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Advance Directive Workshops

Oct 10, 2017, 15:46 PM by Nicole Young
Mary Lepkowsky and Joe Wheatley

Rosemary and Russ Banko discussed a will and an estate plan with their trust attorney years ago but the documents didn’t spell out how they wished to be cared for at the end of their lives. The couple wondered whether family members even knew this paperwork existed. The Bankos recently attended an Advance Directives workshop at Sansum
Clinic to create a more comprehensive plan.

An Advance Directive is a legal document that allows adults 18 and over to prepare for a time when medical decisions cannot be made due to injury or illness. 70 year-old Rosemary left the workshop feeling it was extremely helpful. “I am relieved now that I understand the situation and we can take care of it,” she admitted.

Sansum Clinic partners with the non-profit Alliance for Living and Dying Well to provide free Advance Directive workshops in Santa Barbara and Lompoc. Volunteers Mary Beth Lepkowsky and Joe Wheatley invest their time and talent to teach the sessions. Joe spent many years as long-term care ombudsman for assisted living centers and nursing homes.

His background as a geriatric care manager and member of the Cottage Health bioethics board gives him first-hand insight into the stress that results from managing a grave responsibility without any guidance. “Sadly, we sometimes see families at war with each other. Unless it’s written down, the facilities have to get in the middle of these arguments,” he explains.

Mary Beth agrees that too many people delay these important conversations, often spending more time planning vacations than preparing for the final season of their lives. She purposely shares personal anecdotes during her talks, describing how she helped her son create an Advance Directive before he deployed to Afghanistan, and how she considered final wishes with her elderly mother before she passed away. “We knew
what she wanted and it was a true gift of comfort,” says the Tri-Counties Regional Center assistant director for training and organizational development.

The non-profit provides support and services for people with intellectual and developmental disabilities. In her training role there, she regularly helps others evaluate their quality of life. “That whole approach, planning with someone on what matters to them, utilizing their circle of support, it’s so well aligned to this work,” says Mary Beth. As a strategic planning consultant for large organizations, she employs “person-centered practices,” or assisting others to have positive control over their lives. This philosophy makes her uniquely qualified to advise others on the critical life decisions contained in an advance directive.

The workshops utilize an easy-to-understand document called “Five Wishes.” It’s a practical yet challenging list of questions that reflects the writer’s values and beliefs, covering everything from whether life support can be utilized, to the preferred type of funeral or memorial plan. The first two wishes cover California’s requirement for an Advance Directive. The following three wishes cover all the personal, spiritual and philosophical issues that arise at the end of one’s life.

Workshop leaders recommend serious and thoughtful discussion with loved ones while completing the forms. Many participants often attend the sessions twice, once to learn about the directives, and another time to receive one-on-one assistance from Joe and
Mary Beth on the finer points of the document. After the directive is finalized, it needs to be signed by two witnesses or notarized in order to be legally recognized in California and 42 other states.

Sansum Clinic and Cottage Health maintain systems to scan and record these documents, and will assist patients in sending their directives to all the appropriate places, including their network of doctors and family members. What’s important, adds Joe, is having the documents easily accessible, not locked away in a safety deposit
box. “It does no good to go to the class and talk about it and then put it on a shelf somewhere,” he notes. There are also immediate benefits to finishing an Advance Directive, according to Mary Beth. “It reveals how you want to live now, what is important to you, and what brings you joy on a daily basis.”

The workshops are already making a local impact. Sansum Clinic’s Advance Care Planning Facilitator received more than 1,000 referrals from physicians during 2016.

“There is a growing openness to talk,” suggests Mary Beth. “How we define our older years is really different than how it’s been defined in the past. People truly want to maintain choice and control to the greatest extent possible.”

Sansum Clinic is committed to leading patients to resources that help them learn about and complete an Advance Directive. A doctor referral is not necessary to attend the
workshops, and all community members, regardless of insurance benefit, can take advantage of the free sessions. Joe understands the reluctance in talking about death. “The end of life is inevitable,” he acknowledges. “But the important thing is to get the Advance Directive done. It’s imperative.”