In discussing the Lifecare Advance Directive, the Lifecare Discussion Guide, and/or the Lifecare Representative Advance Directive (see below) it can be helpful to have a short, single page (two-sided, tri-fold) brochure regarding each to easily copy and hand out. These complimentary brochures can be downloaded here, here, and here, ready for easy use and distribution.
AD Support Forms
Lifecare Directives offers numerous FREE forms to assist you in managing individual choices, advance directive status, and specialized advance directive instructions. From Agent/Proxy Resignation forms to Peri-Operative DNR Suspension forms, you will find numerous documents that can help advance planning and operations proceed with a minimum of confusion and disruption To learn more, or to download a form, click here.
Resource Text: "Should I Complete an Advance Directive?"
This is a lively, easy-to-read 21-page booklet that is provided FREE as a download-able educational resource for teaching and counseling patients and families about the use of advance directives. It is specifically intended for use with individuals who are reluctant to complete a legal advance directive document. The booklet covers:
- "What is an Advance Directive" and briefly outlines the various forms;
- "The Living Will", with a short review of its history and problems;
- "The Medical Power of Attorney" (and related appointment documents) which reviews the purpose and challenges experienced in selecting someone as a substitute decision-maker;
- "The Outcomes Content Solution," which summarizes recent improvements in advance directives in general, and living wills in particular; and it concludes with a thorough response to --
- "Should I Complete an Advance Directive," giving a detailed case-by-case review of actual experiences and outcomes based upon three key options: "do nothing", "tell others only", and the combined "write out and discuss" option.
Highly readable, this booklet can also be freely copied for educational purposes. Download a complimentary PDF copy by clicking here.
The "Lifecare Advance Directive" and the Completion "Guide" Booklet
(available for $7.99 and $5.99, respectively; bulk discounts available)
As previously noted, the Lifecare Advance Directive is the result of more than 10 years of rigorous research. It's development involved the review of more than 6,000 articles from medical journals, legal publications, and the popular press, as well as the review of all relevant state and most territorial statutes, and the comparative review of more than 100 independently designed advance directives.
Further, it was reviewed by literally scores of physicians, nurses, elder law attorneys, ethics specialists, and many other scientific and secondary researchers. Finally, nearly 1,000 members of the general public participated in university-directed research to validate the document, with over 400 participants also involved in direct comparative testing of the Lifecare Advance Directive with other popular advance directive versions.
The Lifecare Advance Directive out-performed every other directive tested on all investigated measures, including:
- quality and quantity of patient-proxy discussions,
- confidence in a quality decision-making process,
- actual patient-proxy decision-making concurrence,
- confidence with the decision-making process,
- comprehensive coverage of essential concerns,
- accuracy of decision-making between patients and their proxies in decision-making exercises, and
- the frequency of refusal of overly burdensome medical treatment.
Research demonstrates that the Lifecare Advance Directive it is superior to all others tested (including the Five Wishes living will), and that it fully and methodically covers all the key issues found most likely to be of significant importance to patients and families.
To obtain a copy visit the Ordering page now. For bulk rates and institutional and organizational discounts, contact Lifecare Directives, LLC.
The "Representative Advance Directive" and its Guidebook
(available for $7.99 and $5.99, respectively; bulk discounts available)
Clinicians frequently encounter patients who have already lost decisional capacity (i.e., competency) and who have no advance directive, but who are at high risk for requiring life-sustaining treatments in the near future. For these persons and their families, Lifecare staff have created the "Representative Advance Directive." Drawing upon state-specific statutes, court rulings, and accepted guidelines for proxy/surrogate decision-making, the Representative Advance Directive:
- organizes the selection of appropriate decision maker(s),
- presents key advance decisions which should be made,
- addresses issues of conflict and resolution,
- prepares for guardianship/conservatorship (if needed), and
- resolves unnecessary delays in advance planning before it is too late.
The accompanying explanatory "guide" booklet quickly and easily leads family members through the entire advance decision-making and completion process. It is an invaluable resource for clinicians who can otherwise be caught in the dilemma of urgently needed decisions with no organized advance planning in place. For more information click here. Or, obtain copies through the Ordering page on this website.
