In this episode of Medicare Simplified

In this episode of Medicare Simplified, we focus on the Advanced Care Planning.

Transcript

Courtney Collen (Host):

Hi, welcome to Medicare Simplified a podcast by Sanford Health Plan created to help you review your Medicare options and discuss health topics as you become eligible for Medicare. I'm your host, Courtney Collen. At this stage in life when you are nearing Medicare, it's really important to plan ahead and encourage important convers with your loved ones. To help us identify what we need to do and to become better prepared, I have Ellie Schellinger who is director of the DeGroot Center, specializing in bioethics, advanced care planning and integrative health, as well as Rochelle Holloway, as senior social worker and advanced care planning specialist. Ladies, thank you so much for being here.

Ellie Schellinger and Rochelle Holloway:

Hi, thank you.

Courtney Collen (Host):

Let's start with this. We always want to be prepared at any stage of life. Walk us through advanced care planning.

Rochelle Holloway:

Advanced care planning focuses on allowing you to write down what you want when you're not able to make decisions. So if a tragedy happens or as you just go through life and age and you need somebody to step in and help make decisions for you, advanced care planning is really getting what your wishes are written down so that your healthcare providers and your family know about what your preferences are and allows people to be aware.

Courtney Collen (Host):

Ellie, why is it so important to be prepared at this point in your life?

Ellie Schellinger:

Really it's important to be prepared any time in life. We never know when a healthcare crisis is going to hit and we, we can't make decisions for ourselves. So we encourage people throughout their lifespan to talk about these things. Some people find it uncomfortable at first, but we found that most families are relieved by having the conversation and we can help facilitate that too. But it is really important because when these things happen and people are taken unawares, they struggle, and this is to help ease that struggle and help ease, what would be the patient's mind that things will go as they planned. Not as a big question mark.

Courtney Collen (Host):

Sure. Thank you. Now, the five D’s, as they're often referred to are an important part of this conversation. So let's break down what those are, what they mean and how they relate to this conversation we're having.

Rochelle Holloway:

Absolutely. We like to refer to the five D’s as when you have to reconsider your advanced care plan. So it's diagnosis. If there's a new diagnosis or a change in diagnosis. Decade. So that every decade, so when you're 20 and 30 and 40 and 50, you just know that it's my new decade and I should relook at my advanced care plan that I have written down. Decline. So if you have a health decline, if you're worsening if you say had one stint or two stints in your heart, and now you had open heart surgery, which might be considered a decline. If your disease, prognosis declines, those sorts of things is when you look at it. Death. Oftentimes we find that people have had an advanced care plan written and their loved one that they had named their surrogate decision maker actually has passed away. And they don't update it to have another person, so, or maybe a death has influenced them and how that death occurred. And they might want to change the wishes that they had based on that. The other one is divorce. So sometimes we'll see advanced care plans that have the ex-spouse on them. So really at that time of divorce, the advanced care planning document is a legal document. So it's a good time to also update that so that you can have an appropriate surrogate decision maker if you would want to change it. So death, decline, decade, diagnosis and divorce.

Courtney Collen (Host):

So when you say decade – if we maybe haven't gone through divorce or received a diagnosis – how soon is too soon, or how early is too early to start thinking about advanced care planning?

Rochelle Holloway:

It's never too early to consider your advanced care plan document. I have met with a couple who were just recently engaged young couple. I've met with couples who have been elderly and done facilitations with them to discuss what they, our individuals, not always couples … individuals as well. All ages.

Courtney Collen (Host):

Great information. Thank you. So speaking of documents, let's talk about what documents we will be creating, reading, reviewing, signing.

Ellie Schellinger:

There's really two different pieces that make up an advanced care plan. One you can fill out is called a durable power of attorney for healthcare and the others that live more of a living will type piece. And so the advance the entire document then is an advanced care plan. And the durable power of attorney for healthcare is a formal term for your surrogate decision maker or agent, the person who would speak for you. And you can name a primary person and then also a secondary or even third person in line to speak for you in case something happened and one of them was not able to be present or be there for you. The other part is probably equally as important is that those wishes we were talking about, how do you view you your end of life? How do you view your healthcare and what are your wishes for treatment as you go through these different healthcare issues or problems? And so having that conversation, not just getting it down on paper, but actually having a conversation so you can express those wishes is an important part of the whole process. But then we get it down on paper, what we have available combines both of those. It's a document that's been tested. The questions have been studied to make sure they're actually useful in the healthcare setting. And we fill that out, get it signed and witnessed and make it into a formal legal document.

Courtney Collen (Host):

Okay. Thank you for breaking that down for us. In the wintertime, many Midwest seniors escape, the cold weather. I don't blame them. Many head south for the winter to places like Florida, Texas, Arizona, everywhere in between or beyond. How should we adjust this planning for that travel if we're gone for an extended period of time throughout the year?

Ellie Schellinger:

You know, that's a great point and a great -question because we're so mobile in our society, but advanced care plans are intended to be transportable. So they were designed to go from state to state. Now, if you have a place you go where you're established, any people say Arizona or Florida, and you have a clinic there, you can lodge your document with them to hand a copy over and they'll put it in their files and talk to your physician there. I would always encourage someone to keep a copy with them or have it on an internet service where you can pull it up.

