Episode 71

April 13, 2024


#71 | Carla Sutter | How to File Advance Directives

Hosted by

Tony Siebers Bina Colman
#71 | Carla Sutter | How to File Advance Directives
Parent Projects - Aging In America
#71 | Carla Sutter | How to File Advance Directives

Apr 13 2024 | 00:21:03


Show Notes

Carla Sutter holds her master's degree in social work and has spent her 30-year career working with organizations who are dedicated to helping clients and families care for themselves and others whose needs are changing due to age or illness. She is a subject matter expert on end-of-life tools and conversations. Her present work at Contexture and the Arizona Healthcare Directives Registry has her focused on engaging healthcare organizations, community agencies and Arizonans on enhancing goal concordant care through advance care planning conversations and the resulting advance directive documents.
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Episode Transcript

[00:00:05] Speaker A: Welcome to Aging in America. I am Bena Coleman, your host, and this podcast is brought to you through parent projects. On Today's show, we're so excited to welcome Carla Sutter. Carla, who's an advocate for choose your person. This is a very important campaign for all of us to be aware of. So at this time, let's welcome Carla. Carla, welcome to the show. [00:00:24] Speaker B: Thank you so much. [00:00:26] Speaker A: Thank you for being here. Really, right off the bat, for those who know and think they know or just don't know, can you let us know what an advance care directive is? [00:00:36] Speaker B: Sure. So, an advance directive, sometimes called a health care directive, is a document that allows you to kind of pre populate your decisions, your wishes, your goals for your healthcare, and potentially for who you would want to be, your voice for those decisions prior to you needing that, because up until that point, you are able to communicate your wishes on your own to your healthcare team. [00:01:07] Speaker A: Yeah, it is so important. You kind of touched on it. But can you elaborate a little more on why it is so important? [00:01:14] Speaker B: Absolutely. So, first of all, these documents are for anybody over the age of 18 and every state, while we're talking, mostly here in Arizona, but any state has some version of these documents, and they typically are transferable between states as long as they've been produced in that state in the way they need to be. But the reason that they are so important is because at the time that people need to make healthcare decisions, either in an advanced state of illness, at end of life, or in a critical situation, typically, 50% of people don't have the capability of being able to communicate their goals and their wishes. And so you want to have somebody who aligns with those goals, who represents what it is that you're wanting to be that person who is either communicating it or to have those documents share those wishes for you at that time. [00:02:16] Speaker A: Yeah. Everything you said is so true, and it is so important because, like you mentioned, I didn't realize the statistic was 50%, but that's a very high number of people who can't verbalize what they want at that time. So you did talk about something, and I want to touch on it for a second. You said that these documents can be transferred from state to state, and I mention it because we live in Arizona, as you said, and there's so many snowbirds here. [00:02:40] Speaker B: Yes. [00:02:40] Speaker A: Was that something people would worry about? Or like you said, it is transferable. [00:02:46] Speaker B: So most states, including Arizona, do have a component of the statute that guides advance directives in that state that says that if you bring in an advance directive that has been completed in the way that that state document that you have needed to be completed. It can be followed in the state you are receiving care. And that is, of course, as long as the wishes for that state are legal in that state and medically ethical in that state. [00:03:20] Speaker A: Yes, totally understood. Okay, wonderful. [00:03:24] Speaker B: Yeah. The one document I do want to just share that is you're going to want to look for the document within that state is if you do not want to be resuscitated, which would be called a do not resuscitate or a DNR in the community setting. So first responders coming to you, every state has a form that guides their ems and first responders, and you would want that document to be within that state's guideline so that it is familiar and recognizable to the first responders. [00:03:54] Speaker A: And, Carla, it's funny you brought up the DNR, because when I was doing other stuff within the industry, I used to tell my clients, put that on your refrigerator. That is such a good one to put on your refrigerator. So thank you for bringing that up. [00:04:07] Speaker B: Absolutely. [00:04:08] Speaker A: Yeah. Okay. So you obviously are very passionate, just like I am about all things senior and you know so much. But tell us a little bit about you and how you got started into this. [00:04:20] Speaker B: Sure. So my background is as a clinical social worker, and I have worked in healthcare for over 30 years, with a majority of my work being focused on hospice, palliative care, and end of life conversations. And while I did work in Minnesota, the community in Minnesota, all of the large hospital systems in the Twin Cities, were putting together a program called honoring choices. And it was really a way to make sure that no matter what provider you were receiving care at, that there was kind of a shared understanding of how these documents worked, and that there was a real focus on having these conversations. So we did training with many of the clinicians in our hospitals and clinics to really be able to start these conversations. And so when I moved to Arizona, that passion continued. And I was lucky enough a few years ago to be hired at contexture, which is the state designated health information exchange organization, who was then being identified as the designated state registry for advance directives. They were going to move that from the secretary of state's office to the state designated Hie. And so I began to work with this program to really ensure that, one, there was education about these documents, and two, these documents could then be registered with the AZHDR, viewed by healthcare providers across the state. [00:05:58] Speaker A: Wow. So you moved here from Minnesota, you touched on honoring choices, which sounds great, which I'm going to assume kind of goes into choose your person campaign. Is that correct? Am I off base? [00:06:10] Speaker