When it comes to advance care planning literacy, there are often misconceptions about which steps patients and their families should take, and when such decisions should be made. While the process is lifelong and one that should happen early and often, some discussions, dialogues and documents are meant for people that are truly at end-of-life and others are not.
Below is an explanation of when and why to use the four most common forms individuals complete to communicate their healthcare preferences:
HIPAA Release and Authorizations
A HIPAA Release is an important directive for all adults to complete. Prior authorization enables your family members or trusted friends to receive information about your medical condition or prognosis, should you end up in the hospital. For injury claims, it is useful to provide your attorney with authorization, so they can find evidence that your injury was not pre-existing. Healthcare agents are also often given access to inquire about medical bills.
The HIPAA Privacy Rule enables patients to keep protected health information (PHI) like health conditions, insurance details and health transactions confidential. In order to grant a third-party individual access to this information, you must complete a HIPAA Release Form. This authorization is voluntary and can be revoked at any time. It is typically utilized to give spouses, children, parents or friends access to health information. To be legally valid, the form must be written in plain language. Once you choose to execute a HIPAA Release and Authorization, your agent generally has the same rights you would have to your PHI. However, your agent is generally not authorized to access psychotherapy notes or information gathered in anticipation of legal actions taken against you.
Advance Directives Naming a Healthcare Agent
This form, sometimes called a “Healthcare Proxy,” “Healthcare or Medical Power of Attorney Form” or “Designation of Healthcare Surrogate,” serves the purpose of appointing a trusted person to make difficult care decisions when you can no longer act on your own behalf. In some states, like Michigan, you can also choose a patient advocate by completing a document that gives that person the authority to make decisions for your care, custody and medical treatment when you are unable.
Proxies are often determined when a person gets serious about general estate planning. For example, if you are planning to complete a living will, your attorney will also ask if you have thought about a proxy. Your selected agent is able to make healthcare decisions and is also given access to your PHI to make the best choice possible. When selecting a healthcare agent, it is crucial to name a person you trust will honor your decisions, even if they conflict with his or her own wishes.
When designating a healthcare agent, you have the option to indicate precisely when that person’s authority starts. For example, you can decide that your agent’s power only begins when you are incapacitated and that your medical information will not be disclosed until a qualified medical professional determines that you cannot make decisions for yourself. It is also recommended to name a durable power of attorney, which means the person’s power is retained when a patient is deemed incapacitated.
Advance Directives for Mental Health Treatment
Nearly 14 percent of adults aged 50 or older have a mental illness. As the U.S. population continues to age, mental health advance directives become increasingly important, and everyone is encouraged to have this conversation with their family and friends. Many states mandate a separate advance directive specifically for mental health care, which is often called an “Advance Directive for Mental Health Care” or a “Declaration for Mental Health Treatment.” These forms should be completed before symptoms of dementia appear, as any decisions should be made when an individual is lucid and not under any undue influence. This form asks you to consider your wishes as they relate to psychotropic medication, electroconvulsive therapy, admission to and retention in a mental health facility and other preferences for emergency mental health treatment. Additionally, you may specify which physician you would like to treat your mental health issues.
Advance Directive Regarding End-of-Life Care
People are often unable to effectively communicate at the end-of-life, so advance directives become critical to dictate what measures are taken. End-of-life care advance directives, also known as “Living Wills” or “Directives to Physicians,” allow you to specify which procedures and treatments you would want performed. These directives provide critical care guidance to healthcare providers, deliver clarity and prevent conflict for friends and family and limits the burden of decision-making on your loved ones at the time of your death.
While it is impossible to consider every single medical treatment and intervention, it is important to be as specific and detailed as possible when completing an advance directive. Areas like CPR, mechanical respiration, artificial nutrition and hydration, antibiotics and pain relief may all be stipulated in this form. For example, this where you can specify if you would want to be kept alive in a vegetative state or kept alive by a ventilator.
It is critical to understand the value and different use cases of advance care planning and have these crucial discussions about future care preferences. Advance care planning technology solutions like Vynca empower patients, their families and caregivers and healthcare providers to ensure individuals’ care preferences are heard. Vynca arms clinicians with the tools to honor patients’ wishes — improving patient and caregiver satisfaction and reducing unwanted, unnecessary healthcare interventions at end-of-life.
Ryan Van Wert, MD is CEO and Co-founder of Vynca, and a part-time Clinical Assistant Professor at Stanford University.