Start the Discussion: The Importance of Advance Directives

Presented by:

Rebecca A. Levy, Esq.

Mary M. Petti, MPA, RN

October 24, 2012

Please hold all questions until the end of the slide presentation. There will be plenty of time for questions.

The Patient Self Determination Act (PSDA)

• Passed by Congress in 1990• Effective December 1, 1991• Applies to Hospitals, Nursing Homes,

home health agencies, hospice providers and HMOs

• Does not apply to individual doctors

PSDA Patients’ Rights Include

• The right to facilitate their own healthcare decisions

• The right to accept or refuse medical treatment

• The right to make an advance healthcare directive

PSDA Requires Certain Facilities to:• Inquire whether the patient already has an

advance healthcare directive and make note of this in their medical records

• Give the patient written information about preparing an advance directive (specifically the patient’s rights under law)

• Provide education to their staff and affiliates about advance healthcare directives

What is an Advance Directive?

• An advance directive is a legal document that you can complete on your own that can help ensure your preferences for various medical treatments are followed if you become unable to make your own healthcare decisions.

When does an Advance Directive go into effect?

• An advance directive goes into effect when you are unable to make medical/treatment decisions on your own behalf.

• An advance directive is not effective for a competent adult patient who is able to communicate his/her own wishes for medical care.

Types of Advance Directives

• Health Care Proxy Directive/Power of Attorney

Allows you to choose who will make decisions on your behalf if you become incapacitated

• Instruction Directive (“Living Will”)

Provides specific instructions for how your representative should make decisions

Who can I appoint as my healthcare representative?

• Spouse/Domestic Partner• Family Member (adults only)• Friends• Religious/Spiritual Advisor• Any adult EXCEPT your physician,

employees/administrator of a healthcare institution where you are a patient/resident unless they are related to you.

Where do I get an advance directive form?

• WWW.state.nj.us/health/advancedirective/document

• Five Wishes booklet prepared by Aging with Dignity

What do I need to do?• Study and understand the terminology

used in discussing treatments and end-of-life decisions

• Identify someone you would like to be your healthcare agent/representative and get their agreement to assume that role if you become unable to make decisions for yourself

Have the discussion…

• With your healthcare agent/representative

• With your spouse/partner• With your family members/loved ones• Using the form, make your choices for

treatment clear

Complete the Form

• Sign the form• Get signatures of two witnesses (may

not be witnessed by your healthcare representative)

• New Jersey does not require notarization (but may be notarized)

What do I do with my advance directive?

• Keep the original in an easily accessible place in your home (Not the safe deposit box)

• Give copies to: Your healthcare agent/representative Your Primary Care Physician or Summit Medical

Group The hospital or extended care facility if you are

admitted there Fill out the wallet card and carry it with you

Still have questions?

• Mary Petti, RN• Patient Relations, 908-277-8928

• Spend some time preparing your advance directive. It could become a great gift to your loved ones in the future.

What is POLST?• Practitioner Orders for Life

Sustaining Treatment• 12/21/2011 legislation that

enables patients to indicate their preferences regarding life-sustaining treatment

What is the POLST Form?• Standardized form for practitioner

orders• Signed by a physician or advanced

practice nurse• Provides instructions for health care

personnel to follow for a range of life prolonging interventions

Who Should Have a POLST Form?• Seriously ill patients• Medically frail persons with limited life

expectancy• Those living in a nursing home or

hospice• Those afraid of losing the capacity to

make their own healthcare decisions in the near future

POLST

Questions?