Be Prepared-Expect the Unexpected

There are a lot of things that we need to be prepared for as we get older. We have to expect the unexpected. Our guests, Dr. Pam Tronetti and Janet Rooks with Parrish Healthcare shares their expertise with you. What forms do you need to have completed before a medical emergency? What do these forms really mean? We dig into it all while sharing how you too can share with your family what is important to you.

*This podcast represents the opinions of Dr. Tronetti and her guests. The content here is for informational, educational and entertainment purposes only, and should not be taken as medical advice. Please consult your healthcare professional for any medical questions or before making any changes in your personal health regimen. No other use, including without limitation, reproduction, retransmission or editing, of this podcast may be made without the prior written permission of Parrish Medical Center. This podcast is HIPPA compliant. All people, places, and scenarios mentioned in this podcast have been changed to protect patient confidentiality. This website and podcast should not be used in any legal capacity whatsoever, including but not limited to establishing standards of care in a legal sense or as a basis for expert witness testimony. No guarantee is given regarding the accuracy of any statements or opinions made on this podcast. In no way does listening, reading, emailing or interacting on social media with our content establish a doctor-patient relationship. Dr. Tronetti does not receive any money from the pharmaceutical industry.

Transcript

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SPEAKER_04 0:19

Hello, everyone. Thank you so much for joining Senior Living Guide.com Podcast. I'm Darlene with Senior Living Guide.com. We are a national reach website serving seniors and their caregivers, providing them quick access to everything in senior housing and their resources in assisted living, home health care, independent living, and different resources seniors might be interested in. And today we have our guest in the podcast studio. We have Dr. Pam Trinetti and Janet Rooks. Dr. Trinetti is an osteopathic physician who specializes in geriatrics. Janet Rooks is a social worker and a dementia care specialist. They work together at the Parish Senior Consultation Center, where they focus on the care of patients with dementia. Dr. Trinetti is the director of aging services at Parish, and Janet Rooks coordinates Parish Senior Solutions, which provides education, resources, and support for seniors and caregivers. And we're super excited to have them in the studio today. And we're going to talk about being prepared. Can you ever really be too prepared, right? There are a lot of things we need to be prepared for as we get older. Of course, we expect the unexpected. So, ladies, welcome.

SPEAKER_07 1:44

Thank you.

SPEAKER_04 1:44

We're so excited to have you. So, first order of business, what are we going to chat about today?

SPEAKER_06 1:51

Well, to be prepared, you know, you come in the office and you're filling out all kinds of forms about your history, and one of the most important things is who you're going to call. On your HIPAA form, on any emergency contact. Who do you need to be in contact with if we have an abnormal lab work, an abnormal uh chest x-ray, or if there's an emergency and you end up in the emergency room.

SPEAKER_07 2:17

Yeah. And the key and the key to that is the HIPAA form. And that stands for your health information portability accountability act. And it was established in 1994. Now I know that's a mouth for. Right. But every you're going to hear it quite a bit in healthcare. And on that form, every health entity is bound by that. You name who you want to receive information. We cannot talk to anybody that is not listed on that form. It is crucial that you list who we can talk to on that form. Right. Your right to privacy.

SPEAKER_06 2:54

Right, right. Yeah. And things have changed over the years. I remember growing up they actually listed who was in the hospital in the newspaper. And over the years, before we had HIPAA, which it's just easy to remember, hey, it's the privacy laws, we would have uh all family members, landlords, ministers, neighbors, people calling up saying, Tell me what's going on with Mrs. So-and-so. Mm-hmm. And Janet in the hospital, it must have been worse.

SPEAKER_07 3:20

Oh yeah, we used to have a board that when you walked onto the floor, it was written who was in the hospital and what floor they were on and who their doctor was. Oh my gracious. And it was, you know, that's all changed. Yeah. Trust me. Oh, absolutely. Absolutely. But you know, as a medical social worker, we are there to uh protect their privacy, and that's what we're gonna do. There's a lot of privacy that is in the health care, but it's very important to list who that we can talk to, and you're gonna hear it a whole lot when you do enter the health system. Um, it's it's okay to have who that we can talk to in an emergency, but it's not necessarily you limit it to your favorite child, right? Or or just one person. And with our population of dementia patients, they don't always want to list someone there. They no, they don't have any business knowing my business. Right, right. So so you can have multiple people on your hippo form?

SPEAKER_06 4:16

Yeah, we we actually recommend that because suppose you have a husband and wife, and the husband lists his wife, and they both get in a car accident, right? And then the s the kids are calling and we say, Well, we're sorry. You're now of course there are exceptions to rules when it comes to a true emergency, but uh we can't talk to people who aren't on the hippiform, generally speaking.

