I'm going to share a few things with you what's coming up in the months and we do have speakers that we do. >> We have a one month we got to find out what's going to be before we do. So anyway, uh December, as you know, most
people come all the time in December, December 2nd, we're going to have our annual Christmas party right here. And we'll have a shot meeting before that, there will not be any speakers involved. It will just be us. And the ones that
want to stay for the Christmas things we do, all you have to be involved is $10 gift. And uh I was told by Joe that say say this no
>> gift card >> gift card. She said no gift cuz she doesn't want any. So she probably won't give it. >> Anyway, so that's what we're going to have. going to be the election of uh offices and the only offices we really
be doing is the normal ones because the treasurers D. She's still treasur on this, aren't you? >> Yes. >> And so now has enough. So she unless I ask her, she doesn't have to be here for
that. But we'll be looking for a secretary. to see if the secretary wants to stay had or she know and we also look for a chairman if the chairman wants to stay on whatever happen but that's when
we have meeting uh next month December it's on the second and uh January we have some people that want to come in but I don't know I'm not sure at the moment what January do you have one for January special
>> yes yes we do um But we'll we'll go to Jan and February because we're not quite sure. >> Okay. >> So any fill in for January needed and February the moment is going to be on
director at the library. Uh Dylan >> Dylan Dylan >> Dylan is >> Dylan. Yeah. >> Yeah. I met him for a while. He's seemed like a great guy and he's had a good past career on a lot of different
things. So, uh he said he would take it either January whatever one we needed from January February. Then we also talked to the uh Chris where Chris >> She's outside.
Okay. Chris is going to see what we can do about the comfort dogs again. Where are the comfort dogs then? And Chris is also has other things lined up which we can get started for our first year or in the spring. Uh talking about the the
puppet dogs. >> Okay. >> If if it's available. Anyway, Chris said she would say about >> Oh, absolutely. I'll look into that here. >> And I also have two women uh one of them uh uh I think both of them know Darlene.
They're from the Social Security office. One will be on the uh the new laws and social security starting up. And the biggest one that I want to read is that uh they claim in news, newspapers and TV
that as of 2034 there will be no more social security. So that is something that they can't eliminate that. That to me somebody's got to get off the rear end in Washington and do something about it. That's that can't be done. And the
yellow one is on some of the new laws and uh social security. That's a different woman. >> So it's a change. >> So anyway, that's all I want to say today. And Dene is going to take over because she has the uh speaker for today. And Jeanie Queen who was working
with Darene. She's home sick. That's it. Darene is >> good morning everyone. Good morning. We're so glad that is able to join us today. Um, Ellen is the president and CEO of Honorary Choices Massachusetts.
And Honoring Choices Massachusetts I met some time ago back in maybe 2000 uh through the Shine program. And I was fortunate enough to um utilize the uh honoring choices um uh tool books and
planning for the future of planning in in terms of um conservative uh uh guardianship and conservatorship. Um so I thought I knew it might be a nice idea to have Ellen join us today to talk about questions that come up often in in
um in the office. And if if you can't get it from the second hand, I prefer to get it from the first the first choice and that is Ellen. So as I mentioned um Ellen had she a former uh she had a former law practice and and she focuses
on the guardianship as well as conservation. Um Mr. Mr. Po oversees all aspects of quality choices and convenes the New England health and living collab collection and consumer health equity advisory group. She chairs the
guardianship serious illness advisory group co-sponsored by Massachusetts housing hospital association and I want to welcome Ellen and this is our first time having a webinar which is it's a zoom meeting so um Ellen will present
and um provide us with information and also I I have access to things and we can print off things for you as well but then you can actually it's interactive so that means that you can ask she's And you know there's other additional
things that you need to so you want to welcome. >> Hi everyone. Hi Darlene. Can everybody hear me pretty well? >> Yep. >> Yes. >> Yes. >> Okay. Good. And I can see most of you which is unusual for these two meetings.
