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Scott Webb: Facing mortality, especially in our loved ones, is difficult for most of us. But my guest today wants us to know that having end-of-life discussions, including conversations about advanced directives really benefits all of us.

And joining me for this conversation today is Cassie Ferguson. She's a hospice nurse practitioner with Genesis. This is Sounds of Good Health with Genesis brought to you by Genesis Healthcare System. I'm Scott Webb. Cassie, thanks so much for your time today. We're going to talk about advanced care planning and what that means exactly. So, what are advanced directives and when should we complete them?

Cassie Ferguson: Advanced directives, these are documents that we complete that are going to detail our instructions to our loved ones, our medical providers about our medical care. And they're going to be used in the event that we cannot speak for ourselves. So whether we have a serious illness or an injury, something happens, then we want to complete these to detail those.

In Ohio, we use the DNR, which is a do-not-resuscitate. We have a living will, power of attorney, and then organ donation. Those are what are authorized here. Anybody over the age of 18, they can do those. You can update them, revoke them as many times as you want to. So, those are really the main ones, I would say, DNR, the living will, the power of attorney and organ donation. Those are really the main ones that we do.

Scott Webb: Yeah. And that's a good list to start from, especially for those of us just sort of entering into this or facing this for the first time. So, who really makes the decisions about our medical care if we don't have an advanced directive?

Cassie Ferguson: Well, it depends. So usually, we follow law in the state that you're in. So in Ohio, first they're going to look at your legal guardian if one has been appointed. Most often that has not been done, but it happens occasionally. And then, it's going to follow an order of spouse, then followed by majority of adult children, followed by parents, followed by majority of adult siblings or any other nearest relative that they can find that would be willing to make decisions. So if you're married, like I said, it's usually going to go to your spouse, whoever that may be, and then follow that next line down if not. And that's only if you've not completed those advanced directives.

Scott Webb: Yeah. And of course, one of our messages today really is to complete those advanced directives. But if for some reason you don't, there's this sort of hierarchy and it kind of works its way down through there. So, what's meant by end-of-life discussions, who has those discussions and what goes on in those discussions and what does that really mean?

Cassie Ferguson: It can mean a lot of things

Scott Webb: Sure.

Cassie Ferguson: So essentially, like I said, if you've got that illness or some type of injury, how do you want to proceed if things are not going well and you're not improving? So, those end-of-life discussions. So, how aggressive do you want to have your care? You know, do you want everything done? Would you want to have CPR? Would you want to be put on a ventilator or a breathing machine? Some people will need to have hemodialysis, which is where your blood is put into that machine to filter out your blood if your kidneys are not working. You know, is that something you would want to do? Because usually once you're doing dialysis, you're on that for the rest of your life. You know, do they want to try some less invasive things, but nothing too aggressive? Or would you would just not want anything done? You know, in the instances of end-stage cancer or an end-stage COPD, something that you've been dealing with for, you know, maybe months or years, and those aggressive measures are not going to change your outcome, maybe you opt to not have any of that done and you just want to tell your family, "You know, what if I start needing some of these things, just keep me comfortable at that point." It could be a very sudden event that you weren't expecting some type of accident or something that came about, and you may benefit from having CPR done and have some quality of life or maybe put on a ventilator and have some quality of life. But especially if you've got some type of life-limiting illness that you know ahead of time, it would be better to talk about these things that way if you get to that point, family's not feeling like they're stressing about what you might want. Are they making the right decision? Do they feel they know what you want? And some people say, you know, "I really don't know." It's easier to talk about it ahead of time, so that the family doesn't feel quite as burdened by those decisions.

Scott Webb: Yeah. Sometimes they're not easy conversations to have. So, do you have any recommendations about how we can have these conversations, how we can have these end-of-life discussions in a sort of productive and peaceful manner?

Cassie Ferguson: Yes, of course. Yeah. It's not easy. You're right. The field I work in, I do hospice and palliative, so I have these discussions all day, every day. And I'm very familiar with it. My husband and I, we sit and watch, you know, different medical shows and things all the time. And I'm like, "Don't do that. Don't ever let that happen to me."

