Larimer Advance Care Planning

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• About Advance Care Planning
• Myths & Facts
• RECURSOS EN ESPAÑOL

In April 2023, Extension became the new home to Larimer Advance Care Planning. The Health District of Northern Larimer County launched the program seven years ago when community data showed a low rate of completed advance care directives.  With Extension's robust healthy aging programming, Larimer Advance Care Planning aligned with our priorities and will give the Health District an opportunity to address new, emerging community needs as it did with advance care planning.

MYTH: Advance care planning is only for the elderly or the terminally ill. 
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FACT: Anyone, at any age can become suddenly ill or severely injured and need to make decisions about potential health-care treatments. In Colorado, it is particularly important to designate your decision-maker with a Medical Durable Power of Attorney.

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MYTH: Talking about advance care planning needlessly worries our children and other loved ones. 
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FACT: Talking about health-care wishes now relieves the burden on the family of having to make decision(s) in a time of crisis and ensures your wishes are upheld. 

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MYTH: I need a lawyer to complete my advance care directives. 
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FACT: Our team can guide you through the necessary documents. If appropriate, a physician or medical professional may need to sign your CPR directive or Medical Orders for Scope of Treatment (MOST) form.

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MYTH: If I sign an advance care directive, I won't be able to get medical treatment. 
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FACT: Expressing treatment wishes through advance directives may be for any/all treatment, or to withhold any/all treatment. The choice about how much/how little care or quality/quantity of life is up to each individual. You will always be able to make these decisions until it is clear that you lack capacity to make decisions for yourself. ​

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MYTH: I'm a parent or spouse so I will automatically have medical power to make decisions for my child or spouse. 
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FACT: Selecting a health-care agent is important in Colorado. Parents do not automatically have the power once their children are legal adults. Spouses may not be recognized as the main decision-maker for their partner if there is a family dispute over medical treatment. Therefore, it's important to designate your health-care agent by completing a Medical Durable Power of Attorney with your advance care plan.  

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MYTH: Once I create my plan, it's final and I won't be able to change my documents.
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FACT: You can revisit your plan at any time! We recommend revisiting and potentially updating your advance care directives whenever there is a death that is close to you, a decline in your health, a divorce, you've moved, or a diagnosis of a serious medical condition is given. If you are fortunate to go a decade without any of these happening, it may be a good idea to revisit your plan to be sure everything fits with your values, wishes and preferences. Whatever document has the most recent date takes precedence over past documents.

Usted tiene el derecho a comunicar el tipo o nivel de atención médica que desea recibir, hasta si no puede hablar por sí mismo.

El siguiente video y documentos le ayudarán a explicar sus deseos para el cuidado al final de la vida, identificar a un agente de atención médica para que hable por usted (si no puede hablar por sí mismo), y formalmente documentar sus preferencias de atención médica por medio de directivas anticipadas de atención.

 

 

Su Kit Para Iniciar La Conversación

Cómo Escoger/Ser Un Agente De Atención Médica

Su derecho a tomar decisiones relativas a la atención médica

FAQs

1. What is advance care planning?

   Advance care planning is making decisions about the care you would want to receive if you became unable to speak for yourself. These are your decisions to make, regardless of the choice for care. These decisions are based on your own personal values, beliefs and preferences. Part of the planning process is to share your wishes with your family, friends and medical providers.

   Advance care planning includes:

   • Personal reflection about what matters most to you about care at the end of life including:
     • Identifying cultural, religious, spiritual or personal beliefs that might influence treatment choices
     • Exploring goals of medical care in the event of a terminal diagnosis or severe, permanent brain injury and a poor cognitive outcome (i.e., the individual is unlikely to recover the ability to know who they are or whom they are with)
   • Choosing your health-care agent to express your wishes and navigate the healthcare system on your behalf if you are unable to.
   • Documenting preferences through written advance directives
   • Developing strategies to share your wishes with:
     • your health-care agent
     • family 
     • friends
     • medical providers

   • Ensuring your wishes are honored by providing the advance directives to appropriated family, friends and medical providers.

2. Why should advance care planning matter to me?

   
   Accidents and sudden severe illness do not discriminate and can happen to people of all ages. In Colorado, it is particularly important to have someone designated - in writing - as your medical health care agent. Your Medical Durable Power of Attorney is the document that allows your representative to make decisions on your behalf if you cannot. Every day people arrive in the emergency rooms of hospitals unable to communicate. In these situations, having advance directives ensures that your doctor knows your wishes about the kind of treatment you want, as well as the person you choose to make medical decisions on your behalf. We recommend that any legal-aged adult have a completed advance care plan.

