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Posted September 28, 2022 by Kyle Yoder, DO & Ellen Saal-Patterson, MA, MSW, LISW-S
Listen to this episode of the Healthy Vitals Podcast.
In this episode, Dr. Kyle Yoder and palliative care social worker Ellen Saal-Patterson lead a comprehensive discussion on preparing for end-of-life care.
Kyle Yoder, DO | Ellen Saal-Patterson, MA, MSW, LISW-S
Kyle Yoder, D.O., is the Medical Director of Palliative Care, Hospice and Homecare at Summa Health. He has practiced Hospice and Palliative Medicine within the Summa Health Medical Group for 5 years. He attended medical school at Ohio University Heritage College of Osteopathic Medicine, completed a residency in Family Medicine at Summa Health System - Akron Campus, and a fellowship in Hospice and Palliative Medicine at Summa Health System – Akron Campus. Dr. Yoder is board certified in Family Medicine and Hospice and Palliative Medicine.
Ellen Irwin Saal-Patterson, LISW-S holds a master’s in Counseling Psychology and a Master’s of Social Work degree and has been employed as a licensed social worker since 2010. Ellen began employment with Summa Health in 2012 and joined the Palliative Care team in 2018 and serves both patients and their caregivers in the hospital as well as in the community. Ellen frequently assists patients in completing Advance Directives including Health Care Power of Attorney and Living Will paperwork.
Scott Webb: Advanced directives for end-of-life care are a gift to everybody involved because they ensure that our wishes will be followed by our relatives and caregivers. And on our podcast today, Dr. Kyle Yoder, Medical Director of Palliative Care, Hospice and Home Care at Summa Health, and palliative care social worker, Ellen Saal-Patterson, are here to explain advanced directives and encourage us all to consider them for ourselves and our loved ones.
This is Healthy Vitals, a podcasts from Summa Health. I'm Scott Webb. So I want to thank you both for joining me today. We're going to learn more about advanced directives for end-of-life care, what does that mean, what do we need to think of and so on. So I'll start with you, Dr. Yoder, what are advanced directives and why are they so important?
Dr. Kyle Yoder: Advanced directives are documents that exist by each state. Here in Ohio, we primarily talk about two types of advanced directives. One is a healthcare power of attorney and the second is a living will. The healthcare power of attorney is a document that allows a person to designate someone else to be their decision-maker around medical issues. That person is only allowed to make decisions when you as the patient are not able to make your own decisions. And they are required in good faith to be able to follow the wishes that you have told them you want.
The other document, living will, doesn't have anything to do with your belongings or your estate. It has everything to do with what your wishes are in a specific circumstance. When two doctors agree that you are in a terminal or vegetative state, then the information that you write in that document is what the medical providers would follow in the way of your wishes.
So they're important because they allow you to think ahead typically around emergent or high stakes medical situations, people often think of life support type of serious illness that gives the information that the healthcare providers and families need to know. It's hard when these documents are not available. And family members are left questioning, well, what would this person want under these circumstances? And so it's really a gift to your family and friends and your medical team to be able to follow your wishes that support and follow your goals and values.
Scott Webb: That's an interesting word choice, the word gift. I've heard that before and good to know the difference and understand the difference between the two documents. But as you say, it's really a gift because then no one is guessing what your wishes are, what you wanted when you could make those decisions for yourself. Good jumping off point here. Ellen, at what age should people begin advanced care planning?
Ellen Saal-Patterson: I think the best answer to that question is today. It is never too early to begin thinking about completing advanced directives. Anyone who's 18 and over and of sound mind can complete this paperwork. It's important as it's a way to ensure that your wishes are known and a way to communicate your wishes if there's a point where you're unable to do so. And paperwork never expires. So if you complete it, in 20 years, it's still active and you can always update it if you need to, as long as you have the capacity to do so.
Scott Webb: That's a good way to put that. The paperwork never expires. There's no expiration dates, not like something in the fridge; that once you've completed the paperwork and it's all signed, sealed, and delivered, so to speak, it never expires. So that's good to know. And beyond the directives, are there other advanced care planning efforts that we should consider?
Ellen Saal-Patterson: One that can be completed is a financial power of attorney. So the healthcare power of attorney focuses on healthcare decisions. And then, there's a financial power of attorney or sometimes referred to as a durable power of attorney that focuses more on financial transactions, allowing somebody to access bank accounts, allowing somebody to help with bill paying if you are ever in the position where you're unable to do that yourself.
Scott Webb: And Dr. Yoder, who makes the decisions if there's no advanced directives for a patient?
