“It Always Seems Too Early – Until It’s Too Late” …. Plan Now for Your Future Care

 April 16 is National Healthcare Decisions Day (NHDD), but it is celebrated the entire week of April 16-22. The goal of NHDD is to increase awareness of the need to have discussions with loved ones about healthcare wishes and encourage individuals to complete advance care planning documents, which provide guidance to family members when you are unable to make decisions for yourself.

Would you like to complete your advance care planning? Palliative Care team members will be on hand with materials in the hospital cafeterias on the following days this week:

  • Tuesday April 17, 11 a.m. to 1 p.m., UM Shore Medical Center at Dorchester, Main Lobby
  • Wednesday April 18, 11 a.m. to 1 p.m.  UM Shore Medical Center at Easton, Cafeteria
  • Thursday, April 19, 11 a.m. to 1 p.m., UM Shore Medical Center at Chestertown, Cafeteria

The UM SRH Palliative Care team is actively engaged in helping patients in UM Shore Medical Centers at Chestertown, Dorchester and Easton in making health care decisions and creating advance care plans. “Between the three hospitals, we do about 80 palliative care consults every month, and for those patients who are able to make health care decisions, the consult always includes an offer for assistance with advance care planning, says Maddie Steffens, regional coordinator, Palliative Care, “The response is overwhelmingly positive.”

Patients do not have to be on Palliative Care to receive this assistance. Steffens estimates that the total number of hospital patients who complete advance care planning each month with assistance from palliative care team members is roughly 120.

To expand this success, the Palliative Care team has launched a new initiative, “If Not You, Who?” Now in progress in the hospital acute care units, this initiative provides information to patients and their family members about the benefits of advance care planning and the availability of assistance from Palliative Care team members. Plans are for expansion to all rooms on all floors.

Q & A – WHAT YOU NEED TO KNOW ABOUT ADVANCE CARE PLANNING

What is advance care planning? Advance care planning is making decisions about the healthcare you would want to receive if you become unable to speak for yourself. These are your decisions based on your personal values, preferences and discussions with your loved ones. Advance care planning provides you with a way to make your wishes regarding end-of-life care known to those who will be making decisions for you in the event that you cannot make those decisions.  You do not need a lawyer to complete advance care planning.

Why is advance care planning important? The most difficult part of advance care planning is often just raising the topic –tools from www.nhdd.org provide guidance. Short videos are available to assist in starting the conversation with loved ones. Advantages of completing the process while you are still in good health are:

  • You continue to have a say in your medical care, even if you become too sick to speak for yourself.
  • You will have peace of mind, knowing that you are more likely to receive the medical treatment you would want and not receive the treatment you would not want.
  • By knowing your wishes, your family and friends are relieved of the burden of having to make decisions without knowing your choices in a highly stressful situation.
  • Research shows that if health care providers inform people about possible future treatments and listen to their wishes, better end-of-life care is maintained.
  • Studies conducted in a range of healthcare settings suggest that advance care planning can improve individual and family satisfaction with care, reduce the number of hospitalizations in the last months of life and reduce stress, anxiety and depression in surviving relatives.

What is involved in advance care planning? There are four steps involved in advance care planning process:

  • Designation of Healthcare Agent — This document allows you to designate someone else to make healthcare decisions when you cannot do so. The best time to do this is when you are in good health.
  • Living Will — This document records your treatment preferences in certain situations, such as a terminal condition, vegetative state and end-stage condition, providing guidance to family and health care providers.
  • Maryland Medical Orders For Life-Sustaining Treatment (MOLST) — The MOLST supplements the Living Will for patients with chronic advanced or serious medical conditions. It is a medical order form covering options for the following: cardiopulmonary resuscitation, artificial ventilation, blood transfusion, hospital transfer, medical workup, antibiotics, artificially administered fluids and nutrition, and dialysis. It is completed with the assistance of a physician, nurse practitioner or physician’s assistant. Your MOLST form travels with you to other healthcare facilities (hospitals, rehabilitation centers, etc.) and needs to be verified during each hospital admission because sometimes preferences change. There is a MOLST Worksheet to help in making decisions about the items covered on the MOLST.
  • Communicating your wishes — Discussing your medical preferences with your family and loved ones provides them with guidance to your end-of-life wishes. This also allows you to discuss issues that are not in the advance directive or LIVING WILL.

What actually is an Advance Directive? An Advance Directive is a combination of the Designation of Healthcare Agent and Living Will into one document. There is also a section for after death preferences. (

What should be done with your completed Advance Care Planning Forms? Give copies of your advance directive and MOLST forms to your healthcare agents, health care providers and local hospitals.  Also, keep a copy of the MOLST form on your refrigerator in case emergency medical services must be called. 

Where can you get the advance care planning forms? An advance directive is a future document that all adults should complete when in good health. A MOLST is a present document that is important for people with chronic advanced or serious medical conditions. Download the forms from the following sites:

Where can you get more information or help on advance care planning? Call the Palliative Care Program, 410-822-1000, ext. 5041.