And and as Darlene said, you know, we some of this information today you're going to know it's going to be familiar to you. Some of it might be a little different. But we always like to stop. I'm gonna stop periodically and just see what your thoughts are. If you have questions or if things are different for
you than I'm talking about, then we'd like to know what that is and see how we can uh Darlene came to me and said, "How do we how do we do this all as a community? How do we make sure all of our first responders and and all of our healthcare people can know your choices
for care and can honor those choices?" And that's what we do in online choices. Um, but I'm so happy to be able to work with all of you and the community to say what is best for you, how is it working here? Um, and how we can support you. Now, darling, I see that this is this is
people from the community. Um, do we also have other folks in the room? I just want to be I can't see everybody. >> So, we have we have individuals from the district attorney's office as well as the sheriff's department. Please
Oh, thank you. I love that you all stand up. >> We have our preserve as well for the senior center and that's official. >> Yeah. And so this is an interesting webinar for me to do both at the same time. A lot of times we just offer a
webinar to just everyday folks. But what I love about this is we might also be able then to hear some of the other issues around um you know what happens if somebody gets sick and EMS has to come to your house. So how does that work and what what can we do ahead of
time um to make sure that that's going to work for us. And so that's some of what we're going to talk about today. Um, and then okay, let me stop periodically. Um, I think I can hear you, but darling, it's up to you. People can raise their hands, and if I can't
hear them, you can just help me figure it out. Sound good? >> Yeah. I just have one more thing. Um, Chief Wam actually just joined us from our Halifax Fire Department. And this this week actually has been an unusual
week for here in Halifax. He had a large fire um and a lot of life was lost. So he has um he dealt with that and handled it very well and we're very fortunate to have the police and fire department behind us in the street.
>> That's wonderful. Welcome everybody. So, we're going to do a presentation here that kind of talks to all of you as everyday people, consumers, and we're also going to include some of the things that we know in terms of responding in ter under Massachusetts law and under
the protocols of the state for EMS. And then let's, you know, figure out how we can help you make this work better. So, let me put up the slide deck here and um we'll we'll go through some of these slides here.
Okay, everybody can see that. Yes, darling. >> Uh, yep. Maybe a little bit bigger. I think >> that a little full screen here. >> Just a little. That's a full screen. >> Yeah.
>> Well, there's a lot of words in it, so you can just listen as well. Unfortunately, it's a Yeah, >> you can tell me when you're ready. >> Okay, that looks good. >> Okay, great. So, I'm Ellen Dello. I I finally set up a former uh attorney um
and I closed my law practice about 13 years ago um to start honoring Choices Massachusetts because it was just so frustrating to me that people of all ages um didn't know that they could do a free document called the healthcare boxing. And it is one of these
wonderful, highly protective documents for people to say, "If I get sick tomorrow, even if I'm going to get better next week, I'm going to I'd like to choose a person to be my advocate. I'd like to choose a healthcare agent so that a can come into the hospital and
talk to first responders and say, "Here's here's what I want you to know about this this person, and here's what they'd like for care." and in this crazy system we have in healthcare be a big advocate to be there to get that care for you and that is really this
wonderful thing under Massachusetts law we get to do that and we can do it for free and we can do it ourselves and it really does help all of our care providers to know who that advocate is who that agent is so what was really bothering me I was a guardianship
attorney so that's the next step if you don't have an agent and you H and sorry, you haven't done your healthcare proxy. Uh in this state, the court then steps in to say, well, that person still needs care. They can't make decisions for themselves, so we need to appoint a
guardian. That happens in a court process. And we try really hard not to get there if we don't have to. And so that's why I closed the law practice. I said, "Look, I'm going to put up a website that's going to tell people what their rights are to do these documents
and to get good care every day, not just when you're sick, not just at the end of life, but really, you know, as we go through life. Um, and then uh and make sure those documents are free and downloadable for everybody. So, that's part of what choice's mission is. And
today we're going to talk about two of those documents uh and and just all of them generally but focus on the healthcare proxy the most form medical orders for life sustaining treatment and we'll talk more about that and what happens in medical emergencies and when
darling came to me she said there's this great book in in healthcare group but um uh come and talk to us about how maybe we could work together as a community and how we can help how honoring choices can support the work you're already Okay. So, this is what we're going to
talk about today. My hope today, at the end of today, is you feel like you have the best information there is, reliable information, accurate information that helps you. It helps your community get you that best care every day, every single day, and in a medical emergency.
