Advance Directives in

YakimaLaurie Oswalt, M.Div.

Director of Spiritual Care/Ethics and End-of-Life EducationYakima Valley Memorial Hospital

Starting with Gunderson

•Next: Honoring Choices Pacific Northwest

•What We’re Doing in Yakima

Education

Tracking

Process

Process for Receiving and Inputting 5 Wishes into computerized Health

Information Exchange: YVMH Inpatient YVMH Facilities

(Phreesia, when applicable) NonYVMH Inpatient NonYVMH Clinics All Home Health/Hospices All Nursing Homes/Retirement Homes

Education Of Five Wishes and ProcessStaff (departments & orientation)Physicians (all entities & orientation)Patients (in-house tv?, lobby flyers, in-room wall holders)Community (churches, monthly gatherings at YVMH, senior centers, senior living, public schools, Five Wishes parties)

Tracking Advance Directive Utilization

At death (we will look at HIE):Did patient have AD?Did we follow it?

Memorial’s Focus on Advance Directives in

Yakima

WHY FIVE WISHES?

• Valid in 42 States

• Customizable

• Addresses Biggest Fears

• Cost-Effective

• User-Friendly

• Previous Advance Directive

• Not a DNR in the Home

Advance Directive

•Durable Power of Attorney for Healthcare• Wish 1

• Living Will• Wishes 2-5

Durable Power of Attorney for Healthcare

Durable Power of Attorney for Healthcare

•General vs. Durable Power of Attorney

Durable Power of Attorney for Healthcare

• Decision-Maker Order in Washington State:

Durable Power of Attorney for Healthcare

• Decision-Maker Order in Washington State:1. Legal Guardian

Durable Power of Attorney for Healthcare

• Decision-Maker Order in Washington State:1. Legal Guardian

2. Durable Power of Attorney for Healthcare

Durable Power of Attorney for Healthcare

• Decision-Maker Order in Washington State:1. Legal Guardian

2. Durable Power of Attorney for Healthcare

3. Children of Patient OVER 18—all must agree

Durable Power of Attorney for Healthcare

• Decision-Maker Order in Washington State:1. Legal Guardian

2. Durable Power of Attorney for Healthcare

3. Children of Patient OVER 18—all must agree

4. Parents

Durable Power of Attorney for Healthcare

• Decision-Maker Order in Washington State:1. Legal Guardian

2. Durable Power of Attorney for Healthcare

3. Children of Patient OVER 18—all must agree

4. Parents

5. Siblings—all must agree

Living Will

• The Decisions You Want to be Made on Your Behalf

Living Will

•Wish 2:

Medical Treatment

Living Will

•Wish 3:

Comfort

Living Will

•Wish 4:

How I Want to be Treated by Others

Living Will

•Wish 5:

What I Want Others to Know

What to do Next

What to do Next

• Signatures

What to do Next

• Signatures

• Make Copies—give it to others (family, DPOAHC)

What to do Next

• Signatures

• Make Copies—give it to others (family, DPOAHC)

• Make a File

What to do Next

• Signatures

• Make Copies—give it to others (family, DPOAHC)

• Make a File

• Take it with You

Let’s Change our Culture

Remove Fear from End-of-Life

•Questions, Comments

Advance Directives in

YakimaLaurie Oswalt, M.Div.

Director of Spiritual Care/Ethics and End-of-Life EducationYakima Valley Memorial Hospital