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What you should know about Advance Directives

An interview with Julie Kaczmarek, Social Worker at Saint John’s

What is an advance directive?
The form recommended and utilized as an advance directive in health care is the Power of Attorney for Health Care (POA-HC). This is a document you can complete empowering another individual to make your health care decisions if you become unable to make or express these decisions (incapacitated).

Why is it so important to have one?
It is important to have completed the POA-HC while you are able because it gives authority for someone else to follow YOUR health care wishes if you become incapacitated. I believe it also takes guilt away from your loved ones as they are following your specific expressed choices rather than having to make a potential “life and/or death” decision based on what they think you would have wanted. Completing the POA-HC should prevent the need to appoint a guardian, which is a timely and expensive process involving the court system. There is no charge to complete a POA-HC.

What medical issues are covered in an advance directive?
First of all, there is often a confusion regarding the difference between the living will and the power of attorney for health care. There are a lot of differences between these documents.

The living will gives the physician instructions when an individual is terminally ill or in a persistent vegetative state.

A power of attorney for health care becomes effective when a person (the principal) becomes “incapacitated” meaning they are unable to make health care decisions. It names the person that the principal wants to be their “agent” to make decisions for them. It covers a wide variety of possible medical scenarios such as decisions regarding placement in a long-term care facility and feeding tubes. There is also a special provision section, statement of desires or limitations. This is a great asset to the POA-HC document. This section gives you the opportunity to express your individual desires regarding any health decisions not already addressed. You can focus on or clarify issues like kidney dialysis, artificial hydration, artificial nutrition, respirator, and/or cardiopulmonary resuscitation, also called CPR.

What is your job regarding advance directives?
It is my job to assist all Saint John's residents and families in completing their power of attorney for health care. Every resident should have one on file, and Social Workers at every long-term care facilities should be the person for families to work with regarding these matters. The Social Worker and Chaplain are the only health care staff legal to sign as a witness.

Have you ever been in a situation in which an advance directive was vital to the family decision?
It happens all the time. If a resident starts to have cognitive and physical decline (which Skilled Nursing Centers see regularly) there are a lot of choices to make regarding medications, surgical procedures, et cetera. If families have talked to their loved one prior to the decline, experiencing the dying process can be completely different. The family can make the proper choices so as not to struggle and prolong their loved ones life. Then the transition to the end of life can be peaceful. I rarely have a resident who is reluctant to complete their POA-HC. It seems in the last few years there has been a lot of education on the topic; residents seem to understand the value in it.

Julie Kaczmarek obtained her Masters degree in Social Work from the University of Wisconsin-Milwaukee. She has been at Saint John’s for two years but working with the elderly in a variety of avenues for seven. Kaczmarek works with the social model of care, focusing on choice, individuality, and quality of life for the people she serves.

Do I need an
advance directive?

Pauline Coggs discusses her advance directive.

Watch RealVideo clip (3:34)
featuring Pauline Coggs

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Essay by Betsy Abramson

»Interview with Julie Kaczmarek


Additional resources

The American Bar Association answers questions regarding Advance Directives

More questions answered about completing your Advance Directive

What is a 'Do Not Resuscitate Order'?

Download your state's Advance Directive

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