SPEAKER_04 4:42

Right, right. So if you have a hi a hippiform at your doctor's office and then you have a hippo form at another office, do you typically really just want to have one hippiform and the same information on the hippoporum? Um, kind of how does that how does that work just out of curiosity? Because I know that when you visit different offices, do they have you fill out different forms? Okay.

SPEAKER_06 5:04

They do. It's it's all their own protocols. You might want to print something up because what we need to know is what are the phone numbers? And I can't tell you how many times I've been looking at people's phone numbers because you you tend to fill those out really fast. Like and it's like, wait, is this a four with an eight written over it? Is this an eight with a four written over it? I need to get in touch with this person's daughter because they're on their way to the emergency room.

SPEAKER_07 5:27

Right. Or they push four on their cell phone, they don't know the telephone number. Right. It's pro you know, we all program those numbers in our cell phone. I don't know my mother's cell phone number. She's in Tennessee. I it's on my phone. Yeah. And and the same thing with, you know, my sister. It's programmed in my phone. So I don't I don't need to know it. I should know it, but I don't need to. It's it's number four and five. So, you know, it's important to have those numbers available. And then you got the little card that it's all faded out and they can't figure out the number. Yeah, absolutely.

SPEAKER_06 6:02

And update it every year or so because sometimes we've here it is the the husband puts his wife's name down and she passes away. Right. And unless you update it for every year, then you won't know well who moved, who changed their phone number, right? Who g who's estranged from the family now?

SPEAKER_04 6:20

Yeah, that's all super important. So um on the HIPAA form, super important to have a very clear phone number. I will tell you, my handwriting is atrocious, and sometimes I write my own, I can't even read my own handwriting. I'm like going, I don't even read that, especially numbers. Because they can definitely look different.

SPEAKER_06 6:38

Yes, they can.

SPEAKER_04 6:38

So it's really important um to have something very transparent and reading it, and then maybe just keeping that one HIPAA form so every time you go to the doctor you have everything is the same. Exactly. Okay. Good to know.

SPEAKER_07 6:52

And this form is updated annually. So you know, in the event that, you know, it it's in our office it's updated annually.

SPEAKER_04 7:00

So when you visit the emergency room, one of the things that they ask, they ask you the same questions every time when you're going to the emergency room. Um and you go through, you know, you go to the desk and then you go, you're asking the same questions over and over and over again. Why do they do that? I know that that's something that can be annoying to really anyone, but is there a rhyme or reason for that?

SPEAKER_07 7:24

It's to get the correct information. Everybody has a need to know that information. The paramedic is going to ask you at home. The the triage nurse is going to ask you, the billing office may the intake in the billing may ask you, the business office if you will, and the doctor is going to ask you certain information. Everybody has a need to know that information. Your allergies, your medication, this sort of thing. You can print up a sheet that has that information on there, uh, your insurance, your demographics, next of kin, your physicians, and that includes all your doctors, not just your primary care, uh, your next of kin, your insurance, but keep it current. Also list your medications, any allergies you may have to the medications and your insurance information. Keep it, you know, available so that in the event 911's called, any MS shows up, you can hand them a copy of that sheet. They can use it, and the same thing with going into the emergency room, they can have it as uh available too. They're gonna verify that information, but it's to make sure that your correct information is there available for the folks that are gonna be taking care of you. Now, when you get up on the floor, they're gonna ask you the same information. Right. But you know, think about it. Would you rather they ask you that information and you give them the correct information than that information be passed along and something be left out? Yeah.

SPEAKER_06 8:49

But I I guarantee in an emergency, you will not remember when you had a certain surgery or what the doctor's name and phone number is. So it's best to have it printed up that way it's consistent. And like allergies to medications. Are you allergic to anything? No. And then you remember, oh wait, I'm allergic to such and such. Well, what side effect did you have from that medication? Did it upset your stomach or did it make you stop breathing? Right. And that's crucial for us to know.

SPEAKER_04 9:21

Right. Even even anything as simple as being allergic to um tape. Tape. I mean, some people forget that they're allergic to that. Well, when you go in the hospital, they're definitely going to put some tape on you somewhere. And that is an irritating allergy.

SPEAKER_03 9:35

Yeah.

SPEAKER_07 9:36

So good to know. And what you were saying, Dr. Pam, is like, you know, a rash. If it's a sensitivity, they may have to use that medication to save your life. And there may be something they can use. So if you they'll deal with a rash. They'll deal with the rash and they'll give you something, but it's very important to have it listed. And you know, I can't tell you how many times I've heard people say, Oh, I can't have that.

