Advance care planning involves making decisions about health care before you actually have to make them.
It can involve difficult conversations with loved ones but can also provide peace, comfort and clarity in making sure questions with no right answers still have the best answers.
Dr. Dan Heinemann recently retired from acting as the vice president medical officer for the Sanford Health Network. Shortly before retirement, he shared his perspective on advance care planning with host Alan Helgeson on the Sanford Health radio show “A Better You” on KSOO-AM in Sioux Falls, South Dakota.
A longtime family physician who then moved into administration, Dr. Heinemann oversaw the small hospitals in the Sioux Falls region, as well as several nursing homes.
He has been witness to the disproportionate price paid by older adults during the pandemic. The isolation brought on by restricting visitors, coupled with vulnerability to the coronavirus, has presented facilities with an unprecedented set of challenges.
Often advance care planning can help families through what can be a series of difficult decisions. The peace that comes with knowing a loved one’s care wishes are being followed make end-of-life challenges more manageable.
Making an advance care plan
“Many of those infected with COVID chose not to have heroic measures taken,” Dr. Heinemann says. “When they entered the long-term care facility, they made a decision they were not going to do that.”
In a conversation that included several pandemic-related topics — as well as Dr. Heinemann’s own history in health care — the Sanford vice president outlined what goes into a comprehensive advance care plan. He also provided a personal account of the benefits of having one in place.
“When COVID started in our communities, we made sure to have conversations with our residents and their family members to understand what their wishes were regarding hospitalization, aggressive care, ventilators and aggressive treatment,” Dr. Heinemann says. “So this way we understood what their wishes were.”
They’re important conversations and important documents. The result is knowing more about patients’ wishes should they no longer be able to express how they want their health care to proceed.
Documents that frame care
There are three main legal documents involved in establishing a comprehensive advance care plan:
- A living will. In Dr. Heinemann’s words, a living will allows “an individual to frame up what their wishes are surrounding their care.”
- Advance directive, or durable power of attorney. This designates someone who will make health care decisions for you should you be unable to do so yourself.
- Medical Orders of Scope of Treatment. This is a physical set of orders that align with your health care wishes that takes place in the company of a trusted source of primary care. It could be a doctor, a nurse practitioner or a physician assistant.
Dr. Heinemann’s support of advance care planning includes his own story involving a beloved parent.
Not easy, but easier
Floyd “Bud” Heinemann was an active 90-year-old who was still volunteering at the Sanford Medical Center four days a week as he approached his 91st birthday. Last April, however, he called his son in the morning and said he wasn’t feeling very well. He was going to the hospital because he had a terrible headache.
Hours later he was unresponsive and never regained consciousness.
“He had a viral encephalitis and there was a very high likelihood he would never recover,” Dr. Heinemann says. “He’d never be able to go back and volunteer and do all the things he liked to do.”
Dr. Heinemann and his siblings had prior conversations with their father about how he wanted things to work should he be in this situation. So when the time came and the elder Heinemann was not able to express his wishes, Dr. Heinemann and his family knew their father did not want aggressive treatment or care, nor did he want antibiotics. He wanted to be kept comfortable.
“It made it easier for me but I wouldn’t say it was easy,” Dr. Heinemann says. “It was easier because I knew what he wanted. We had agreed that that’s what we were going to do. It was easy then to say no to some of the things that the health care team would offer in terms of care for my father. And it could have had a totally different outcome in terms of anxiety, stress, uncomfortableness — and pain on his part — because we would have drawn things out.”