A new alternative to the more common Advanced Directive has developed in recent years. This is the new Alzheimer Mental Health Advanced Care Directive. Lisa Brodoff, a professor at Seattle University School of Law, developed the directive discussed in this article.
The common Advanced Directive usually takes effect at the end of life when a person is no longer able to express a preference as to what type of treatment is wanted. This treatment could include mechanical intervention, artificially administered hydration, nutrition, or antibiotics. Advanced Directives do not take effect unless the patient has been determined by physicians to be terminally ill or in a permanent unconscious state.
Alzheimer Mental Health Advanced Care Directives take their cue from Mental Health Advanced Care Directives which have been around for a number of years. These directives take effect when an individual is unable to express their instructions and preferences regarding their mental health care. The client is able to give instructions and treatment preferences regarding their mental health care treatment in advance of the need for such treatment. It allows for important dialogue between family and physicians in this important area of health care.
Alzheimer Mental Health Advanced Directives take the Mental Health Advanced Directive and focuses its instructions and treatment preferences on quality of life issues for the Alzheimer or dementia client before the end of life. The client executes this document while they have capacity, most likely when they have just been diagnosed with a dementia illness. The nominate someone (their agent) to carry out their instructions and treatment preferences. Most people think of Alzheimer’s as the primary dementia illness but there are a number of diseases which can present with dementia as the disease progresses, such as Alzheimer’s, Parkinson’s, and Lewy Body disease. The client expresses their desires in the Directive for how they want to be treated once they are determined to be incapacitated.
The Alzheimer Mental Health Advanced Care Directive allows you to make decisions in regards to the following areas:
- Personal history and care values statement
- When the directive becomes effective and how long it will last
- The ability to revoke the directive
- Preferences and instructions about care and treatment
The Personal History and Care Values Statement states the client’s reasons for executing the directive, their core values, important people and events in their life so their agent knows who they are and what is important to them. Every person is unique so their statements will all be different.
The client can state if the directive becomes effective when they sign it or on a later date. Maybe they want to have it effective when a physician states they no longer have capacity. Maybe they want it effective in two years. They can state that the directive is only effective for a certain period of time or until they die. They can choose.
The directive allows the client to determine when or if they can revoke the directive. Can they do it when they only have capacity or when they are incapacitated?
The directive allows for the client to include their preferences and instructions about care and treatment. This can be specific about who they want to provide treatment, what medications they are comfortable with, care managers, or housing preferences. They can include their preferences for visits by family and friends, driving, food, their environment, favorite music, sexuality concerns, alcohol preferences, treatment for aggressive behavior, qualifying for state assistance or not, or even if they want to be allowed to smoke (tobacco or marijuana).
Alzheimer Mental Health Advanced Care Directives provide a level of comfort and control to my clients who execute them. They are in control and making decisions about their end of life. More importantly, they also give guidance to their family or care givers so that they know they are providing the care their loved one has chosen. What a blessing.