SPEAKER_04 9:58

Yeah, absolutely. So it's really a great idea for seniors or really honestly anyone. It's not even just a senior issue, but have everything maybe just in one piece of paper or a little file or something that um especially ladies, they can actually kind of keep it in their handbags. Um, they can fold it up, keep it in their handbags. They have everything else in there, why not, right? Um that has their specifically, you know, their medications and even their vitamins, because we've talked about vitamins and how important that um that is to have listed because it is a form of medication per se. I know we've talked about and you can maybe expand on that a little bit. Um, but have that listed as well as their contact information, their, you know, people they want contacted, and maybe even maybe even just tape a copy of their, you know, clip a copy of their HIPAA on there as well, so they have all that in one spot. And that's something that they can share or show in each place that they go to when they uh when they do go to the emergency room to answer all those questions so they're all consistent and it may be less stressful on the patient as they're going through those different triage sections in the hospital.

SPEAKER_07 11:05

And one other thing, and and you know, we've talked about that is their advanced directives also have that available with that as well. So that if EMS comes, and unfortunately, if if you know if that does happen, then it's all there. They can put it down in one of those plastic sleeves and have it there available so that everything is just right there and it's up to date.

SPEAKER_04 11:23

Okay. So tell me a little bit about uh an advanced directive. So uh advanced directives um are a little bit um uh an advanced directive is something that uh you would have to talk about with your child or your family member.

SPEAKER_07 11:44

Well, uh an advanced directive is a legal document. You can't sign it until you're 18. Okay. You have you know uh someone under the age of eighteen cannot enter cannot sign an advanced directive. It is your decision, your directive. No one can sign a living will for you. You have to do it for yourself. And it's what your wishes are in the event that you have um a medical condition that you do not want to be resuscitated or your decision regarding artificial feedings. Okay, and then you name a surrogate to carry out the provisions of that document, and you list that person in that on that document. It has to be witnessed by two adults, one of them cannot be the surrogate that you've listed, okay, and it does not need to be notarized.

SPEAKER_02 12:30

Okay.

SPEAKER_07 12:30

And and you need to let the person know that you've named them. And if you name an alternate, which is always a good idea, let them know as well. Talk to your family, let them know what you've that you've decided to do this, give them a copy of it, give a copy to your doctor, give a copy to the hospital medical records department, um, and then have it there. We'll go over some other documents it's important to have and have it all there together. Also, there's the health care surrogate. That's a document that you're asking someone else to make health care decisions for you in the event that you cannot make them for yourself. Now that would be when you say, for instance, you're in the hospital and you go in for a test, and they give you some medication and it makes you a little bit confused, wack-a-doodle. A little loopy. Yeah, a little loopy.

SPEAKER_06 13:26

I love hearing all these medical terms. I know.

SPEAKER_07 13:28

Whack-a-doodle, a little whack-a doodling, a little loopy. Yeah. Um I'm not a doctor, I'm not a nurse, I'm a social worker. So, you know, but you can't make those decisions. So your healthcare surrogate would step in and sign, give consent for that. Now, once you clear up, the healthcare surrogate can no longer intervene in any of your health care decisions. Right. So that's the and they're carrying out the provisions of what you would want done. They can't make decisions for themselves, it's just for you. Right. And so it's and it too cannot be the person that um it has to be notarized. I mean not notarized, it's witnessed and uh with two people.

SPEAKER_04 14:07

So these uh sound to me like these would be really good conversations to have with the people that you are putting on these two documents.

SPEAKER_06 14:16

Yeah, the the time to make these decisions uh it is not when you're in the emergency department. Right. This is something you can talk to your doctor and say, hey, I've been thinking about a Living Will uh healthcare surrogate. Could you explain it to me? You know, they have them online, the uh they have them for you know different states, uh have them available for you. And it's so crucial to say to someone you love, you know, I'm thinking of doing this. And I I want you to understand it, and I want to tell you what my wishes are. Now, the flip side of that is a lot of people don't want to talk about it. Right. And it's you don't want to say, hey mom or dad, um, how you doing, just wondering if you had a living will. Uh kind of a tough conversation. And that's why we kind of do it in a medical setting and say, Oh, by the way, many of our patients have this. Yeah.

