Empowering loved ones through advance care planning
By Kris Leonhardt
MARSHFIELD — Ashley Kozicki’s grandmother was experiencing an ongoing series of headaches. It was not until she crashed her vehicle that the family learned that she had a brain aneurism. After undergoing clipping surgery to address the aneurism, she then suffered a stroke.
“She was in a coma for over a week,” explained Kozicki. “She was bad enough to the point where she could not express her wishes. We weren’t sure how accurate the yes-no questions were being answered.
“Because she didn’t have those directives on file, the doctors were going to do everything to keep her going.”
The battle to make health decisions
With communication nearly nonexistent and no advance directives in place, Kozicki’s stepfather needed to take legal action to earn the right to make decisions for her.
“My stepdad couldn’t make the decision yes or no,” said Kozicki. “He ended up going through the court to proceed with guardianship paperwork. We had nobody to admit her. She needed rehab afterward but stayed in the hospital until the paperwork (was completed).
“It happened in January, and it was springtime before she went to the nursing home.”
Kozicki’s grandmother was a 50-year-old forklift operator living a normal life before the stroke.
“Now she has been in a group home because she needs 24-hour care,” explained Kozicki. “I think that my stepdad looks at grandma and says, ‘Is this really what she would want?’
“It doesn’t only impact the patient. It impacts the family too.”
‘The best gift you can give’
“We know there are higher rates of complicated grief, anxiety, and depression for family members when they aren’t certain of their loved one’s wishes,” added Penney Dupee, advance care planning coordinator at Marshfield Clinic Health System.
“An advance directive is a legal document that states your health care wishes and desires,” she said. “In a Power of Attorney for Health Care, you choose someone to be your health care decision-maker — health care agent. That person would only make health care decisions for you in the event you are unable to make them yourself. Their duty is to make health care decisions based on your wishes.
“The form provides you the opportunity to make your wishes known in the event of a sudden illness or accident, including end-of-life care. It has options about nursing or group homes, feeding tubes, and treatment during pregnancy. It also allows you to state any specific instructions for your health care such as resuscitation, pain control, and religious preferences.”
Dupee said that completing an advance directive should not be a one-time process and should be updated every decade to address health changes, death, and divorce, with the first filing occurring at the age of 18.
“Beginning the conversation is often the hardest part,” explained Dupee. “Sometimes it’s easier to begin discussing if there’s been an experience with someone you’ve heard about such as a neighbor, co-worker, or a story in the media.
“Think about putting yourself in that situation and what your values or beliefs are. As an advance care planning facilitator, we encourage people to think about past experiences they may have had. We ask them to think about what living well means to them and what cultural, religious, spiritual, and personal beliefs they have that may affect future health care decisions.
“Having an advance directive in addition to a conversation is the best gift you can give your family.”
On Jan. 16 Roseanne Heller went in to update her advance directives.
“We went in to update my Power of Attorney for Health Care and for financial,” recalled Heller. “I think my kids were pushing me. My daughter had off, and my daughter, my son, and I went to the clinic, and then we went to the bank.”
Six days later, Heller had a stroke.
“I had been to a hockey game the night before, and I got up in the morning and didn’t talk to anybody, and I fed the dog, fed the cat, fed myself, and I was sitting here, and my daughter called me. Next thing my son was here because I was talking funny and didn’t make sense.”
Though Heller had a fairly minor stroke, she could not speak or read for three days and needed physical and occupational therapy.
Because she had updated her advance directives six days earlier, her children were set up to take over her finances and medical decisions.
After a short stay in a nursing home, Heller is back home and doing well.
For more information on advance directives, call 1-800-782-8581 or visit marshfieldclinic.org/advance-directives.