So, we tell you a little bit about other choices. We have a program here called Who's Your Agent? And it's a a simple structured thing that everybody can use. We'll go through those five planning documents that are available to you to make your own plan. We're going to focus
on the healthcare proxy and what your health care agent's decision making authority is. It's the agent has a lot of power to make decisions, but they also need to do it to be able to help your first responders around you. We'll
talk about the MULES form, the medical orders for life sustaining treatment. That's what MUOL stands for. And I'll show it to you and how it works. And just I I would love to go through just a little bit through some of the EMS protocols about what happens when a
first responder comes to your home or to wherever you're sick and how we can be prepared for that. Um the state is going to move from this mul form medical orders for life sustaining treatment to a pulse form. Now, all that really means
is we're going to get a new form that I think is going to be better for all of us. That form is specifically to talk about your choices when you have a series. So, it's we don't use that form until we're at that point where our doctors, you work with our doctors and
our clinicians and we're in a different phase of life and then we can make some choices for end of life care and life sustaining treatments. That's one form and and but it's an important form and we'll talk more about today. Um and then
finally just what resources we have that you might want. Um uh everything is free and downloadable on our website but central what we do is we work with different partners especially the council on agents right across the state because everybody's a little different
in terms of what they have and what they need. And as I said I'm going to stop often here for some questions. So this is what we do with all your choices. I hope you can see this. Basically it's a consumer organization here and we say it's your healthcare and
it's your choice right that under the law in this state which is very powerful says that every adult everybody in that room can really direct their healthcare choices can say you know what this is what's right for me. this is what I want for care. And we can write that down on
these Massachusetts planning documents to make our own personal plan. And it's not just about advanced care planning documents, you know, but it's about these documents are helping people get good care right now today as well as over their lifime. So we work with
government. um just thinking about how do you get the best care, how do you stay well, how do you manage chronic illness and and then how do you live well? So that whole trajectory is what we think about.
So in addition to everything that's on our website is for consumers, it's also there for all of the care providers that we work with a lot of partners at. We have hundreds and thousands of providers and the whole idea is we want to give
you and give everybody access to these planned outs and so this wheel of people are is everybody we work with primary care doctors all our community groups we've been uh very fortunate to work with all of the counseling agents for a
very long time we work with hospital staff and rehab nursing facilities home care you can see right away the wheel anybody any care professional who you come into contact with who can have a bit of a conversation about
um what would you like for care in these documents. So we also support all these partners with events and documents and it's been a really great journey for the last 13 years. I had no idea this was really going to be such a need and um
was still still very powerful. Um the partners take the tools and they help people have conversations and they've had over 3.5 million at this point in time. And we do staff trainings to get make sure the staff know the same thing
I want to tell you today. Um and uh and and consumer webinars like they're doing now. So that's a little bit about choices. But whether we're talking to you as an everyday consumer or we're talking to
nurses or hospitals or or or fire or police, we say the same thing. We say that everyone is on this healthcare journey. Everyone wants the same thing to get the best possible care. And everybody needs to plan. and that
you writing it down and making a plan, it just becomes your personal road map to say, "Let me tell you a little bit about me. Here's what I want if I get sick. Here's who to contact. Here's the kind of care that, you know, I'm looking for to be able to get that care when we
need it." So, we we need to tell people what we want so that they know our choices and those. And that's what the plan is about. So I wanted to start here because no matter how long I do this work I find people don't know that they have these
basic rights. Every one of us who's 18 and above is an adult and we have no matter what in healthcare we have a right to get information to make informed choices. And sometimes this doesn't work as well as I hope. You
know, if I'm I was sitting at my doctor's office the other day and she wanted to tell me about a new medication and I couldn't understand a word she said to me. It was in some language I didn't get. And then she said to me, would you like to do that? And I said, you know, I didn't understand it. So if
I don't have the information, I can't make that choice. And that's what's important. And as a as a patient, you can always say that and always say, "Look, you need to explain this to me in a way that I can understand it." And that's one of your rights that's in the law. Um, you don't have to make any
choices until you have that information. Everybody has a right to say yes, I want this care, no, I don't want this care. Accept and refuse treatment. It's totally your choice. The law in Massachusetts is very specific that everybody uh who's 18 and above can
choose a healthcare agent. So that's the person the agent is the person you choose to make decisions for you if and only if you can't make those decisions for yourself. Now, where we're finding the agent is really most powerful is
when someone gets sick for a short time like a pneumonia or or Boston gets hurt and they're the agent steps in to be able to help them get good care until they get better and then the agent steps right back and the person still holds
their right to make their choice. So in this state it's very important that when you choose somebody can be a friend a family member someone the council name that we write their name in a document called the healthcare proxy in this state you have to actually appoint that
person in a document in a lot of states around us it's not true but here we do and then we have a right to use the other planning documents I'm going to show you the other four today pretty quickly just so you get a sense of what they
You can use those to make your own plan. And the whole idea here is that the people who care for you and and all of your first responders can see those documents can know what you want and do their best to get you that care.
