“It Always Seems Too Early, Until It’s Too Late”

Improving care at the end of life is one of the principal health care challenges of in our time. Our health care system often does not support patients and their families properly or sufficiently as they face serious illness or death. And patients’ care preferences are often not being met.

“Five Big Ideas to Improve Care at the End of Life” is a newly-released national report addressing this exact topic. Four of these ideas from the Aspen Health Strategies Group focus on changes to health care delivery and health insurance/reimbursement. But the first “big idea” in this report is different. It goes well beyond just the medical folks and points to our society at large:

“Build the development and updating of an advance care plan into the fabric of life.
The Aspen report concludes that we badly need a systematic effort that “engages people long before they are ill and evolves as their lives and health conditions change.”  I agree. In fact, I’ve been thinking along these lines for some time now.

It stands to reason: deciding one’s health care preferences – and sharing them – is easier if it is an expected, routine, “normal” life action that everyone takes. This produces less discomfort. No stigma. No crisis. Clearer thinking. No fear that doing so signals an impending death. Some folks might even say, “duh.”

Here is where you come in.
As a trusted estate planning professional, how can you best bring your expertise to bear to help weave advance care planning discussions “into the fabric of life?” I’d like to offer the following approach:

• Start with yourself and your family and move outward from there. Think in concentric circles of influence.
• Use National Healthcare Decisions Day as your catalyst. This ready-made annual event is coming on April 16-22 – this year it’s an entire week of activities to honor its 10^th anniversary.

Below is my guide to using the 7 days of NHDD week to actually do some of this activity and also plan future endeavors.

You and Your Personal Sphere

Day 1 You.  Write that advance directive if you haven’t yet. Review it if you have. Talk with your loved ones about your wishes. In other words, do as you say — and as you do.

Day 2 Your family.  Talk with them about your wishes. Make sure they have an advance directive and that they talk to their surrogates about theirs.

Day 3  Your staff.  Offer them your firm’s advance directive package at no charge. Or give them your state’s statutory form to complete on their own. Discuss this at a staff meeting and offer them the same guidance you offer to clients about how to choose a surrogate decision maker.

Your Professional Sphere

On the railroad of life’s opportunities for advance care planning, your firm is an important station stop. Presently, it is one of the few “built-in” opportunities that exist for creating an advance care plan.

Day 4  Your Existing clients.  Remind them to review their directives to see if they still reflect their wishes. Urge them to talk with their health care agent about their wishes. Invite clients and their surrogates to sign up for a seminar you will offer on how to serve as a good agent.

Day 5  Your existing clients’ adult family.  Encourage other adult Members of your clients’ families and extended families to complete an advance directive and discuss their wishes with relatives. Advise your clients that you are trying to protect their loved ones and protect them — from unnecessary hardship and stress if they become the health care agent for a loved one without ever receiving any guidance. Lastly, get clients’ children to do this basic planning when they turn 18. Offer a college student/young adult package (including advance directive, HIPAA release, financial power of attorney, FERPA release). Or, even simply offer health care directives gratis as a good will gesture.

Day 6  Your new clients.  Consider doing more to help guide new clients in making the important decisions reflected in their advance directive. Before clients complete their advance directives, consider offering them tools, as “homework,” to help them do this. To enhance their general comfort with this topic and get them thinking about conceptual goals, there are card games, such as “Hello,” that can be fun to play. (In fact, we played a game at our office with staff – it was enjoyable and quite interesting). To think about choosing their surrogate, and to help them clarify their wishes on their care preferences, there are interactive websites like Living Voice. And also note – these tools can be used with anyone and everyone mentioned above for Days 1-5, as well.

Day 7  Your community.  Consider doing more to advance this cause, about which you are knowledgeable, as a gift to your community. Offer public talks on the importance of advance care planning and advance directives at your local library, hospital, senior center, independent living facility, or AARP chapter. You may wish to team up with your local NHDD chapter (state-by-state liaisons are on the NHDD website – or contact me.)

Of course, the follow-up work of the individual is an important piece in this advance care planning process and I don’t want to minimize it. As you know, creating advance directives isn’t enough. Talking with one’s surrogate and other loved ones is equally important. (The Conversation Project has great resources for this.) It’s also important to talk with one’s doctors about one’s wishes and make sure they have one’s advance directive on file. It’s also useful to have additional way(s) to get hold of these documents in an emergency, since we don’t carry these papers around with us.

Please let me know if you are moved to adopt any of this social fabric “weaving.” And feel free to contact me with questions or more detail. Happy National Heath Care Decisions Day!

Randi J. Siegel, MBA, is the President of DocuBank® (docubank.com), which ensures that the emergency information and healthcare directives of its 250,000+ enrollees are available 24/7/365 through the largest advance directives registry in the U.S., as well as access to an online safe for storage of digital assets and other vital documents. 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 member of the Philadelphia Estate Planning Council, the International Society of Advance Care Planning and the Coalition to Transform Advanced Care, Randi is active in health education and public engagement related to advance care planning/advance directives. She serves as Pennsylvania liaison to the National Healthcare Decisions Day initiative and as a board member of the Center for Advocacy for the Rights and Interests of the Elderly. Randi is an ongoing contributor to the Academy blog.

Academy Guest Blogger
American Academy of Estate Planning Attorneys, Inc.
9444 Balboa Avenue, Suite 300
San Diego, California 92123
Phone: (800) 846-1555
www.aaepa.com