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Planning ahead

Health care providers discuss importance of medical advance directives

A medical advance directive is filled out by Jennie Garrett-Bureau, executive director/administrator at U.P. Home Health and Hospice during Tuesday’s Transitions of Care Marquette County meeting at Bell Hospital. The group, which consists of health care providers from hospitals, assisted living facilites, skilled nursing facilities, hospice and home health agencies, pharmacies and more, discussed the importance of advance directives and filled out their own at the meeting.

MARQUETTE — A little planning ahead can make a big difference in a crisis situation.

For this reason, the importance of medical advance directives was discussed at the Transitions of Care Marquette County meeting held Tuesday afternoon at UP Health System-Bell.

The group, which includes health care providers from hospitals, assisted living facilities, skilled nursing facilities, hospice and home health agencies, pharmacies and more, aims to “streamline the transition of patients from the hospital into home health and into hospice,” and give attendees a chance to “talk about challenges and opportunities to provide the best care to all the patients in the community,” said Jennie Garrett-Bureau, a member of the group who serves as executive director/administrator at U.P. Home Health and Hospice.

With the group’s focus on patient care and outcomes, they wanted to take time to discuss medical advanced directives and fill out their own at Tuesday’s meeting, she said.

“Patients don’t always have advanced directives and family members don’t always necessarily know what someone would want,” Garrett-Bureau said. “So if we don’t have them already, we are all doing our own advanced directives today. Then we’ll talk about if anyone has seen any challenges or if we have any other new opportunity to help each other and help the patients.”

In a medical advance directive, a person can name a patient advocate; state where they would like to be cared for at the end of their life; share their wishes about life-prolonging efforts such as feeding tubes and breathing machines when recovery is unlikely; express their spiritual and religious preferences; preferences for organ and tissue donation, as well as autopsy and burial options.

Whether a person is in their 20s or 60s, its never too early to fill out a medical advance directive, said Julie Giackino, director of care management at UP Health System – Marquette.

“One of the things we’ve found is we all benefit from knowing what the patient wants before they get into a crisis,” Giackino said. “So they can communicate what they want done when they’re not sick, when they’re feeling well and we can assist them in completing that paperwork. Then their voice is heard when they’re not able to speak.”

When a person doesn’t have a medical advance directive, it can put a tremendous strain on family members and the health care system, meeting attendees said, as each of the 20-plus attendees raised their hand when Giackino asked if they or their agency had been adversely impacted by the lack of an advanced directive for a patient.

While it can be difficult to think about the end of one’s life, it’s important to recognize planning for the end of life can make the situation easier on the individual, their loved ones and the health care system, said Jacki Lasich, oncology social worker at UP Health System-Marquette Cancer Care.

“When we’re at that (end-of-life) point, it’s way too late. And none of us can sit down and say, my point’s going to be ‘here,'” Lasich said. “… We think if we just put it off, nothing’s going to happen. And unfortunately, things will happen whether we put it off or not.”

Making choices about end-of-life care can be daunting — but it’s going to be easier in a relaxed environment than in a crisis situation, Lasich emphasized.

She recommends filling out advance directives as a group activity with loved ones, especially if there is a person who may be facing a life-limiting diagnosis, as it can normalize the process and open up discussions.

Lasich recommends using a simple, straightforward advance directive form that can start discussions surrounding the end of life and avoiding those that are overly complex or cumbersome, she said, as the process is already overwhelming for many people.

For Michigan residents, Lasich recommends the Making Choices Michigan form, as it is relatively simple and can inspire discussion. It is specifically adapted to meet the legal requirements for the state of Michigan can be easily printed and completed at makingchoicesmichigan.org.

“These are the ones that I have found the easiest when I’ve worked with patients, and my cancer patients especially,” Lasich said.

Making Choices Michigan, as well as some physician and attorney offices can register the advanced directive, but it is recommended to bring a copy of the advanced directive document with you to the hospital.

If nothing else, Lasich and Giackino recommend that a person names a patient advocate for themselves.

A patient advocate can be any person at least 18 years of age who an individual trusts to carry out their wishes and speak for them if they are unable to participate in their own medical or mental health treatment decisions.

“Discussion makes all the difference in the world. And at least, we want the guardianship,” Giackino said. “We want these things so somebody can make a decision medically and not have to go through the court.”

Overall, Lasich, Giackino and Garrett-Bureau emphasized it’s critical to encourage patients complete advanced directives while offering them support in the process. Furthermore, it’s especially important for those in the health care field to fill out an advance directive so they have firsthand knowledge of the process and feel comfortable speaking about it, Lasich said.

“The more we have these done ourselves and put out there, the more this community is going to start having them,” she said.

To learn more about the Making Choices Michigan and download its advance directive form, visit makingchoicesmichigan.org.

Cecilia Brown can be reached at 906-228-2500, ext. 248.