But even and this is for some of the other folks in the room as well. You know, even though we can tell you the law, we also know that things can change that every organization has their own policies. So things might change when you get to a hospital or a nursing
facility or uh a rehab, but you should know that those are your basic rights for care. So we have this program here called who's your agent? And and that's where I wanted to start with this idea that everyone has a right to make these
choices and one of the first choices I can make is just to choose a person who can be there for me, who can be my advocate if I get sick. But that's what who UA is about. It's this structured approach. We use the same language and
the same tools whether you're a consumer or whether you're a care provider. Hoping then that we can clear up a lot of the misconceptions about and just things that are wrong about the law and so that consumers and
care for professionals can really talk better together. So we have two toolkits. Everybody can have one of these. are free and downloadable. The getting started toolkit has been very popular and that's just starting a simple conversation.
One of the things we we've learned here is that we don't have to always talk about end of life care. You can just talk about how you doing today and do you have a healthcare proxy um to make to pay someone to be your advocate and
if you don't what do we do about that? One of the things we can do is to use another document called a personal directive. And I'm going to show you that today. And then after you have that simple conversation, you can start to build on those conversations with your care
providers to manage chronic illness and live well with serious illness. And that's in the next steps toolkit. So I just want you to know that the next steps is they're both on the website, but today you can just know that they're there and you can take a look at them
later if you like. So, it can get a little confusing in Massachusetts. We do have at least five documents and it's hard for people to know what they are, what they do, when to use them. First, I want to say that planning is
all voluntary. You don't have to do it, but it certainly helps your loved ones and it helps your care provider to know what you want. But you don't need these documents in order to be treated or admitted. But again, sometimes with our organizational policies, they'll say,
"We require a healthcare proxy." So, it's always good to do this if you can. So, in that getting started with um you'll see a healthcare proxy, which is that it's a legal document. We're going to go through it more in depth, but basically all it does is say, "I have a
right to make my own decisions, and I'm transferring that right. I'm giving that right to this other person, to my advocate, to my healthcare agent, a person I trust, who can step in and make decisions for me if I can't make those
decisions myself. They're healthcare decisions, they're personal decisions, but it's a pretty simple document and it's really powerful as well. Then, honor choices uh offers this document called a personal directive. In this
case, um, we we have some type we call this document a lot of things. Sometimes it's usually called a most usually often called a living will, but it's personal. There's no law really behind it, but I'm going to show it to you. It's such an important document because it gives
instructions to your agent or to your family or to your first responders around here's what I want you to know about me and here are some of my instructions for how I'd like you to treat me if I get sick. Now, since it's
personal, it's not legal and nobody's really bound to use it. But we find that our doctors really like it a lot because it tells them something about the human wishes. So both of those documents are in the getting started toolkit and
that's really all you have to start with. Um of all the things today we're just going to focus on that and then know that if you've done that terrific. Um and if you want to move to the other documents sometime as you as you go
we'll tell you about those other three documents. very quickly. The durable power attorney you may have heard of that's actually a legal document and it does uh one thing you get to pick a person to be your
financial decision maker. So the healthcare proxy is a person you choose you pick a person to make healthcare decisions but the durable power attorney is different. This is a person to help you make financial decisions if you're
not able to do that or if you just need some help, someone to manage your money, to write checks, um to be able to keep safeguard your money in your property. And that document we typically say that please do with an attorney. We can talk
more about that. I'll show you the um the fact sheet we have on that. And the last two documents are actually called medical orders. So, you can see why it's a little confusing here. We have legal documents, personal documents, and medical orders. Most of you out there
have heard about the DNR or the it's typically bigger names, the comfort care, do not resuscitate order. Um, and it it's a medical order you do with your clinician. So, medical order only comes from a doctor or or a licensed clinician
that you sit down and you talk with them. Typically this is done when somebody has a serious illness and the question becomes if your heartbeat and breathing stops tomorrow what do you want us to do? Would you like us to attempt to resuscitate you and to get
your heartbeat and breathing started or would you just like to die in it comfortably and get that comfort here? And that's a decision you make with your clinician in the medical order. And we'll show you that what that looks like a little later on.