SPEAKER_04 15:10

And and sometimes I think the the children don't want to talk about it either because they they are like mom and dad are gonna live forever, and I don't want to talk about it because that means there's a possibility they're not gonna live forever. But I still think it's a com, you know, clearly no one lives forever. So you have to have that conversation and just be realistic and really find out what your your loved one, what your mom and dad or your your loved ones want so that you can fill those needs and desires, especially, I guess, you know, on the DNR, what what that looks like for them, what their desires are, so that um especially probably within a family, so you know what they want so that it helps the family make the right decision and there's no issues within the family, um, should it come down to making that decision and they're everyone's on kind of on the same page so they know what mom and dad wanted.

SPEAKER_06 16:05

And you know, I want to pull this apart a little bit and define our terms because people get them confused. The living will, the healthcare surrogate, the power of attorney, and then the DNR, or in some states it's called pulsed, which is physician orders for life sustaining treatment. The living will, I call it the if then. Okay. If I'm incapacitated and I'm terminally ill or I'm going to be in a persistent vegetative state, if I'm in that state, and two doctors agree, then the decision can be made to withhold or withdraw life support, uh, not do surgery, not do other things. The thing is, is you could list a hundred things, and I guarantee what will happen to you will be the 101st thing. So it's more general than specific. But people will say, I have a living will, therefore I won't get CPR. And that's not necessarily true. Right. It's if you have have a living will, uh you have to be in that state and have the two doctors agree. Okay. So that's your living will, you sign it with your witnesses, and you say, Well, wait a minute, uh that's all well and good, but uh if I'm uh uh under uh the influence of medications or if I'm very ill, I've been in an accident, who makes those decisions? That's your health care surrogate. And yes, don't just list one person like on the HIPAA, list one person and then if they are unable, there's a backup.

SPEAKER_07 17:44

And if I could jump right in here, never ever, ever, ever, ever name two people as a co because then both of those people have to agree. Name an alternate, but never uh, you know, Dr. Pam and Janet as as the same person on that, I mean on that list. Because we'd have to agree. Right. And your children or whoever you name would have to agree to that. So you name an alternate.

SPEAKER_04 18:11

Yeah, no, I agree with that. Um, that along with the fact that I feel like sometimes the first person may not be emotionally able to make the decision, and so that second person would be the one that may be like able to make that decision um versus the first one because you you never know how people are gonna react in situations like that. So it just gives the opportunity for that.

SPEAKER_06 18:31

Or the the first person may have become ill or they're out of the country. Sure. Yeah. All kinds of things happen.

SPEAKER_04 18:36

All kinds of things happen for sure. So it just it's like a little bit of a safety net, a backup plan.

SPEAKER_07 18:41

That's why you don't name your favorite child or the person that you name the person that you feel like would be strong enough to make those decisions and that you've had that heart-to-heart talk with. Right. Right. Because they're carrying out your provisions, not theirs. Right. Your provisions.

SPEAKER_04 18:56

Yeah, no, I agree with that. That's that makes complete sense.

SPEAKER_07 18:59

But it's hard, you know. Yeah. I've stood by too many people over the years, and you know, and it's like, okay, what did your mom well she's already filled out the living will. All you're doing is saying, I want to do what she said. Yeah. Right. What he said. And yeah, it's like, oh, okay.

SPEAKER_04 19:14

Yeah. You know, it's it's hard to let go, but you you also have to really consider what's best for the person that you love, you know, what what really would they have wanted, and um, but letting go is definitely it's it's hard to do for when you love someone, but it sometimes has to be done. So oh I'm so sorry.

SPEAKER_06 19:32

Oh, I was just gonna say, and and people will say, Well, I just won't fill one out. My kids will figure it out.

SPEAKER_02 19:37

Yeah.

SPEAKER_06 19:39

What happens if you don't have anybody named? Right. First it's your your spouse will be asked, then your children. And then it goes to uh your oldest siblings and then your parents, and uh you know, then a a significant friend.

unknown 19:56

Uh-huh.

SPEAKER_06 19:56

So especially if you're getting married again, do you want your second husband that you've known for two years to make life and death decisions? Right. Or do you want uh a child who's known you their whole life to make that decision? If you're in a same-sex relationship and you've been in it for years and you're not married, you get gravely ill, but that person is not the next person they would contact. It would be family members first. So you want to have everything in place as to who's the best person to make your decision.

SPEAKER_04 20:34

Absolutely. And it can put family members at odds as well. And you never you never want that. And I've seen a lot of families where it can really destroy a family when they're at odds over something like that. And you don't want to do that to your family. You want your family to come together and not let something like that tear your family apart. So I think that's really important um as well. So for sure. So when there is an emergency situation and you're unconscious or um you've had a stroke or something and you're in the emergency room, what document is it specifically? Is it the healthcare surrogate document that is the most important document, or is it all of them combined? Which which would be the most important document to have absolutely completed if you had to pick one to know that you had to have completed for an emergency type of situation?

