A healthy living blog from Marshfield Clinic

Consider, then communicate your health care wishes

Being prepared during a time of health crisis for you or a loved one is half the battle. Decisions and next-steps can come quickly during such times.

So, have you thought about “important documents” to have in place?

COVID-19 _Important Documents

Being prepared during a time of health crisis for you or a loved one is half the battle. Decisions and next-steps can come quickly during such times. So, have you thought about important documents to have in place?

If not, you should.

If you do think about them, complete or review the following to make sure your current wishes are known:

  • Power of attorney for health care (POA)/Advance care directive
  • Last will and testament
  • Financial power of attorney

Ruth Wagner, Palliative Medicine social worker for Marshfield Clinic Health System, counsels patients and their loved ones about these documents, considering their wishes and conveying that information.

“There are so many people who haven’t thought about them. We see it every day,” Wagner said. “Our goal is to guide and educate patients and families about the importance of these documents.”

For all adults

If you’re 18 or older and you’re well, complete or review your documents, especially the advance care directive. Having decisions made when you’re healthy help when your health may not be so good.

During a pandemic like COVID-19 as an example, helping hospitalized patients requires some creativity from staff like Wagner and her colleagues. During COVID-19, hospitalized hospitalized patients with COVID cannot have visitors but can have face-to-face conversations using technology.

“People can help their loved ones make decisions without being with them in the hospital,” she said. “We want agents and family to know they can feel comfortable making decisions from a distance.”

The 4 Ds

Wagner references the “4 Ds” to get documents done or reviewed, especially in light of a COVID-19 scenario:

  • Death – when your primary agent, the person you choose to have authority to make decisions, has died.
  • Divorce
  • Disease – a new diagnosis is made.
  • Decade – every 10 years to ensure they outline your wishes.

“If there is no POA, next-of-kin can’t make decisions outside the hospital,” she said. “If you’re incapacitated, can’t make decisions and you’re married, your spouse has zero authority to get you in a nursing home. If this document is not in place, your family will have to secure an attorney to petition for guardianship.”

If you can’t update the POA, talk to your agent and people you’ve listed about your wishes. “For example,” Wagner said, “if you get COVID and need to be on a ventilator, what do you want to have happen if you’re not getting better? Do you want to remain on life support? Do you want a feeding tube?

“It’s hard to plan when we talk to loved ones about certain situations but we know how severe COVID symptoms are. You may need to be on a ventilator. What if you’re not getting better? Do you want to have everything done to sustain life? Have discussions about specific incidents – a car accident, suffering a stroke, COVID. Conversations with loved ones before decisions are needed make it easier. When you’re really distressed it’s hard.”

Last will and testament

The last will and testament is important and matters only after you die, Wagner explained. This document can be completed by an attorney or on line. To be legal in Wisconsin, only two witnesses are required.

A POA and financial power of attorney are valid only while you’re living.

Financial power of attorney

The financial power of attorney helps manage your finances if you can’t do it yourself. “That’s important because if you’re on a ventilator for three weeks or in the hospital after you’ve lost functionality how are your bills going to get paid?” Wagner asked.

If certain things are not in order and you’re incapacitated, no one can help.

Do you have a trusted person on your POA and bank accounts, so bills can be paid? Are you an authorized user on your cell phone plan?

“These are things you don’t think about,” she said.

Release of information

No information about your health status can be released if you’re hospitalized to anyone unless you’ve designated them. Have a release of information form on file with your health care provider. Include who’s important to you. Medical staff won’t release information otherwise.

“For example, if my sister calls to learn my condition and says ‘I’m Ruth’s sister’ they can’t give information unless I’ve designated that,” she said.

Make a list

Wagner advises making a list of all your financial institutions, credit card companies, combination to your safe, regular bills and account numbers. Give the list to someone you trust. So much information is electronic and not available on paper in your home.

Then make a list of people to contact, to be kept with important documents. “If I’m hospitalized and not doing well, my husband would have a list of people I’d want him to contact so they’re informed, like family or a close friend,” she said.

“Courts say ‘preservation of life’ so we preserve life for as long as possible if you’ve never had anything documented saying otherwise,” she said. “A 90-year-old man with a hip fracture is not eating. If there’s nothing documented, he’ll most likely get a feeding tube. It’s preservation of life.”

For details about helpful forms and medical records, go to the Health System’s website by clicking on this link.

For additional related information on Shine365 that may help you, check out these links:

Advance care planning team offers critical service

The Rounds: Planning ahead with advance directives

Advance directives: Who’s making your health care decisions?

Why high school seniors need an advance directive

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