Rochelle Holloway:

I want to add, don’t keep it in your safe just for yourself. The advanced care plan is most useful when the hospital actually has a copy of it. So to get that where it is needed, once it's completed to bring it to the clinic, to bring it to your primary care doctor or whoever needs to have it to get it in your medical record. You can do that with, you know, if you have a clinic down south to get it into your medical record as well. So I've met with some people in my role as an advanced care planning facilitator that they're like, ‘yeah, I did it. It's been in my say’ and I'm like, ‘awesome, let's get it out of your safe because if it's in the safe, nobody knows what your wishes are’. You've done the hard work of processing it, but nobody can act that out.

Courtney Collen (Host):

As an advanced care planning specialist, as an expert in this area, what is like the number one question that people come to you with as they look to plan ahead?

Rochelle Holloway:

I think the number one question that people have is how to choose a decision maker: who should they have as a surrogate decision maker? Most of the parents that I've met with have some sort of relationship with a child that they feel like might be able to carry out their decisions more which is one thing that we look at when we have individuals assign somebody to be their surrogate decision make. However, they may feel pulled that the oldest one should be the one. And when I'm talking with them, it's not about what should it's really about how the person who you name is going to be able to carry out your wishes. For some, they know that one of their children will be just emotionally distraught. Another one is just more analytical and will be able to make decisions. All of those things, depending on the individual come into play. Sometimes families are just like, ‘you know what? My family is not. Who's going to carry out my wishes, but this person is’ and they'll have another they'll name another person.

Courtney Collen (Host):

I can imagine that this conversation or this decision making can bring on a lot of stress or turmoil in a family. Maybe it's an easy decision, who knows? I'm sure it varies from family to family. What would be your biggest advice for families going through this stage when they're trying to name a decision maker?

Ellie Schellinger:

To talk about it. To talk about your reasoning and to help people understand why you've made the decisions. I come from a family of eight, someone had to be a decision maker. Someone had to take the lead. Families rally around and support if they know what the decisions are, but when there's too many surprises like a healthcare crisis, it just exacerbates what's happening. So answering those questions, talking, you know, we encourage Easter, Thanksgiving, Christmas, we encourage families when they're gathered to talk about these things, to encourage their parents to talk. The parents may not want on to broach these kinds of subjects, but it's a great time to just lay a few things out there and see what people say.

Courtney Collen (Host):

Ellie thank you for that. What ideas do you have to start the conversation with families or friends or whomever?

Ellie Schellinger:

You know, there's some kind of lighthearted things you can do. There's I know I've been involved in and advanced care planning dinners, “death dinners”, whatever you want to call them. But when you get your family and friends together and go through your advanced directives, usually those are the people you're going to have as your decision makers or the people you'd want as witnesses or to support your family. So you have these discussions as a big group, maybe witness the documents for each other and offer that support to each other and it becomes a, a community of people who know and can support each other through really hard times. So it's kind of an easy way to do it.

Rochelle Holloway:

There's a card game out there called ‘Go Wish’ not ‘Go Fish’. And it talks about different wishes. Like if this happens, what would you want? And you just can flip through the cards. And it's also a kind of lighthearted way to have the conversations with families and with friends. I, similar to Ellie's idea, had heard of a family that had a Halloween party and a death and dying party. And everybody came over and they were celebrating in costume and had skeletons and such and all of a sudden, “here's your advanced care plan, fill it out!”, so you can get creative.

Courtney Collen (Host):

Surprise.

Rochelle Holloway:

Surprise.

Courtney Collen (Host):

Well, I love that. Anything to get the conversation started and to move that planning process forward with people you know and you trust. That's great. Yeah.

Ellie Schellinger:

Anytime we can get a conversation going, it's a step in the right direction.

Courtney Collen (Host):

Absolutely. So, so we've talked about what we need to do and when we need to do it, but how, and where do we start this advanced care planning process?

Rochelle Holloway:

I typically recommend that patients go and talk to their primary care physician. There is other resources available. Sometimes in the clinic, they have a facilitator like myself. The provider typically is aware and they can assist you in getting the documents or on the Sanford Health website. There is a link to the documents as well as most healthcare systems.

Ellie Schellinger:

I think reading through the document, looking at the questions, formulating some thoughts and writing down your questions so that if you sign up for a facilitation, you can get your questions answered and fill in the blanks and have help talking through the different things you're curious about.

Courtney Collen (Host):

I'm learning very quickly that these advanced care conversations are necessary and I understand now that they can be difficult emotionally as well. Do you have any other advice for how we navigate through this planning process?

Ellie Schellinger:

It always seems like once you start, it's a lot easier than you think it's going to be. Families are curious, we're all curious and we all have great imaginations. You see things on TV or hear about things in the news that spur these conversations. I wouldn't want to be like that. I'd never want to live that way. So expand on those things. Take that opportunity to just think about it and talk with your loved ones. It becomes a really meaningful type of conversation to have and it pays off in the long run.

Courtney Collen (Host):

Thank you both so much for helping us break down advanced care planning. Appreciate you being here.

Rochelle Holloway:

Thank you for inviting us.

Ellie Schellinger:

Thank you very much.

Courtney Collen (Host):

If you'd like to learn more about your options from Sanford Health Plan, visit align.sanfordhealthplan.com or find more information in our episode show notes. Thanks for being here.

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CMS ID Number: H8385_603-650-222PODCASTArticleAdvanCare-PY2022-ND-SD_C, H3186_603-650-222PODCASTArticleAdvanCare -PY2022-MN_C Last Updated On: 6.01.22 at 10:30 AM