SPEAKER_07 21:28

I would say both of them. If you had both of them, you know, the the two of them. And then, you know, we have and then to add to that is your medical power of attorney or your durable power of attorney. Okay. Which uh talks about making health care decisions, you know, that would have the authority to make decisions as far as agencies, um what's gonna happen after you leave the hospital to sign contracts to for for medical care. For medical care.

SPEAKER_04 22:00

Okay. So all of these documents are really important to really kind of button up as soon as possible. You don't want to wait on them and wait till you maybe do get ill or do need to be hospitalized or anything like that. These are things that seniors really honestly anyone should really be looking into because, you know, none of us none of us are guaranteed tomorrow. We we may, you know, have an accident, anything could happen, and we want to make sure that um people are looking out for our best care. Um so it's just something really important to kind of just look into. You know, how would you recommend? Is this something that you would like go online or talk to an attorney, or what what would you recommend a step in order to attain these?

SPEAKER_06 22:41

Well, the power of attorney is a legal document. It's done in an attorney's office, and that one is notarized. Okay. So that would give someone else permission to jump in and and make your medical decisions and uh financial decisions if they needed to find an assisted living facility or they needed to run your household while you were incapacitated.

SPEAKER_02 23:06

Okay.

SPEAKER_06 23:07

Um these must be portable. Yeah. Because as we've often said, we've met people who say, Well, I have a living willpower of attorney. Uh it's in my safety deposit box at the bank. And we always say the the ambulance is not going to stop at the bank on their way to the hospital to pick up your power of attorney.

SPEAKER_07 23:29

Exactly.

SPEAKER_04 23:31

And typically a the power of attorney is also held at the attorney's office, correct? So you don't necessarily need to store your power of attorney at I mean you can as a copy, but you don't really need to.

SPEAKER_06 23:44

Copies can be there. Yeah. But what happens if you get sick on Saturday and your lawyer's office is closed? Yeah. No, you should definitely have one at home.

SPEAKER_04 23:53

But as a backup in case your house burns down, you got one there too. I mean, knock yourself out with the copies.

SPEAKER_07 23:58

You need a copy of it and your family needs a copy as well. So that if you are not able to even express your wishes or anything like that, whoever you have named as your power of attorney, they definitely need a copy. Yeah. And you know, and right now we're going through this COVID-19 crisis. You know, it's not people that are elderly that are just getting sick. Yeah. We have had younger individuals that are with life-threatening situations, they're on ventilators, yeah, and they don't have advanced directives in place. Yeah, they're next to kindor making decisions, life-threatening, life-determining decisions. So anyone over the age of 18 should have these documents in place. Yeah. A living will does not mean do not treat. It just means that in the event that these certain provisions take place, there will be a conversation with the doctor and the healthcare surrogate. You know, and it rarely does it ever get to where that it ends up in the courts. Right. Right, you know, you can, but definitely want to avoid that. Yeah, we it we don't want it to get there. Yeah.

SPEAKER_04 25:04

All right. On that note, we're going to take a quick break, and then we will be back with uh Janet and Dr. Chanel.

SPEAKER_01 25:23

At Paris Healthcare, we believe every life is poetry in motion, motivated by strength and determination. As your bone, muscle, and joint healthcare partners, we believe in blending the art of healing with the science of medicine to keep your body in motion. We believe in healing patients, healing families, and healing communities. For a free orthopedic health assessment, visit parrothealthcare.com forward slash orthoaware at Paris Healthcare, where the art of healing comes to life.

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SPEAKER_04 27:36

Welcome back, everyone. So we're going to talk a little bit more about some of these documents that we need to have completed when we're going to see physicians and for emergency purposes. One of the things that I was curious about, so if you have dementia or early onset dementia, so how do you kind of work around some of those these documents? Because clearly you want to know some of the documents that you're signing and some of the decisions that you're making.

SPEAKER_06 28:16

Well, if someone comes in and we're making an early diagnosis of mild dementia, part of our team is you need to see your lawyer, you need to see your financial advisor.

SPEAKER_02 28:27

Okay.

SPEAKER_06 28:28

And they can put things into place, living wills and health care surrogates and name somebody powers of attorney. But eventually, as the dementia progresses, you reach a point where that person uh doesn't have the capacity to make those kind of difficult decisions. Right. So hopefully something is in place before that.

SPEAKER_02 28:49

Okay.

