What if you couldn’t communicate in an emergency? Who would tell health care providers what medical treatments you would want done?

“God forbid there is an emergency where you end up in my emergency department and you can’t communicate with me or your family. It’s important for us to know what you would want in that situation because everyone is so different in their values. With a Health Care Directive, we know what to do,” says Perham Health family medicine provider, Dr. Jennifer Stong.

What is a Health Care Directive?

A Health Care Directive (HCD) is a legal document that tells health care providers how you want to be treated if you cannot make your own decisions about emergency treatment or illness. In a HCD, you say which common medical treatments or care you would want, which ones you don’t want, and under which conditions each of your choices applies.

It’s only used if you cannot communicate your own wishes.

Taking time now to think about what kind of medical treatments you want in an emergency is really important. It leaves you in control and allows you peace-of-mind knowing your family and health care team are aware of the treatment options you choose, and will know and be able to honor your choices.

Perham Health social worker Taylor Helmeke wants people to know that having a HCD can actually be a gift to your loved ones. “It takes away the decision making from them and lets family members know what your wishes are so there is no guessing if there comes a time when you are not able to communicate what you want.”

As part of Taylor’s job, she talks to people about HCDs and helps them fill one out. “We want people to know that you can be as detailed or as simple as you like, it’s just important that you share that information with your loved ones and health care providers so they can follow your own personal plan of care.”

An HCD can be done by anyone 18 or older because emergencies can happen at any time.  You shouldn’t wait to be elderly to do one.

Dr. Stong talks to patients about the importance of a HCD when they come in for a physical. “Most people like to have control over what happens to them, and a HCD provides that control. I say to my patients ‘Isn’t it a relief that you can have some control? You have the opportunity now to think about how in the case of emergency, disability, injury or sickness, you would want to be treated even when you cannot communicate.’”

What happens when there isn’t a Health Care Directive

“When we don’t have this information, we will often do everything we can including possibly invasive procedures such as CPR, chest compressions, and putting a tube down someone’s throat to help them breathe, because we make assumptions if we don’t have those things written down,” says Dr. Stong.

When a family member is ill or injured, it can be a very emotional and scary time, especially if they aren’t sure what you would want. It can lead to families fighting over what to do.

“I’ve been in situations where elderly parents come in, and discussions are happening amongst family about the quality of life that mom or dad will have moving forward and there can be five children with five different opinions. This can lead to delays in delivering comfort or delivering medical care, and the provider doesn’t know who to listen to because there isn’t one medical approach. That’s why a HCD is so important,” explains Dr. Stong.

At Perham Health, we believe everyone should have a HCD. Here is information to get you started and answers to your questions.

How to get started.

Download a HCD and read through it at www.lightthelegacy.org. Guide to Completing Your Health Care Directive There are good videos and articles online that explain a HCD and answer questions you may have. You can also make an appointment with the social workers or your provider to talk about a HCD in more detail and ask questions. They can provide the forms so you don’t need to print them out.

Spend some time thinking about what you want and talk to your family and friends so they know what you want. A HCD is only good if your loved ones know about it and know what your wishes are. When you know what you want, fill out a HCD.

There are two versions of a HCD: a long form and short form. The long form is more in depth and has a lot more end-of-life wishes and options. The short form is straightforward and to the point. You choose which form is right for you.

Health Care Directive Long Form

Health Care Directive Short Form

Health Care Directives are also available at all Perham Health locations.

How to Complete a Health Care Directive.

The first step is to choose your Health Care Agent. This person is the one you trust to make decisions for you if you cannot do it yourself, and will be good in an emotional situation. Sometimes the best person for the role of Agent is not the first person you think of. Talk about this with those closest to you and determine who will be best suited to carry out your wishes.

The second part is stating your treatment choices. This part may be as detailed or as simple as you would like. There are no right or wrong choices.

Frequently Asked Questions about Health Care Directives

Selecting your Health Care Agent:

You may choose an immediate family member, a trusted friend, or another person to speak for you. Ask yourself:

1. Do I trust this person to be able to make complex or tough decisions?
2. Will this person honor my wishes even if they don’t personally agree?
3. Is this person emotionally strong enough to make choices at a difficult time?
4. Can this person stand up for my wishes if family members or others disagree?
5. Is this person likely to be nearby and available in case of emergency?

Then sit down and talk with the person you’ve chosen, asking them if they are willing and able to take on the role. Once they agree, make sure they clearly understand your wishes and your goals for future healthcare and have a copy of your HCD.

When will my directive be used?

As long as you can make your own choices, you control your own medical care. If you can’t make choices for yourself, your health care team, in cooperation with your Agent, will follow your wishes as described in your HCD. Therefore, it is very important that you give your health care provider(s) a copy of your directive for your medical record.

What do I do with it once I’ve completed it?

1. Bring your HCD into Perham Health or one of its clinics to have it scanned into your health care records. Providers and medical staff can easily access it if you are in the clinics or hospital.
2. Make multiple copies and give one to each of your health care agents you selected in your HCD. Your agents should have it in case you end up in a hospital that isn’t your hometown hospital.
3. Provide a copy to specialists you might see such as a cardiologist or oncologist.

Where should I keep my HCD?

Keep copies at home in a readily accessible area and let family know where it is. Don’t put it in a lock box, safety deposit box, or places that are hard to access. You may want to put it on your fridge so that anyone, including emergency personnel, can find it.

Can I change my HCD and how often does it need to be renewed?

You can change your HCD at any time throughout your life. It never expires UNLESS your wishes or health care agents change. Times when you might want to change your HCD:

• Changes to your health such as a new diagnosis
• Your wishes/desires for your health change over time
• You want to change your health care agent(s)
• Life-changing events or relationship changes
• You move

It’s a good idea to review your HCD once a year. If you ever update your HCD, your previous one becomes null and void. Make sure you bring it in to Perham Health, give a new copy to your Agent(s) and family and make it easily accessible in your house.

You may want to set a reminder on your phone or put it in your calendar to review it once a year.

Can my health care agent go against my wishes that are on the HCD?

No. If you made your health care directive when you are of sound mind, your health care agent cannot go against your wishes.

Where can I find a notary to sign my HCD?

Perham Health has notaries on staff in the clinic lobby and in the social work department. You can typically walk in.

Is it good in other states if I am traveling?

Keep a copy with you when you travel, but be aware that every state has its own rules about directives. Many will honor a document which is legal in the state where it was written, but if you spend significant time away, you should check on local laws.

Can I fill out a HCD and store it online?

Yes, there are HCDs online that are fillable and provide storage. You can also set up annual reminders to review it and make any changes. Make sure to print copies to bring in to Perham Health and to provide to your Agent and family and friends.

About Perham Health 

Perham Health is a 25-bed Critical Access Hospital with three primary care clinics, a 96-bed nursing home, home health care agency, adult day services, memory care assisted living, and senior housing.  The medical staff consists of 24 physicians, a nurse midwife, 14 advance practice clinicians, and three chiropractors. Visit perhamhealth.org to learn more.