Advance Care Planning

"I have an advance directive, not because I have a serious illness, but because I have a family."

~Ira Byock, MD

 

Advance care planning is a decision-making process that enables you to have a clear voice in your future health care. The process includes gathering information, considering your options and making your decisions known to others. It's legally binding, free, and a gift to yourself and those who love you:

  • Learn what the treatment options are in the case of failing health or serious illness.
  • Think about those options in light of your own personal values and your definition of "quality of life".
  • Have conversations with those who love you, and share your thoughts and decisions with them.
  • Choose someone to speak for you if you cannot speak for yourself, and document this choice also.
  • Communicate your decisions in writing in documents called advance directives (Living Will and Healthcare Power of Attorney).
  • 90% of Americans say that talking with their loved ones about their end of life care is important

    71% have thought about what they would want

    28% have actually had the conversation

    23% have put their wishes into writing

    Why Should I Do It?
    Advance care planning is a gift to those you love, providing clear guidance on what you want. It gifts you with the assurance that your voice will be heard.  It provides direction to health care professionals if you are not able to make decisions or communicate your choices.  It reduces any anxiety you might have before about what might happen to you, and improves your care at the end of life.
    WHEN SHOULD I DO IT?
    It's best to do this planning before there is an accident or illness that prevents your having a voice in your future health care. And it is appropriate for adults at all stages of life, 18 years and older.
    Frequently Asked Questions
    The most frequently asked questions about advance care planning and advance health care directives are summarized in this document. Click here to access the document.
    HOW DO I GET STARTED?
    There are a number of resources you can access online, including the documents needed to record your wishes, that will help you get started.  Links and brief explanations are provided below for advance care planning resources, state-specific advance directives, and other related end of life documents.

    If you would like to speak with someone directly about advance care planning or completing or updating your documents, contact your local hospice provider who has staff trained to guide you through this process. If you need contact information for your local hospice, you can find it on our Provider Locator, or contact us at 800-692-8859.

    Others who can be helpful are your doctor, hospital, pharmacist, spiritual adviser, or attorney.

    EVERYONE'S TALKING ABOUT IT!
    "The Conversation" has come out into the open in recent times. In this section you will find links to news items from around the country that highlight the growing movement to normalize death and exercise some control over your experience.

    The Cause of Death (American Nurse Today,December 2015 Vol. 10 No. 12)

    Whose Job Is It to Talk to Patients About Death? (The Atlantic, August 18, 2015)

    What Good Is Thinking About Death (The Atlantic, May 28, 2015)

    Doctors Are Poorly Trained in End-of-Life Care (Scientific American, May 19, 2015)

    Addressing end-of-life care in the emergency department (KevinMD.com, May 9, 2015)

    For young and old, it’s wise to have a living will to state health-care wishes (Washington Post, April 27, 2015 from Consumer Reports)

    Doctors to families: Talk about death before it's too late (Independent Mail, April 15, 2015)

    Teenagers Face Early Death, on Their Terms (New York Times, March 28, 2015)

    How do you want to die? A mission to make death part of popular conversation (PBS NewsHour, March 28, 2015)

    George Washington University expert: Innovation in health care must include better deaths (Washington Business Journal, March 20, 2015)

    The Trouble With Advance Directives (New York Times, March 13, 2015)

    Non-interoperable directives: End-of-life wishes and EHRs don't yet mesh (Modern Healthcare, March 7, 2015)

    Being Mortal (PBS Frontline, February 10, 2015)

    Living Wills Are the Talk of the Town in Lacrosse, Wisconsin (NPR, March 5, 2014)


    Advance Care Planning Resources


    Online Resources to Help Get you Started
  • Isn't It Time We Talk? - The Carolinas Center-sponsored campaign and helpful resources that are dedicated to helping families talk about their preferences for health care treatment in the future and make written plans that will be honored by their families and health care providers.
  • Begin the Conversation - An advance care planning program created to encourage the use of advance directives, was created in 2009 by Lower Cape Fear Hospice. To help everyone prepare for the unexpected, the goal is to encourage the completion of advance directives, with a focus on the value of conversations in advance care planning.
  • The Conversation Project - Dedicated to helping people talk about their wishes for end-of-life care, this 2010 initiative was founded by those who believe that the place for conversation to begin is at the kitchen table, not in the ICU.
  • Five Wishes - This advance directive was introduced in 1997 by Aging With Dignity, a national non-profit with a mission to affirm and safeguard the human of individuals as they age and to promote better care for those near the end of life.
  • Got Plans? - Hospice & Palliative CareCenter, Novant Health, Rowan Hospice & Palliative Care, and Wake Forest Baptist Health have come together to promote a common cause in the Piedmont Triad region of North Carolina. Recognizing the importance of advance care planning for their patients and community-at-large, their goal is to promote advance care planning so that communities are educated and engaged in the process.
  • National Healthcare Decisions Day - NHDD, now in its 10th year and partnering this year with The Conversation Project, exists as a 50-state annual initiative to provide clear, concise, and consistent information on healthcare decision-making to both the public and providers/ facilities through the widespread availability and dissemination of simple, free, and uniform tools (not just forms) to guide the process.
  • South Carolina Hospital Association's SC/National Healthcare Decisions Day Action Guide - The SCHA values and promotes informed decision making that is done before there is a crisis.
  • South Carolina Lieutenant Governor's Office on Aging - Information on advance care planning--including instructions and brochure--and copies of the SC legislative approved advance directives.
  • Living Will (Advance Directive for a Natural Death or Declaration of Desire for a Natural Death)
    A LIVING WILL is a legal document in which you specify your preferences for future medical treatments in case you are unable to speak for yourself when medical treatment becomes an option.