SPEAKER_07 28:50

But unfortunately, we do see those individuals that they have some paranoia with the dementia. And they do not want to give up that responsibility. No, I'm not going to have anybody paying my bills. No one's going to take power of attorney. I am not going to do anything. You are not going to do that. I can take care of myself, I can pay my own bills, and they will not under any circumstance sign anything. And it it's unfortunate. The family will really struggle in times like this.

SPEAKER_04 29:20

So when that happens and you do have a dementia patient that doesn't have any documents that's been completed, um, what is the solution to that to you? Is that something that you have any advice on?

SPEAKER_07 29:37

Well, it all depends. If it's make if if they're in the hospital, then there's provisions through the hospital um for assumption of proxy.

SPEAKER_02 29:46

Okay.

SPEAKER_07 29:47

There's a form that they will sign and you know we'll notify the risk manager and at the hospital and that we have someone that they would sign assumption of proxy.

unknown 29:58

Okay.

SPEAKER_07 29:58

So they assume that role of there being their proxy.

SPEAKER_02 30:01

Okay.

SPEAKER_07 30:01

Because they don't have those provisions in place. If if they need to have access to the bank account, then that's something they'd work with uh the bank. Uh Dr. Pam will actually fill out a document or a letter that states they do not have the ability to make decisions for themselves due to a medical condition, and that suffice most of the time. There's a lot that has to it's a lot of responsibility for the family. It's like herding sheep back in there after they ran out. So we really encourage to get it done ahead of time.

SPEAKER_04 30:41

Right. Does that usually typically and uh include bringing in an attorney? Does it get more in the legal side of it when it's not done prior to?

SPEAKER_06 30:50

Not necessarily. Okay. Because uh sometimes it's obvious that here's this person who's been taking care of their mom or dad for a number of years, they have acted on their behalf, they have their best interest in mind, and then they uh uh can can jump in and take over things because they have to, but it's much, much easier for them if it's already already.

SPEAKER_04 31:16

Yeah, absolutely. So when this occurs, does this declare a person incompetent? Is that what this kind of means?

SPEAKER_06 31:25

That's what a lot of people think. Okay. But only a judge can declare someone incompetent. Okay. Uh what physicians do is we measure decisional capacity. Okay. So uh this person might have the capacity to say you know what they want to wear and what they want to eat, but do they have the capacity to understand that we want to do open heart surgery? Could they c sign a consent? And the answer is probably no. So we need someone else to assume that responsibility to do that. So what Janet was talking about is often we have to write a letter of decisional capacity saying this person has dementia and now it is up to their next of kin or power of attorney to take over that role and that responsibility.

SPEAKER_02 32:14

Okay.

SPEAKER_06 32:15

Which of course, you know, you're assuming that the power of attorney is going to act in that person's best interest if they start taking advantage or mismanaging funds, then there's other recourses.

SPEAKER_04 32:25

Right. That makes complete sense. So that's um that's really interesting. So tell me a little bit about um when those decisions are being made, the um declaring someone potentially incompetent, um how does it affect you know any of these other documents? So the documents are not something you would go forward with, that's something that becomes more of a legal issue or um well there's a couple different different questions in that.

SPEAKER_06 33:02

And sometimes if the person, like Janet said, is is fighting and they don't want your help and they're not taking care of themselves, the family will go before a judge. It's a guardianship hearing. Now it's different in every state, but it's always costly. Yeah. Because it always ends up in court. You have to have expert witnesses, you have to have a hearing, and then the judge will say, Okay, I am naming this person as the guardian, which is essentially an elevated power of attorney. They get to make all of the decisions for this person.

SPEAKER_04 33:36

So you really, really kind of want to avoid that, because that can be very costly.

SPEAKER_07 33:40

Yeah. And there's different levels of guardianship. They can be guardian of the person, they can be guardian guard guardian of their finances, or they can be guardian of both. Right. And to help with that. And there's agencies that do that, they're private guardians. But you know, so it's and they have to report back to the courts annually. Right. So, you know, we do try to avoid that. We'll go through, we'll look at everything and try because we're all about the patient. Right. You know, and I'm an advocate for the family and for the patient, but the patients come first, and we're gonna do everything we can. And I you know, the attorneys are out there and uh to try to help as long as well. So you know, it's a lot of talk.

SPEAKER_06 34:22

It is, and and you need somebody who knows what they're doing. A dementia care specialist will help you, there's senior specialists because what you kind of had buried in that question is families will come to us and say, Okay, my mom needs bathed and dressed and fed. Can I fill out a living will for her? No, you can't. Can I sign, can I sign as her power of attorney? No, you can't. Those are things that the person had to do.

