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Diane and Bill Evans are active seniors with no intention of slowing down as they age. But a recent health incident served as a wake-up call and prompted them to consider their wishes for the inevitable end of their lives.

The Evanses made an appointment with Kaiser Permanente physician Margaret Marquez in Santa Rosa to talk about topics like whether they'd want to be buried or cremated and if they'd want to be placed on life support if they had a grave health problem.

"It's important because, gee, my husband is 84 and I'm 75. We're young, but we're not going to be around forever," said Diane Evans, who resides in the Yulupa Avenue intergenerational co-housing development in Santa Rosa.

During the 45-minute appointment with Marquez, the Evanses reviewed a helpful checklist regarding possible future medical decisions.

"My husband plays golf three times a week, runs and lifts weights. He thinks he'll live to be 100," said Evans with a laugh.

Whether he becomes a centenarian or not, the Evanses' family members will be able to make decisions based on what Bill and Diane want if they're unable to voice them.

"I don't want to be stuck in a hospital with tubes so I wanted it documented with the hospital," said Diane Evans.

The topic of advance care planning for seniors is sensitive, and many don't want to broach it until they're forced to. But health care professionals are increasingly urging anyone over age 18 to fill out the California Advance Health Care Directive, which includes the power of attorney for health care.

In this document a person is designated as an "agent," who will be responsible for making decisions if the relative or friend is unable to do it for himself. The form needs to be witnessed, but a lawyer is not required.

Marquez, medical director of outpatient palliative care at Kaiser, says anyone with a chronic illness should have an AHCD, even if the patient's current situation is not considered imminently life-threatening.

"People don't necessarily think about the late stages of illness, especially if they have a high quality of life," she said.

At Kaiser, the AHCD information is put into electronic medical records and physicians "would know in moments who we should talk to," said Marquez.

While much of advance care planning relates to intensity and type of medical care, such as whether someone would want mechanical ventilation or artificial feeding, there are a myriad other issues to consider, like who will care for a beloved pet if someone is hospitalized long-term or dies, and who will oversee financial details, such as bill paying.

"There are social work topics that you need to discuss with your health care agent, like if you run out of money and can't afford private caregivers, where do you want to live? Family members may be willing, but have you talked to them about it? People shouldn't assume that the spouse would want to be the primary caregiver," she said.

Although completing the document is important, it's vital to have conversations with the agent about whether the senior wants pain-control medicine and whether they would want to be informed if their condition worsens, Marquez said.

"It's not about the answers you check on a list. It's the conversation with the agent. As we age, our priorities and wishes change," she said.

In 2009, a new California law went into effect creating the Physician Orders for Life Sustaining Treatment (POLST) form, a legally binding "portable" care plan for people with advanced, progressive or chronic conditions.

"It's the missing piece for end-of-life care and is a really important tool," said Susan Keller, executive director of Community Network for Appropriate Technologies.

The document spells out exactly what type of care seriously ill patients want for themselves.

"It looks at the medical reality of their health situation now and their care choices in the near future," she said.

Dorothy Reagan, a medical social worker with Sutter Care at Home in Santa Rosa, regularly speaks with clients who have chronic illness or frequent hospitalizations about advance care planning.

"When they come back home and things simmer down a bit is a really good time to talk," she said.

While it's important to have a durable power of attorney for health care, it's also critical to give someone durable power of attorney for finances, Reagan said. In Sonoma County, the nonprofit Council on Aging will help with money management and come to a senior's house to assist with bill paying.

"A lot of people don't have family members to step in," she said.

Reagan is sensitive to some clients' reluctance to discuss certain topics because of religious beliefs or cultural traditions, but if they're interested she'll discuss medical terminology and offer the AHCD paperwork.

"I tell them it's an opportunity to let your doctors and family know how aggressive you want them to be for your care. There are a lot more options now than there used to be," she said. "A lot of times patients and their families are relieved I brought up a topic. They may have strong opinions, but might not have shared it with family members. We use it as a springboard for conversation, and I try to let them know it's about their wishes, and if they put it in writing, it will be respected."

"It's really a gift to your adult children to speak these things aloud," said Reagan. "I try to reassure people that I'm hoping for their full recovery, but it's good to get their affairs in order and then they don't need to give it more thought. It's done. It's a kindness."

For Rohnert Park resident Nancy Crawford, 88, who's had recurring skin cancer, it's a relief having the AHCD filled out.

"It's extremely necessary to face facts," said Crawford, a widow who recently met with Marquez. "She was extremely compassionate and understanding. We discussed the worst-case scenario. It was exceedingly valuable, and doing the directive was a source of comfort."

The rest of her family lives in the East, but she has a strong support network of local friends.

"I've seen an attorney and everything is in order," said Crawford. "If it's time, it's time. I'm at peace with it."

Janet Parmer is a Bay Area feature writer. She can be reached at jhparmer@comcast.net.

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