At HealthHive, we want you to Bee Well, but we also want you to Bee Prepared. That's why we want you to think about what matters when it comes to your healthcare treatment options and make sure that others know what you want.
With that in mind, HealthHive has a place for you to document your preferences and keep copies of your healthcare instructions. In many cases, copies of your instructions won't be enough to meet local legal requirements as some people may require the original paper version. However, having copies in HealthHive will always be helpful.
We want to introduce you to some critical documents and explain why you may want to have them. In this article we will review:
What is an Advance Directive?
Advance Directives help doctors, family members, and other caregivers make decisions about your care. Importantly, they tell others about your personal preferences if you cannot make those decisions independently. While nobody likes to discuss these things, we suggest that you talk to your health care provider (or your lawyer) about filling out Advance Directive(s).
The laws around Advance Directives differ from state to state, but you can find many well-developed forms online for each state. For instance, the AARP offers free forms here.
What are the Categories of Advance Directives?
Generally, the Directives can include a Living Will, a Health Care Proxy, and a Durable Power of Attorney. The first two solely relate to health matters, and the third can be much broader.
A Living Will provides written instructions that tell others how you would like your medical care to be delivered if you cannot make decisions for yourself. These instructions help doctors, family members, and other caregivers make care decisions based upon your personal choice instead of letting them make those decisions for you.
By choosing to complete these documents, you can get the medical care you want and relieve family and caregivers of the stress of making these decisions at a time of crisis or grief. In addition, you help to reduce disagreement about the choices you would want people to make for you.
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You can tell everyone how you want your end-of-life care to be delivered. What happens if you suffer an incurable illness, disease, or condition and your doctor determines that your condition is terminal? Would you want "life-sustaining measures" that would solely extend your life?
You can be much more specific and talk about your preferences for things like Resuscitation (Do Not Resuscitate), Intubation (Do Not Intubate), Life Support, Antibiotic Therapy, and Intravenous Infusion. In addition, the Living Will may indicate your desire to donate all (or specific organs) upon your death.
Health Care Proxy
While the Living Will defines how you would like to be treated, the Health Care Proxy identifies who you can act for you if you cannot do so. Selection of the right person is essential, as the person you choose has the legal right to make health decisions for you if you can't do so yourself.
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Unfortunately, since the rules on these documents are often specific to a state, the person you choose to make decisions can be called many different things, including:
- Health care agent
- Health care attorney-in-fact
- Health care proxy
- Health care surrogate
- Health care representative
- Patient advocate
Durable Power of Attorney
A power of attorney will provide rights to someone to act on your behalf to do things beyond simply engaging in healthcare decisions. A Power of Attorney might allow someone to access your bank account, sign checks, or apply for disability. The Power may also allow someone to write checks to pay your bills during any period in which you are medically incapacitated.
As with the Healthcare Proxy, selecting the right person is essential, as the person you choose has the right to impact your healthcare and financial well-being.
Do Not Resuscitate and Do Not Intubate Orders
You don't need to have an advance directive or living will to have Do Not Resuscitate (DNR) and Do Not Intubate (DNI) orders. To create these DNR or DNI orders, you can simply tell your doctor about your preferences and ask them to put those orders in your medical record.
How do I create an Advance Directive?
Advance directives always need to be in writing. Each state has different forms and requirements for creating these documents. In addition, many states require that the form may need to be signed by a witness or notarized.
Review your advance directives with your doctor and your health care agent to be sure you have filled out forms correctly. When you have completed your documents, you need to do the following:
- Keep the originals in a safe but easily accessible place. We also suggest that you place a copy of the document within HealthHive and note where the original documents are located.
- Give a copy to your doctor so that they can have it on file.
- Give a copy to your health care agent.
- Keep a record of who has your advance directives.
- Talk to family members and other important people in your life about your advance directives and your health care wishes. By having these conversations now, you help ensure that your family members clearly understand your wishes. Having a clear understanding of your preferences can help your family members avoid conflict and feelings of guilt.
Physician Orders for Life-Sustaining Treatment (POLST)
Some states allow physician orders for life-sustaining treatment (POLST) (also referred to as provider orders for life-sustaining treatment (POLST) or medical orders for life-sustaining treatment (MOLST)).
A POLST is for people who have been diagnosed with a serious illness. This form does not replace any other directives. Instead, it serves as doctor-ordered instructions to ensure that you receive the treatment you prefer in case of an emergency. The form is completed by your doctor based (i) on your advance directives, (ii) the discussions you have with your doctor about the expected course of your illness, and (iii) your treatment preferences.
Once again, forms vary by state, but a POLST lets your doctor include details about what treatments not to use, under what conditions specific treatments can be used, how long treatments may be used, and when treatments should be stopped.
A POLST also indicates what advance directives you have created and who serves as your health care agent. Like advance directives, POLSTs can be canceled or updated.
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While the specifics of the POLST are individual, it is common to address issues such as your preferences for:
- Mechanical ventilation
- Tube feeding
- Use of antibiotics
- Requests not to transfer to an emergency room
- Requests not to be admitted to the hospital
- Pain management
HIPAA Authorization Form
As you may know, the HIPAA Privacy Rule protects the confidentiality of your health information. The rules are very complicated, but say that somebody cannot release your information unless you approve. The HIPAA authorization is the form in which you authorize medical practices, hospitals, insurers, and certain other businesses, to share your information with other people that you choose.
Unfortunately, there is no "standard" release form, and therefore, the form requirements may differ between organizations. However, an authorization must include (i) a description of the "protected health information" to be used and disclosed, (ii) the person authorized to make the use or disclosure, (iii) the person to whom the party may make the disclosure, (iv) an expiration date, and, (v) in some cases, the purpose for which the information may be used or disclosed.
Within HealthHive, we provide you with a method of generating a HIPAA records request containing the required content. Although this should be acceptable, don't be surprised if an organization says that you must use their form.
Will (Last Will & Testament)
Upon death, it is essential to define who gets any assets you may have and who is responsible for distributing them. That is the goal of a Last Will & Testament.
Although about 2/3 of people die without a Will, having this document is helpful regardless of how much money you have. The Will helps to avoid family disputes and ensures that your preferences are respected.
How you prepare your Will may depend upon your familiarity with the law, the number of assets you have, and your family situation. Typically, you should use a lawyer to prepare or review your Will. However, many online resources such as Nolo's Quicken WillMaker, LegalZoom, RocketLawyer, US Legal Wills, & Do Your Own Will allow you to create your own Will at no, or very low, cost. The most critical element is to ensure that you make a Will that meets your state's exact requirements.
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A Will can be a simple one or two-page document or may be long and complex. But really, it is just intended to allow you to say whether how you want to share your assets (money, accounts, jewelry, furniture, etc.) with others. Do you want to leave some money to your church or other charity, a gift to a caregiver, or otherwise share your assets in a way that differs from what the law would say in the absence of a Will?
As you prepare this document, pay particular attention to the requirements for signing, witnessing, and/or notarizing the Will. If you don't carefully follow these rules, your Will may be unenforceable.
Although you can store your Will in HealthHive, depending upon how you intend to use HealthHive, and to whom you intend to give access, we would recommend that within HealthHive, you simply indicate the presence of the Will and the party who has access to that Will at a time of need. You may also want to include notes indicating if/when you have updated your Will and referencing the fact that it is the operative document.