Caring House The Smarties Series Care Planning for Smarties 1. The - - PDF document

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Caring House The Smarties Series Care Planning for Smarties 1. The Six Keys to Care Planning Success 2. Who Ya Gonna Name? Plus Advance Directives 101 Ive Been Named: How Do I Do an Amazing Job? 3. What Ya Gonna Tell Em? 4. Ive Been

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Providing peace, comfort and support to men and women at the ends of their lives

Caring House

Care Planning for Smarties I’ve Been Named: How Do I Do an Amazing Job? October 9, 2018

The Smarties Series

1. The Six Keys to Care Planning Success
2. Who Ya Gonna Name? Plus Advance Directives

101

3. What Ya Gonna Tell Em?
4. I’ve Been Named. How Do I Do an

Amazing Job?

5. Care Lingo Decoded. Plus California’s End of

Life Option Act

Background

Ellen Gorbunoff, RN Ed Long, JD Handouts Time Questions

Handouts, Slides and More

You can get all class materials and be notified about future classes by signing up at

YourCaringHouse.org/materials

Core Concepts

1. You have a right to decide whether to
- start,
- decline or
- stop

available medical treatment (“care decisions”).

2. You have a right to name another

person to make care decisions for you.

Keep Score / Up to Date

Agent selection Documentation What’s Important Communication

Copies at yourcaringhouse.org/scorecard

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Legal Lingo

Principal = The person signing the

advance directive naming others to make decisions for them.

Agent = A person named to make

decisions under an advance directive.

Star Trek Prime Directive

Starfleet personnel shall not interfere with the internal development of alien civilizations.

Agent’s Prime Directive

1. Follow the Principal’s wishes
2. If not known, follow the Principal’s values

and views

3. If not known, use Agent’s best judgment

and act in the Principal’s best interests

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Top Duties

(It’s a collaboration)

Subject Principal’s Duty? Agent’s Duty? Communicate about Principal’s wishes, values and views Yes Yes Keep up to date Yes Yes Strengthen and support the Agent Yes Speak for and make care decisions for the Principal Yes

Agent’s Part of the Conversation

Listen Ask questions Echo back in your own words Confirm that you both understand

Principal’s wishes, values and views

Communicate

Two monologues do not equal a dialogue

Let’s Vote

Would you be comfortable saying “I don’t understand” to a doctor?

1. Yes
2. No

Agent’s List of Tasks

See your handout Let’s create a list of tasks

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Task #01

Regularly communicate with the Principal and others.

Task #02

Get educated about how to do an awesome job.

Task #03

Be available when needed.

Task #04

Let the healthcare team know that you are the Agent.

Task #05

Establish who will be the “MD Quarterback.”

Task #06

Ask questions until you have enough information.

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Task #07

Understand the context.

Context

Just getting started vs. ODTAA Syndrome Progressive illness? What stage? Exhaustion? Looking for a cure vs. Peace Time

Task #08

Set and revise Goals of Care.

Goals of Care

Return to Good Health Create a Good Death See Your Way page 11 Combat or Slow Illness Peace and comfort

Task #09

Make decisions.

Two Hands Up?

 Question #1 --

Would the treatment be medically helpful?

 Question #2 --

Would the Principal say “Yes” to the treatment?

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Two Hands Up?

Pursue the treatment if Don’t pursue the treatment if

Task #10

Set time limits

Hours, days, weeks

Task #11

Keep family informed.

Task #12

Self-care.

About Caring House

The first and only non-medical home in

Los Angeles County totally focused on end-of-life care

An IRC 501(c)(3) nonprofit Volunteer originated, professionally

staffed, volunteer supported

Revenues from resident/family payments

and community donations

John’s Story

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Where to Find Help

Doctor Nurse Social worker Spiritual care Bioethics committee Family and friends

Additional Resources

 Your Way, A Guide to Help You Stay in

Charge of Decisions About Your Medical Care, from H.E.L.P .

 Hard Choices for Loving People, by Hank

Dunn.

 End-of-Life, Helping with Comfort and Care,

from NIA & NIH

 Being Mortal, Atul Gawande, book and

Frontline documentary

Kanako is the Principal You are the Agent

Woman, age 76 Dementia, not recognize family for 2 years In hospital for urinary tract infection Can no longer swallow Feeding tube is proposed

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Agent’s Prime Directive

1. Follow the Principal’s wishes
2. If not known, follow the Principal’s values

and views

3. If not known, use Agent’s best judgment

and act in the Principal’s best interests

Deciding on Feeding Tube

What wishes, values and views of Kanako

would tell you

Yes on feeding tube? No on feeding tube? Time limits on feeding tube?

Five Steps to Doing an Amazing Job as an Agent

1 4 2 3 5

1. Know Principal’s wishes,

values and views

2. Gather information
3. Set goals of care
4. Decide on care/treatment

with time limits

5. Re-evaluate