Advance Directives in New York – Planning for the Future
Posted in Advance Directives in New York, National Healthcare Decision Day, Planning for the future
Do You Have Advance Directives?
SelectCare offers a wide variety of home health care services to our clients throughout New York City, ranging from occasional assistance around the home to around-the-clock nursing services for people experiencing major illnesses.
During every client’s free in-home health and safety assessment, Selectcare’s RN Field Nurse Supervisors cover an extensive list of health topics with their new patient, not only discussing a client’s current medical and social needs, but also beginning important conversations about the patient’s future, including plans for Advance Directives.
With National Healthcare Decision Day just a few weeks away, SelectCare wanted to provide readers with additional Advance Directive resources. Although it can seem like a morbid subject, this is an important issue for people of all ages, and view Advance Directives as just another part of patient protection – ensuring the independence of our clients at every stage of their lives.
It’s important to remember that anyone 18 or older, regardless of their current health, can and should have Advance Directives in place. These documents should be reviewed at least once every five years to ensure they have accurate contact information for your health care proxy and represent your current medical wishes.
In New York State, the term “Advance Directives” covers a long list of medical and social decisions that could arise during a future hospital stay and ensures your wishes are followed in the event you cannot speak for yourself. These decisions cover everything from whether or not you would like to be brought to a hospital or kept at home, what type of medical procedures can be performed on you (like the use of a feeding tube or ventilator), and, in the event you are not expected to survive, whether family members or a member of the clergy should be brought to your side. 
In New York State, there are three major categories of Advance Directives:
1 – New York State Health Care Proxy: This document allows you to name a health care agent, someone who will make medical decisions for you if two doctors decide you are unable to make choices for yourself. This directive requires a specific form be completed and copies given out to your family and physician.
2 – Living Will: This directive describes the specific medical care you want or refuse if you are diagnosed with a terminal condition but cannot voice your desires. While there is no specific document for this directive, the MOLST (Medical Orders for Life-Sustaining Treatment) form is very comprehensive and widely recognized.
3 – Do Not Resuscitate (DNR): This is the shortest of the directives and simply tells hospital workers or emergency responders not to revive you if you stop breathing or your heart stops. This form goes into effect as soon as it is signed by your doctor, but must be reconfirmed every 90 days.
While many people discuss end-of-life decisions with their loved ones, SelectCare urges everyone to ultimately put these decisions into writing. By writing down your decisions, you can minimize confusion and stress amongst your family during what is surely an already trying time. This is especially true if your end-of-life choices have only been discussed with a small portion of your family.
SelectCare’s staff is well-versed with these documents and is always ready to answer any questions you might have about these forms, but we also respect the privacy of our patients and urge anyone who wishes to learn more about these topics independently to visit Compassion and Support, which offers comprehensive, line-by-line explanations of these documents.
If you or a loved one have any questions about Advance Directives, home care or wish to learn more about our free, in home health and safety assessments, call us today.
I totally agree with it all.. It’s great to be a step ahead!
For sure! I actually downloaded and filled out the MOLST form and my healthcare proxy form while researching this article, didn’t take more than about half an hour.
It’s one of those “Have and hope you don’t need, rather than need and not have” things.
Another thing to mention that is very important, is that once you have completed any of these forms, you must give copies out to your GP, any other doctors who are treating you, your appointed health care surrogate, family members, etc. These documents cannot be helpful if they are not accessible. Some people even carry theirs with them at all times and also have a copy in the home where anyone can access it.
It is also vitally important that you not only express your wishes in documents, but that you also have “the conversation” with your physicians, family members, and most importantly, your health care surrogate. Many people agree to being designated as a health care surrogate, but they don’t really know what the individual wants because there was never a discussion about it.
Lastly, an additional form that might be worth completing is a Non-Hospital DNR form. This form is usually given to a family when they elect to receive hospice services. However, it can also be downloaded here http://www.health.ny.gov/forms/doh-3474.pdf.
Because EMT personnel and all first responders are obligated by the law to resuscitate and/or intubate to save someone’s life, a regular DNR or MOLST form will not serve to override the law. This form also needs to be filled out by an MD and reviewed intermittently. If someone is absolutely adamant about not being resuscitated, this form protects them from medical personnel overriding their wishes, should a crisis happen in an individual’s home.
Great crash course, Select Care!!
I totally agree with you about discussing and disseminating these documents amongst your family members and physicians once completed. The last thing you want would be your advance directives sparking off a fight amongst your loved ones.
I’ve actually received a few emails about the non-hospital DNR since going to print. It’s true, this is an important document, but I omitted it because National HealthCare Decision Day is supposed to be something of an introduction to advance directives for laymen.
Since non-hospital DNR’s are only really discussed when people begin hospice, I decided that the image of an EMT not resuscitating a patient would be a pretty jarring introduction for someone new to this subject..
By the way, thanks for reading! I’m always looking for interesting subjects for patient education posts, so don’t hesitate to send along any other ideas, either in the comments or via email.
Pat,
Many clients also choose to have a non-hospital DNR in place without Hospice services. It has been my experience that many clients have given a great deal of thought to how they wish to live or die if a catastrophic health event occurred.
Pat,
The Non-hospital DNR is useful primarily for when a person states that they do not want to be “brought back” if they have a heart attack or other fatal incident. In my professional experience, it has been very useful for when a person dies in their sleep, for example, and they are not on hospice, and yet although the family is obligated to call 911, when the EMT personnel arrive, they do not have to try and resuscitate the person. For folks who really don’t want extreme measures to be taken to revive them, no matter what the cause of death, this document can be very helpful in fulfilling the person’s wishes.
Obviously, young people do not need such a document, but for the Seniors, and especially those who have thought about their eventual deaths, and what they do not want, this document can provide peace of mind for them. And they do not have to be on hospice to obtain one.
However, as both you and I have stated, none of these documents will carry any weight if they are not shared with family and/or significant others. But it will protect the person’s wishes in cases where not every one agrees with the individual’s decisions. It’s sad, but true, that when family members are not aware of the wishes of their loved one, as in the documentation has not been shared, conflicts often break out between family and medical professionals, and the outcomes are never good for anyone involved.
Thanks for addressing this very relevant and extremely important topic!
Kathy Gurland, LCSW
NYC