B: So, yeah, in some way, honoring choices was really a kind of an approach to ensure that conversations happen along people's journey. Whether you are healthy and young or, you know that there is something in your healthcare, you know, kind of world that could limit your. Your lifespan. And the choose your person really comes from the idea of ensuring that we have our documents in place, that we've had these conversations, but we really wanted to focus in on, if you do only one document at this time, it is to choose the person that you would want to be your decision maker, your voice for your decisions, if you were unable to do so. Okay. [00:07:03] Speaker A: Yeah, that is so interesting. So you're saying. Right, so you're saying that is your most important, that's what you would say is your most important document, to choose your person. How would someone go ahead and do that? Like, how did people listening? Were they saying, well, how do I do that? [00:07:22] Speaker B: No, it is a great, and it's a great starting point, because what people need to understand is that if you don't identify that person in a health care power of attorney document, the state will identify and does identify who would be the individual that your healthcare team would turn to. And that does not always align with the person that you want. It doesn't mean that that person is not. It's certainly going to be a close connection to you, but it may not be the person that you would want to be that decision maker. And so that's why it's really key. We also want to focus on choose your person, because for many people, they're just not at a place that they can either see themselves at an end of life situation, or the idea of talking about end of life and death and dying really is not a comfortable subject, or it really goes against their faith or cultural beliefs to bring that into kind of their home, their healthy home at that moment. But choosing your person allows for different types of conversations and doesn't always mean that end of life is imminent when you end up needing that person, because it could be from an accident that you will recover from, but decisions have to be made that you can't participate in. [00:08:44] Speaker A: And I think that's so important as well, to know that this isn't, like you said, death isn't knocking on the door. I mean, I could have this for my children. I'm 40. I could have one now. So I think that's a really important topic. To bring up, to have people prepared for the future. Is there an age limit? We talked, like you mentioned, you're not on death's door. Would you recommend an 18 year olds do this? [00:09:07] Speaker B: Yeah, absolutely. At the age of 18. It also is often a time when people are going off to kind of their first independent living situation, whether they're going to college or they're just moving into their own apartment. They have to understand that when you are now 18, the ability of a parent, a guardian, or somebody in your life to help you with your health care becomes more complicated because you are now an independent individual. And these documents allow at that time, when it has been identified, that you cannot participate in your own healthcare. You want to be able to move that needle to allow for decisions, for information to be shared with people as it needs to be shared. And so it really is a great time as you're kind of planning, planning that next step in your life to do this. [00:10:03] Speaker A: It's exactly what I was thinking. You hit the nail on the head with the independent part. Like these, you know, these 18 year olds are being independent now, and this is an important topic. Okay. So, like, can you walk us through the legal process or how to file? [00:10:17] Speaker B: Sure. Yep. So these documents are, again in Arizona. We'll talk about Arizona. In Arizona, there's four identified versions of an advance directive. They all kind of go under the umbrella of an advance directive. There's a living will, there's a healthcare power of attorney. There's a mental health care power of attorney. And there's a pre hospital medical care directive, otherwise known as an out of hospital DNR. We know it as an orange form because that's the color background it needs to be on for first responders. Some of these documents are going to be. You can have these documents all. Well, the first three all identified in one document. It would maybe name, you know, this part is my living will. This part is my healthcare power of attorney. This is now my mental health care power of attorney. You can have them individually. The attorney general has a life care planning packet that you can download for free, and that is. That's going to have all the four form types. Now, again, you don't need to do all four. You can choose one, or you can choose all four, depending on your health situation and your kind of status and where you're at with your, you know, health care or, you know, so you can do. You can write up your own form. You could literally, if you're motivated after today's session, you could take a legal pad. You could write on the top of it that this is my living will. You could identify what it is you want for your health care if you weren't able to communicate that, and as long as you have signed it and dated it and a witness or notary has done, it is going to be a legal, active document. [00:12:11] Speaker A: Wow. [00:12:12] Speaker B: So it's very simple. Simple in those ways. And there are a lot of different versions at the end. I believe we're going to share our website. On our website, there are free downloadable versions of a variety of different types of forms. Some just align more with your kind of process or how you want to answer questions or things like that. They are free. You can get them free. You can use an attorney to complete these documents, but you don't need to. Many people, if they're doing an estate plan, may have it as incorporated into that estate plan, but it doesn't need to be done by an attorney, even though we consider them a legal document. [00:12:59] Speaker A: Oh, that's. I think that's very different from what most people probably think. So I think that was very helpful to know as well. Okay, so we. We have talked about such wonderful things. But real quick, back to the younger person who may have set this up. They become independent for the first time. Things change. Will they be able to change that person easily? And I'm assuming, yes, if they can just write their own as well. [00:13:23] Speaker B: Yes. So that's a great question. One of the reasons people do get concerned about completing these documents is they think, well, you know, my life's gonna change