The "Personal Choices Discussion Guide" and Guidebook
(available for $7.99 and $5.99, respectively; bulk discounts available)
Clinicians will occasionally encounter individuals who are unwilling to complete a formal advance directive. Some fear that the information may be misused. Others are simply distrustful of institutional systems and/or legal forms, etc.
For situations such as these, Lifecare Directives staff have created the "Personal Choices Discussion Guide." It has the same core decision-making content as the "Lifecare Advance Directive," but it is arranged in an informal, discussion-based format.
It can be used by clinicians and patients as a guide to comprehensively discussing their wishes together, and by patients and their families to help ensure that they've clarified all important concerns.
Upon reading through it, and realizing the importance of the content it covers, many patients may find themselves willing to complete a more formal document. For more information click here. The Guide can be purchased through the Ordering page.
Durable Medical Protection Orders
(available for $3.99 a copy - bulk discounts available)
As patients' legal rights have grown, so have the various "medical protection orders" which can be issued to ensure that a loved one's wishes are known and followed. Some of these medical orders include:
- DNAR: Do-Not-Attempt-Resuscitation. A written DNAR order (also referred to as a "DNR" (Do Not Resuscitate) or "No Code" order) is issued when an individual or his or her duly appointed representative has declined CPR (cardio-pulmonary resuscitation). A DNAR order is typically considered when it becomes apparent that CPR would no longer reasonably succeed, or in situations of poor health that the individual finds intolerable.
- DND: Do-Not-Dialyze. This is a written order confirming that an individual or his or her duly appointed representative has declined the use of kidney dialysis (in situations of kidney failure coupled with very poor health).
- DNH: Do-Not-Hospitalize. This order is most often issued for a long-term nursing home or terminal hospice patient -- for whom alternate in-facility or in-home care options have already been arranged -- and when re-hospitalization can no longer enhance their health and comfort care goals.
- DNI: Do-Not-Intubate. A written DNI order is issued when an individual or his or her duly appointed representative has declined the use of a breathing tube -- inserted (i.e., "intubated") into the nose, mouth, or windpipe through a "tracheotomy" (a hole cut in the neck) -- and/or breathing machine (i.e., a "ventilator" or "respirator").
- DNT: Do-Not-Transfuse. This order is written when an individual has declined further blood transfusions and/or the use of other specific blood products, or when the transfusions or blood products will no longer meet personal health care goals.
Extensive research has shown that these orders are often "lost" in the medical record, not posted in nursing notes, neglected at the time of transfer, and/or overlooked by medical and ambulance staff as much as 77-93% of the time.
At other times, no one is comfortable with bringing up the need for these orders due to patient instability or recency of admission, etc. Research also demonstrates that waiting for an "ideal" discussion time leaves an overwhelming majority of patients without appropriate protection orders, even when all involved recognize the need.
Finally, some patients and families may find themselves repeatedly approached by health care staff who are anxious not to overlook their patient's rights. The recipients of such multiple approaches may at times find themselves concerned that medical staff seem more preoccupied with withholding key medical treatments then providing them.
Thus, to aid to resolving these concerns Lifecare staff have created the "Durable Medical Protection Orders" booklet. It is designed for use only by individuals already in extremely poor health -- severe enough to have discussed and received one (or more) of the above orders from a licensed medical practitioner.
Its purpose is to provide an ongoing and enduring cumulative record of these orders.
Current medical protection orders 'expire' within days, and remain valid only within the issuing care facility or setting. If discharged, transferred, or returned home -- or when existing orders simply expire -- it can be very difficult to promptly reinstate the orders previously obtained.
Therefore, the "Durable Medical Protection Orders" booklet provides a permanent record of any 'standing' medical protection orders, all signed by the issuing physician(s). It serves to provide ongoing evidence of the enduring intent of any extended medical protection orders.
Not only can it better secure a patient's wishes, but it can avoid unnecessary reinstatement delays and emotionally traumatic and stressful repeat discussions needed only to verify previous decisions that were already thoughtfully made.
Obtain copies through the Ordering page, or contact Lifecare Directives, LLC, for bulk, institutional, and/or organizational discounts.
