Maggie McKay (Host): Welcome to the Kirby Connections Health Podcast, where we help you nourish your wellness journey with Kirby Medical Center. I'm Maggie McKay. On this episode we'll talk about end of life planning with Director of Quality and Infection Prevention Leslie Sheets. Leslie, thank you for joining us.

Leslie Sheets, RN, BSN, MPH: Thank you.

Maggie McKay (Host): Let's start with what are the steps for legal and financial planning.

Leslie Sheets, RN, BSN, MPH: Before that, I think that in terms of making a decision about planning, no one ever plans to have any sort of health event or get sick or a medical crisis. And so, talking about this is really important and, not just for people that are older, but for all ages.

because we just never know when those kinds of things are gonna happen. So, being prepared and having those legal documents and having them in an accessible location, hopefully provides some peace of mind, for knowing that your wishes will be honored and help ease the burden of loved ones. So, the steps for legal and financial planning.

to start off, I would just suggest that you reflect on your values and wishes. this can help you think through what matters most to you and, what you may want at the end of your life. help guide decisions about future care and medical treatment. reflect on previous friends and family members and how Their end of life, care was handled.

those previous experiences can help you figure out what, worked well and what didn't work well, and what you want, and how those things were handled.

Maggie McKay (Host): And what documents are necessary to determine what you want for end of life care.

Leslie Sheets, RN, BSN, MPH: The documents that I see to being the most critical, in being in a hospital setting, are, a power of attorney for healthcare, and that's usually termed POA. a power of attorney for financial. Again, that's a POA for financial. And then, living will in a posts form. so each of those forms, have different, meanings to them and, address different things similar but different.

So, your power of attorney for healthcare form, this is the person, that you have designated to make healthcare decisions. if you are unable to. Speak for yourself. power of attorney for financial. This is the person that you've designated to make financial decisions. If you're unable to do that for yourself, a living will.

That's a document that is a general outline, for how you want your care and how you wanna be treated. should you be unable to make those decisions, in an emergency or a medical situation. And then the final form that is, very, very helpful, is, called a pulse form. And that's a Physician's Order for Life sustaining treatment.

and this form provides guidance about your medical care. and this is a form that per healthcare professionals will use in an, in immediate, emergency. so the, pulse form is typically, state by state based. So you wanna find your state's form. and it specifically addresses, certain things such as. Cardiopulmonary resuscitation.

So do you want CPR to be performed? if you're found unresponsive? and what kind of medical treatments do you want done, such as, intubation. do you want IV antibiotics or do you just want comfort care measures where we just relieve your pain and suffering? The final part of a pulse form is.

artificial nutrition and would you like a feeding tube in place? to, again, to help prolong life sustaining measures. So, those really are the, main legal forms, that you need in place. none of these have to be completed by a lawyer. but once you have completed them, on the appropriate designated forms and then have them signed, by the people, your physician, the witnesses, those kinds of things, then they are then legal forms.

So. A few other things that I wanted to mention about, really important things to have and, down on writing would be, your social security number, your full legal name, birth certificates, financial matters such as, sources of income and assets, tax returns. Having all of that is just in one place is, gonna be really helpful for end of life planning.

Maggie McKay (Host): That's so smart. So again, the power of attorney makes the medical decisions and who makes the financial decisions.

Leslie Sheets, RN, BSN, MPH: That would be the power of attorney for financial.

Maggie McKay (Host): Oh, and so what about medical?

Leslie Sheets, RN, BSN, MPH: Medical is a power of attorney for healthcare. So you have one for healthcare and one for financial. And it can be the same person, that's designated on those forms. but those are broken out into two separate forms.

Maggie McKay (Host): and that's only if you're unable, correct.

Leslie Sheets, RN, BSN, MPH: Yes, yes. So even if I have an emergency or a health crisis and I can still speak for myself and, I am making good decisions and the doc doctors will help, determine that. If I'm making good choices for myself, then or I will be able to make those decisions for yourself and to speak.

it just becomes when you are unable to speak for yourself. So if you, have head trauma and you, cannot communicate or you had a stroke that, renders you unable to speak for yourself. So that's when those people come into play and then, uh, defaults to them to help make those decisions.

Maggie McKay (Host): So there are a lot of documents. Where are those stored and who has access to them? Because I know when my son went off to college, it's different than this obviously, but we filled out a lot of things in case something medical happened. 'cause he was so far away.

And I have it like on my phone, but how does that work?

