Social Workers and Advanced Directives
Social workers have a large and diverse role in hospice. Often people think of social workers when there is a negative situation or someone would need help applying for Medicaid. Social workers do very meaningful work in hospice. It looks different from patient to patient and day-to-day. One of the very important things our team of social workers helps with at River Valley is navigating advanced directives.
Advanced Directives mean a lot of things, they are all very important to ensure the patient receives the best possible end-of-life care. It is often confusing and people are scared to navigate. However, they are one of the most important things to put into place. It helps those who are going to make decisions for you know exactly what you would want.
In this article, you will find information on the following:
MDPOA
Proxy
Living Will
5 wishes
MOST
Medical Durable Power of Attorney (MDPOA)
The MDPOA is a document the patient signs to appoint someone to make their healthcare decisions. The person they name is called the “healthcare agent.” This document must be signed when the patient is still considered competent to make decisions and the power expiries upon death. Meaning it only covers medical decisions. The authority this healthcare agent ends at the time of the patient’s death
This document does not need to be witnessed in the state of Nevada. In most cases, the patient’s agent only makes decisions when they cannot. This may be temporary, or long term. Sometimes patients feel tired or weak and even though they are still decisional they can choose to have their MDPOA make decisions for them.
The health care agent can get copies of the patient’s medical records, consult with their doctors and other healthcare providers, and make all decisions necessary for the patient’s care. The healthcare agent is supposed to act according to the patient’s wishes and values, so it’s important that the patient talks to him/her about his/her life values, goals, and preferences for treatment. Ideally, the agent is someone the patient knows very well. He or she must be able to devote the time and energy to handle the patient’s healthcare needs.
An MDPOA is not the same as a general Power of Attorney (POA). The MDPOA agent is only authorized to make healthcare decisions. A general POA covers legal and financial affairs.
River Valley will help our patients who do not have an MDPOA in filling out the paperwork. It is not required to have an MDPOA (if you are still decisional) when signing on to hospice, but we recommend having one so we can help ensure all your wishes are being honored. CLICK HERE to download an MDPOA form.
Proxy Decision Makers for Medical Treatment
If a patient has not appointed a healthcare agent (MDPOA), and if they are unable to make or express decisions for themselves, a “proxy” is needed. The physician (or another provider s/he appoints) has the responsibility to gather together all the people who have an interest in the patient’s well-being.
An example of people who have an interest in the patient’s wellbeing is spouse or partner, parents, adult children, grandchildren, brothers or sisters, close friends, or even professional advisors such as clergy, attorneys, or financial managers The group of “interested parties” must agree by consensus which one of them will serve as the patients “proxy” decision-maker. The selection of the “proxy” is documented by the physician.
Like the healthcare agent (MDPOA), the proxy should act according to the wishes and values of the patient. Proxies selected in this way cannot refuse artificial nutrition and hydration for the patient unless two doctors agree that such treatment would not help the patient get well but would only prolong dying.
If the group can’t agree on who the proxy should be, then guardianship needs to be pursued through the courts.
Living Will
In Nevada, the Living Will is called the “Declaration as to Medical Treatment.” It tells the patient’s doctor what to do about artificial life-support measures if the patient has a terminal illness and are unable to speak for themselves, or they are in a “persistent vegetative state” In Nevada, a Living Will does not go into effect until 48 hours after two doctors agree in writing that the patient has a terminal condition and are unable to speak for themselves or are in a persistent vegetative state. In these circumstances, the Living Will directs the patient’s doctors to continue or discontinue, as they specified in the document, life-sustaining procedures, artificial nutrition, and artificial hydration. In the Living Will document, patients can list people they want to be kept informed of their condition and the doctors’ certification of terminal illness or persistent vegetative state. Other medical instructions can be listed, but these instructions will only be followed when the patients Living Will goes into effect (that is, after the doctors’ certification). An attorney or a doctor is not required to complete a Living Will, but two witnesses are needed. (The witnesses cannot be the patient’s healthcare providers, an employee of the healthcare provider, the patient’s creditors, or anyone likely to inherit property from the patient.) The witnesses may be other patients or residents in the facility a patient is receiving care, as long as they are at least 18 years of age and mentally competent. A notary’s signature and a seal is a good idea but not required. A Living Will is not the same as a regular will (“Last will”) or a Living Trust, which refer to possessions and property. A Living will only provide instructions on medical treatment, not the distribution or disposal of property.
A tool that River Valley often uses is called the Five Wishes. It is a document that is written in easy to understand terms, as opposed to unfamiliar medical or legal terms. This booklet meets the legal requirements for an advanced directive in Nevada. It helps you to express how you want to be treated if you are seriously ill and unable to speak for yourself, using a document that you can easily understand. Once this document is signed and witnessed, it becomes a legal document. You can purchase a copy of Five Wishes here https://fivewishes.org/shop/order/product/five-wishes-advance-directive
MOST Form
Nevada Medical Orders or Scope of Treatment, or a MOST form is a document that has certain life-sustaining treatments. This is a form that requires a signature from a Medical Doctor (MD), Advanced Practice Nurse (APN), or a Physicians Assistant (PA). This form is for patients who are at risk for a life-threatening clinical event because they have a serious life-limiting medical condition. In this form, you will review life-sustaining treatments including CPR, artificial nutrition, and hydration. Usually, this form is printed on green paper and kept on the patient’s refrigerator. To learn more about this form please read our next blog on CPR and the MOST form.