About uh 14 years ago, this new document came into the state a little longer now. Uh the short name for it is mult but the longer name is medical orders for life sustaining treatment. And what it basically did is it took the
do not resuscitate order and put it in this form and then it added two more decisions to make if your heartbeat if you have a serious illness and then one day your heart beating stop or or you get to a point where it it's a you're in
a respiratory arrest or cardiac arrest or you're in a position where you need some help. You need to make a decision. So, we'll show you what the multiple does, but the decisions there are um to uh uh you again you do this with your
doctor. You sit down, you talk about your health at that point in time, say I have this serious illness. What happens if I get into trouble? Do you want us to resuscitate you? Yes or no? Would you like us to help with breathing, with
ventilation if you can't breathe on your own? Yes or no? And the third choice on that form is for people who are quite sick and may be in a hospice situation. Um and they they're tired of going back to the hospital. Um and so they say
please don't transfer me um to a hospital situation. So I want to show you that form. I just want you to remember these last two forms are really they're not for everybody. They're for people who are have an advancing illness or a serious illness and still have that
very sacred right to say I still want to choose the treatments I get at that point in life. I'm just going to stop for a minute and see if any initial questions come up or thoughts about the documents. I just threw a lot of information at
you, but this is what we we work with at Honor Choice. Any thoughts about this document, please? the way they work in town. We're good so far. Okay. Um, so those are the five documents and
all that information is on our website. We have downloadable fact sheets and actual documents for for for the getting started. Okay. And what's really worked here well is we just said, you know, everybody in the
state, every single person can start to make their own personal plan to just have a simple conversation. Now, you may have already done this, but we have this kit called the getting started. We hope it's as easy as one, two, three. You can download it. The first step is about
choosing a healthcare agent. If you can choose an agent, a person you trust to make those decisions for you when you're not able to refer. We do that first. You put their name, you put them in a healthcare proxy.
And then step two talks about, you know, the real um important things that are important to you, what matters to you. And you can use this personal directive to actually write down um what's important to you, what kind of care you
want and don't want. So it becomes instruction for your healthare. Yeah. >> Well, what they were doing coming and saying, "Let me write down what was important to me here. Let me give
instructions for care and then to um people who are important in their life and they also can share with their primary care doctor to say if I get sick, put this in my medical record so that you know what it is that I want forget."
so that you can use that personal directive in a couple of ways. But also in the toolkit, step three is just um other tools for you to talk to your care providers. You know, as soon as you do a document, you got to give it to that provider, let them know what you
want, and then the provider can put it in your medical record. Um, it's great to have a healthcare proxy, but it's not going to do you much good if it's in your drawer or on your refrigerator unless it's also in the medical record.
We've got to tell our providers and our first responders what we want for care. So, that step is really important and sometimes people just don't, it's not easy to do it, right? We have to get it to our doctors, get it, they they get it in the medical record for you. They
don't scan it. But that's the toolkit that everybody can start with. Uh I'm not going to go through it in depthly today, but again I'm happy to talk more about it if you want.
But don't really talk today about um just what the authority of that agent is. It's a very powerful document that healthcare boxes. So you choose a person to be your agent and that agent has a job. That agent has powers.