Directive Scoring Tools
The Lifecare Advance Directive is a highly structured, content-enriched document than can readily be scored for a normative, aggregate content value. Derived from over 1,000 prior research participants, this score allows physicians, clinical educators, and counselors (as well as patients and families) to easily see where a given individual falls in the normative context of the choices they are making.
In this way individuals who are at high risk of inordinately burdensome medical care can be quickly identified and targeted for additional counseling and/or education.
Click here to download FREE "Completion Review and Scoring" evaluation sheets for Lifecare Advance Directives from your state, territory, or other locale.
The clinical resource text, "Strengthening Advance Directives" (described below) contains an extensive review of the research and development of this aggregate score and the normative range values as found in the Completion Review and Scoring evaluation sheet. It also provides a recommended "Best Practices" clinical pathway for use in addressing scores that fall outside the normative range.
Lifecare Guide: Advance Directive Statutes Summary
($16.99 by download; $24.99 softbound)
This is a 93-page text summarizing the key state and territory statutes issued for advance directives and other representative decision-making. It is an invaluable resource for those who wish to better understand the current range of advance directive laws in the United States and the territories of American Samoa, Guam, Puerto Rico and the Virgin Islands. It can be obtained through the Ordering page.
Clinical Resource Text: "Should I Use a Shorter Advance Directive?"
($6.99 by download, $21.99 softbound)
There is a tendency among patients (and sometimes among professionals) to want to short-cut the advance planning process. One way this is attempted is by the use of shorter state-standard advance directives.
This 32-page, 199-footnote book very briefly reviews the history, challenges, and solutions to past advance directive problems. It then presents a lengthy overview of essential enriched content derived from quality research.
After reading this material an individual can better understand what they will be leaving out of their advance directive if they choose a shorter document.
It is another useful tool and source-book for educators, patients and families alike when the inevitable question arises, "Should I use a Shorter Standard Directive?" This e-book (or a hardcopy) can be obtained by proceeding to the Ordering page at any time.
Clinical Resource Text: "Strengthening Advance Directives: Overcoming past limitations through enhanced theory, design, and application"
($39.99 download; $49.99 softbound)
This is a 355-page book summarizing the historical, social, theoretical, and legal issues surrounding the use of advance directives. It contains never-before-published research, data, findings, and a wealth of supplemental information. With more than 900 individual references in the bibliography, it is a must-have in depth educational resource for physicians, clinical educators, hospital social workers, medical counselors and others who encounter advance directives in their clinical practice. Obtain the e-book (or a hardcopy) by proceeding to the Ordering page.
Clinical Resource Toolkit: "Clinical Pathways and Advance Directive Toolkit"
(Incorporated in the text, above)
The 355-page text above, "Strengthening Advance Directives" also contains a research-derived "best practices" or "clinical care pathways" that explicitly link every stage of advance planning. The patient's advance directive is effectively placed at the heart of the process.
The supplemental "Toolkit" contained within the text has additional information to aid in implementing a highly effective advance directive program in any medical setting. Obtain this text through the Ordering page.
Lifecare's "Federal Inmate Advance Directives" and Guidebook
($7.99 and $5.99, respectively; bulk order discounts available)
There are unique federal codes and regulatory guidelines providing for advance directives to be used by federal inmates cared for in the medical and correctional facilities of the federal Bureau of Prisons.
These codes and regulations allow for the portability and enforcement of a properly designed advance directive, regardless of interstate transfers between federal facilities.
Advance directives (including "Representative Directives") based upon these guidelines have now been created for use in these settings.
By using these directives, BOP staff will not have to recreate advance directives every time an inmate transfers from one facility to another.
To learn more about these advance directives, see the "Federal Inmate Directives" page. You may order this advance directive and its supporting documents through the Ordering page, and then selecting the "Federal Inmate Directives" subheading under the "Professional Resources" section of the Lifecare Shopping Cart.
NOTE: Bulk rates, and institutional and organizational discounts can be arranged by contacting Lifecare Directives, LLC. See our Contact page.
E-mail this webpage to your colleagues and other professionals who will benefit from these important resources. Just copy and paste the URL address at the top of this page into an e-mail and send it as "Information That Will Be Important To You." They will thank you for thinking of them.
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