Five Types of Advance Care Planning Directives in New York State:
- A Health Care Proxy lets you appoint a healthcare agent — that is, someone you trust to make health care decisions for you if you are unable to make decisions for yourself.
- A Living Will allows you to leave written instructions that explain your health care wishes, especially about end-of-life care. You cannot use a Living Will to name a health care agent; you must use a Health Care Proxy.
- A Living Will together with a Health Care Proxy lets you state your health care wishes and name a health care agent.
- A Do Not Resuscitate Order (DNR) only lets you express your wish to do without cardiopulmonary resuscitation (CPR) – that is, emergency treatment to restart your heart and lungs if your heartbeat or breathing stops.
- Medical Orders for Life-Sustaining Treatment (MOLST) are one way of documenting a patient’s treatment preferences concerning life-sustaining treatment.
Authority of Nurse Practitioners under Current NYS Law
As a result of 2017 amendments to the Family Health Care Decisions Act (FHCDA) and 2018 amendments to the Health Care Proxy Law, a nurse practitioner can exercise substantially the same authority as an attending physician to determine patient incapacity and to write do-not-resuscitate (DNR) and other orders to withhold and/or withdraw life-sustaining treatment pursuant to those laws. Chapter 430 of the Laws of 2017; Chapter 342 of the Laws of 2018.
It’s About How You LIVE
It’s About How You LIVE is a national community engagement campaign encouraging individuals to make informed decisions about end-of-life advanced care planning and services. The campaign encourages people to:
- Learn about options for end-of-life services and care
- Implement plans to ensure wishes are honored
- Voice decisions to family, friends and healthcare providers
- Engage in personal or community efforts to improve end-of-life care
CaringInfo, a program of the National Hospice and Palliative Care Organization (NHPCO), is a national consumer engagement initiative to improve care at the end of life http://www.caringinfo.org/files/public/ad/New_York.pdf
Hospice Care
Hospice is a program of care focused on providing comprehensive care for the terminally ill and their families. The program provides supportive care to meet the special needs arising out of physical, mental, spiritual, social and economic stresses experienced during the final stages of illness, dying and bereavement. Hospice care programs are regulated under federal and state law.17
In New York State, there are about fifty state certified hospice care programs. You or your health care agent may indicate a preference for a hospice program in advance to fulfill your needs. Here are some factors to consider about hospice care:
- Hospice care services provided by state certified programs are usually covered by insurance such as Medicare, Medicaid, and commercial health insurance plans. Generally, hospice care is a covered benefit if you have a terminal illness with 6 months or less to live and a physician has certified that hospice care is appropriate.
- In New York, you can opt to receive hospice care in settings of your choice such as your home, in a hospital, or nursing home.
- Under federal and state law, hospice care must be administered by a coordinated team which may include your doctor, the hospice’s medical director, registered nurses, certified home health aides, licensed social workers, pastoral counselors, bereavement counselors, rehabilitation therapists and volunteers who provide support with day-to-day life challenges
Make advanced care planning a priority in your health care to ensure your wishes are understood.