Durable Power of Attorney

Please click the link below to find a printable version of a Michigan Advance Directive Planning Form:

Advance Directives

Policy

Patients have the right to make decisions concerning their care, including the right to accept or refuse medical or surgical treatment, and the right to formulate advance directives as permitted under state statutory and case law. Hospice will honor each patient’s known advance directives and inform an individual patient if Hospice has any limitations in respecting a patient’s advance directives. A patient’s admission to Hospice will not be affected by his/her desire to not formulate an advance directive or by the contents of an advance directive.

Purpose

To define and assure the rights of adult patients in health care decision-making.

Prior to coming under Hospice care, the patient will be provided with written information concerning the patient’s rights under state law (both statutory and case law) to make decisions concerning medical care, including the right to accept or refuse medical or surgical treatment and the right to formulate advance directives.

This information will be provided by Hospice employees at time of the initial assessment before care is provided and documented in the medical record.

Each patient will also be informed of Hospice’s written policies regarding respecting the implementation of the patient’s advance directive.

If an adult patient is incapacitated at the time of admission or at the start of care and is unable to receive information (due to a mental disorder or incapacitating condition) or articulate whether or not he/she has executed an advance directive, staff may give the information to the patient’s family or surrogate in accordance with state law. Hospice is not relieved of the responsibility to provide this information to the patient once he/she is no longer incapacitated and able to receive such information. Staff will provide advance directives information to patient at this time.

Staff will document in the patient’s medical record whether the adult patient has executed any advance directives. Copies will become a permanent part of the patient’s medical record. If copies cannot be obtained during initial assessment, the RN or SW will document the patient’s wishes. All staff involved in the patient’s care will be informed of the patient’s advance directive.

No individual will be discriminated against or have care conditioned upon whether an advance directive has been executed.

Advance directives include:

Living wills.

Durable power of attorney for health care.

Any written, signed and dated document executed by the patient, which expresses the patient’s health care treatment decisions.

Any statement (verbal or written) that revokes or modifies a previous directive becomes the current directive to be honored. Such revocation is to be noted in the patient’s medical record.

State law authorizing a written declaration directing the withholding or withdrawing of death-prolonging procedures does not also authorize withholding or withdrawing of nutrition and hydration (food and water).

State law authorizing durable powers of attorney for health care does not authorize the intent to cause death by withholding or withdrawing of nutrition and hydration (food and water) which are able to be ingested through natural means.

In the event that the patient does not have any advance directives but would like additional information, such information will be provided by staff. The patient will inform the Hospice of any updates to advance directives.

If the patient has been determined to have the capacity (whether verbally or non) to make a decision, the patient may state any advance directives to Hospice professional staff.

Any oral advance directive will be documented in the patient’s medical record.

The patient’s attending physician will be notified of any advance directives by Hospice professional staff within 24 hours.

If the patient’s attending physician cannot be reached, the physician on-call or Medical Director will be contacted. This contact will be documented in the patient’s medical record.

If the patient is returning to the care of Hospice and has previously provided copies of advance directives, the advance directives will be verified as being current to this admission.

Verification of the current validity of the advance directives will be documented in the patient’s medical record.

The patient’s attending physician will be notified within 24 hours of the preexisting advance directives and will be requested to write appropriate orders.

Staff will be educated about advance directives during orientation and ongoing.

Hospice will provide education to the community served about advance directives.

Education may be provided during health fairs or community forums. Such education will be provided at least annually and documented.

The educational materials provided will define what constitutes an advance directive, emphasize an incapacitated individual’s control over medical treatment and describe applicable state law concerning advance directives.