In This Issue

	What is the difference between an Advance Directive for Healthcare and a DNR?
	If you answer yes to any of these questions, Hurley Elder Care Law can help
	Life Care Planning Goals
	The Nuts and Bolts Guide to VA Benefits

What is the difference between an Advance Directive for Healthcare and a DNR?

	For those of you who have read this newsletter for some time, you may recall that in November of 2008, I recounted the story of my grandfather “Da.” As part of that story, I stated that one day Da decided that he needed to do some things in the basement. He turned on the light at the top of the stairs and started to walk down. At some point along the way, he slipped and fell. The fall was a bad one. He cut his head open and was bleeding profusely. Doing what she had to do, the daytime caregiver called 911 and the EMTs came. Even though the primary care physician had a Living Will and DNR order in his file, when the EMTs arrived, they had to revive Da. I found out what had happened later in the day and went to see him in the CCU at the hospital. Da was not conscious, he was hooked up to many tubes and monitors and he was just lying there in a fetal position. It was one of the saddest sights that I have ever seen. He spent the next two weeks there, during which time he regained consciousness, before being discharged to a skilled nursing facility four blocks down the street.
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To attend our monthly Professionals’ Luncheon please call Louise Morris at 404-843-0121 or email her at lmorris@HurleyECLaw.com

If you answer yes to any of these questions, Hurley Elder Care Law can help.

		Has the elder been diagnosed with a mentally or physically debilitating disorder such as Alzheimer’s, Parkinson’s, ALS, stroke or a decline in functional capacity?
		Is the elder isolated due to the recent death of a spouse, or have family that either lives too far away or is too busy to provide adequate care?
		Is the elder soon to be discharged into a care facility or currently receiving in-home care?
		Does the elder have a variety of healthcare providers and need coordination and advocacy for quality care?
		Does the elder seem unusually concerned about costs of medication and services, indicating he or she may be having financial troubles?
		Does the elder have assets that fall between $50,000 and $400,000 – enough to finance a short stay in a care facility but not enough for an extended stay?
		Does the elder have a spouse whose financial needs must be considered in light of the elder’s medical condition?

Life Care Planning Goals

1. Meeting the elders’ immediate health care and long-term care needs.
2. Making sure the elder/family is making good health care and long-term care decisions.
3. Helping the elder/family sort through the maze of their long-term care options including residential options.
4. Identifying and accessing public benefits and resources to pay for care should the elder meet the qualifying criteria.
5. Help with asset management, including the burden of home ownership and personal property.
6. Providing the entire family the peace of mind that comes from knowing their loved one is monitored by a team that combines legal and financial expertise with specialized knowledge of the elder’s physical, mental and emotional health.
7. Ensuring the highest level of independence the elder can achieve, while ensuring safety.

What is the difference between an Advance Directive for Healthcare and a DNR?

As can be seen from this true life story, advance directives (in this case a Living Will) and DNR orders play a significant role. Why, under the circumstances described above did we have to endure a year of sadness and no quality of life? The explanations can be seen and understood through the questions and answers that follow. What is a Georgia Advance Directive for Healthcare? On July 1, 2007, the new Georgia Advance Directive for Healthcare replaced the Georgia laws on the Living Will and the Durable Power of Attorney for Healthcare. The new document is called the Georgia Advance Directive for Healthcare. The Georgia Advance Directive for Healthcare is a document that allows an individual to appoint an agent to make medical treatment decisions on his or her care if direct communication is not possible as well as authorizes an individual’s doctor to withhold or withdraw certain treatments or procedures. In addition, the document contains specific HIPAA release language. What type of procedures and treatments are you talking about? Treatments and procedures that may extend life for otherwise terminal patients such as a ventilator, CPR, artificial nutrition (feeding tubes), hydration (IV fluids) kidney dialysis, etc. Why do I need to complete a Georgia Advance Directive for Healthcare? This document allows individuals to express their wishes about their own end of life care even when they can’t communicate. It lets the family and the doctor know what they want and what they do not want to happen to them when they are near the end of their lives. Is the Georgia Advance Directive for Healthcare the same as a durable power of attorney for healthcare or my living will? The Georgia Advance Directive for Healthcare combines these two documents into a single legal document and makes it easier for individual's wishes to be known. Durable powers of attorney and living wills made before July 1, 2007 are still valid. However, if possible the new document should be executed. What is a “Do Not Resuscitate” (DNR) order? A DNR order is a written order from a physician that informs medical personnel that resuscitation should not be attempted if a person suffers cardiac or respiratory arrest. There are DNR orders in the hospital and then there are DNR orders written for out in the community. Community can mean home, assisted living, personal care home and skilled nursing home. Just because a person has a DNR order in the hospital does not mean it will transfer out of the hospital. If a person wants a DNR order once leaving the hospital another one needs to be filled out for use in the community. When does a physician write a DNR order? A physician can write a DNR for a patient after a verbal conversation with a competent adult patient or the person’s healthcare agent. Both the agent and the doctor should try to abide by the person’s wishes, which are listed in the Advance Directives. In some instances a physician will write a DNR order when resuscitation will not alter the outcome of the disease or if resuscitation will cause unnecessary suffering. Two physician’s signatures are required for a DNR. How will medical personnel know that a DNR order is in place? In a hospital or a skilled nursing home there will be a large notice on the front of the chart. In the community identification necklaces and bracelets are available and can be worn to make sure all medical personnel recognize and adhere to patient’s wishes. Does a DNR order stop medical personnel from treating a patient completely? No, a DNR only refers to resuscitation (CPR) efforts and does not interfere with other treatments, for example: transfusions, dialysis, use of a ventilator and antibiotic therapy. Treatment that keeps a person free of pain and comfortable should always be given. Can a DNR order be revoked? Yes, DNR orders should be reviewed periodically by the doctor and revoked if appropriate. A person can revoke his DNR at any time. What is a “code”? A code is a word that hospital and nursing homes use to mean resuscitation efforts should be initiated. What is a “no code”? A “no code” is an informal name for a DNR. In my grandfather’s case, he did not have a community DNR in place. Without immediate knowledge of the existence of one that was held by his doctors, the EMTs had to act. This was a difficult way to learn this lesson. We hope that this bit of education may save your families from the same problems.