Advance Care Planning

• Planning for times in your life when you cannot speak for yourself is a way to make sure that your wishes are met. Clearly stating your preferences can make it easier for your loved ones to make choices in a difficult time.
• Having an advance directive does not necessarily limit your healthcare options and does not replace an ongoing conversation with your healthcare provider and healthcare agent.

Advance care planning has multiple parts, and the ones that best meet your needs may depend on your unique situation and your health condition. Some parts of advance care planning include:

• Naming a healthcare agent who you would trust to make healthcare decisions.
• Talking to your loved ones and care team about your preferences for your care.
• Completing advance care planning documents such as advance directives.
• Ongoing conversation over time, as your choices may change.

• Your healthcare agent (also known as a surrogate decision-maker) should be a person you trust and who you would want to make decisions for you if you could not speak for yourself. You want this person to respect and advocate for your wishes.
• A healthcare agent must be at least 18 years old and available when needed.
• In the state of Delaware, if you do not have any advance care planning documents, there is a legal order for who would make medical decisions for you [Reference: Delaware Code: 16 Del. C. c. 25; § 2501.
  • The spouse unless a petition for divorce has been filed.
  • An adult child.
  • A parent.
  • An adult sibling.
  • An adult grandchild.
  • An adult niece or nephew.
  • An adult aunt or uncle.
• If you would like to name someone outside of this order as your healthcare agent, you can fill out a legal form to name your medical power of attorney (a healthcare agent who is legally named on a document). Information on how to do this is included below.
• If you are receiving care in Pennsylvania, the legal order of decision-makers is [reference Pennsylvania Title 20]:
  • The spouse, unless an action for divorce is pending, and the adult children of the patient who are not the children of the spouse.
  • An adult child.
  • A parent.
  • An adult brother or sister.
  • An adult grandchild.
  • An adult who knows the patient’s preferences and values, including, but not limited to, religious and moral beliefs, decides how the patient would make health care decisions.
• If you are receiving care in Maryland, the legal order of decision-makers is [reference Maryland law]:
  • A court-appointed guardian.
  • The patient’s spouse or domestic partner.
  • An adult child of the patient.
  • The patient’s parent.
  • An adult brother or sister of the patient.
  • A friend or relative who:
    • Is competent, and
    • Presents an affidavit to the attending physician stating that the patient is a relative or close friend of the patient and the specific facts and circumstances that prove routine contact sufficient to be familiar with the patient’s activities, health, and personal beliefs.

Good communication with your loved ones is key in planning for the future.

• The Conversation Starter Kit helps people talk about their wishes for care through the end of life. This tool can help you share your wishes with those who matter most to you (loved ones, friends, chosen family, and so on) to know and respect your wishes. 

Talking to your primary care provider can help you learn about care options to decide your choices for your healthcare.

• Bring your questions and concerns to your healthcare provider. You do not need to wait until they start the conversation. You might start with, "What makes life worth living for me is. . ." Or "I would not be willing to live if . . ." Talking about these things helps your healthcare provider understand your wishes.
• Talk openly and honestly with your healthcare team. Tell them what you’re hoping for and what you’re worried about. Ask them for the information you need to plan ahead for your future. This is the best way to understand the decisions you may need to make as your health changes. 

Advance directives are legal documents that tell your healthcare team how you want to be cared for at the end of your life.

Advance directives most often have two sections that can be filled out:

1. A durable power of attorney for healthcare allows you to name your medical power of attorney (legal healthcare agent/person who would make decisions for you).
2. A living will gives written instructions about your healthcare wishes.

You do not need a lawyer to write these papers. There are many available advance directive forms that you can fill out on your own. These become valid when you and two appropriate witnesses sign the form.

Here are some options for different advance directive forms:

1. PREPARE for your care is a step-by-step program with video stories to help you:

• Have a voice in your medical care.
• Talk with your care team.
• Fill out an advance directive form to put your wishes in writing.
• Learn more at PREPARE for your care – (prepareforyourcare.org).

2. The Five Wishes Booklet helps you decide your personal, emotional, and spiritual needs and medical wishes. The booklet includes your Living Will, Durable Power of Attorney for Health Care and addresses the following:

• The person I want to make care decisions for me when I can’t.
• The kind of medical treatment I want or don’t want.
• How comfortable I want to be.
• How I want people to treat me.
• What I want my loved ones to know.
• If you’re interested in a copy of Five Wishes and are on-site at a ChristianaCare hospital location, Patient Relations has a limited supply of forms available free of charge.

3. Advance Directive forms by state:

• Delaware.
• Maryland.
• Pennsylvania.
• New Jersey

Make sure your healthcare provider has a copy of your advance directive on file (see instructions on how to upload it to ChristianaCare below). Give a copy to your healthcare agent and other important people in your life.

These legal papers can always be changed as your wishes may change over time. 

DMOST stands for Delaware Medical Orders for Scope of Treatment. The DMOST is an advance care planning document which is a standing order for medical treatment preferences. It is used for certain patients who are nearing the end of life. This form goes into effect once signed by you and your healthcare provider and protects your wishes across different settings. A DMOST works along with an advance directive. You can get more information at DQOLC.org.

• Maryland uses the Maryland MOLST (Medical Orders for Life-Sustaining Treatment).
• Pennsylvania uses the POLST (Pennsylvania Orders for Life-Sustaining Treatment).
• New Jersey uses the POLST (Practitioner Orders for Life-Sustaining Treatment). 

When you get admitted to the hospital, you will be asked about your healthcare wishes as a routine part of your care.

• Bring a copy of your advance directive with you to the hospital so your healthcare team will know your wishes.
• Your healthcare provider will ask you about code status, which means your wishes related to cardiopulmonary resuscitation in case your heart stops (CPR includes pressing on the chest, electric shocks, and artificial breathing), as well as intubation in case you can’t breathe for yourself (having a breathing tube placed into your lungs so that a ventilator machine can breathe for you).
• If you cannot speak for yourself when you arrive at the hospital and do not have your wishes documented, the default is generally to perform all emergency care.
• Prepare for your stay with us at ChristianaCare with helpful tips and downloadable guides at Your Hospital Stay – ChristianaCare.