‘Healthcare directives – a gift to your family’

Registered nurse Karen Kleinschmidt recently spoke about health-care directives and palliative care. Kleinschmidt has many years of nursing experience – some at the St. Cloud Hospital.
Sponsored by the Health and Wellness Committee of the St. Joseph Catholic Church, Kleinschmidt titled her talk, “Healthcare directives – a gift to your family.”
Often, health-care directives can make decisions easier for families and help families not to disagree at a difficult time.
Kleinschmidt said health-care directives have replaced what used to be called a living will.
This change was made in 1998. The old living wills are grandfathered in but differ somewhat.
St. Cloud Hospital is switching to a new form of health-care directive called “Honoring Choices,”
People can change their health-care directives at any time as long as they are able to make their own decisions. They are responsible for knowing who they have given copies of their directive to so it can be replaced if they do make changes.
Kleinschmidt said a health-care directive is like an insurance policy. Most people never need to use it, she said, but it’s available if needed.
Health-care directives are for people who are unable to make their own health-care decisions. By completing a health-care directive, an agent is named to make substituted judgment for people if they are unable to do so for themselves.
It’s important to keep a copy and give each designated agent a copy. Agents should also be asked if they want to be named in someone’s health-care directive.
Decisions that directives help families and loved ones decide are things such as whether to sustain a person’s health by use of a feeding tube, a ventilator, whether to resuscitate, to use IV fluids, to hospitalize, to turn a pacemaker off and other choices. It can also state whether or not the person wants to donate their organs or tissues. Funeral plans can also be stated in a directive.
Kleinschmidt said if a person has a “Do Not Resuscitate” request, it’s important they get a doctor’s order through a Do Not Resuscitate form. Otherwise, if 911 is called they sometimes will still treat the patient without the form.
A directive should be notarized or witnessed by two people who will not inherit from your estate if you die. Also, your agent cannot be your primary health-care provider.
If a physician disagrees with your health-care electives, they are required by law to find another doctor who can provide the care that will honor your directives. Often an Ethics Committee can help with these decisions.
Those 18 and older should be given a chance to do a health-care directive. It’s important to name an agent and alternate agent to represent the person if she/he can’t make decisions. Sometimes a spouse is not the best choice — for example, if both the person and his/her spouse were both injured in an auto accident.
“Young people should be making choices and having discussions,” Kleinschmidt said.
Volunteers at Whitney Senior Center in St. Cloud will help people with free health-care directives. This service is available on the first and third Tuesday of each month from 11 a.m.- noon.
Kleinschmidt also talked about palliative care. She said good palliative care and hospice care can decrease the cost of medical expenses and can often help keep a person in their home longer.
Palliative care focuses on the physical, emotional and spiritual needs of people who are seriously ill. It helps to reduce suffering, protect dignity and to improve the quality of life for patients and their families.
Kleinschmidt said families are defined by how the patient defines it, not by how others define it.
Palliative care can take place at any time and at the same time as other treatments.
The palliative care team includes a doctor or advanced practice nurse, practice nurses, social workers and chaplains. The team can offer support in making difficult health care choices and help families cope with a loved one’s illness. They can help manage pain and symptoms such as nausea, throwing up, shortness of breath, anxiety, trouble sleeping, diarrhea and spiritual distress.
Hospice differs from palliative care because it provides quality and compassionate care for people who are dying. It’s for people who are not expected to live longer than six months.
Currently, the St. Cloud Hospital only offers palliative care to inpatients.