. The point at which dementia patients can no longer direct their own care isn't predictable or obvious.

Hence, the clients' goals and preferences might well change over time. In the early stage, life may remain enjoyable and rewarding despite memory problems or difficulties with daily tasks. So there would be many years in which they would not want a 'do not resuscitate,' but if they become bedridden, unresponsive and dependent, they might feel differently -- yet no longer be able to say so.

Whereas a persistent vegetative state occurs rarely, dementia strikes far more commonly. It's crucial for families to talk about the quality of life we find acceptable and unacceptable, which interventions we agree to or don't -- and then document those decisions and circulate the documents to the designated decision-makers and everyone else who might be involved.

And yes, we should incorporate decisions about dementia into that process. Let our office help you with that conversation.

 

 

 

 

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