by Samantha Morton – CEO, MLPB
August 3, 2021
Last month I had the pleasure of joining a conversation about care planning and how relatively easy it is to take charge of one’s care-related decisionmaking. Here’s the podcast, which was moderated by Caroline Gangji of Age-Friendly Rhode Island and featured Ellen DiPaola, President and CEO of Honoring Choices Massachusetts (HCM). (MLPB is a member of HCM’s New England Healthy Living Collective and our Law & Policy Director Jeannine Casselman helped to develop HCM’s Rhode Island Care Planning Toolkit. This tool was released in April 2021 and features templates in English and Spanish.)
Individual care plans are a way to document your goals and wishes so that they can be honored by family members and the health care system. HCM describes care planning as:
“an active process to get good care that honors . . . goals, values and choices over your lifetime. [It] is both: Everyday care planning with [care team members] . . . about your care goals and treatment options to stay healthy and live well; and . . . Advance care planning to write down your instructions and care preferences . . . in case you are not able to make decisions yourself, even for a short while.”
Unlike many other areas of legal planning and problem-solving, advance care planning is relatively simple to accomplish on one’s own, without a lawyer. In Rhode Island, any person 18 or older can fill out a legal document called a “durable power of attorney for healthcare.” Memorializing whom you’d like to speak for you – if you are temporarily unable to speak for yourself – is a powerful legal tool to have in place to protect your autonomy.
Highlights from the podcast:
- Advance care planning forms – like the ones referenced in the RI Care Planning Toolkit – are simpler and easier to fill out that many other legal forms.
- In most instances, a person can complete this kind of form without needing help from an attorney. (That’s a big deal from an access to justice perspective!)
- Getting your health care proxy (or similar form) into the hands of your physician is ideal – and getting it into your medical record is even better.
- Thinking about, let alone talking about, a future – scary – change in health status can be uncomfortable for many people. But in our COVID-19 pandemic landscape, there is greater awareness that one’s health can take a rapid turn and that planning ahead might be stress-reducing.
- Planning for future healthcare-related contingencies doesn’t occur in a vacuum. People live, and plan, in broader social, economic and environmental contexts. Care team members committed to Whole Person Care are welcome to check out MLPB’s Digital Digest, which spotlights key Know People’s Rights! and Know Your Role! information in RI, MA and at the federal level.
Notably, this podcast was recorded less than a week before Annie Lowrey’s new article, The Time Tax: Why is so much American bureaucracy left to average citizens?, was published in The Atlantic on July 27.The piece frames the “time tax” as “a levy of paperwork, aggravation, and mental effort imposed on citizens in exchange for benefits that putatively exist to help them. . . . [it mediates] every American’s relationship with the government and wasting countless precious hours of people’s time.” Lowrey goes on to detail how the time tax is regressive, impacting lower-wealth people much more than higher-wealth people:
“Programs for the wealthy tend to be easy, automatic, and guaranteed. You do not need to prostrate yourself before a caseworker to get the benefits of a 529 college-savings plan. You do not need to urinate in a cup to get a tax write-off for your home, boat, or plane. You do not need to find a former partner to get a child-support determination as a prerequisite for profiting from a 401(k). The difference is so significant that . . . many high-income people, unlike poor folks, never even realize they are benefiting from government programs.”
Wonder if the health-promoting government programs spotlighted in Lowrey’s article might take lessons from advanced care planning tool design?