Advance Healthcare Planning for Emergency Preparedness
with fewer healthcare services up here, mountain residents focus on planning
What would you do if you tripped and fell on the ice or over a log and couldn’t get to your landline and your cell phone isn’t working d/t a power outage? What would you do if you broke a hip and couldn’t get around your house? What would you do if you needed help with daily activities such as eating, grooming, dressing, for any length of time, for any reason?
Resilient mountain people plan in advance for evacuation, for floods, fires, huge snowstorms, power outages, and more. Yet strangely, very often we forget to plan for healthcare emergencies, including how we are going to manage the inevitable difficulties of living at altitude when we are physically less capable, either due to accident, unexpected illness, disability, or expected old age.
We know that realistically it’s hard to get services from the plains to come up here on a regular basis, especially in winter. Neighbors help neighbors they know, as much as they can, if they can.
If we don’t plan, anything can be an emergency. If we do plan, we may be able to save trips down the mountain to Urgent Care or the ER and more.
Luckily there are planning tools that can help us think through what we want and don’t want. The end result for each of us can be written legal directives that tell all healthcare providers, including emergency paramedics, exactly what we want them to do or not do.
There’s no right or wrong: each of us makes our own decisions, after considering the facts and hopefully talking with our close loved ones, who may be family, friends or community members, and also healthcare providers.
Is this only for old, longtime mountain folks?
No, actually it’s for anyone who has turned 18 and is capable of making their own medical decisions. If you are a young mountain resident who does risky mountain work and/or recreation, if you care for children, if you travel – and if you don’t do any of those things, but you value making your own decisions about your own life-- you may need this as much as elders.
The great thing is that even after deciding what you want and writing up your advance care directives, you can change your mind and update them. People often do as they age or pass life milestones such as birth of a child, marriage, divorce, moving farther into the mountains, or simply seeing how other people in our lives have handled unexpected medical needs.
What are the basic healthcare directives in Colorado?
In Colorado there are four: Medical Durable Power of Attorney (MDPOA), Living Will, the MOST form and the CPR Directive. We will focus below on the MDPOA and preparing for the Living Will.
Medical Durable Power of Attorney
Your Medical Durable Power of Attorney (MDPOA) form legally designates your personal representative who will advocate for your expressed wishes as your decision-maker in the event you cannot communicate at all. This could be a temporary situation such as being in a coma after a car accident, after which you later recover and are able to resume communicating what you want and don’t want. Or it could be a permanent situation such as a permanent coma or worsening dementia.
Your MDPOA rep, aka agent, is your voice for your preferences. So choose someone as your MDPOA whom you trust and who respects, honors, and will advocate for your choices if the time comes, even if this person does not agree with them. You will have spelled out what you want in your written directives and also hopefully you and your whole family will have talked over the years about what you want so there are no surprises. (“Family” here means both blood relatives as well as close friends who are like family.)
What if you are lucky enough to have several family members or friends who all want to be your MDPOA and you want all of them, too? No problem, list them all. But healthcare bureaucracy can’t handle dealing with more than one representative, so you have to choose one as your spokesperson,to be your formal MDPOA, though there is a place on the form for an alternate. Your formal rep will ideallly huddle with the rest of your informed family in making decisions and listen to what they have to say. You can of course change your MDPOA and alternate if circumstances change. You are in charge. (MDPOA can even be hired legal representatives, though this is much less common.)
Living Will
Becki Parr of TRU Hospice writes: “this is a wonderful document for a very narrow set of circumstances. It is only in effect when a patient lacks decision-making capacity and cannot communicate in limited situations of terminal condition or persistent vegetative state as determined by two doctors. But its important to fill it out.”
The Conversation Starter Guide is a very helpful for helping you figure out what you might want in this kind of situation. It asks you all the questions you might not think of, if this topic has not been on your radar. It’s a great prompt for discussions with family and friends. It’s also a useful bank of effective questions to ask your healthcare provider, who can provide the medical info to inform your decisions.
People have found that writing down what they want in terms of medical healthcare treatment brings a huge sense of relief to their families. Otherwise your family could be agonizing like so many others, trying to guess what you want in terms of treatment if you are ever in the emergency room, are unresponsive and can’t communicate, and they get called to make a medical decision. Families end up feeling guilty and second-guessing themselves if the choice they made was not optimal, even though they made the best choice at the time. Family members or close friends may disagree on what course of treatment you might want; this conflict can create lasting damage to relationships. Save your family and friends stress by stating clearly in writing what you expect.
On a separate sheet of paper you can always add more information about what you want and don’t want in terms of care that isn’t expressly medical. Mountain people especially might write down where you could stay on the plains, close to services, if it would be AMA (Against Medical Orders) to come back home to the mountains.
Some people get very specific with this info, such as: “please try to get a hospital room with a view of a tree,” or “please keep socks on my feet, they always get cold” or “I don’t want my ex in the room where I am dying unless she’s there to support our child.” Some write down what kind of aromatherapy, music, poetry, spiritual guidance they want. To others this is not important.
Those caring for you will want to know your preferences, if you have them, so they can accommodate you.
Copies of all your advance care directives should go to your MDPOA and other family, friends, and spiritual/religious or healthcare professionals who would be involved in your care; a copy should be in your medical chart.
When is the right time to do this advance planning?
92% of people in the U.S. think advance care directives are very important to do. But only 32% of us have done them. Most of us think, “I’m feeling perfectly fine. I’m too busy right now; I’ll do it later.” Ellen Goodman, founder of The Conversation Project is fond of saying: ‘It’s always too early to make your wishes known-- until it’s too late.’
Find relevant forms and documents here. More info is available at Colorado Care Planning and at the Colorado Health Institute’s survey The Last Word: Advance Directives in Colorado.
The Conversation Project in Boulder County
The Conversation Project is a national non-profit dedicated to helping “everyone talk about their wishes for care through the end of life, so those wishes can be understood and respected.” Boulder County has a strong CP team (which serves well beyond Boulder.)The Conversation Project Coaches are specially trained volunteers who can help you assess your values and wishes and also help prepare you for a conversation with your family and your health care provider. They will also help you complete the Medical Durable Power of Attorney document. They also do community presentations. This is a free service and there are mountain residents on the team. You can reach out directly to the team’s coordinator, Becki Parr, at beckiparr@trucare.org or call her at (720) 584-5808.
