Unless you are a spring breaker partying it up, you have probably given your own mortality a once-over or two during these long COVID-19 days.
You might want to revisit the subject during National Healthcare Decisions Day, strategically designated a day after April 15, because, as Ben Franklin famously quipped, “nothing is certain except death and taxes.”
Discussing mortality is, well, a bummer, but it is critical before the Grim Reaper’s visit.
The Conversation Project, which organizes National Healthcare Decisions Day, surveyed Americans about the need for end-of-life directives. Ninety-two percent of respondents considered it important to discuss their wishes for end-of-life care and 95 percent of them are willing to talk about these wishes, yet only 32 percent have actually had the discussion.
National Healthcare Decisions Day aims to get the words flowing on the subject. Age is not an excuse, says Barbara Fradkin, director of One Senior Place in Viera.
“I would suggest starting at any age 18 or over,” she said. “You may think that is very young, but when the children start working or are in college, there are decisions to be made. It is up to the individual to do what they want for end of life. It is better to have these thoughts on paper, just in case something happens. It is a very hard decision to put someone on a ventilator, and even harder to have it removed when there is no chance of recovery.”
The specter of COVID-19 adds urgency to engaging in discussion of how you would prefer exiting the earth.
While the young and healthy usually can get through the illness, the older and sicker are not likely to make it, even with the help of a ventilator.
Months of nursing may not provide them with enough strength or function to ever return to normalcy.
As the pandemic progresses, access to intensive care may become limited. It behooves us to think about what we would want if were to become very sick with coronavirus.
“If there are no advance directives, if you ended up on a ventilator and those were not your wishes, you could live a long time in a nursing home with a very poor quality of life,” said Fradkin.
Before you commit anything to paper, designate someone who can speak for you when you can no longer do so and familiarize the individual with your wishes. In this time of social distancing, a phone call or video chat will do.
“When someone does not have an advance directive and they are not able to speak for themselves and have not named an agent, the state gets involved and a guardian is put in place,” Fradkin said. “This is someone who knows nothing about you and they start to make decisions about your health and well-being. Then, if family is found and they disagree with the guardian, it really becomes a mess.”
Your agent will need to make tough, quick decisions on your behalf.
“Make sure this person understands what you want is not based on their beliefs, but on your beliefs and decisions,” Fradkin said.
To get the discussion flowing, a Conversation Starter Kit, available in 13 languages, can be downloaded free from theconversationproject.org.
After you’ve had “the talk,” you will need to complete a health care proxy or power of attorney, a legal document in which you appoint the person to be your proxy when health care decisions need to be made and you cannot speak for yourself.
You will also need an advance directive, or living will, another legal document that states your wishes regarding end-of-life medical care and delineates treatments you do or not want.
Every state has its own advance directive form, available for download at medicare.gov/manage-your-health/advance-directives/advance-directives-and-long-term-care.html.
“The Designation of Health Care Surrogate, along with the Durable Power of Attorney, are two of the most powerful tools available to avoid guardianship,” said Viera attorney Ruth Rhodes. “Have these two documents at a minimum. The cost of advanced care planning is far less expensive than the costs of a guardianship.”
Your agent needs a copy of your living will.
“A piece of paper is a static document that can address everything,” said Virginia health care lawyer Nathan Kottkamp in an interview with AARP’s Inside E Street show.
Kottkamp, who launched National Healthcare Decisions Day in 2008, added that “to have the right person be named and be able to talk with the doctors and nurses and everybody else is the best way to be sure your wishes are known.”
Do not hide away a living will in a lock box. Besides giving it to your proxy, distribute a copy to your primary care physician and to anyone else you think should have it. Keep a copy at the ready for yourself, too. Let your family know where the document can be found.
Advance directives should address issues such as DNR, or do not resuscitate, plus the use of a ventilator or tube feeding, hospice and palliative care and organ donation.
Completing a living will is not a done deal, either. You can and should revisit it at any time and make changes as needed. However, first and foremost, do it.
“Very few people talk to their loved ones about their end-of-life wishes, even less of them have actually documented their wishes in advance directives,” said Cassidy Petersen, an attorney with Estate Planning and Elder Law Center of Brevard. “As the coronavirus spreads, it is even more important to get these documents in place.”
The topic is difficult, but the time to talk about is before you’re headed for the hospital.
“We are always busy making a life plan, but never think of our death plan,” Fradkin said. “Everyone should have a choice on how they to want to live and die.”
More information on advance directives is available from One Senior Place at 321-323-7325.
Barbara Fradkin is a Social Worker and Director of One Senior Place in Viera, Florida. One Senior Place, The Experts in Aging, is a marketplace of resources and provider of information, advice, care and on-site services for seniors and their family caregivers in Central and East Central Florida. Visit OneSeniorPlace.com for calendar updates and information or call for a free 30-minute consultation with an experienced Aging Services Expert.