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Sheri Samotin

2018 CSA Conference

 

Sheri L. Samotin, MBA, CLFP, NCG, PDMM

LifeBridge Solutions, LLC
Founder and President
Sheri@lifebridgesolutions.com
www.lifebridgesolutions.com

 
 

 

Tales from the Trenches: What Happens (In the Real World) with Advance Health Care Directives and End-Of-Life Decisions

As a trusted advisor to older adults you are often made aware of the existence of documents like Advance Healthcare Directives, Physician’s Orders for Life Sustaining Treatments (POLST) and Do Not Resuscitate Orders (DNRO). You may find yourself in the role of advising clients as to medical capacity and end-of-life decisions. This session will provide insight into what can happen when your clients (or the family) tries to use your advice and/or the documents their attorneys have provided. We will offer ideas on how to avoid the inevitable pitfalls. 

State law sets forth the laws of public polity which recognize a patient’s right to control decisions relating to his or her own health care. A patient’s right of individual autonomy, privacy and dignity includes the right to exercise the prolongation of life beyond natural limits. An individual has the right to appoint an agent to make medical and other important and related decisions (e.g. Housing). The intent is that the designated agent will be aware of and carry out the patient’s wishes. The agent is appointed within the Advance Healthcare Directive. This document is intended to give the agent and treating providers guidance on the patient’s wishes for his or her care. 

People assume they will always be able to make their own healthcare decisions. Often, this is true until the very end, yet other times, sadly, it is not true at all. It is a common misconception that spouses automatically assume agency authority when their spouse has become unable to make medical decisions. There is no automatic right or entitlement of a spouse to make such decisions. Similarly, most parents don’t think about the fact that once their son or daughter is 18, they have no decision-making authority for their child’s health care in the absence of an advance directive. Another erroneous assumption is that the Advance Directive is like a cookbook that can be followed literally. However, often, the decision to be made is not black or white or there is disagreement among physicians or family members. 

Determination of capacity becomes an important consideration in the use of Advance Healthcare Directives and POLSTs. It is typical for these documents to require written declarations from one, and sometimes two, physicians before the agent can take over the method for determining capacity often depends upon whether the client/patient is in an acute care setting or is living in the community. It is in the community setting where it can be a bit tricky to obtain the necessary declaration(s). As a trusted advisor, you can help to explain the importance of allowing the capacity determination to be made in a timely fashion. 

Perhaps your most valuable role as a trusted advisor to older adults and their families is to educated them on the availability and importance of these documents and then to make sure that those who have been appointed as agents are well informed as to the client/patients’ wishes in clear, easy to understand language. 

Learning Objectives

  1. Participants will have a working knowledge of the content and use of Advance Health Care Directives, POLSTs and DNR orders.
  2. Participants will learn about the real life scenarios that often occur at the bedside and how they could have been prevented.
  3. Participants will become aware of the variety of resources available to help guide important conversations about end-of-life issues.

About Sheri

Sheri Samotin, CLPF, PDMM, NCG and President of LifeBridge Solutions is a license professional fiduciary and founder of LifeBridge Solutions.  Sheri is the author of Facing the Finish: A Road Map for Aging Parents and Adult Children. Sheri brings more than 35 years of business and management experience to LifeBridge Solutions. In addition to her professional certifications, Sheri is a graduate of Wesleyan University where she studied economics and holds a Master of Business Administration (MBA) from the Amos Tuck School of Business at Dartmouth College in Hanover, NH.  Sheri serves on the board of OPICA, an adult day program and counseling center for people suffering from dementia and their families and on the board of the American Association of Daily Money Managers.

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