Back in November, I posted “6 Myths People Tell Themselves About Advance Directive Accessibility.” The takeaway: clients, family members, doctors, and hospitals can’t be relied on to produce a client’s advance directive when it’s needed.
In honor of National Healthcare Decisions Day – which falls on April 16, a few days from now, let’s talk about some better ways to make sure your clients’ advance directives are easily available at the hospital in an emergency. And in honor of David Letterman’s retirement, I’m presenting them in a “Top Ten” format (or in this case, 7).
Before diving in, you may want to point out to clients that their advance directives are not like the other estate planning documents you’ve prepared for them. Clients need people to be able to find them easily, and not bury them in file cabinets or guard them with secret passwords.
Having said that, you can advise your clients to:
7. Keep a copy on their fridge. Clients can attach them to the fridge in a clearly marked envelope. Some EMTs are trained to look there. But clients should be aware: in many states, EMTs are required to treat your client if they respond to a 911 call. Even if a client’s advance directive says the client wants to be DNR (do not resuscitate), paramedics can’t honor this unless their state has a law recognizing outpatient Do Not Resuscitate orders. (Once a patient reaches the hospital, the Emergency Room staff in all states can use the advance directive to honor client’s wishes.)
6. Keep a copy in their glove compartment. If your client isn’t home when a crisis strikes, having a copy in the car can help with an unanticipated need for access.
5. Keep a copy in their purse or wallet. Well, it’s definitely easier in a purse. This one is a great option in theory, but may or may not be possible in practice, depending on the length of the directive that you draft. I know firms whose directives are over 30 pages long.
4. Email it to their smartphone. And save it to a place on their phone where it can be easily found in an emergency. (This may or may not be easy.)
3. Enroll in their state’s advance directives registry. If your state has one, this can be a good option. The vast majority of states, however, do not offer one. For states with a registry, it’s worth being clear with clients that there are some significant limitations. Most state registries will not store all the advance directive documents that you create for your clients. Most importantly, none will accept a HIPAA release, and many won’t accept a mental health power of attorney, organ donation authorization, a POLST form, or even instructions to the healthcare agent. (Check out your state’s provisions.) Also, ask if an out-of-state hospital can get the directives.
2. Enroll in an independent advance directives registry. These registries make directives available nationally and even internationally. Clients often receive a wallet card that provides access to the directives and also displays allergies, medical conditions and other emergency information. Many offer additional services, including alerting clients’ loved ones if the client is hospitalized. In most cases, there is a fee.
1. Get a tattoo. While I don’t recommend this, it’s been done. (Seriously.) Certainly, you’d want to steer your clients away from this option for a multitude of reasons – not the least of which that it’s not for a client with subtle, nuanced preferences. But if you have a client who wants to be “DNR” or “Full Code” and were to insist on this approach, just make sure they get it notarized.
Randi J. Siegel, MBA, is the President of DocuBank (docubank.com), the largest advance directives registry in the U.S., which ensures that the emergency information and healthcare directives of its 200,000+ enrollees are immediately available 24/7/365. Working with estate planning professionals since 1997, Randi frequently speaks at national estate planning conferences and has appeared on radio and television as an authority on registries. A board member for the Center for Advocacy for the Rights and Interests of the Elderly and a member of the International Society of Advance Care Planning and the Coalition to Transform Advanced Care, she is active in health education and public engagement related to advance care planning and advance directives and serves as Pennsylvania liaison to the National Healthcare Decisions Day initiative. Randi is an ongoing contributor to the Academy blog.
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