In This Issue

	National Healthcare Decisions Day
	If you answer yes to any of these questions, Hurley Elder Care Law can help
	Life Care Planning Goals
	The Nuts and Bolts Guide to VA Benefits

National Healthcare Decisions Day

	April 16, 2008 is National Healthcare Decisions Day. The mission of this collaborative effort of national, state and community organizations is to ensure that all adults with decision-making capacity in the United States have the information and opportunity to communicate and document their healthcare decisions. Hurley Elder Care Law enthusiastically joins this Initiative. This newsletter discusses ways to thoughtfully reflect on this critical issue and explains Georgia’s approach to advance healthcare directives.
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To attend our monthly Professionals’ Luncheon please call Louise Morris at 404-843-0121 or email her at lmorris@HurleyECLaw.com

If you answer yes to any of these questions, Hurley Elder Care Law can help.

		Has the elder been diagnosed with a mentally or physically debilitating disorder such as Alzheimer’s, Parkinson’s, ALS, stroke or a decline in functional capacity?
		Is the elder isolated due to the recent death of a spouse, or have family that either lives too far away or is too busy to provide adequate care?
		Is the elder soon to be discharged into a care facility or currently receiving in-home care?
		Does the elder have a variety of healthcare providers and need coordination and advocacy for quality care?
		Does the elder seem unusually concerned about costs of medication and services, indicating he or she may be having financial troubles?
		Does the elder have assets that fall between $50,000 and $400,000 – enough to finance a short stay in a care facility but not enough for an extended stay?
		Does the elder have a spouse whose financial needs must be considered in light of the elder’s medical condition?

Life Care Planning Goals

1. Meeting the elders’ immediate health care and long-term care needs.
2. Making sure the elder/family is making good health care and long-term care decisions.
3. Helping the elder/family sort through the maze of their long-term care options including residential options.
4. Identifying and accessing public benefits and resources to pay for care should the elder meet the qualifying criteria.
5. Help with asset management, including the burden of home ownership and personal property.
6. Providing the entire family the peace of mind that comes from knowing their loved one is monitored by a team that combines legal and financial expertise with specialized knowledge of the elders’ physical, mental and emotional health.
7. Ensuring the highest level of independence the elder can achieve, while ensuring safety.

