Advance Care Planning with Heart Failure
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Advance Care Plan Components

An advance care plan can consist of any number of written documents including:

  • An advance care directive.
  • A do-not-resuscitate order.
  • A living will.
  • A power of attorney.
  • A financial plan.

These documents are discussed in more detail in the following pages. Your doctor, nurse, or hospital can give you information and written materials about advance care planning. Many agencies on aging, state and national bar associations, and medical societies may also be good sources of information.

You may wish to use a lawyer with experience in estate planning or elder care to help you prepare an advance care plan and ensure that it meets your individual wishes and state legal requirements.

Advance Care Directive

You or another person that you specify can provide guidance about your future medical care in a document called an advance care directive. An advance care directive should provide clear evidence of your wishes regarding treatment and can include a living will, a durable health care power of attorney, and a statement about organ donation.

A U.S. federal law called the Patient Self-Determination Act requires hospitals, nursing facilities, hospices, home health agencies, and other health care providers participating in the Medicare and Medicaid programs to give all patients written information about their rights to accept or refuse medical or surgical treatment and to make advance directives.

Do-Not-Resuscitate Order

A do-not-resuscitate order is a type of advance care directive that tells doctors, nurses, and other rescue personnel what they should or should not do when a person stops breathing or when their heart beats so irregularly as to threaten life or stops entirely. The decision to have a do-not-resuscitate order is made by the patient or his/her family in consultation with the doctor.

A do-not-resuscitate order can include instructions on whether to use different types of methods to revive a person including:

  • Cardiopulmonary resuscitation (CPR) - Manual chest pressure and mouth-to-mouth breathing to circulate blood and oxygenate the lungs.

  • Defibrillation - Delivering an electrical shock to the heart to restore a normal heart beat.

  • Breathing tube and machine - Used to assist with breathing.

  • Medicines - Given to restore an effective heart rate and improve circulation of blood to major organs.

Living Will

A living will is a legal document that lets a person who is unable to participate in decisions about their medical care express their wishes about life-sustaining treatment. A living will is usually used during a terminal illness when a person is unable to communicate. A terminal illness is one in which death is expected to occur with or without medical intervention and also applies to an irreversible condition, when there is no reasonable chance for recovery.

A living will guides healthcare providers and allows the patient to set limits on what is done to them. You can personalize your living will by including specific statements about the use of medical treatments which may apply to your condition, including CPR, blood transfusions, mechanical breathing, surgery, antibiotics, kidney dialysis, and invasive measures to provide nutrition and fluids. State laws vary in their requirements for living wills, so it is advisable to contact a lawyer to make a living will that is valid in your state.

Health Care Power of Attorney

A power of attorney lets another person make legally binding decisions for you. A health care power of attorney lets someone make all health care decisions for you including the decision to refuse life-sustaining treatment if you are unable to make the decision for yourself. If you have a living will, the person with a power of attorney also has the authority to interpret your living will in the event there are questions about it and make decisions that he or she believes to be in your best interest.

You can give someone a general power of attorney to make decisions for you or you can limit their decision-making to certain issues by including instructions about your care. For example, you can specify preferences regarding particular treatments such as tube feeding, intravenous fluids, and organ donation, to the extent you have not already covered those subjects in a living will.

If the power of attorney is a "durable" power of attorney this means that the person authorized to make your healthcare decisions can make them even after you become incapacitated. Having a durable health care power of attorney helps ensure that the specific person you want to make decisions for you, such as a family member, will have the legal right to act on your behalf.

While state laws vary, in general, the paperwork granting someone any type of power of attorney must be signed voluntarily and be witnessed by a notary public. A power of attorney must be completed when you are still capable (competent) of making decisions and before you become terminally ill. To ensure that a power of attorney complies with the laws in your state, it is advisable to consult with a lawyer who has experience in that area of law and can verify who may or may not serve as a health care power of attorney.

Financial Planning

Heart failure can be expensive to treat. You and your family may have concerns about paying for medicines, doctor and hospital bills, and other types of health care. If paying for care is a worry for you and your family, talk with your doctor or nurse. They can often help you find ways to pay for medicines, and other health care bills. Many hospitals or clinics also have social workers that can help with these issues.

Some drug companies have programs that provide medicines free to low-income patients if a doctor or nurse fills out special forms. Do not be shy about applying for these programs if you meet the criteria. The programs are there to help people get the medicines they need.

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