Healthcare Advocacy Partners
  • Home
  • About Us
  • What We Do
    • Healthcare Advocacy
    • Healthcare Agent
    • Menopause Guide
    • Medical Guide
    • Client Resources
  • Schedule a Consultation
  • Journal
  • Contact

Planning Considerations for Elder Orphans and Solo Agers

8/6/2021

 
(PAST EVENT)
Free Upcoming Virtual Event

Planning Considerations for
Elder Orphans and Solo Agers

Wednesday, August 11th, 2021
1pm PST on Zoom
Join us for a riveting virtual panel discussion with Sima Kahn, MD of Healthcare Advocacy Partners, and Lisa Mayfield of Aging Wisdom. 

We will discuss who solo agers are, the intricacies and issues of life planning for solo agers, and how to choose a healthcare power of attorney that you can trust with your decisions. 

Planning ahead is essential for the well-being of solo agers, and there is no better time than now to begin the process of managing your own care, choosing your support community, and setting yourself, and those you love, up for success.  
Picture
Twelve million adults over age 65 live alone.
That is 27% of the population–the highest rate in the world.
​The majority are women.
By age 75, the rate of women living alone rises to 44%.

-- Sara Zeff Geber, Forbes
Picture
Sima Kahn, MD
Founder
Healthcare Advocacy Partners

In 2009, Sima founded Healthcare Advocacy Partners to fill a critical gap in our healthcare system. A board certified physician, Sima Kahn has always been a passionate advocate for her patients. 

With 25 years of Obstetrics and Gynecology practice, Sima’s breadth of clinical experience has given her a deep understanding of the complexities of the medical system.
Picture
Lisa Mayfield
Founder and Co-Principal
Aging Wisdom

Lisa Mayfield founded Aging Wisdom® in 2003. She is trained and licensed as a mental health counselor, geriatric mental health specialist, and is a certified Aging Life Care Professional. 

Lisa brings over two decades of experience supporting and finding hope for individuals and families impacted by Alzheimer’s disease and related dementias. ​

The Importance of End of Life Planning

9/18/2020

 
Several months ago, at a time of relative innocence, we were only thinking about one pandemic.  Then, with the murder of George Floyd, the world erupted and a second pandemic - racism -  became much more clear.  (See my last newsletter)

Having read this article several months ago, I had planned to write a newsletter about it then, but the news of the day was much more important. Circling back, I want to reconsider the article, and how poorly prepared most of us are for end of life care.  

Fearing COVID-19, and ventilators, older people alter their living wills
By Judith Graham - The Washington Post / Seattle Times

​COVID-19 has thrust this knowledge into our collective consciousness, and has helped some people make decisions for themselves that they had not done previously. In the last month alone, I have had 2 people in my life about to undergo surgery who were unprepared for end of life decisions.  They had no healthcare power of attorney, no durable power of attorney for finances, and one of them had no advanced directive accessible to anyone who might need to see it.

I now ask: What if you got COVID-19 and had to be on a ventilator? Would you want that? Have you confided to anyone close to you about what your decision would be?  

Most of us are going to answer no.

Until approximately 5 years ago, I thought that the way my family had dealt with end of life planning was normal (I can hear my siblings laughing to think I believed anything our family did was “normal”). 
  • My father had a pension from the university where he was a professor, and he was able to buy extra years so that he received close to his salary after retirement. 
  • My parents had filled out a very explicit advance directive long before it was needed. 
  • A healthcare and durable power of attorney was in place. 
  • My parents had set up a family trust.
Most interesting of all, I remember when I was in high school, my parents would sit us down around the dining room table to discuss what each of us three kids would get when they died. (My poor brother, being 6 years younger than me, got the short end of the stick.) Eight years later we sat down and repeated this discussion when we were all more mature. It did not feel morbid or scary, it was just normal.
​I have since learned that this is unusual. What it did for me was to make the subject of end of life not scary. My husband’s story is 180 degrees from mine. 

When my husband's father died prematurely and unexpectedly, there was nothing in place to guide the family, including no life insurance. Now that is scary. Thankfully, it made him proactive as opposed to avoiding the topic altogether.

Now that we are all faced with the possibility of COVID-19  and the uncertainty of how we will fare with this disease, I would like to make some suggestions. 

Here is what everyone should have in place:
  1. Healthcare Power of Attorney (also called healthcare proxy or HCPOA). This is someone who knows what your decisions are, that you trust, and that you are confident will rise to the occasion and be able to make decisions about your health when needed.  In Washington state where I live, you can get HCPOA documents online.  Once you have designated your proxy, and have had someone witness it, you are prepared.  ​
In Washington, our HCPOA does not need to be notarized, although I do recommend that you take this step.   If you are traveling to a state that requires notarization, you will already have it in place. 
         
Please note that I function as a healthcare proxy for those who do not have or do not  want a family member or friend to serve in that role. If you are interested in learning more, contact me.
  1. Durable Power of Attorney (DPOA) for financial matters. This is someone who will uphold your wishes in regards to your estate, large or small, if you are no longer able to manage. Often this is not the same person as your healthcare proxy, but it can be. In Washington state, DPOA forms are also online, available to all who want them.
  1. Advance Directive (also called a Health Care Directive or Living Will). This important document lets other people (family, friends, medical staff) know what you want to be done in terms of medical intervention if you are not able to speak for yourself. Do you want to be on a ventilator if needed? Does it depend on the circumstances?  Do you want CPR done?  It will ask a whole host of questions that are better to figure out before the situation arises. ​
Especially now.

