Gateway End-of-Life Coalition membership is open to individuals or agencies that support our mission and goals. Based in St. Louis, Missouri, our mission is to Promote High Quality End of Life Care for Patients and Their Families. We do that by educating the public, health care providers and students regarding optimal care for the maximum benefit of persons at end-of-life. We promote collaboration among health care providers, patients, family members, educators and organizations. We advocate for quality end-of-life care with policy makers.
The Mission of the Gateway End-of-Life Coalition is to Promote High Quality End of Life Care for Patients and Their Families.
Our Vision is for everyone in Metro St. Louis to have access to high quality end-of-life care.
- Educate the public, health care providers and students regarding optimal care for the maximum benefit of persons at end of life.
- Promote collaboration among health care providers, patients, family members, educators and organizations that provide or promote end-of-life care.
- Advocate for quality end-of-life care with policy makers.
Advance Care Planning
Completing Advance Care Planning is easier than you think. Following these 5 simple steps.
1. A CONVERSATION
It starts with a conversation, talking about what you want at the end of your life. These are the conversations you have with yourself, your family or your close friends, often after you’ve heard about or witnessed another person’s end-of-life experience. Before you do anything else, have conversations to help you better understand what it is you want.
The first decision is, who will be your Healthcare Agent. This is the person you want to make healthcare decisions for you if you’re ever not able to make them for yourself. Next is a group of decisions around the kind of care you want when your end of life is near. Caring Conversations, Five Wishes and Prepare for your care are helpful tools.
3. LEGAL DOCUMENTS
The primary document that needs to be completed includes:
- Durable Power of Attorney for Healthcare – in this document you name your Healthcare Agent.
- Healthcare Directive – in this document you indicate what kinds of medical care you do and don’t want at the end of your life.
This document requires nonrelative witnesses, and it needs to be notarized.
- HIPAA Authorization – allows your doctor to share information with designated people.
- Outside the Hospital DNR, TPOPP, POLST – for terminally ill patients, this document requires a doctor’s signature.
- Body Disposition – designates the person who can make decisions about a person’s remains after death.
- Durable Power of Attorney for Finances
- Will or Trust
Once the legal documents are complete, the next step is to communicate that they exist and what’s in them to the people who matter most. Share copies of these documents with your family, physicians, lawyer, and other people who should know your wishes.
5. LIFE CIRCUMSTANCES CHANGE
Since we are all growing older and life happens, there may be several times that we change how we feel about the kind of care we want. When this happens, it’s time to review your choices and see if they still reflect your wishes. At the very least, review your documents and refresh those conversations routinely.
Advance Care Planning Resources
The Conversation Project Starter Kit theconversationproject.org/get-started
Common Practice commonpractice.com/hello
Caring Conversations practicalbioethics.org/resources/caring-conversations
Prepare for your care prepareforyourcare.org/welcome
Missouri Bar Durable Power of Attorney for Healthcare and Healthcare Directive missourilawyershelp.org/wp-content/uploads/2020/02/final-dpa-forms-fillable-2.pdf
Missouri HIPAA Authorization missourilawyershelp.org/wp-content/uploads/2020/02/final-hipaa-fillable-revised-mary.pdf
Gateway End-of-Life Coalition gatewayeol.org/
The Language of Advance Care Planning
Advance Care Planning The process of planning for your future care.
Advance Care Planning Legal Documents that describe your wishes include:
- Durable Power of Attorney (DPOA) for Healthcare or Healthcare Agent
- Healthcare Directive or Living Will
- HIPAA Authorization
- Outside the Hospital DNR or POLST or TPOPP
- Body Disposition
- Durable Power of Attorney for Finances
- Will, Trust
Healthcare Durable Power of Attorney Identifies your health care agent (or proxy), the person you trust to act on your behalf if you are unable to make healthcare decisions or communicate your wishes. This is the most important document. Make sure you choose the person who will follow your wishes and advocate for you.
Healthcare Directive or Living Will Specifies which medical treatments you want or don’t want at the end of your life, or if you are no longer able to make decisions on your own (e.g. in a coma)
Do Not Resuscitate (DNR), or no code or allow natural death, is a legal order written either in the hospital or on a legal form to withhold cardiopulmonary resuscitation CPR. It only applies in the hospital.
Outside the Hospital DNR This document states that even outside the hospital CPR cannot be used if your heart and/or breathing stops. It must be signed by your physician. This is for people who are not expected to live a year due to a terminal illness. It’s also known as Practitioner Orders for Life-Sustaining Treatment (POLST) and Transportable Physician Orders for Patient Preferences (TPOPP).
Covid-19 has changed our lives. It’s also given us an opportunity to reflect and grow. Below are some resources that may assist or inspire you during this difficult time.
Because of the national emergency before us, Aging with Dignity has decided to take the unprecedented step of making the Five Wishes document available online to individuals. Use it for yourself. Use it for your parents, spouse, siblings, adult children, extended family, and friends. Just use it!
In this podcast, Dr. Karen Wyatt shares resources for surviving and thriving during the coronavirus quarantine. She discusses some important issues to consider regarding your own advance directives and those of your loved ones as we face a medical crisis that is unprecedented in our lifetimes. This is a difficult conversation to have but one that is of utmost importance right now.
Jennifer Moore Ballentine is the Executive Director of the California State University Shiley Institute for Palliative Care. In this communication, she offers considerations specifically for those who work in palliative care.
People who are considered high-risk for coronavirus-related complications are feeling especially vulnerable, as are their loved ones. Building two decades of research and experience, Respecting Choices has developed a toolkit of resources that focus on Covid-19. The toolkit includes guidance for a conversation about treatment preferences before a medical crisis, to support specific treatment decisions in high-risk individuals and resources to support high-risk individuals and their agent/loved ones. We are making these tools freely available during this crisis and encourage you to distribute the resources widely.
Ariadne Lab’s, Serious Illness Care Community of Practice hosts this webinar with the objectives to provide an overview of the Serious Illness Conversation Guide, a tool that may become more relevant in a variety of settings as a result of COVID-19, and to provide COVID-19-specific resources for serious illness care. Ariadne Labs is committed to saving lives & reducing suffering for patients everywhere. We aim to create simple, scalable solutions for critical moments at all stages of the health care journey.
VitalTalk is offering this playbook freely. Email it, link it, spread it around. Don’t hesitate to change the links so it works for your particular clinic or institution or system. Then help them improve it. Tell them what they missed, what didn’t work, where you got stuck. The next iteration could be better because of you.
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