3. What are advance directives?

   Advance directives document your health-care wishes and are used if you are unable to communicate for yourself. The most common directives include:

   • Medical Durable Power of Attorney. A document that legally appoints a health-care agent to make medical decisions for you when you are not able to
   • Advance Directive for Surgical/Medical Treatment (also known as a Living Will). This directive is used only when a physician (or physicians) has determined that the patient has a terminal condition or is in a permanent vegetative state. The directive documents your wishes related to life-sustaining procedures and artificial nutrition. 

4. What are the different forms in an advance care plan?

   Advanced Directive Type	Definition	Pros	Cons	Comments
   Medical Durable Power of Attorney	Agent appointed by patient to make decisions when patient lacks capacity, temporarily or permanently. (Agent with general POA has no medical decision-making authority)	Agent has broad range of authority to respond to situation at hand according to the patient values.	Patient must have shared values with agent. Only for healthcare decisions. Patient can fire agent - even if lacks decisional capacity.	Agent has latitude in making medical decisions; most adaptable way for patient wishes to be expressed. Cannot override LW, CPR directive.
   Living Will	Person directs withdrawal of life-sustaining treatments when s/he lacks capacity and in terminal or persistent vegetative state	Must be honored unless a MDPOA is given express authority to override.	Only in effect when patient lacks DMC and in terminal condition or PVS as determined by two doctors	Very narrow, inflexible.
   CPR Directive	Colorado state form documenting refusal of CPR in the event person's heart or breathing malfunction	To be honored by all EMS, facilities.	Does not instruct on how much to intervene on other pre-death care, like dialysis, transfusions, and intubation for respiratory distress only.	Order across settings; only effective in cardio-pulmonary arrest. (DNAR order is translation of this during hospital admission.)
   MOST form (Medical Orders for Scope of Treatment)	Orders (not directives) signed by patient (or representative) and health care provider to determine treatment wishes near the end of life.	Orders (includes copies) are to be fully honored by all providers in all settings in Colorado.	Intended for only patients with chronic, serious or advanced illness.	New form, broader scope than CPR directives. Wishes for wide diversity of treatments can be expressed.
   Proxy decision maker for health care	Surrogate when patient lacks decisional capacity but hasn't designated an agent (MDPOA). Selected by "interested parties" as person who can best speak for the patient's wishes/best interest.	Provides consent for non-emergent interventions or restraint by representing patient in giving "informed consent."	Family and friends may disagree, causing significant stress. Proxy cannot withhold artificial hydration, nutrition in most instances. Many providers unaware of process for getting proxy in CO.	Less freedom than agent with MDPOA to make medical decisions.
   Five Wishes	Privately produced legally accepted document executed by patient to express preferences for medical treatment, pre & post-death wishes.	Offers opportunity to express wide range of peri-death wishes.	Procedure based medical wishes; often not useful as guide in clinical care in actual situation.	Wishes are intended to be followed by may be overridden by MDPOA or proxies.

    

5. Can the Larimer Advance Care Planning Team help with financial power of attorney or last will and testaments?

   NO. The Larimer ACP Team can only help individuals with medical directives. If you are looking for resources to help with legal documents like power of attorney, wills, or trusts, please visit our resources page and look under the "Legal" section. 

6. What does the Larimer Advance Care Planning Team do?

   The Larimer Advance Care Planning team guides adults in deciding their wishes for end-of-life care and in documenting those wishes through advance care directives. We want to make advance care planning a part of the continuum of health care for all adults. 

   It’s time to start talking about dying, time to share the way we want to live at the end of our lives, and it’s time to communicate about the kind of care we want and don’t want for ourselves. Together, we can make these difficult conversations easier. We can work toward making our own wishes and those of our loved ones expressed and respected. If you’re ready to start your conversations and make your wishes for end-of-life care known, let us guide you through the process of advance care planning. The Larimer Advance Care Planning team services are provided at no cost

   The Larimer Advance Care Planning team: 

   • Guides individuals through the advance care planning process
   • Ensures advance directives are shared with appropriate family, friends and health-care providers
   • Promotes advance care planning through community presentations
   • Serves as a resource for organizations to refer individuals to for more help in advance care planning
   • Coordinates with other existing advance care planning efforts within Larimer County