Scott Webb: That's not what I want.

Cassie Ferguson: But not everyone, you know, is comfortable with that, discussing mortality and things. Honestly, just being involved as much as you can with their medical things, you know, attending doctor's appointments, you know, knowing what's going on. And if you have heard their physicians or medical providers, you know, mention things, "Oh, hey, dad, the doctor said that, you know, that blood pressure pill is only going to work for so long to, you know, handle things. If these things don't work anymore, what would you want to do about that?" And you kind of just gently approach it with some support from their medical team that they've already got in place. Even requesting to have a palliative consult if maybe you don't feel comfortable, all the medical systems typically have some type of palliative professional, whether it's a nurse practitioner or physician, even RNs that will just do like a goals of care discussion with you. And they can kind of open that door a little bit. But yeah, I think just being involved, it's going to be harder if you're not around and don't know what's going on. And if they don't want to talk about it, then I wouldn't force too much or press too hard and just do the best you can.

Scott Webb: Yeah. I think that that's what we're all trying to do, just do the best we can for our loved ones and sort of be involved and there's a good word you use there, be sort of as gentle as possible to have these conversations. I often wonder this one, you know, I hear these terms and I'm like, "I don't know what that means or what the difference is. What's the difference between a financial power of attorney and a healthcare power of attorney?

Cassie Ferguson: So essentially, it's those first words that financial and healthcare. So, your financial power of attorney, that is going to be over your financial matters. So, that can be things involved with your bank or loans or anything like that, your credit cards, things like that. They're going to be able to manage that. Your healthcare power of attorney is only for those healthcare decisions that you cannot make for yourself. So, again, it only becomes effective if you can't speak for yourself. So if you can sit there and say, "Yep, I want this" or "No, I want this," that healthcare power of attorney really doesn't mean anything. So if you're not speaking because you're on medications or maybe you're sedated on a ventilator, things like that, then your healthcare power attorney is going to be the person speaking for you.

Scott Webb: All right. So, what's a durable power of attorney? Sorry to ask you all these legal questions, but what is that? What's a durable power of attorney?

Cassie Ferguson: So, your durable power of attorney, that is going to be over a variety of different things. So, that one can actually be over your banking, your housing, your taxes, your real estate, everything. And you're really going to do that with an attorney, is who is going to draw that up. So, that one actually doesn't really have anything to do with healthcare, any decisions along that line. It's more of all the other type things. It is pretty similar to the financial power of attorney. But they have a little bit more power as far as they can, you know, maybe change some things. If you want to sell your house or property or anything like that, they've got a little bit more power.

Scott Webb: Got it. Okay. Well, this has been really educational and I think that the takeaways really is we all want the best for ourselves and our loved ones. And maybe you could just sort of underscore that here at the end, the importance really in your mind of these advanced directives and having these conversations.

Cassie Ferguson: Yeah, I mean, honestly we just never know what could happen, and when it's going to happen. And I would say that's the biggest thing that I hear from a lot of patients and families, is they didn't think that it was going to happen or if they only knew this was going to happen, they would want to speak about these things. So really just, you know, start the conversations early. My family is very open and honest about these things just because I've been working in healthcare and hospice more specifically for the past 12 years. And you always want to think if you haven't had those conversations and you're asked to make those decisions, you know, really put yourself in that person's shoes. What would they choose for themselves?

Scott Webb: Yeah. And as you said earlier, you used the word mortality and that's not easy for any of us to face our own mortality, the mortality of our loved ones, family, friends, whomever. So as you say, try to be as involved as possible. Be as gentle as possible. Have these conversations. You know, think about the what ifs. So, good stuff today. Thank you so much. You stay well.

Cassie Ferguson: All right. Thanks. You too.

Scott Webb: And for more information, go to genesishcs.org/services-search/palliative. And thanks for listening to Sounds of Good Health with Genesis, brought to you by Genesis Healthcare System. If you found this podcast to be helpful, please be sure to tell a friend and subscribe, rate and review this podcast and check out the entire podcast library for additional topics of interest. I'm Scott Webb. Stay well.