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Planning can help assure final wishes are met

An estate plan can help assure that a person's assets are preserved and distributed appropriately after their death. Researchers have also discovered that careful documentation of a patient's end-of-life wishes, such as executing a health care power of attorney, can help avoid unwanted hospitalizations and health care intervention.

Ohio State University researchers reviewed health records of 1,185 cancer patients who were referred to hospice. They discovered that a verified do-not-resuscitate order before the last 30 days of their life lowered the odds of hospitalization. Placement of a power of attorney or other valid legal directive in the electronic health record also lowered the chances of admission. These were even more effective if the document was placed in the record at least six months before death.

This legal guidance advances the goal of avoiding unnecessary and unwanted hospitalizations and procedures for terminally ill patients who entered hospice care. This helps focus care on the patient's wishes, quality of life and pain management. It also reduces medical costs.

Only 13 to 44 percent of terminally ill patients documented advanced care planning in their electronic health records, according to earlier studies. Location and ease of finding these directives were also inconsistent.

Lack of planning and difficult access is especially troubling when end of life is approaching. Hospice patients are often unable to advocate their wishes, priorities and best interests. Matters are further complicated if family members disagree on care or are unsure or scared to make medical decisions.

Earlier is better for planning. Advanced care planning noted before the final six months of life lowered the likelihood of hospitalization, according to the research.

Decisions should not be put off until a disease becomes terminal. Because these decisions and conversations are complex and emotional, these should start at a less stressful time when family members can be more objective and not pressed by time.

An attorney can provide guidance on this issue and options. Their assistance may help assure that an effective and legally valid power of attorney and other documents are drafted.

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