What Is Health Care Planning?
What is Health Care Planning?
Health care planning, also referred to as, Advance care planning (ACP) is defined as a process that supports individuals in understanding, and sharing their values, goals and preferences for future medical care. These care decisions are then formally documented within an Advance Directive, a forward-thinking legal document that empowers individuals, their loved ones and their care teams to make the right healthcare decisions moving forward.
Despite its many benefits, widespread participation is still relatively low. In fact, 9 out of 10 adults believe they should discuss advance care planning with their doctor. However only around 2.4% of end up having these discussions with their doctor.
In today’s healthcare model, most individuals don’t have access to high quality advance care planning services. If they do complete advance directives, it’s typically on their own, with little to no outside support to help define and document their goals of care.
Who is a Candidate for Health Care Planning?
Ultimately, everyone is a good candidate for health care planning. Otherwise healthy individuals still benefit from discussing and documenting their care preferences in the case of an unexpected healthcare emergency.
For people with serious illnesses, planning for future care is especially valuable and urgent; these conversations can help them work through the various medical scenarios they’ll likely face in the coming weeks, months and years, giving them confidence and peace of mind about their care choices.
Why is Health Care Planning Important?
An individual’s goals and values serve as the foundation of their advance care plan; the “right” care choice for one individual can be completely different from the “right” care choice for another individual with identical circumstances based on a variety of personal factors.
When crafting an advance care plan, exploratory, open-ended questions about goals and values can help uncover these crucial differences. Some key questions to consider include:
- What is most important to you in life?
- What would be hard for you to live without?
- What does satisfactory quality of life look like to you?
These questions will eventually lead to more specific considerations about topics like independence, long-term symptom management, life-sustaining treatment options and more.
Types of Documentation
Once you’ve settled on your ideal care plan, it’s time to formalize your decisions within legally-recognized ACP documents. There are a number of documents you’ll need to fill out during this process. Making sure these documents are filled out correctly in accordance with federal and state regulations is key, as any errors could render them ineffective.
Unfortunately, this document is written in legal terms, making it difficult for the average person to understand on their own. When filling out a living will, it’s helpful to consult someone that is familiar with both the legal and medical aspects of the document, such as a trained ACP facilitator or lawyer. This person should help you understand the options at your disposal, and should assist you in translating your care goals into a legally binding document.
The power of attorney for healthcare is also known as a medical power of attorney or healthcare proxy. This document formally recognizes the individual(s) that will be responsible for making care decisions on your behalf if you are unable to do so for yourself. Ideally, a healthcare agent is someone that is available to help in an emergency. This means your proxy should be close enough to join you at the hospital if needed, or, at the very least, they can answer the phone if they are called on to make a medical decision.
Medical orders include forms such as Physicians Orders for Life Sustaining Treatment (POLST) or Do Not Resuscitate (DNR). Medical order documents vary on a state-by-state basis. These documents generally seek to describe:
- Resuscitation instructions
- Instructions for intubation and mechanical ventilation
- Treatment guidelines
- Artificially administered fluids and nutrition
These are legally-binding documents that every healthcare worker involved in your treatment must follow.
This is a personalized document that clearly outlines and defines each individual's unique care goals. Unlike standard state directives, it also includes additional care preferences including location of care, treatment shift points and preferred duration of treatment using scenario-based decision making.
Iris Planning Summary includes:
- Goals of Care
- Location of Care
- Hospital Use
Family Involvement in Healthcare Planning
Although ACP is very much centered around the patient, family individuals should be an integral part of these discussions, as well. Involving family individuals early and often in ACP is important. Just like any other plan, it helps to have everyone involved in an individual’s care be on the same page about ACP in order to eliminate any potential roadblocks or conflicts.
Benefits of family involvement include:
- Giving patients someone to bounce ideas off of
- Removing family individuals’ uncertainty about treatment options and responsibilities
- Creating family alignment around the patient’s goals
- Providing clarity if family individuals need to act on the patient’s behalf
Making Documentation Accessible
Even if your advance directives are filled out correctly, they’ll still be ineffective if they’re not accessible when it matters most. Unfortunately, when most people fill out advance directives, these documents are then left in a safe or file cabinet — where they can be of no use during a healthcare emergency.
To ensure your healthcare directives are accessible, make sure you, your loved ones and your physician all have copies. In your home, this could mean taping a copy to the fridge so emergency medical personnel will be able to find them. In the hospital, you’ll want to make sure your documents are uploaded to your electronic health record so physicians can access them whenever they make a care decision.
By disseminating these documents widely and thoroughly, individuals increase the likelihood that their care wishes are actually followed, ensuring all of their hard work crafting an advance care plan is not wasted.