Advance Care Planning Video

About this Video

Learn more by watching our advance care planning video.

Advance directives are formal, legal documents:

• Wisconsin Declaration to Physicians (Living Will)
• Wisconsin Power of Attorney for Health Care.

Bill Bishop: Hello, I'm Bill. I'm a social worker at Sauk Prairie Healthcare. Today I'd like to talk to you about advance care planning, a subject that isn't always the most popular to discuss, but it is an important one. In this video, we will walk you through the advance directive documents. If you have further questions or want to discuss specific situations to you, please call the Continuum of Care Department at Sauk Prairie Healthcare, and we can assist you in more detail.

Advance care planning is a discussion and reflection that allows you to plan ahead and put your wishes in writing with an advance directive in the event you cannot communicate your wishes later. It can give you peace of mind that your preferences will be followed.

What are advance directives? Advance directives are legal documents that share what your health care preferences would be if you are unable to communicate them. They also allow you to name your Agent, which is another word for decision maker. The type of advance directives that are offered here at Sauk Prairie Healthcare are the Power of Attorney for Health Care and a Living Will. Another term for a Living Will is the Declaration to Health Care Professionals. At this point, it may be helpful for you to have your documents in hand as we walk through them.

Let's start with the Power of Attorney for Health Care document. Page one is a description of the document. You can read this on your own time. Before we begin, it is important for you to know two things. Number one: there are multiple places where you date the document. All of the dates on the document must match the date you and your witnesses are present to sign. Number two: Your two witnesses must be present when you sign the document. So, do not sign or date anything until you have completed the document and you and your two witnesses are present to sign and date everything.

Let's flip ahead to page two. At the top of the page is one place that requires a date. Again, do not fill this in yet. The next section, the Creation of Power of Attorney for Health Care is where you will print your name, address and date of birth.

Now, let's move to the Designation of Health Care Agent section. Your chosen Agent should be someone you trust to make medical decisions consistent with your wishes and is willing to use this document as their guide. So, on the first line, print the name, address and phone number of your chosen Agent. On the second line, you will identify an Alternate Agent and print their name, address and phone number. This person too should be someone you trust to make health care decisions on your behalf if your agent is ever unable or unwilling to act in that capacity.

Let's now flip to page three and look at the section called Admission to Nursing Homes or Community-Based Residential Facilities. Your Agents can admit you to a nursing home or a community-based residential facility for purposes of either recuperative care or respite care. If you check yes, you are giving your Agents the authority to admit you for reasons other than recuperative care or respite care. If you check no or leave those questions blank, your Agent is only allowed to admit you for short-term stays of recuperative care or respite care.

Now let's go to page four and look at the Provision of Feeding Tube section. This section addresses the withholding or withdrawal of a feeding tube. A feeding tube is a medical tube through which nutrition or hydration is administered into the vein, stomach, nose, mouth or other body opening. If you check yes, your health care Agent may have a feeding tube withheld or withdrawn from you unless your physician has advised that in his or her professional judgment, this will cause you pain or will reduce your comfort. If you check no or you leave it blank, your health care Agent may not have a feeding tube withheld or withdrawn from you. Keep in mind your health care Agent may not have orally ingested nutrition or hydration withheld or withdrawn from you unless provision of the nutrition or hydration is medically contraindicated.

The next section is Health Care Decisions for Pregnant Women. If there is a chance you can or will become pregnant in the future, this section will apply to you. You would check yes if you want your Agent to make health care decisions for you even if your Agent knows you are pregnant. If you check no or leave it blank, your health care Agent may not make health care decisions for you if your health care Agent knows you are pregnant.

Now let's look at the Statement of Desires, Special Provisions or Limitations. Many people leave this section blank, and that is okay leaving it blank assuming you have a discussion with your Agents to inform them what you would want or more importantly, what you would not want in case of a health care incident. I always encourage people that if there's something you feel really strongly about wanting or not wanting done, you should write it in the spaces provided here. An example would include: I do not wish to be kept alive on life-sustaining procedures. My health care Agent can determine the timing of the discontinuation of treatment. A life-sustaining measure is a medical intervention introduced when biological functions no longer maintain themselves, such as artificial ventilation, medications to stimulate your heart function or artificial nutrition and hydration for those who cannot swallow.