Dr. Kyle Yoder: Again, I just want to reiterate because it's very common that family members who are designated as healthcare power of attorneys will come in to the hospital. Their loved one will be here and they may believe that, well, because this is filled out, they have some influence on the decisions that are being made. It really starts with that determination of whether or not the patient themselves can make their own medical decisions. That is determined by the medical provider at the time of the conversation about a decision. And so that's important for everybody to understand. Just by completing a healthcare power of attorney does not mean that person gets to overrule your own decisions and what you're choosing.
But you're asking if these documents don't exist who makes decisions for patients? And in Ohio, there's a law that's very clear that there's a hierarchy when patients do not have these documents, who we look to in order to make decisions. And so if there's no power of attorney, there's no guardian, it begins with the patient's spouse. If the patient is not married or they are divorced or widowed, then the patient's adult, child or children. It's important to note here also that this misconstrued perception that, "Well, I'm the oldest child. So I get to make the decisions." That is not the way the law is written. It's all children equally. It's then followed by parents. After that, adult siblings. And if of those people are in existence or available, it's the nearest blood-related adult who the hospital team or medical provider can find.
Scott Webb: I just love how well organized all of this is. It's really taking the guesswork out of it. Ellen, how does someone make their advanced care directives official? Like what's the official thing, the official stamp? How does that work?
Ellen Saal-Patterson: First, it's important to make sure that the paperwork is completed fully, that it is completed, that it's legible and then is signed by the patient and then is either witnessed or notarized. And the paperwork is laid out very nicely, where it tells you exactly what is needed and what to do next. Witnesses are very convenient, but whoever you ask to help you witness your paperwork, they cannot be listed as an agent. They cannot be related by blood or marriage, for example. Some people prefer to use a notary, which is very accessible. That's an option. Banks, for example, can offer to be a notary if you need. And then, after paperwork is completed, it's recommended that you give a copy to the agents that you chose so that they have a copy if ever needed. You can give a copy to your physician's office, and it's always helpful to bring a copy in if you're ever admitted so that the hospital also has a copy.
Scott Webb: Yeah, I wanted to just follow up, is this the type of thing, these documents, the types of things that could be included in somebody's electronic medical records? Or would you always just sort of need to carry those copies with you?
Ellen Saal-Patterson: They are often scanned in to an electronic medical record. So ideally, if you're admitted and then you come back again in the future, Summa will have a copy for you. But every once in a while, something happens. And then, we do ask for another copy to be brought in. So it could be good practice to bring a copy in every admission or, again, to make sure that the agents that you've chosen have a copy just in case you happen to be admitted to a system that doesn't have a copy previously, that they'll be able to access it as well.
Scott Webb: Yeah, and this has again been really educational, really helpful today. I'm sure listeners are nodding their heads and agreeing. As we wrap up here, Dr. Yoder, so let's just say we've got the paperwork, right? We've got the directives they're signed, sealed, delivered; we have copies; we've given them to everybody, then how do you ensure that it doesn't get messy at times? I think anecdotally, we've all heard of some of the messiness that can happen, even when it feels like everyone's dotted the I's and crossed the T's and done everything they were supposed to do related to advanced care planning. So how do you ensure that advanced directives are followed?
Dr. Kyle Yoder: I think it's not overstated that making them available to the people who are designated along the forms to your primary care providers, if you're ever in the hospital, bringing them in like has been emphasized. That's really step number one. Having them available is the first step to make sure that they're followed.
I think, in my opinion, the second thing is really having conversations. Many times these documents are prepared and then put away, they're filed away and forgotten or not really talked about. But it's the conversations that you have with your family, friends and healthcare providers that allows that information to more readily be known so that, if they need to be advocating on your behalf, they are able to do that, and they're able to do that with confidence.
Many circumstances when these documents are needing to be used, they're highly emotional situations where it requires people to really be knowledgeable of what you've said before and be able to recall that information. And so even though it is difficult to talk about serious illness and end of life, I said it before, it's a gift to have these completed. It is also a gift to have the conversations. The more we try to have the conversations, the better we will be at sharing and receiving this information. And then, you are more likely to be able to get the care that you want to have at the time that you want.
Scott Webb: Yeah, there's no doubt. Difficult, tricky conversations to have, but just the planning and the paperwork is a gift, as you say. It's such a perfect way to put it. It really is a gift to have these conversations. Really good stuff today. Thank you both. You both stay well.
Dr. Kyle Yoder: Thank you. Same to you.
Ellen Saal-Patterson: Thank you. You too.
Scott Webb: And for more information, go to summahealth.org/advancedirectives. And if you found this podcast to be helpful and informative, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is Healthy Vitals, a podcast from Summa Health. I'm Scott Webb. Stay well, and we'll talk again next time.