October 13, 2002
Organizing life's end; it's all about your choices
By DONNA SYVERTSON of the Missoulian
Local institute creates 'bank' to electronically file wishes for final care
How many times has it happened that directions for hospital care written by the patient before he or she entered the hospital can't be found?
Too many.
A new agency in Missoula, Life's End Institute (formerly Missoula Demonstration Project) has a solution.
"We're the first community (to offer this program)," said Linda Tracy, Life End's community liaison. "It's a problem throughout the country, and we're the first community to solve this problem. It's already working for people."
The right to accept or refuse medical care, even for those who can't speak for themselves, is an American right. Americans sign advance notices or directives signifying who has their power of attorney and the type of health care they want in advance of hospitalization.
Unfortunately, Tracy said, "So many times, they couldn't be found easily or weren't found at all."
So Life's End collaborated with nine Missoula-area organizations to launch "Choices Bank," a free service that makes it much easier to find those advance directives.
Those agencies are Christ the King Church and its Parish Nurse Program, Community Medical Center, Home Health of Montana, Life's End Institute, Missoula Aging Services, Nightingale Nursing Services, Partners in Home Care Inc., St. Patrick Hospital and Health Sciences Center and the Western Montana Clinic.
Blank advance directive forms are available at any of the nine partner organizations. When completed, they should be returned to any one of the organizations where staff members will review the directives to make sure they are complete. Directives then will be scanned into a computer and stored on a secure Internet site, www.choicesbank.org.
The person filing the advance directive will receive two wallet-size cards, one for the person and another, perhaps, for the person with power of attorney and/or the spouse.
Hospital personnel, who will have a special ID and password, then can access the Web site to gain information about the patient's wishes and learn who to contact when power of attorney is needed.
"So many times," Tracy said, "we're not able to make our own decisions (due to surgery or extreme illness). It helps stay in control."
"I want my wishes on record so even if my children are not around, they can be carried out," said Lula Winchell, who had deposited her advance directive in the Choices Bank. "When I'm traveling, I want to know that my wishes can be found so my children and my doctors will know what I want done."
The four-page advance directive begins with a power of attorney form on the first page. There's more need for power of attorney in life and at the end of life, Tracy explained. A living will follows on the second page, a signing/witnessing section is on the third page and special instructions on the fourth.
It's written in an easy-to-understand style and conforms to Montana law, Tracy added.
Choices Bank is designed to make this a normal part of life, not an emergency last-minute item.
"As an emergency physician, I have to make quick decisions every day," said Warren Guffin, a doctor at St. Patrick Hospital and Health Sciences Center. "When my patients can't tell me what they want, I need to be able to find an advance directive quickly to help me give better care and honor my patients' wishes."
In a two-year study of the medical charts of deceased persons, the Life's End Institute found that less than 50 percent of those who were reported to have advance directives actually had them in their charts. A more recent study showed that 80 percent of the hospital personnel have a difficult time finding advance directives. Sometimes a day or more passes before the directive is found.
The project is supported by a $461,180 federal grant that the nine partner organizations and a contribution from the Hospice Care Foundation matched. The three-year grant is from the U.S. Department of Commerce National Telecommunications and Information Administration, Technology Opportunities Program.
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