June 30th, 2011 at 5:38 pm
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Approaching conversations about advance care directives

by Kathryn Kilpatrick, M.A. CCC/SLP

It is not unusual for a health care professional to come across a situation where a patient may have a durable power attorney for both health care and financial matters, but not an advance care directive. In other situations, those documents may be in place, but have not been updated which can complicate situations in the event of a medical crisis.

After a car accident, one of my clients was discharged from the hospital with a mild head injury. An older gentleman, he lived alone and didn’t have any of these documents in place. He realized his accident could have left him more disabled. His wife was no longer living, and he shared with me that she was always in charge of those kind of matters. We helped him to process some of his options and he made a referral to our social worker to learn more about resources.

In one of the meetings I attended about advance care directives, several health care professionals mentioned they made sure their documents were in order, but were having trouble getting their spouse to do the same thing. One of the suggestions was to first talk about lifestyle preferences if they needed to be in the care of another person. That is a much simpler discussion to open with rather than whether or not a person wants to have life support discontinued under specific circumstances.

Start by discussing lifestyle choices

A friend’s husband was seriously ill and they had early discussion about some of his personal preferences as his limitations increased. Her parents were often part of these discussions since they lived nearby. Creating a lifestyle care plan can include less intimidating questions like food, music, clothing or other personal choices. What eventually happened was that all of the older family members began talking about what they might prefer. The discussion, for some, led to creating their advance care directives.

During some recent presentations on person-directed care for activity professionals, it was very interesting to watch the participants open up to what mattered to them if they needed to be in the care of another person.

One woman relayed she would be happy if she could have her hair and nails done once a week and she had to wear her earrings. If she was unable to put them on, she wanted to pick the pair for someone else to put on her. Another person wanted to make sure she was dressed in bright colored and comfy sweats each day. One of the men said he wanted the family to make sure his photos albums were in his room so he could look at the pictures of the years he played professional football.

Knowing a person’s story can also help create an environment that meets the interests of an older adult. If I were not able to do some of the craft projects I enjoy when my schedule was less hectic, I would probably enjoy watching someone weave or look through a book showing a variety of quilts. A friend who loved gardening wanted to make sure his room had a view outside and that friends and family would be able to create a small flower garden for him to watch grow during the summer.

Just starting with what you might like to be surrounded by if you were in the care of someone else can help begin a conversation on an important topic. It is certainly worth a try. If nothing else, you have possibly created a situation where this person might feel more relaxed sharing.

For additional information, refer to The critical conversation: six tips to consider.

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