Health Care Planning, In Case of Emergency (ICE) & Advance Care Planning
Health Care Planning & In Case of Emergency
Plan for now and plan for emergencies...
Health Care Planning is for right now. It is is about getting organized so that you are in charge of your health care and your medical history. Read the blog.
The In Case of Emergency (ICE) document was developed by Patient Pathways and it serves as both a health care planning document that you can take to all medical appointments, and as an In Case of Emergency document to be kept on (or near) your fridge with your other Advance Care Planning documents (see below) to be immediately available for first responders, paramedics, and emergency room teams.
The ICE form is FREE, downloadable, fillable and printable. You will need Adobe to fill in this document on-line, or you can print it and fill it in by hand.
These are detailed instructions that we recommend you read before filling out the ICE form.
This is a comprehensive health care documentation form that can be updated as needed. It serves as an ongoing reference that be taken to appointments so nothing is missed.
Advance Care Planning
Advance Care Planning (ACP) is an umbrella term for ongoing conversations and documentation about your values, beliefs, and preferences for care for a time when you are seriously injured or ill, if you have diagnosed with a life-threatening or life-ending illness, or if you have advanced cognitive decline.
Advance Care Planning is planning ahead for a time when you will require assistance or you are not capable of making your own health care decisions.
See the detailed list of Advance Care Planning Documents, below.
Your Advance Care Planning documents should be immediately available at home (on your fridge) and at all points of medical care.
It is up to you and your substitute decision maker (hopefully, your Representative) to make sure these documents are delivered at each point of care and that healthcare teams are aware of them and following them. (If in doubt, talk to the social worker for the hospital unit or facility.)
Steps in Advance Care Planning:
• Determine your values and beliefs and preferences for future health care.
• Decide on who will be your future decision makers regarding your health and personal affairs (in BC, your Representative) and your financial affairs (power of attorney).
• Document your wishes for future health care.
• Have vital, ongoing conversations with your loved ones. substitute decision makers, and your healthcare team.
Your preferences for future care are likely to change with progression of serious illness and age. It is important to re-examine and update your documents if your health or personal relationships change, and as you age.
Advance Care Planning documents
Detailed articles are available in our Educational Blog series
Substitute Decision Makers & Representation Agreements
Substitute Decision Maker (SDM) is the universal term for the person who will make decisions for you if you are not able to speak for yourself (due to serious injury, illness, or cognitive decline.) The term for the person you legally choose to be your SDM is different in every province.
Temporary Substitute Decision Maker (TSDM) Is a hierarchy of those who may be called to help make decisions if you have not legally named your SDM.
Representative is the term used in British Columbia when you have named who you want to speak for you on a legally enforceable Representation Agreement.
A Representation Agreement is a powerful document and should be considered for all adults of all ages and stages of health, especially for those who will want their spouse or adult children to assist or speak for them. In BC, this document is the only formal and legal way to name a person who can assist you while you are capable, or speak and plan for you if you become incapable. (See the blog regarding limited financial powers and for adults whose capability is in question).
The two types of Representation Agreements are outlined in the blog.
Be aware that if there is not a Representation Agreement in place, your healthcare team is under no obligation to reach out or speak to your loved ones or Temporary Substitute Decision Maker .
Enduring Power of Attorney
In BC, a Power of Attorney is used to name a person to assist or manage your financial and legal affairs. "Enduring" means it is in place while you are capable and stays in effect while you are incapable. (Note: Your Power of Attorney document might not say the word 'enduring' in the title but there will be wording regarding capability and incapability.)
One person can be both your Representative and your EPOA but two separate documents are required.
An EPOA is only required in healthcare to set up home care services or residential care subsidies.
Note: Do not include an EPOA document with your In Case of Emergency documents but let your EPOA know where the document(s) can be found.
In BC, this is a legally binding document stating your wishes for future healthcare. You can write your own advance directive but it must meet certain legal criteria. For any complex issues consider hiring an estate lawyer.
If you do not want to be resuscitated you must also have a physician-signed No CPR order.
A Basic Advance Care Plan, Letter of Wishes or a Living Will are non-legally binding documents that your health teams will take into consideration but allows them some flexibility depending on circumstances (and that is often a good thing).
A copy of your document must be provided at every point of healthcare to ensure you receive the care you want. Consider adding a copy in your In Case of Emergency folder.
No CPR (optional)
In British Columbia, this is an order form signed by you and your physician stating that if you quit breathing and your heart stops, you do not want to be resuscitated.
A No CPR order is only in place in the community (not in hospital). The order must be immediately available for first responders or paramedics - or you can wear a special Medical Alert bracelet.
If you do not want CPR in hospital, write an Advance Directive and talk to your healthcare team who should discuss Medical Orders for Scope of Treatment (MOST). (See below.)
Expected Death in the Home (only for those nearing the end-of-life)
This is a physician signed order. Generally, it is put in place for those who are likely to die within the next three months (it should be reviewed but it does not expire.) When it is in place, and when the adult dies, the paramedics, RCMP and coroner will not be called, reducing stress for the family and caregivers. The designated funeral home can be called directly. The family will have additional time (if wanted) for special ceremonies and longer goodbyes.
Medical Orders for Scope of Treatment (MOST),
(also known as Options for Care within Providence Health Authority)
Medical Orders for Scope of Treatment, or it's common acronym, MOST, (known as 'Options for Care' in Providence Health) are medical orders for level of resuscitation and treatment in hospital, residential care, or palliative care and hospice.
If you have an Advance Directive (or Letter of Medical Wishes or Living Will), it is to be used in conjunction with MOST to facilitate conversations and decisions. Your Advance Directive will likely include your values and beliefs and other instructions, so it is meant to be paired with MOST.
MOST orders are generally used in the hospital setting, residential care, palliative and hospice care (in the home or in a facility).