Advanced Care Planning
Advance Care Planning
As a quality care provider, we encourage and highly recommend that everyone has an Advance Care Plan in place.
What is Advance Care Planning?
Imagine you are in a situation where you no longer are able to speak, write or make decisions for yourself. This could be due to an accident, an illness, or a progressive health condition. The inability to communicate your preferences in regards to where you receive care, the type of care you receive, and by whom the care is given, would understandably be very upsetting.
This is why an Advance Care Plan is so important.
Advance Care Planning allows you to record your wishes and decisions in advance. This will be in relation to your care, types of medical treatment that you would wish or not wish to receive and anything else that is important to you as an individual. If you are ever in a situation where you are unable to make decisions for yourself, having an advance care plan in place will give both you and your loved one’s peace of mind that your wishes will be respected, wherever possible.
How do I make an Advance Care Plan?
Each Advance Care plan will be as individual as you are, but for all plans, they will need to start with a conversation. This conversation can be with a family member, friend, healthcare professional or advocate and may result in a written plan or just ensuring that those close to you know what your wishes are. All Advance Care Plans are flexible and we encourage you to update yours as your situation, priorities and preferences change over time.
There are usually four sections that people will look at within an Advanced Care Plan but not everyone will decide to complete all four.
These are:
Advance statement of wishes
A statement of wishes gives you the opportunity to record things that would be important to you if you became too unwell to express your preferences, or became unable to make decisions. The statement is not legally binding but wherever possible, will be taken into account by anyone making decisions on your behalf.
Common themes in a statement include:
- Your next of kin
- Who you would want or not want your care discussed with
- Whether you have anyone as an Attorney
- Where you would like to be cared for if you were unwell or dying
- Any important wishes in regards to spiritual beliefs, religion, or culture
Lasting Power of Attorney (LPA)
Lasting Power of Attorney is a legally binding document which allows you to appoint one or more people as your Attorney. This can be a friend, relative, or a professional person that is able to make decisions on your behalf.
There are two conditions that must be met at the time when you make your LPA. You must be over 18, and you must have mental capacity (the ability to make your own decisions). Lasting Power of Attorney can be used if you lose mental capacity. You can read more about how mental capacity is assessed on the gov.uk website.
There are two types of LPA and you can choose one type or both when appointing your attorney. They are registered separately, as they work slightly differently.
Health and welfare Lasting Power of Attorney (LPA)
This allows your attorney to make decisions about things like:
- Your daily routine
- Medical Care
- Where you receive care
- Life-sustaining treatment
This type of LPA can only be used when it has been registered. Healthcare or legal professionals will only contact your attorney about these types of decisions if they are confident that you are no longer able to make decisions for yourself- based upon the Mental Capacity Act (2005).
Property and financial affairs enduring or Lasting Power of Attorney (LPA or EPA)
This allows your chosen person or persons to make decisions about money and property on your behalf. This type of LPA can be used straight away. This means that your chosen person can help you with financial and property matters, even whilst you are still able to make all of your decisions for yourself. They can also continue to help you if you eventually are unable to make these decisions – ensuring that your finances will be taken care of, even when you are unable to take care of them yourself.
How to make a Lasting Power of Attorney
- Speak to the person or persons that you would like to be your attorney(s) to see if they are happy to be appointed.
- Fill in the necessary forms to appoint them as an attorney. These can be downloaded on the power of attorney section of the government website.
- Register your Lasting Power of Attorney with the Office of the Public Guardian (this can take up to 10 weeks).
Advance decision to refuse treatment (ADRT)
An ADRT is a formal, legally binding document that allows you to specify that you would refuse certain treatments in specific circumstances. It will only be used when you have lost the mental capacity to consent to, or refuse treatment. We highly recommend speaking to someone who understands the process such as a doctor or solicitor, before making an ADRT.
Key points about an ADRT
- You must be 18 and able to make decisions for yourself (have mental capacity) at the time you make the ADRT.
- The ADRT must specify precisely which treatment is to be refused and what the specific circumstances surrounding this refusal would be. If both of these conditions are not met, an ADRT will not be legally binding. For example, you might state “If I have a stroke which results in swallowing problems, I would not wish to be fed artificially by tube or drip”. This refusal would not be legally binding if swallowing problems were due to another cause.
- ADRT does not allow you to have your life ended.
- If you want to refuse life-saving treatment (such as artificial breathing on a ventilator) you must state that your wishes apply “even if my life is at risk as a result of my decision”.
- If an ADRT applies to life-sustaining treatment it must be in writing, signed and witnessed.
- You can cancel an ADRT at any time while you have mental capacity. Where possible you should inform your family, GP and medical team of this decision.
- You can decide to ask your GP to fill in a DNACPR form to say that in the event of a cardiopulmonary arrest (when your heart and breathing stop) that you do not wish to be resuscitated. It is important to discuss this decision with your GP and your family and ensure that your next of kin are aware of where to find this form in the event of an emergency.
You can find more information about resuscitation from the Resuscitation Council website.
Making a Will
A will is a document that explains what you would like to be done with your money, property, dependents and pets after your death. Any adult can write a will and we recommend that you receive legal advice before doing so. You will need to get your will formally witnessed and signed to make it legal and valid.
You can find more information on making a will from the government website or from Citizens Advice.
Other things to consider
Other conversations that may be useful to have when looking at Advance Care Planning, are talking about any funeral plans you have, if you wish to be an organ donor, or if you would like to donate your body to medical science. As you can see, having an Advance Care Plan in place can give both peace of mind to you and your loved ones. It reduces stress for your family if you lose the ability to make your own decisions, and ensures that you feel reassured that your wishes and preferences will be taken into account.
This information was provided by the Milton Keynes “Planning your Care in Advance” booklet which can be viewed and downloaded from the link below.
Useful Links and Further Information: