Denver Senior Care consultants recently had the pleasure of attending the Advance Care Planning (ACP) Certification Training Program developed by The Denver Hospice and University of Colorado School of Medicine. We thought it would be beneficial to pass on some key information we learned especially when considering that only 23% of people have actually put their medical wishes in writing (California HealthCare Foundation, 2012).

What Are Advance Care Directives?

Advance care directives are legal written documents that outline in detail your medical preferences. These documents only go into effect when you are unable to speak for yourself.

Do I Need Advance Care Directives?

If you are 18 years and older with the capacity to make decisions for yourself then you have a right to have advance care directives. If you want a voice in your health care decisions, then advance care planning is for you! Advance care directives are not just for older adults. Even if you are in good health, you never know when your health status might change. If you have a chronic or serious illness then it is even more important to have these documents in place. With these documents in place your loved ones will know your medical wishes and therefore won’t have to make guesses on decisions regarding your medical care.

Colorado Advance Care Directives:

Each state has their own laws regarding advance care directives. In Colorado there are the following advance care directives:

1.) Medical Durable Power of Attorney (MDPOA)

In Colorado, it is especially important to assign a MDPOA since there is not a default MDPOA. The Colorado Proxy law states that if a MDPOA is not designated your doctor will gather all interested parties and then the gathered group will appoint someone as your proxy decision maker. In other states there is a default MDPOA which is usually the person’s spouse, then an adult child, a parent, a sibling, and then other relatives. A MDPOA must be 18 years and older, mentally competent, and willing to serve as your healthcare agent. If you were to become incapacitated, your MDPOA would make your medical decisions on your behalf. It is recommended to pick someone who lives in the same state or city as you and to have one or two backup agents in case your first choice is unable to serve. To make the MDPOA legal in Colorado the document only requires a signature from declarant.

2.) Living Will

A Living Will specifies the types of life-sustaining treatments you would want or not want in the event of a chronic or terminal illness or unexpected, critical medical event. Some examples of life-sustaining treatments include: artificial nutrition/hydration, CPR, intubation, life support and dialysis. In Colorado a living will does not go into effect until 48 hours after two doctors agree that you are in a terminal condition, can’t make decisions, or are in a persistent vegetative state. To make the Living Will legal in Colorado the document requires a signature from declarant and two witnesses. If you would like a more detailed living will that takes into account your personal, emotional, and spiritual needs check out Five Wishes.

3.) Cardiopulmonary Resuscitation (CPR) Directive

A CPR Directive is a medical order stating that you do not want CPR in the event of cardiac arrest. This order is valid outside of a healthcare facility. If you do not have a CPR Directive the law requires emergency personnel to perform CPR. To make a CPR Directive legal in Colorado the document requires a signature from declarant and physician.

4.) Do Not Resuscitate (DNR Order)

The only difference between a CPR Directive and a DNR Order is that a DNR Order is used within a healthcare facility. DNR orders are discussed when your doctor believes that resuscitation will end up in death or cause more harm than good.

5.) Medical Orders for Scope of Treatment (MOST Form)

A MOST form is only recommended for those who have a serious, chronic illness. People with MOST forms usually reside in a nursing facility and have frequent interaction with healthcare providers. A MOST form is a medical order focusing on immediate treatments that records your choices for CPR, general scope of treatment, and artificial nutrition. To make a MOST Form legal in Colorado the document requires a signature from declarant and physician. In Colorado, a MOST form is usually printed on bright green piece of paper.

After Completion of Your Advance Care Directives:

Go over your advance care directives with your MDPOA, loved ones, and doctors. Ensure that these individuals have a copy of your advance care directives. Make sure to have your advance care directives in a safe and easily accessible spot. Review your advance care directives every 2-10 years or if there are any major life changes like your health status.

We hope that the information in this blog post both educated and empowered you to complete your advance care directives to ensure your medical decisions are truly respected when you are unable to speak for yourself. If you are interested in attending the ACP Certification Training Program please contact Lierin Flanagan, MSW, Advance Care Planning Program Coordinator, at lflanagan@care4denver.org or (303) 780-4514. The opportunities do not end on the last day of your training. People who complete the training receive newsletters and are connected with ACP Guide-led Leadership Network meetings.