Dartmouth Health offers tips for having advanced care planning conversations

Talking to elders

This holiday season, give your family the gift of knowledge by discussing advanced care plans

During the holiday season, we get the chance to spend precious time together with family that we often don't get the rest of the year. It's a time to make new memories and reminisce on old ones, to laugh and have fun together—but also offers the opportunity to discuss important topics, including our loved ones' wishes related to care during illness and end-of-life.

Many avoid advance care planning because it is hard to imagine ourselves in a vulnerable situation and we're fearful of giving up control of our care. But developing an advance care plan is actually about taking control.

This is especially true for people diagnosed with a neurological disorder, such as Alzheimer's or Parkinson's disease—but is also true for people at higher risk of severe disease from COVID-19, people with physically dangerous occupations, or anyone occasionally tempted to text and drive.
"Losing the ability to make health decisions for ourselves is scary," said Lori Guyette, RN, a registered nurse at Dartmouth Health's Cheshire Medical Center. "It's also upsetting to think people might make decisions at odds with how we would like to be cared for—especially well-meaning choices that may end up causing us to suffer. Few of us want to burden our families with difficult or controversial decisions during times of emotional distress. By creating an advance care directive document and designating the person you would like to carry out your wishes, you make those decisions for yourself while you are able."

The best first step is for families to have a discussion about wishes and preferences for care during a serious medical incident or end-of-life care. Important questions to discuss include:

  • How do I want to be treated in my last days?
  • Do I want to receive life-extending care even if it means causing pain for myself or anguish for my family?
  • If I don't want extraordinary measures taken to extend my life, how do I make that clear to my family and my doctor?

These are sensitive and emotional questions to consider. Clarify and document end-of-life wishes with an advance care plan. Make copies of that plan and designate an individual to stand up for you when you no longer can.

"There are two parts to the New Hampshire advance directive: a durable power of attorney for healthcare and a living will, said Catherine Amarante, RN, honoring care decisions specialist at Dartmouth Health. "You do not need an attorney to complete an advance directive.A durable power of attorney for healthcare is a document in which you name someone who will make medical decisions with your healthcare team on your behalf if you cannot. The person you choose becomes your "healthcare agent" or "proxy."A living will documents your written wishes about life-sustaining treatments if you are permanently unconscious or terminally ill and unable to speak for yourself."

Advance directives can be changed at any time by destroying current copies and filling out a new form. Patients should notify their healthcare provider and durable power of attorney for healthcare to make sure they are aware of changes and provide them with new updated copies.

"Everyone should have an advance directive on file. When I work with patients, many people are unsure of what to include in a living will—the types of scenarios and options to consider, and their possible repercussions. Collaborative care nurses are all experienced with these conversations. We can guide your conversation to ensure your values guide your care," said Guyette.

Find more information at the Honoring Care Decisions section of the Dartmouth Hitchcock Medical Center and Dartmouth Hitchcock Clinics website.