Completing Advance Care Planning Documents: Part 2
A conversation in real time on completing advance directives. Mettle Health counselor and MD Claritza Rios walks through the 5 Wishes forms with a member of the Mettle Health community. What does each section cover? What do people need to understand in order to make the best choices for themselves or someone they're caring for? These are forms all adults should have completed so they are prepared for a situation where they cannot speak for themselves. In this recording, we cover sections 4-5 of the Five Wishes form and all sections of the POLST/MOST/MOLST form.
We discuss:
0:00 Introduction to Part 2
0:30 Wishes for how we want other people to treat us. How we want to be physically treated, how we want our surroundings to look, who do you want to be in your space?
3:12 What is the role of clergy or a chaplain at the end of my life? How might that look?
6:42 Questions about physical care and touch: do i want physical contact or not? Is it common for preferences for change?
11:47 Wishes for what do I want my loved ones to know? You can always write your own! This can be about what you want people to know, and also what you want for your body after you die
14:06 How to talk about what you want your family to know before you can no longer speak for yourself? Is there a way to bring this up?
20:32 Thinking about practical planning for after you die: do you want to be cremated? Do you want a memorial? After these decisions you can start to find the places that will take care of completing your wishes. It’s also a moment for delegating tasks to people who want to be helpful
22:50 Questions about funeral services - how much variation is there?
26:18 It feels like there’s a rush after someone dies, is it OK to have the body remain in place for a while? What do you need to do to plan for this?
33:20 Every state has their own rules about paperwork and what needs to happen to make it valid. Many states allow one form to be used, AND each state will have it's own Advance Care Directive - you can search for and download these forms online
35:19 POLST, MOST, MOLSTS: Forms that cover specific forms of treatment for people who are at the ends of their life. Every state has their own form. These forms are signed by a doctor and are considered “medical orders” that are applied in real time without a discussion.
36:43 When should you have a POLST/MOST/MOLST vs. an advance care directive?
37:54 The language varies slightly by state, but they are broken into 3 sections. It goes into specific types of care.
38:15 Part A: do you want to be resuscitated if your heart stops beating? (CPR)
44:33 Part B: What types of medical interventions do you want? They are in 3 big buckets
50:37 Reminder that this is for guiding clinicians when the person is in a state where they cannot speak for themselves. The steps in Part B build on each-other. Comfort focused is the first step.
54:32 How does nutrition by tube feeding work and who does it help?
01:01:45 What to know about antibiotics as listed in a POLST/MOST/MOLST?
01:04:03 Remaining sections of the MOST/MOLST/POLST form. Ensuring that you aren’t contradicting what is selected in each section
01:06:01 This document is changeable and not written in stone, what’s most important is continued conversation.
01:08:21 Information on time limited trials for people experiencing serious and terminal illness