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Caitlin Whyte: Talking to your older loved ones about their assets, wishes and wills is always a difficult conversation to get started. So today, we are discussing Massachusetts Advance Directives, what they are, why they are important and how to get started completing yours.

Joining us for this important conversation are Lee Holbrook, a Social Worker Supervisor at Emerson Hospital and Mary Crowe, the Director of Professional and Community Education at Care Dimensions and This is Health Works Here. I'm your host, Caitlin Whyte. So Mary, start us off by telling us what an advance directive is.

Mary Crowe: Sure. So an advance directive is a legal document put in place in advance, indicating who you would want making healthcare decisions for you when and if the day comes that you cannot do that for yourself.

Now, I always like to amend that a little bit and say a legal document put into place in advance, indicating who would be your voice. It's important that again, the person who's really following what your wishes are if and when that day comes that you're unable to do that for yourself.

So an advance directive falls into three different categories. It can be a healthcare proxy, a durable power of attorney or a living will. A living will is an important guideline in terms of one's wishes, but it's not legally binding in the state of Massachusetts.

Caitlin Whyte: And just why are these documents so important?

Mary Crowe: It is so important that everyone 18 and over legally designate who they would want to be their healthcare agent if they're unable to make their own healthcare wishes known. You know, during usual times, it's important to understand an individual's values and goals around their healthcare wishes. The COVID-19 pandemic heightens the importance. These are challenging times and many, many are struggling with feeling out of control or the lack of certainty in life on so many different levels.

But one way we can take control is by being prepared. And the way to do that is to pick the person you want to be your healthcare agent, talk with loved ones and your healthcare agent about what matters most, and then make sure you talk to your healthcare providers as well. It's important to have these documents in place and is as important as having the conversations around that. These are much more than just making decisions. This truly gives a voice to hope and fears, and it can also help guide against regrets. You know, these documents, they truly is a gift that you'd give to your loved ones.

Caitlin Whyte: Now, Lee, there's a lot of terminology when it comes to these stuffs. What is the difference between a healthcare proxy, a living will, durable power of attorney and MOLST?

Lee Holbrook: That's a very good question. And there is a lot of confusion among patients and families about these documents. The healthcare proxy is a simple, legal document that the patient can do on their own. It's when they choose a trusted person who is called their health care agent. That is someone that will talk with doctors and make healthcare decisions on their behalf if they're not able to make decisions for themselves at that time. It guides the doctors and clinical team on what care you would prefer in an event that you cannot make those choices on your own.

The healthcare proxy is a legal document that is witnessed by two witnesses that cannot be the person who is your agent. And then that will go and be your legal document from then on. That form can be changed any time. And the newest healthcare proxy is the one that is legal. The living will is a guide and also sometimes referred to as a personal directive and that along with the proxy is very powerful because that allows your agent to make decisions very spelled out by you on what your wishes would be. And it's not a legal document, but it's a very important document to have. And that is also a very good guide to have a discussion with your family regarding what your wishes would be, because it's a much more lengthy form as opposed to the healthcare proxy, which is a one-page form that just assigns you the duty.

The MOLST form is an order that is done by the physician that communicates the patient's choices and preferences about life-sustaining treatment to the care providers. This is also known formerly as the DNR form, which in Massachusetts is transitioning to the MOLST, which is a little more robust and gives you more indication of specific treatments you may want and may not want such as artificial feeding, using non-invasive ventilation, things like that.

Caitlin Whyte: Now, when would you say is the right time to complete these documents or start having these conversations with my family?

Lee Holbrook: Well, anytime is a good time to have these conversations with your family. They can often be difficult conversations to have, but it's very important that these conversations are ongoing and happen when you are healthy and feeling well. It's much more difficult to have conversations with what your preferences might be if you're sick and not feeling yourself, because it may sort of cloud your judgment.

There is some guides that you can find online to help certain questions that will sort of stimulate a conversation. We partner with an agency called Honoring Choices. They have a lot of good tools on there and also helps guide discussions with your physicians if you have any sort of questions about what those treatments would look like.

Caitlin Whyte: Now, Mary, how do I go about starting a conversation with my family member about what I want or what they want?

Mary Crowe: Yeah, this is always a tricky one, too. You know, Americans aren't good about talking about death. But, you know, talking about death is ultimately talking about life. And this is a really important thing that we do. As I mentioned earlier, this is one of the greatest gifts that you can give your family, is having these conversations.

You know, dying is a stage of living. And we're all going to get there hopefully later than sooner, but it's important to make sure that your wishes are intact and that you have these conversations. So there were ways of starting these conversations. And as Lee mentioned, you know, what we usually do is we wait until crisis point. A lot of these conversations end up happening in the emergency room, in the ICU. That's not the time to do it. We want to do these well in advance when we're well, and we can have these conversations, when emotions aren't running high.

And, you know, there are things that can start a conversation and ways of you can do this. And, you know, even the pandemic is kind of a stimulus to that, isn't it? Being in a crisis like this, this is actually a push people in a way, in that positive way of having these conversations maybe sooner than later, too. So like I said, the important time is to do this much earlier.

Caitlin Whyte: And what happens if I want to change my advance directive?

Lee Holbrook: Well, you're actually able to change your advance directive anytime, and they often do change. They're very fluid as we have experienced life changes and things like that. As far as the healthcare proxy goes, that would require two new witnesses and then you would change that form. And then, like I mentioned, previously, the newest one will be the legal one. If you're talking about changing a MOLST, that would be a discussion with your physician since that is a doctor's order form. And typically, when people are wanting to change a durable power of attorney, they usually will speak with a lawyer since that has to do more with possessions and things like that.

Caitlin Whyte: And wrapping up here, Lee, how do I complete the forms?

Lee Holbrook: Well, there's many ways to complete the forms. I think I mentioned that we do partner with Honoring Choices, which is a grassroots Massachusetts company that provides all the forms online, guides. You can get your forms at your local hospital, at your doctor's office, but you can actually print off the things offline and then fill them out and have them signed if it's a power of attorney, if you need that notarized, or if you're looking at the MOLST, to talk with your physician. But it's always good to look and get as much information as you can, have your discussions and put a lot of thought into these forms because they really do mean a lot.

And what we found recently is that it's a much better form, if you've actually had a discussion as just filling it out, just to fill it out. So we really tried to educate and make sure that people are making informed decisions, choosing the right people for their agents, just to make sure that they're getting exactly what their wishes are.

Caitlin Whyte: Great. Is there anything either of you wanted to add to the conversation?

Mary Crowe: Just one thing in terms of, again, how do we talk to families about that, we can do this even virtually right now. I know that we're at a time when we're separately apart, but there are times we can even make events. There are families that will actually use holidays or the get togethers where most of family members are together to have these conversations. And then certainly later celebrate their holiday as well. But whatever a good time is to pull people together to have these, there are certainly many ways people can do that.

Lee Holbrook: Yeah, well said, Mary. And I think it's something to celebrate having these things completed and it really is a gift for your family and your loved ones that if they have to speak for you, then they know exactly what your wishes would be. And they're just letting the providers know what they would want as opposed to having to make the judgment on their own.

Caitlin Whyte: Well, Mary and Lee, thank you so much for joining us. I know most of us get a bit uncomfortable, like you said, talking about these stuffs, but it is so vital to get it in order while you still can.

Visit honoringchoicesmass.com for information and to download the forms mentioned in this episode. And thank you for listening to the Health Works Here podcast. Subscribe to this podcast on your favorite podcast source, including Apple podcasts, Google podcasts, and Spotify. I'm your host, Caitlin Whyte. We'll see you next time.