SPEAKER_04 34:48

Right. So it's harder for the family to get the things that they really want and desire for the simple h healthcare things for their loved one if they're going through more of the longer route to get those things done.

SPEAKER_06 35:02

It is. And you know, it's just harder because uh when you get to a critical situation, uh family members say, I don't want to make the decision to they'll say pull the plug, you know, withdraw uh withdraw all of this uh uh machinery and ventilators and life support. Right. But if th they said, you know what, I am doing this because my mom or dad said that's what they wanted or didn't want, that's a whole different mindset.

SPEAKER_04 35:33

Sure, absolutely, absolutely. So there's something that's called five wishes. So explain that a little bit to me, do the five wishes.

SPEAKER_07 35:42

It is a fabulous document. And it encompasses the living will, the healthcare surrogate, but it also gets into end of life. What would it gives me goosebumps? It gives me goose bumps when I talk about it. Um it talks about what you would like, your comfort. You know, what type of music would you like played? Do you want music played? Would you want lotion rubbed on your arms and your hands as you know, at um at at the end of life? Um would what who do you want to visit you? You know, what things have you left unsaid? And um it's you it's your final word, you know, you get in the last word. Yeah. Okay. But it's also uh a document that you can actually say, Well, yeah, I'd like a funeral, I'd like a memorial service, I would like a full you know, or I'd like a party. You know, I want a party, a celebration of my life with rock and roll music or whatever. Um and it's and when you fill out the document, it's something that a talking point. You can talk to your family. I got this document. I want to sit here and talk about what I want done at the end of, you know. Okay I want I want all of y'all, I want my kids to get along, you know, and you can write that on there. Um or you know, Billy was m not nice to me in school, so you know, the heck with you. Yeah, that kind of stuff. And you know, here I am, 90 years old, I'm dying, and you were mean to me, you broke up with me in high school, and the heck with you. I never forgave you. Yeah, you know, and it's just really interesting, but that document is there. You could where do you find that document? Um hospice has it. Okay, we have them in our office, uh, doctors' offices have them, but it is um it's it's on behind.

SPEAKER_06 37:34

Yeah, and it it's valid. I want to say 44 states of the 60, 50 states. So about that.

SPEAKER_07 37:42

You know, 40 states, I'm a little behind.

SPEAKER_06 37:45

And it does include a healthcare surrogate and a living will.

SPEAKER_04 37:49

That is super interesting. That is not something I have ever heard, so that is completely new information for me. I like new information.

SPEAKER_06 37:55

We we brought one with us. We can show it to all of our podcast listeners. Yeah, yeah. Just hold it up.

SPEAKER_04 38:02

Let me see if I can get this. I think that this if I can get it really good, really good in the camera. Um and I'll actually include a link at some point where we can find it. Um, yeah, it's multiple pages, so it's not just one sheet where you just fill out a few little questions. Um it takes time. Yeah, it's it's thoughtful. So it's very thoughtful. Um my wish for how I want people to treat me, my wish for how comfortable I want to be. I'm just going through a few of these. Um, my wish for what I want my loved ones to know that that just makes me want to cry, in all honesty. And there's um I wish to be forgiven for the times I've hurt my family. You know, there's all kinds of ideas in here and different um thought-provoking um sentences and um different things. I think this is absolutely uh wonderful to be able to fill this out. I think that um a lot of people that are going through end of life, especially people that have, you know, life-threatening diseases that know that their time is, you know, imminent or even years from now or what have you. I think this is a really important document to fill out um and talk about with their family long before it comes to that point. Um, first of all, I think it will probably bring families closer together. Um, because I think, you know, people that are ill, it it's stressful. It's so stressful on families because you know, you don't want to accept that your loved one is that ill, um, whether they have dementia, cancer, you know, heart anything.

SPEAKER_06 39:45

Yeah, lung disease, oxygen, kidney disease. Yeah.

SPEAKER_04 39:48

It's it's hard on families. Um it just is it's just one of those things. And to have these kind of conversations, I think it can only bring a family closer together. Um and then it just really can fill in some of those gaps at the end.

SPEAKER_07 40:02

This is a good document that as I mentioned with a family, but it's it's a non-threatening. So you, you know, as a I've my caregivers, I've given them to them and um we'll give them several copies so that they can sit down and say, Hey, I got this document. Uh, you know, I'm filling out one, my husband's filling out one. Um but let's look over this mom, let's look over this dad. So it's not, well, you know, here you've got this such and such diagnosis, I want to have you fill this out. So it's it's a non-threatening it's uh or and it's something that you can't it it's better to do over a period of time. Let's have a uh let's have a Danish and uh a cup of coffee and let's let's read over this. I heard about this. I heard about this five wishes document. And even the states that it's not valid in, they will use they will recognize it and um honor honor some of the um the wishes, the advanced direction.

