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Medical Services


Advance Directive

“90% of Americans know they should have a conversation about what they want at the end of life, yet only 30% have done so.” - The Conversation Project 2013

Planning ahead is important at any age and at any stage in life. And an advance directive is not just for someone who might be elderly or facing a terminal diagnosis. Unexpected end-of-life situations can unfortunately happen at any time. It is important to plan ahead, to avoid unnecessary suffering and relieve caregivers of decision-making burdens during moments of crisis or grief.

An advance directive acts as a guide for both caregivers and doctors when a person is terminally ill, seriously injured, in a coma, in the late stages of dementia or near the end of life. There are many types of advance directive, such as a living will or a power of attorney.

The most important thing to remember is that as hard as this conversation may be, it would be even more difficult for our loved ones to make those decisions for us without knowing what we would and would not have wanted. By having an established plan, you can help reduce confusion or disagreement about the choices you would want your loved ones to make on your behalf. And, you can feel empowered as an active decision maker, for your own end of life care.

What is a Living Will?

A living will is a document that states, in writing, your choices about medical care and/or names someone to make medical choices for you if you become unable to make decisions regarding medical care for yourself. It is called a “living will” or an “advance directive” because it is signed in advance to let your family and doctor know your wishes about medical treatment. Through a living will, you can make legally valid decisions about your future medical care.

Kentucky law recognizes several types of living wills. They include advance directives, health care surrogate designations, durable powers of attorney for healthcare and living will directives. Living wills must be filled out in the presence of a notary. There are exceptions to who is able to notarize this document. Any St. Elizabeth Hospice social worker will provide this service free of charge.

By law, hospitals and healthcare institutions are required to ask patients when they are admitted if they have a living will. As a patient, you will be asked if you have a living will each time you are admitted to the hospital. If you have one, you will need to provide a copy each time you are admitted. Because of the sensitive nature of living wills, St. Elizabeth Healthcare will not accept copies of your living will before you are admitted.

What is a Healthcare Surrogate?

A healthcare surrogate is a person that you may identify to make healthcare decisions on their behalf if they are unable. This document can be used in addition to a general power of attorney. The Attorney General's Kentucky Living Will Form, includes a healthcare surrogate designation.

What are Medical Orders for Scope of Treatment (MOST)?

The Kentucky MOST document is more than an advance directive or living will. A MOST is intended for individuals who are diagnosed with a very serious illness, and is in addition to your other directives. It contains doctor-ordered instructions which ensure that, in case of an emergency, you receive the treatment you prefer. Your provider can fill out the form with you based on the contents of your advance directives.

A MOST should be easily accessible. If you are in long term care or skilled nursing facility, the document should be kept on your bed or in the room. If you are living in a home or in a hospice facility, the document is prominently displayed where medical team members can easily locate it. 

Quick Facts About the MOST Form:

  • It does not replace a living will or Power of Attorney document.
  • It is completed for a patient regardless of age.
  • It is intended to be used by patients who are already chronically or seriously ill with limited life expectancies.
  • It must be signed by a physician and the patient or patient’s surrogate to be valid.
  • It is brightly colored (pink) to be easily identifiable for patients, caregivers, and health care providers.
  • It can be revoked or changed at any time by the patient or patient’s surrogate.
  • It must be reviewed annually, when the patient is transferred, or when there is new knowledge of a change in the patient’s condition or medical wishes.

What is the difference between a Power of Attorney (POA), Medical Power of Attorney (MPOA) and a healthcare surrogate?

It is important to review these documents and understand what types of decisions they cover, before an urgent situation arises.

Medical Power of Attorney- A medical power of attorney (MPOA) is a type of advance directive in which you name a person to make medical or healthcare decisions for you when you are unable to do so. In some states this directive may also be called a durable power of attorney for health care or a health care proxy.

General Power of Attorney - A general power of attorney is only able to make financial decisions on your behalf. Many patients believe that a general power of attorney document serves as a medical power of attorney too, but this is unfortunately not always the case.

Health Care Surrogate – A health care surrogate designation is similar to a medical power of attorney. The Attorney General's Kentucky Living Will Form, includes a healthcare surrogate designation.

What is Legacy Planning?

Legacy planning helps you examine not only your financial and non-financial goals and concerns but it also focuses on the values and legacy you wish to leave behind. Legacy planning can be done with your loved ones, and can be a very empowering experience for those who are facing a serious illness. Legacy planning provides peace of mind.

St. Elizabeth Hospice created this worksheet for future planning. Let your families know about important information such as social security number, location of will, power of attorney, health and life insurance provider, banking account, loans, etc.