Leslie Sheets, RN, BSN, MPH: So keeping those documents, stored in a safe location. So, a lot of people still have, safety deposit box. Fireproof, safes in their home, but also having them in a place where, others might be able to access them. So, making sure that, if your son filled out forms, that you have copies of those and that maybe you then give a set of copies to someone else that you trust.

having those, copies, on file at, the primary care provider's office is always a good place. And also, getting those forms on file at your local house. Hospital or the hospital where, you receive care, you might most likely, would be treated for an emergency. So, having those on file, in multiple locations is great.

Just so that way should that time come again, you are unable to speak for yourself. they then have those copies and they understand what your wishes will be.

Maggie McKay (Host): This could be the hardest part of. How do you approach talking with family and physicians about end of life?

Leslie Sheets, RN, BSN, MPH: So it's always a sensitive, subject when it comes up. it can be filled with a lot of emotions, and people may or may not be ready to have those discussions, but. Again, as we know, health events occur at any age. So having those discussions are really, really difficult and important.

but, starting those conversations off, helps have some comfort around those decisions when they come at the last minute. So, I think it's important to talk to your family members and loved ones about what you appreciate and enjoy about life most, you know, understanding. Or explaining your values and memories and, past family events, that are meaningful to you.

And you can sort of segue that into then, about what you want. And, is there anyone in your family or around you that would be willing to help you be committed to making those decisions for you? if you were unable to make those decisions for yourself? Choose wisely because this is the person that is going to make.

and even though you. Have discussed with them and you've written it down, you would hope that that person, will follow your wishes. However, they don't have to. And so I think that's the importance of them, this person understanding, what you want and how important that care is to you.

and that, they be committed and willing to follow through with that. And, so this person really needs to be. Able to make that decision in a high tense, high stress, even when they're maybe getting pressure from family members or friends to make a different decision, you know, it's choosing that person wisely so that they can hold strong to what and what you want and what those commitments are to you.

Maggie McKay (Host): Right. And when it comes to living arrangements, when to transition from home to a facility that provides, say, additional resources to meet increased care needs, how do you decide if you wanna stay in the local community? Or is it time to move where family members are located?

Leslie Sheets, RN, BSN, MPH: so changing and, living arrangements, aging in place is really important, I think, to most people. and so to be able to maintain that independence for as long as possible is. Is what most people express that they want. And so, deciding whether to move, again, is very emotional decision at times.

And, people choose to stay or go for different reasons, but you know, living at home, as you age requires some careful consideration. And, I think, again, having those open communications with your family members about what's important to you, understanding your chronic disease conditions and what those long-term, health. effects might have in terms of what that might mean for you to be able to stay in your home.

is important, transitioning to a facility, based on some different things that you could be looking for in, your loved ones. difficulty with daily activities. Are they having trouble with things like, personal care, bathing and, preparing their meals? You know, are you seeing frequent falls? are they unable to manage their medications?

are you seeing some increased confusion? So those are some things to look for that might help sort of set that hard line in place with people about whether or not it's safe to stay in their home or, it's time to transition to somewhere that can provide that additional resource and assistance for them to keep them safe.

Maggie McKay (Host): In closing, is there anything else you'd like people to know about end of life planning?

Leslie Sheets, RN, BSN, MPH: I think the important thing to keep in mind, with end of life care, especially with our aging population is, is that they do have the right to make decisions whether or not we feel that they're the right ones or the safest ones. if that's something that they're choosing and they are of sound mind, to make those decisions, then it is their right.

To be able to do that. So, again, this is the importance of starting those conversations before we start to see those declines, so that way, you have a true understanding of what they would like. And then, also, I've talked to patients in the past. if you choose to stay at home, what has to happen in order for you to be okay with transitioning to somewhere else or to move in with.

a family member and, to make a change. So, it's just important to know that, people do have the right to choice. and that should be respected. but it's definitely needs to know, when it's time to make that transition so that way we can keep our loved ones around for as long as possible.

So.

Maggie McKay (Host): Thank you so much for sharing your expertise on this sensitive and important topic. It's been very informative and we appreciate your time.

Leslie Sheets, RN, BSN, MPH: Yeah. Well, thank you.

Maggie McKay (Host): Again, that's Leslie Sheets. If you'd like to find out more, please visit Kirby health.org/patients visitors slash advance directives. I'm Maggie McKay. Thanks for listening to Kirby Connections Health Podcast. I.