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Planning for your future care

Have you ever thought about what would happen if you or your relative became seriously ill or disabled?

Regrettably we often do not consider these situations until it is too late. For example, if you (or a relative) lost the ability to make decisions about your finances or health, do you know what would happen?

Another situation to consider is resuscitation, lots of people would prefer that when the time comes they want to be allowed ‘to go naturally’, however if this is not clearly documented then resuscitation will be attempted if an ambulance is called.

For many people these are difficult subjects to think and talk about which is completely understandable but by doing so ensures that you can make your wishes clear in advance in case that there comes a time when you are unable to do so. Below is some information about some areas to consider.

Dorset Care Plan

For our frailer patients and those at high risk of hospital admission we can complete a Dorset Care Plan. This gives you the chance to tell your GP and health care team what your wishes are and also allows this information to be available to the out of hours and ambulance services.

In the Dorset care plan we include a summary of your health issues and what you are able to do when you are well to give some background information. We also include your wishes and priorities for your care eg would you want to go into hospital if you developed an infection that was not improving with antibiotics at home or would it be your preference to remain at home. It can also include a self-management plan eg if you have a long-term condition such as asthma or COPD. This is something your frailty clinician will be able to discuss with you further during your appointment, but it may be helpful to think about your wishes/ discuss them with your family in advance of your appointment.

Lasting Power of Attorney (LPA)

This is a legal document that lets you nominate one or more people to make financial and/ or health decisions for you if you lose the ability to do so. This is important for people who develop dementia and other health conditions such as a severe stroke.

The LPA has to be set up when you still have the ‘capacity’ to do so, so it’s never too early to think about it. No matter how early you set this up, the people you nominate can only make decisions for you when you are no longer able to.

Allow a natural death

If you have a clear view that you would not want resuscitation to be attempted, then you can discuss this with your frailty clinician or GP who can then complete the relevant form. Please remember that making a decision to allow a natural death does NOT mean that your medical treatment will stop and your healthcare team will continue to ensure that you receive the highest standard of care regardless of your decision.

Advanced decision to refuse treatment

You may decide that there is a specific medical treatment which you do not want to have., eg if you had a stroke and were unable to eat or drink that you would not want to have a feeding tube. This can be done by making an advance decision to refuse treatment. An advance decision to refuse treatment (sometimes called a living will or advance directive) is a decision you can make to refuse a specific type of treatment at some time in the future. This is to be observed if you can’t make your own decision at the time the treatment becomes relevant. There are rules if you wish to refuse treatment that is potentially life sustaining, for example, artificial ventilation or hydration. An advance decision to refuse this type of treatment must be put in writing, signed and witnessed and include the statement ‘even if life is at risk as a result’.

Resources

Here are some links to useful resources where you can find more information.

General information about advanced care planning  
Planning for your future care- A Guide   One way of making people aware of your wishes is by a process that is called advance care  planning. This booklet provides an explanation about advance care planning and the different options open to you.  
https://www.england.nhs.uk/improvement-hub/wp-content/uploads/sites/44/2017/12/EoLC-Planning-for-your-future-care.pdf    
NHS website- End of Life Care   This guide is for people who are approaching the end of their life. Some parts of it may also be useful for people who are caring for someone who is dying, or people who want to plan in advance for their own end of life care. It covers what to expect, thinking about your wishes for your future care, and looking after your emotional and psychological wellbeing.
http://www.nhs.uk/planners/end-of-life-care/documents/planning-for-your-future-care.pdf  
Lasting Power of Attorney  
Gov.uk website  
Government guidance on how to make, register or end a lasting power of attorney   https://www.gov.uk/power-of-attorney/overview  
AgeUK  
Information about Power of Attorney, mental capacity and how to set up a Power of Attorney   https://www.ageuk.org.uk/information-advice/money-legal/legal-issues/power-of-attorney/  
Advanced Decision to refuse treatment( ADRT)  
Ageuk   Information about Advances Decisions to refuse treatment/ living wills, including what to consider when making decisions and how to go about making one.  
https://www.ageuk.org.uk/information-advice/money-legal/legal-issues/advance-decisions/  
NHS Website- Advanced decisions (Living wills)   Information about advanced decisions and advanced statements and how to put one in place.  
https://www.nhs.uk/conditions/end-of-life-care/advance-decision-to-refuse-treatment/  
Resuscitation decisions  
Resuscitation council UK   A leaflet about Cardiopulmonary Resuscitation (CPR) and how decisions are made about it.  
https://www.resus.org.uk/sites/default/files/2020-06/2016_07_25_CPRdecisions_patientinfo_FINAL.pdf  
Dying Matters   A leaflet to help you have a conversation with a health or social care professional about your preferences for your end of life.   https://www.dyingmatters.org/sites/default/files/DNACPR%20Patient%20leaflet_A4.pdf