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.