Advance Care Planning

What is Advance Care Planning? It's the process of considering options and then communicating your choices for health care and end-of-life care if you are ever too ill to speak for yourself. 

There are Four Simple Steps to effective Advance Care Planning:
1. Education - Understanding the medical options for critical and end-of-life care, the legal and medical terminology of Advance Care Planning, your rights as a patient and the role of your health care proxy.
2. Delegation - If you ever need a proxy decision maker, you'll want to choose the one best suited to advocate for you and for your care instructions. That process starts with knowing the proxy's rights and responsibilities and the criteria for choosing someone to act as your proxy.
3. Communication - Once you've made your choices, you need to share with your proxy, physician and other loved ones y
our general beliefs and attitudes about "quality of life" and the specific information they may someday need to act on your behalf. 
4. Documentation - A meaningful written advance directive preserves your wishes for care and gives your proxy the authority needed to make health care decisions on your behalf and in keeping with your preferences.

Effective January 1, 2016,
Medicare will pay your primary physician to discuss Advance Care Planning at your annual wellness visit or at a separate appointment (with co-insurance).

An essential element of a meaningful advance care plan is a Health Care Advance Directive that 1) is an accurate record of your wishes for health care and personal care; 2) includes the appointment of a proxy and an alternate proxy; and 3) can be easily understood and honored by your proxies and health care provides. Effective written advance directives can also serve as a guide for that all-important patient-physician Advance Care Planning conversation.

Advance Care Planning Glossary
Assisted oral feeding: Spoon feeding a patient who can safely swallow but who is unable to feed him or herself.
Advance Care Planning: Considering and then communicating and documenting care instructions and the appointment of a health care proxy (a “proxy”) in the event of future incapacity.
Artificial nutrition and hydration: Intravenous (IV) fluids, or the use of a feeding tube inserted down the throat or directly into the digestive system.
Cardiopulmonary Resuscitation (CPR): Using all available medical means to revive someone whose breathing and heart stop.
Do Not Resuscitate order: A physician’s written medical order to not attempt to revive a person whose breathing and heart stop.
Durable Power of Attorney for Health Care: The written appointment of a health care proxy in the event of incapacity.
Health Care Advance Directive: A legal document that includes instructions for care and the appointment of a health care proxy.
Health care proxy (“proxy”): A person appointed to make health care decisions for another person in the event of incapacity.
Hospice: A multi-disciplinary focus palliative (comfort) care for terminally ill patients and for their loved ones.
Life prolonging measures: Medical procedures used to replace a vital bodily function; examples are a mechanical ventilator, a feeding tube and kidney dialysis.
Palliative care:  A specialty that focuses on the patient's comfort and addresses the symptoms of serious disease and side effects of treatment. 
Living Will: Written instructions for care in the event a triggering event occurs.
Triggering event: A medical condition that triggers the consideration of whether to use or withhold the use of life prolonging measures; examples are a terminal condition, permanent irreversible unconsciousness and dementia.
Ventilator: A device to mechanically force air into a breathing tube inserted down or surgically placed in the throat.