There are many options online to help guide you in this. You can see a previous newsletter I wrote on End of Life Planning here, or check out these resources for more information:

           Know your Choices, Ask your Doctor
           Honoring Choices Pacific Northwest
           Choosing Wisely
           WA End of Life Coalition
           5 Wishes
           The Conversation Project
           Death over Dinner

I am happy to schedule a time with you
to explain your options and help you with your decision making process.
  1. POLST--Physicians Orders for Life Sustaining Treatment. This document needs to be signed by your doctor and is most appropriate for those with an illness or who are quite elderly. 
  1. A Will. I would be remiss if I did not mention a will.  A will indicates what you want to happen to your possessions, especially money, real estate, and valuables once you die. Remember those discussions around the dining room table I mentioned earlier? Those discussions allowed us to hash out who got each item in my parents’ house. ​
When the time came, the three of us sat on the dining room floor with all of the small items around us, drew straws for who would go first, and then picked the thing we wanted most.  We did this in order until there was nothing left any of us wanted. We did not follow what was specified in the will exactly, but we were all happy with the outcome, and we knew that was the main aim of our parents.

For those with minor children, you must make a plan for who will raise your children if both parents die, and how the money will be dealt with. This requires a lawyer, and should have been done yesterday.

All of these documents should be easily accessible, and a copy should be provided to those you have designated. 

Remember, if you need coaching or counseling about what to do or how to make these decisions, I am here to help. 

​In the meantime, stay masked, wash your hands, maintain physical distance, be kind to each other —you know the drill.

Patient Empowerment

9/12/2018

 
Happy end of summer everyone!

The west coast has had so many smoky days!  The fires have stretched from British Columbia to California, leading to skies that are worse than in Beijing! Thankfully, the sky is clearing, and hopefully our end of summer will not disappoint.
I have been thinking about patient empowerment this summer, and what what it actually means to truly empower someone.

The European Patients’ Forum says:
Patient empowerment is a process that helps people gain control over their own lives and increases their capacity to act on issues that they themselves define as important.

The World Health Organization defines empowerment as: 
“A process through which people gain greater control over decisions and actions affecting their health” and should be seen as both an individual and a community process.

They go on to say:
Four components have been reported as being fundamental to the process of patient empowerment:
1) understanding by the patient of his/her role 
2) acquisition by patients of sufficient knowledge to be able to engage with their healthcare provider 
3) patient skills
4) the presence of a facilitating environment.
​

I think we can all get behind this,  but what does it mean in real life? An example:

A woman had cancer that had been successfully treated once, and then had a recurrence, also successfully treated. She then had a second recurrence and had participated in several clinical trials, none of which were adequately treating the disease. When presented with options for further treatment, there was no weighting of the different options, no side-by-side comparison of the efficacy, risks, benefits, and comparison to non-treatment. And that age-old question that doctors hate and patients continue to ask did not come up “what would you do if it were you?”

This was/could be presented to her as evidence of patient empowerment—she was completely free to make whatever decision she wanted. But it was missing some vital parts of what is required for true empowerment:


2) acquisition by patients of sufficient knowledge to be able to engage with their healthcare provider
AND
4) the presence of a facilitating environment

With 3 or 4 choices thrown out and not enough information to understand them, how is that empowerment? Further, the opinion of the doctor is valuable—I have yet to meet an oncologist who didn’t have an opinion about how they would move forward. They may not tell the patient, but it is there. Even the information they don’t know is helpful, because the patient can move on to other criteria to make a decision.  Such as how much is this going to hurt or cause other side effects that negatively impact their quality of life?

In terms of a facilitating environment, this is a place a healthcare advocate can be truly helpful. Exploring the patient’s priorities and understanding their risks and benefits can provide the environment for engaged decision making. Ideally,  the medical team is part of this process, but if not, healthcare advocates can fill the gap.

It is not empowerment to feel lost at sea. That is why we do this work.
​

As always, I would love to hear from you about your thoughts.
Sima

    Author

    Dr. Sima Kahn muses on being a healthcare advocate, the troubles with our healthcare system, and how to advocate for ourselves. 

    Archives

    August 2021
    September 2020
    July 2020
    April 2020
    January 2020
    October 2019
    September 2018
    July 2018
    May 2018
    April 2018
    March 2018
    September 2017
    June 2017
    March 2017
    January 2017
    July 2016
    June 2016
    May 2016
    March 2016
    February 2016
    December 2015
    November 2015
    September 2015
    December 2014
    July 2014
    April 2014

    Categories

    All
    Advance Care Directive
    Advocating For Ourselves
    Anti-Racism
    Being A Healthcare Advocate
    Concierge Care
    Consultations
    Dealing With Illness
    Death And Dying
    Disability
    Doctor-Patient Relationship
    Events
    Grief
    Healthcare
    Inequality
    Integrative Medicine
    Medical Errors
    Medical Tourism
    NAHAC
    Narrative Medicine
    New Services
    Organ Transplantation
    Patient Empowerment
    Peer Connection
    Solo Agers
    Upstreamist

    RSS Feed

ABOUT US
SCHEDULE A CONSULTATION
OUR SERVICES
CONTACT US
  • Home
  • About Us
  • What We Do
    • Healthcare Advocacy
    • Healthcare Agent
    • Menopause Guide
    • Medical Guide
    • Client Resources
  • Schedule a Consultation
  • Journal
  • Contact