National Healthcare Decisions Day

Inspiration and Perspective First, we would like to publish in part a message from Nathan A. Kottkamp, Chair of National Healthcare Decisions Day: History will be made April 16, 2008. Approximately 50 of the most prominent national healthcare, religious, and legal associations as well as countless local and state organizations will participate in the inaugural National Healthcare Decisions Day. At every level, the goal of this nationwide initiative is to ensure that all adults with decision-making capacity in America have both the information and the opportunity to communicate and document their future healthcare decisions. While making healthcare decisions is often difficult in the best of circumstances, making decisions for others is even more complicated. Each of us has the ability to guide our healthcare providers and our loved ones about we want. Advance directives give you the ability to document the types of healthcare you do and do not want and to name an “agent” to speak for you if you cannot speak for yourself. As Terri Schiavo’s situation vividly revealed, having an advance directive can be valuable for all adults, regardless of current age or health status. With the Patient Self-Determination Act of 1990, Congress affirmed the right of every citizen to set forth his or her future healthcare wishes in writing with an “advance directive.” Yet, various estimates suggest that fewer than 25% of all Americans have an advance directive. For an action that can be done without a lawyer, for free, and relatively easily, this figure is astonishingly low. In recognition of this, National Healthcare Decisions Day strives to provide much-needed information to the public, reduce the number of tragedies that occur when a person’s wishes are unknown, and improve the ability of healthcare facilities and providers to offer informed and thoughtful guidance about advance healthcare planning to their patients. With healthcare, “your decisions matter,” however, others need to know your wishes to honor them. There are no wrong answers when thinking about healthcare choices and completing an advance directive. Conversations with Yourself and Others Can you answer these questions? If you became seriously ill or injured and could not speak for yourself, do you know what healthcare treatments you would or would not want? Do other people know what your wishes are? As Director of Palliative Care at Dartmouth-Hitchcock Medical Center, Dr. Ira. Byock emphasizes what advance directives are and are not. Advance directives ARE: A communication tool for assisting people in clarifying their values and preferences regarding healthcare in serious, potentially life-limiting An advocacy tool to help patients project into an uncertain future for the benefit of the families caring for them. A counseling tool for supporting and guiding family members in making decisions in stressful situations. Advance directive ARE NOT specific prescriptions or plans of care. They are attempts at clarity regarding what a patient wants and are guidance for healthcare workers and families. Does a patient want to be resuscitated if he or she loses consciousness and is without any brainwaves? Does a patient what artificial nutrition and hydration if a physician indicates that the patient has fatally and permanently lost the natural ability to swallow? A person’s preference could vary from an enthusiastic yes to both questions to a belief that the care is excessively burdensome without real benefit. These thoughts and feelings should be documented in writing. Based on survey research and physician clinical experience, what matters most to most people is not being a burden to their family, losing control and suffering in pain. Nevertheless, people are often very reluctant to think about documenting in writing their preferences surrounding end-of-life. These decisions involve deepest and most dearly-held cultural, emotional and religious values, beliefs and fears, and therefore need to be addressed with sensitivity and compassion. Betsy Clark, Ph.D., ACSW, M.P.H., Executive Director of the National Association of Social Workers, offers some ideas to help with facing these important planning decisions: Avert a crisis – Aside from the highly-publicized Shiavo case, most people know of another family who faced crisis because it was unclear what life-sustaining treatment was desired by the critically-ill patient. Focusing on real-life crises and the desire to avoid such stress and chaos for one’s own family may be an incentive to face these issues. Normalize it – This type of planning is very common for families and should be a normal process of planning for any uncertain future. Physicians can particularly help to normalize it by explaining “we help all our patients with planning.” Gift to your family – Advance care planning can be the most valuable gift of all to family members and friends by documenting the wishes of the loved one who can no longer speak for themselves. It is important to try and understand loved ones wishes from his or her context, not from one’s own perspectives and preferences. For example, people have many different notions about what it means to have hope and to suffer. Hope is a way of thinking, feeling and acting which may be fact-based, faith-based or a combination, and families have well-established patterns of hoping. These social considerations are important to understand when honoring expressed healthcare decisions. Similarly, while we generally say we don’t want our loved ones to suffer, people suffer in many different ways and to differing degrees. Self-awareness of one’s beliefs and biases is important when considering the care of another. Georgia Leads the Country with Initiatives on Advance Directives Harvard Medical School was one of the first institutions that began discussing the need to redefine death. With enormous advances in technology, death is a unique, fluid process and it is no longer the case that all organs shut down around the same time. It is typical for lawmaking to play catch-up to technological advances. When technology can prolong life sometimes indefinitely, how should the law respond? Recognizing this dilemma between medical advances and patient care preferences, as well as the confusing state of existing law in Georgia, leaders from many different disciplines (law, medicine, social work, ethics, and long-term care ombudsmen to name just a few) collaborated beginning in June 2006 to help the legislature revise the law on advance directives. Unanimously passed by the House, approved in the Senate and then signed into law by Governor Purdue, the new law effective July 1, 2007 provides that individuals have the right to control all aspects of their medical care – including the right to insist on medical treatment, request it to be withdrawn or to refuse treatment – and provides a greatly improved statutory form to accomplish this control. The new form in Georgia contains 4 parts. The first part provides for an individual to appoint a health care agent (and possibly successor agents) to make health care decisions on his or her behalf upon incapacity. In making these decisions, the agent should consider conversations with the patient, treatment preferences described in part 2 of the form, and religious, cultural and other beliefs of the patient. If these considerations still do not clearly direct the agent, the agent should consider the best interests of the patient as well as potential benefits, burdens and risks. The second part lays out specific scenarios, such as a terminal illness with imminent death and state of permanent unconsciousness. For each scenario, the specific treatment preferences may be indicated by the individual. The third part of the new form allows an individual to nominate a guardian in the event a court decides to appoint one. Finally, the fourth part of the form provides clear signature and witness requirements. It is always preferable to have an advance directive in place rather than having to file for guardianship. However, if an individual becomes incapacitated and does not already have an advance directive in place, and the family cannot agree on the level of care, then the family may have no choice but to begin guardianship proceedings. The guardianship proceeding is not a pleasant situation and if it is contested it can be time consuming and costly. Are Advance Directives Honored? Studies from nursing, social work, medical and legal disciplines have agreed that one of the most common reason why an advance directive is not followed is because the families have not talked about it and do not truly understand the wishes of their loved one. In most cases, it is not a failure of the legal document, but rather that families are dealing with crisis, attempting to cope without the information to make informed healthcare choices for their loved one, and often are dealing with tremendous amounts of guilt. These studies highlight the importance of reaching out to your family and to your doctors so everyone understands what you want when the time comes. Use National Healthcare Decisions Day, April 16, 2008, to join Americans across the country in making future healthcare decisions known to family, friends and healthcare providers. Share your wishes and complete your advance directive, because…YOUR DECISIONS MATTER. Learn more about National Healthcare Decisions Day and get free information at www.nationalhealthcaredecisionsday.org.