The next section called Inspection and Disclosure of Information Relating to My Physical or Mental Health explains to you that your Agent has authority to: request, review and receive any information oral or written regarding your physical or mental health, including medical and hospital records; execute on your behalf any documents that may be required in order to obtain this information; consent to the disclosure of this information.

Now, let's go to page five. This page has both the Signature of the Principal and the Statement of Witnesses sections.

If the rest of the document is complete and you are comfortable with the way you want it, and you're now at the point where you are ready to sign the document in front of your two witnesses, please only do this in front of your two witnesses. Your witnesses must be 18 years or older and must not be related to you by blood, marriage, domestic partnership or adoption. Your witnesses should complete the Statement of Witnesses section, and sign it, and date it. If you do not have two witnesses, Sauk Prairie Healthcare can provide you with witnesses when you are ready.

Finally, let's go to the last page, page six. The Statement of the Health Care Agent and Alternate Health Care Agent section is where your Agent should read and confirm they understand that you, the Principal, had designated them as Agent should you ever become incapacitated. Have your Agent complete this section, sign it, and include their address. The last section, Anatomical Gifts, is optional for you to complete. If you want to share the details of your organ donation preferences, complete this section.

After the document is completed, signed and witnessed, you will need to make several copies of your document. Be sure to share copies of the document with your primary care provider, both your Agent and Alternate Agent, any other health facilities you see a health care provider, and keep a copy for yourself that you take with you if you go to a new health care facility. And keep the original in a safe place for yourself.

Now let's talk about the second document, the Living Will. The Living Will is also known as a Declaration to Health Care Professionals. Your Living Will makes it possible for you to state your preferences for life-sustaining procedures and feeding tubes in the event you are in a terminal condition or persistent vegetative state. Begin by filling in your name in the space provided at the top of the form. In part one, terminal condition, check yes if you want feeding tubes if you have a terminal condition and no if you do not want this. In part two, persistent vegetative state, check yes if you want life-sustaining procedures if you are in a persistent vegetative state and no if you do not want this. In part three, persistent vegetative state, check yes if you want feeding tubes if you are in a persistent vegetative state and no if you do not want this. As with the previous document, it is important that all dates match and your witnesses must be present when you sign and date. Again, your two witnesses must be 18 years or older and must not be related to you by blood, marriage, domestic partnership or adoption. The last page in the Attention section is where you sign, date and include your address and date of birth. Then have your two witnesses sign, date and print their names as well.

Now, let's address some common questions people have about advance directives. Who can complete advance directives? Anyone age 18 or older can complete advance directives. Is there a cost to completing your advance directives? Advance care planning is a free service that is offered through Sauk Prairie Healthcare. Can I create both a Living Will and a Health Care Power of Attorney? Yes. The Health Care Power of Attorney is your opportunity to name your Agent, and give them a document as a guide for care and treatment if you ever become incapacitated to authorize your medical care and treatment. The Living Will is to guide your health care team and your support system on your wishes, should you ever be in a terminal condition or persistent vegetative state. Am I handing over power to my Agent if I complete these documents? This authority comes from the person, not the court. Being appointed as a Health Care Power of Attorney Agent is a position of service, not a position of power. I have a spouse. Why do I need to complete these documents? Wisconsin is not a next-of-kin or family consent state. In Wisconsin, your spouse will need legal authority to act on your behalf. Can I change my wishes or create new documents at any time? Rest assured, these documents can be revoked at any time. The most recent document is always the valid version. If changes are needed, you can update the document at any time. How do I revoke my documents? You can destroy the document, have someone else destroy it in your presence, or by signing a statement of revocation in front of two witnesses. Just remember, you should inform your Agents and health care providers of the revocation. What do I do with the documents once they are completed? You, as the Principal, should keep the original and a few copies. Use your spare copies should you ever go to a new or different facility for medical treatment in the future. If you do, share a copy with them. Give a copy to your primary care provider and any chosen medical facility. Also, give a copy to your Agent and Alternate Agent. In terms of revoking your Power of Attorney for Health Care or changing it, keep in mind if you're filling this document out at age 25, your views at age 75 may change. So you may want to update your document.

Thank you for your time today. I hope this made sense, and I hope it was applicable to you. Please feel free to contact the Continuum of Care Department at Sauk Prairie Healthcare with any questions or concerns. We would be happy to assist you.