    Please note the following about a Living Will:

  • It can be created without cost, unless there are attorney or notary fees.
  • In NC & SC, the person's signature must be notarized and witnessed to make it legal.
  • The document goes into effect when the person loses the ability to speak for themselves.
  • It is a state-specific document but generally honored in other states. i>

  • It does not expire, but it is a good idea to review every few years and amend if needed.

    NC Advance Directive for a Natural Death

    SC Declaration of Desire for a Natural Death

    SC Declaración a Favor de Una Muerte Natural

  • Healthcare Power of Attorney

    A HEALTHCARE POWER OF ATTORNEY is a legal document in which you appoint someone to speak for you regarding medical decisions if you are unable to speak for yourself. This person is called an "agent" and you select them to speak on your behalf based on your wishes.

    NC Health Care Power of Attorney (English)

    SC Healthcare Power of Attorney

    SC Oder Legal Para Atención Médica

    Physician Orders for Life-Sustaining Treatment Paradigm
    Both NC and SC have developed forms modeled on the Physician Orders for Life-Sustaining Treatment (POLST) Paradigm, a program currently being used or developed in 45 states. The POLST paradigm encourages a coordinated approach to end-of-life planning. It is based on advance care planning conversations between the patient, Healthcare Power of Attorney (if applicable), family, and healthcare professionals which identifies the care the patient would like to receive at the end of his/her life. As a result of the conversations, the patient’s wishes may be documented on the form, transforming the shared decisions into an actionable medical order to help ensure a patient’s wishes are honored.
    Medical Orders for Scope of Treatment (MOST) Form - Applies to North Carolina Only
    Pursuant to N.C. General Statute 90-21.17, NC Department of Health & Human Services, in conjunction with the Office of Emergency Medical Services (OEMS), has adopted the Medical Order for Scope of Treatment (MOST) form to implement the POLST paradigm in the state. The MOST form is for use by physicians and other licensed healthcare facilities to assist in providing information relating to a patient's desire for resuscitation or life-prolonging measures. The form is only available to physicians' offices or other licensed hospital or healthcare facilities.

    You can access a sample copy of the MOST form at Sample Medical Orders for Scope of Treatment (MOST) Form

    To access a copy of "Key Facts About MOST for Patients and Loved Ones", click here.

    Physician Orders for Scope of Treatment (POST) – Applies to South Carolina Only
    The South Carolina Physician Orders for Scope of Treatment (POST) Pilot Project began on April 16, 2014 and was developed by the South Carolina Coalition for the Care of the Seriously Ill. The Coalition believes that is a needed next step in providing excellent communication between seriously ill patients and their physicians, as well as identifying the active voice for their health care decisions.

    The pilot is in process in Charleston and Greenville counties and includes the Greenville Hospital System, Bon Secours Hospital – Greenville, the Medical University of South Carolina, and Roper-St. Francis Healthcare. The Department of Health and Environmental Control (DHEC) reviewed the POST form and the pilot proposal and alerted the Emergency Medical Systems in the affected counties. The pilot will inform any changes needed to the form and process.

    The plan is that the POST will be available to the entire state of SC at a later date. More information is available online or from a healthcare provider in the two pilot counties.

    You can access a sample copy of the POST form at Sample Physician Orders for Scope of Treatment (POST) Form.

    Do Not Resuscitate (DNR) Form – Applies to North Carolina Only
    The Do Not Resuscitate (DNR) form is used to indicate that a patient does not want resuscitation in the event of cardiac arrest. Like the MOST form, this document must be obtained through a healthcare professional.

    Do Not Resuscitate (DNR) Form – Applies to South Carolina Only
    The Do Not Resuscitate (DNR) form in SC was created in response to a statute that addresses the Emergency Services Non-Resuscitation Order and can be honored by Emergency Medical Services (EMS). The form must be obtained from a physician.