SPEAKER_06 41:00

A lot of times they have another state document that has to be attached, but this is a a launching point. It really is.

SPEAKER_04 41:07

So one of the things that I kind of see with this, it's kind of so it has to be witnessed, it can be witnessed, notarized. Um so it really is a document. It's it doesn't have to be notarized in Florida. Okay. Um and then you can also cut out the fact that it has uh like a card inside of it and you can put it in your wallet so that people will know that you actually have this document in case anyone goes through your wallet, which everyone does at some point. Um but one thing that I kind of see in this, if you're not a um uh you know, if you don't write in journals, um this is l almost like a mini journal kind of. Um, but it's you know, specific bullet pointed, so you kind of get all your thoughts and wishes out. Um it kind of gives you a guide if you're not a journalist, you know, if you're not a journal or is that a word? But um that's what I really like about it. I think it's really great for families, and it's probably something that even after you pass your family's gonna keep this, it's gonna be kind of a keepsake, right per se. So I think that this is really cool. So I just love the fact that this is something that um is actually available. So yeah, I'm so glad you guys brought this. I had no idea. So um we'll definitely include this link, and I actually want to kind of explore that a little bit more at some point. Um so to kind of cap things off, um so who would typically one of the things you know we talked a little bit about DNR. Um so who would typically want a DNR? Would everyone do you think typically most people should get a DNR, or do you think that's something that um is specifically to just a select few of people?

SPEAKER_06 42:58

Well, let's let's start with a good definition. DNR stands for do not resuscitate. Now folks will come to the office and they'll say, Oh, I have one. I did that at my lawyer's office when I did my power of attorney. No, you didn't. Because it's always done in a medical office. It is signed by the patient or their representative or both. It's signed by a physician. It has to be bright yellow.

SPEAKER_02 43:23

Canary yellow canary yellow canary yellow in Florida to be honored.

SPEAKER_06 43:27

Okay. What it says is under no circumstances do I want CPR or a ventilator.

SPEAKER_02 43:33

Okay.

SPEAKER_06 43:34

Now we always say do not resuscitate does not mean do not care, because people will say, Well, what if I call 911, they'll just stand there? No, no, no, no, no. If you're sitting there choking on a piece of meat, they're gonna do the Heimlich maneuver. If you have chest pain, they're gonna give you oxygen, they're gonna give you nitroglycerin, they'll give you the aspirin, they'll take you to the hospital. But if the heart stops, do not bring that person back. If you have a living will, you can wave it in front of the EMS crew all day long.

unknown 44:03

Uh-uh.

SPEAKER_06 44:04

Your living will says if I'm in this condition, and if two doctors agree. So they would have to do CPR until they got to the hospital setting. Most people will keep uh who have a DNR uh that they have severe diseases, and they say, you know what, I don't want to be brought back if I pass away so that I can suffer more. Right. And those are the folks most of our patients, 85 and up, will say, you know what, I've had enough. I I want this DNR. Or I've had a loved one go through this. I watched them on the ventilator. I don't want that to happen to me. So uh it gets signed. We make copies in Canary Yellow. Most people keep it at home on the side of the fridge, on the side of the cupboard. You can you know put it face down, but that way um 911, if you call it, they'll come, they'll see that. Okay. And they'll know where the lines are drawn.

SPEAKER_04 45:02

Right. I appreciate you explaining that because I know some people do have the fear that they just won't try to save me, but that's not the reality of it. It's it's much deeper than that. So, and and clarifying that. So well, on that note, um, I think that we are at our time. Um, but I do want to in on a positive note on the five wishes. So um this the web is there like a link to this? So actually, I'm gonna give one that's a local link. It's hospiceofsaint francis.com. Um, do they have the link on this on this website, or do you have another link, or maybe I'll just share that somewhere else?

SPEAKER_06 45:41

Um, I know five wishes has its own link. Five wishes has its own link.

SPEAKER_04 45:44

Okay, so I just saw this on this document.

SPEAKER_06 45:46

So you know, we're all just passing through. Okay.

SPEAKER_04 45:49

So yeah, yeah. So definitely look up that link um so you can see this document. It's really very interesting if you're still um interested in in looking that up. And um until then, check us out for our next podcast, which will be coming up shortly. Thank you, everyone. Have a great day. Thank you. Thank you, uh Janet and Dr. Pam.

SPEAKER_06 46:10

Great to be here.