I recently learned that April 16th is NHDD. NHDD is National Healthcare Decisions Day. The goal of NHDD is to encourage individuals and families to discuss healthcare decision-making and advance planning. It is an opportunity to explore how your loved one feels about end of life care. It is a reminder to us caregivers to talk with our loved ones about their treatment wishes. And it is a timely reminder that we need to ensure their wishes are followed by creating an advanced directive and having someone appointed to speak for them when they cannot.

What are advanced directives?

Advanced directives are written documents that have two important purposes:

• The first purpose is to let health care professionals know what kind of treatments your loved one wants. Some of the questions advanced directive can answer are:
• Would you want to be put on a mechanical ventilator for a long time or is that not acceptable?
• Would you want to prevent being placed on a feeding tube indefinitely?
• Would you want to have CPR attempted regardless of the outcome or would you prefer a natural death?
• The second purpose is to name someone specific to make decisions for your loved one when they cannot make them for yourself. This is called naming a healthcare representative or healthcare proxy. The advantage for you, the caregiver, of being the healthcare representative is that you can get information about your loved one’s medical condition and treatment. Without this important document, you might be denied information under healthcare privacy laws.

Advanced directives make a difference

I am very grateful that Dad had advanced directives – a living will and healthcare proxy. He had these documents drawn up when he created his will. Dad’s living will gave his doctors instructions on how he wanted to be cared for when he could not make decisions for himself. During those times he was too ill to direct his care, it guided the treatment he received. Dad and I discussed his wishes on a number of occasions. Still, I relied on his living will to help me during times of critical illness. And I relied on Dad’s healthcare proxy constantly. That document allowed me to get all his medical information and ensured that I was a pivotal member of his care team.

Making choices

There are resources available to help you understand your options and create an advanced directive. You’ll find all the resources listed below at The National Healthcare Decisions Day website along with many others as well.

Resources for making decisions

There are resources available to help you discuss future healthcare wishes and make decisions:

• AARP: End-of-Life Planning
• Advance Care Planning Day Initiative: Advance Care Planning
• Aging with Dignity: Five Wishes
• American Bar Association: Tool kit for Health Care Advance Planning
• American Health Lawyers Association:Loving Conversations (video) on Advance Care Planning
• American Hospital Association: Put It In Writing

Creating an advanced directive

There are a numbers of ways to create an advanced directive. Certainly, an attorney can draw one up for you. But it isn’t necessary to have an attorney created the advanced directive. You can create one yourself. Here a few options to consider:

• Aging with Dignity
  An excellent resource and one that makes it easy to create an advanced directive is Five Wishes. The Five Wishes document helps individuals express care options and preferences. The advance directive meets the legal requirements in most states and is available in 20 languages for a nominal fee. Order online or call 850.681.2010.
• Caring Connections
  Each state has created specific advanced directives that meet the state’s specific legal requirements. Caring Connections offers free, state-specific advance directives for all 50 states and DC that meet the legal requirements for each state. Download individual copies for free or call 800.658.8898 to have a copy mailed to you.
• Center for Practical Bioethics

  Caring Conversations is a workbook to help individuals and families communicate with each other about their healthcare preferences and contains advance directive documents. These forms are valid in every state when they are notarized and signed by two witnesses. Download for free or call 800.344.3829 to order.

If your loved one is hospitalized, the hospital may be able to help you. Many hospitals have programs that have a trained social worker or other professional available to discuss living wills and help you create a valid document.

Using an advanced directive

Advanced directives aren’t meant to be hidden away in a safety deposit box. They are living, working documents. Sharing copies with your loved one’s doctors, especially their primary care doctor, can help the doctor understand and follow your loved one’s choices. The person or persons named as healthcare representatives should have copies so that they care share them when necessary.

It’s important to have the advanced directive readily available so that you can find it quickly in an emergency. I recommend keeping copies as part of your emergency information kit.

Thoughts for the caregiver

As your loved one’s caregiver, do you understand their wishes about treatment? Even though they may have an advanced directive, it helps to talk to your loved one about these issues. The advanced directive will tell you what they wish. But it won’t tell you why they made these choices and what their true feelings are. You will be truly grateful to have these conversations as your guide during times of crisis.

Remember, this is not about what you think is best for the person. You need to base decisions that you make for your loved one’s well being on what your loved one wants, not what you would want for yourself. It may be the hardest thing you ever have to do for your loved one. Yet it’s the greatest act of love and fulfillment of trust you can make.