over time. These documents can be updated at any point. You will want to complete a new document. You don't want to just be crossing out things, because it gets confusing as to which one you meant. And as it's a legal document, someone is signing that on this day. This is what you completed. This is the form they had in front of them. So you'll want to update it, do a new document, have it newly witnessed or notarized, and then whatever date is, the latest date is going to be the document that will be active. So if I complete a document, January of 2022, and then I decide, oh, wait, I didn't mean that. And I redo it on January 30 of that same year, that's the document that's going to be followed. [00:14:20] Speaker A: Okay. It makes complete sense. I just wanted to make sure everyone understood. Thank you for clarifying that. All right. And I joke when I say this, but what does my person need to know? Obviously, I got to tell my person, correct, that they are my person. Is there any other legal stuff you got to fill them in on? Or it's just, listen, I've chosen you to be my person for these documents. [00:14:45] Speaker B: So, great question. And I want to kind of go back. One step is before you choose that person really having a conversation to say, will you be my person? And not to be upset if someone says, I can't do that. Because the reality is not everybody feels as comfortable, like, voicing decisions that could impact somebody's life in a public way. It doesn't mean they don't honor those decisions. They don't respect those decisions. But not everybody wants to kind of feel that responsibility. [00:15:24] Speaker A: And I think we see that a lot in families where maybe the daughter doesn't want to be responsible for the mom or the husband, for the wife, vice versa. But yes, I can see that. [00:15:34] Speaker B: So, really important to first say, you know, I would love for you to be my person, my healthcare agent. This is what it means. Here is what my wishes are. I recognize that you may not agree with all of them, that they may not be what you would write on your document, but can you honor these if it came to that? And once somebody says yes, then be able to complete the document, ensure that they have a copy of it, that they can ask questions. If there's anything you've written that they may not understand, know that those. What you write doesn't have to be. You know, I've seen somebody went through a living will with a patient's daughter who had to make a difficult decision. Her father had never mentioned the name of his diagnosis, the symptoms that were going to come up, the intervention that the physicians at the hospital were asking about. But he did talk about what was important to him in his life, what was meaningful, what was successful living for him. And just having that allowed her to know what to do from a medical perspective. So sometimes you're not. These documents are going to be more about your goals of life rather than your end of life wishes. And it really does still provide an amazing ability for that next person to be making those decisions. [00:17:02] Speaker A: Yeah, that's beautiful that that happened. And where would somebody keep this? These, all these? Just one document. [00:17:11] Speaker B: So, another great question. And there's going to be a couple of places you want to make sure that the person who is your agent has a copy of them. I always like that. Your general copy. On the back of it, you write the date that you handed them out and who you gave them to. So if you ever want to make a change, you just turn back over that document and you know exactly where you need to update it. Many people will give it to their healthcare provider. Their general practitioner have a copy if they do go into a hospital setting. But now, because the Arizona Healthcare Directives registry is in play here in Arizona, we can accept those documents. You can send those in in varied ways. The directions are on our website and they will then be stored within this registry. It allows for healthcare providers who are participating in the state to to be able to access those documents. And it gives you a wallet card that is voluntary to carry. But at least if you give that copy to your agents, it has a QR code. They're able to use their smart technology and it will bring up those documents. So you never need to carry around these paper documents with you. So my husband, my daughter, who are my agents, have a copy of my wallet card. If they were called and they were traveling someplace and didn't have the documents, they would simply be able to use their smart technology. See all my documents on the screen and be a reminder as to what we had talked about. [00:18:55] Speaker A: I find that amazing. I find that there's just no excuse anymore that is so technology forward and so wonderful for so many people. Carla, this has been great. I would love for people to get ahold of you, find you. Can you let us know? We're going to put your information on the video as well. But anyways, be sure and look up Carla. Follow her on her socials and make sure to follow us as well. It's aaronprojects on all of your favorite social platforms. Carla, thank you so much for today. I found the information to be so fabulous and wonderful and thank you for sharing it with our audience. And just thank you for your time, talents, and treasures with us all. [00:19:38] Speaker B: Thank you so much for the opportunity. [00:19:46] Speaker C: Well, that's it for the team this week, and thanks for joining us. If you've enjoyed the content, remember to subscribe and share this episode on the app that you're using right now. Your reviews and your comments, they really help us expand our reach as well as our perspectives. So if you have time, also drop us a note. Let us know how we're doing for tips and tools to clarify your parent project, simplify communication, communication with your stakeholders, and verify the professionals that you choose. You can find us on YouTube, follow us on Instagram and Facebook. Thanks again for trusting us. Until our next episode. Behold and be held. [00:20:18] Speaker D: Thank you for listening to this parent projects podcast production. To access our show notes, resources or forums, join us on your favorite social media platform or go to parentprojects.com. This show is for informational and educational purposes only. Before making any decisions, consult a professional credential in your local area. This show is copyrighted by Family Media and Technology Group, Inc. And parent Projects, LLC. Written permissions must be granted before syndication or rebroadcast it.

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