By Pat Shaver
IOWA CITY — It can be a difficult process to go through, but also an important one.
Nearly half of people of at the end of life are not capable of participating in their health-care decisions, said Jane Dohrmann, director of the Honoring Your Wishes program at Iowa City Hospice.
The Iowa City Hospice, through its community-wide advance care planning initiative Honoring Your Wishes, is offering community members (healthy and chronically ill) 18 years and older, a free session to sit down with a certified facilitator to create a health-care directive.
“We really want to normalize health-care conversations,” she said.
A health-care directive is a document that a person fills out, answering several difficult questions about how they would want to be treated medically in the event they aren’t able to make those decisions at the time.
“It’s not uncommon that many people would be at the point where they can’t communicate; some people are over-treated and some people are undertreated,” Ms. Dohrmann said. “At the time of crisis is not the time to make that decision.”
For example, if someone’s family member is in an accident and unconscious, the document would be beneficial for family members and health care providers, she said.
“It really helps the family,” she said. “In some cases, the family says what should we do, what would they want and they disagree.”
Honoring Your Wishes is modeled after a program in La Crosse, Wis. There, Ms. Dohrmann said, about 90 percent of the people had a health care directive in their medical records.
“There’s emotional ramifications and financial ramifications (to not completing a directive),” Ms. Dohrmann said. “It’s a gift to yourself, it’s a gift to your family and friends and it’s a gift to the community.”
The effort in Johnson County has about 30 different local partner groups. Donors that helped fund the program include: the Community Foundation of Johnson County, Hills Bank & Trust, Iowa City Hospice, Iowa City/Johnson County Senior Center, Lensing Funeral & Cremation Services, Mercy Iowa City, Oaknoll, University of Iowa Health Care and University of Iowa Community HomeCare.
During the past two years, Iowa City Hospice has hosted several different pilot programs focusing on people who are healthy to begin to make these decisions.
“In terms of a healthy community and a caring community, we don’t want people to look back and say, ‘I wish I knew what you would have wanted,’” Ms. Dohrmann said.
For more information on the Honoring Your Wishes program, contact the Iowa City/Johnson County Senior Center at (319) 356-5220 or the Iowa City Hospice at (319) 351-5665.
Meanwhile, St. Luke’s in Cedar Rapids has focused its efforts on the other side of the spectrum.
Iowa Physicians Orders for Scope of Treatment (IPOST) was signed into law in March 2012. Different from a living will or a health care directive, an IPOST document allows a health-care professional complete advanced planning orders without liability and is an actionable document, said Dr. James Bell, St. Luke’s Palliative Care and Hospice medical director in Cedar Rapids.
“Our involvement has really been from the end of the story backwards,” Mr. Bell said. “It’s aimed at the population of people who would be in a potentially end-of-life situation where they need to think about what they want.”
IPOST is a double-sided, one-page document that allows a person to communicate their preferences for key life-sustaining treatments including: resuscitation, general scope of treatment, artificial nutrition and others. IPOST is appropriate for an individual who is frail, elderly, or who has a chronic, critical medical condition or terminal illness.
“Basically (IPOST) is a way of turning an advanced planning conversation into actionable medical orders in people who very likely need to have those questions answered in the short term,” Mr. Bell said.
St. Luke’s started piloting the program in 2008 to prepare for the potential that the law would be passed.
“It’s really about making the patient the center of attention and understanding them,” Mr. Bell said. “What we typically find without a document like this, if we have to (make decisions), it’s kind of a panicky meltdown.”
Along with benefiting friends and family, a concise and specific document makes it much easier for the physicians and health care professionals, he said.
“It helps everybody across the spectrum of care, especially when people are in transitions from a nursing home, emergency room, hospital to long-term care,” Mr. Bell said.