So first to know right as he talked about that process of reelecting it. So anybody who sees it, doctors, nurses, EMS, anyone else has to honor it. They have to assume it's valid, a good
document, and say, "Okay, on this document says who we should call, who the agent is to to help make decisions about care. You can do it yourself. You don't need a lawyer. You don't need a notary. We're going to show you the document in a minute. And if you haven't
done this, um I'm happy to help with that. And and Darene, we're happy to think about ways to u bring it to the CLA as well." Um, and just the one of the big problems in this state is that someone will um,
we had a a daughter call me the other day about her mom who was sick and wanted to do a healthcare process. And the daughter said to me, well, do we really need to do this? I'm just going to take care of her. I just make all the decisions for her. And I said, you know,
you may do that, but you don't have the legal authority to do that unless she appoints you in that healthcare proxy. So in this case we can't just say oh my husband or my wife or my friend they'll make decisions. We really need to give them the power to
make those decisions and their name has to be written in that document in that healthcare card. So what does an agent do? Well that agent healthcare agent has the same power that you do to make any decisions
and all decisions about your healthcare. um any personal decisions and when I mean personal I mean what kind of care do you need um and they also can make decisions of end of life care or decisions about what kind of care you
want at the end of life we that's what I mean is agent has a lot of power which is good you want someone helping you or someone you trust you can also in the healthcare processing limit some of those powers and I'll show you how to do
But the healthcare agent can also make changes and can and can uh tell others um they can tell others that you know what if we've done these other documents I don't want to use them anymore. So the
healthcare agent can come in and make changes. Um, and that's again, if you're not able to do that, then your health care agents in charge and they can change. Uh, they're lying about um, uh, making medical decisions. The agent is always
supposed to work with the doctor. Okay? You're always getting information from your treating doctor about what's best for you, what kind of treatments are available to you, but it's the agent who makes the decisions about that.
Um, sometimes family members are really surprised to learn that again they can't just come in and to to an emergency situation and say, "Here's what I want you to do." And this unfortunately happens a lot with our uh first responders and our EMS teams. You know,
we have kind of upset family members. When someone gets sick, of course they're upset. And sometimes family members can have a lot of opinions about what to do next. And this is why it's important to have one healthcare agent to choose one family member or one
friend to say that person has the authority to make decisions for me. So family members are often surprised to learn that they don't have the legal authority to make decisions unless their name is in that healthcare process. Um, so we do talk a lot to families who
say, "Oh, you know, my my daughter will make this sweet, but and she can try, but if another family member objects to it, says, "No, that's not what I want for mom, then we have a problem, right?" Then the doctors don't have one what
someone called a coach um or a agent to say, um, I'm the legal decision maker. So that's another reason you need one more point. Um and and it's very easy for an healthcare proxy to be valid. I'm going to show you how to assign the data to
me. So I brought this report. This I'm hoping you can all see this, but also for the um fire and EMS folks in the room and others um and from the other departments. Does this follow what your
thinking is on this? Um, are there issues that come up with this when you're out trying to help people? I'll just stop and hear if there are comments about that question. Follow protocols. >> Yeah. >> So, yes, it does follow protocols. Um,
obviously we want to make sure that these documents are updated at all times because, you know, what you think you have on that paperwork may change in the future or you have thoughts about what you put on that may change in the future. You know, for us, uh, when we arrive on scene and we see that
documentation, whether it be most of the DNR, public health care, whatever it may be, uh, the healthcare proxy, there's a couple things that come into play is a, we need the proper documentation or else we're treating the way that our protocols are to be
treated. Um, so for us this documentation is extremely important because if your wishes are that you want to be treated in a certain way and that paperwork is not present to us, it doesn't exist. Okay? So when she's talking about all these pays that are
here and you decide on one thing and you change your mind, make sure you update your paperwork. Okay? um because we need to see that paperwork to confirm that a someone is your healthcare proxy b on most or whatever it is what your wishes are if we don't have that then it's
implied consent and we treat towards our protocols okay so yes it does follow up >> I just comment thank you really important to keep these updated and we'll show you how to do that as we go and I also appreciate you saying how
important it is to you to have it um people don't always know Was there another question for me? >> Yeah, Ellen, I do have a question. Um, doesn't necessarily have to be on a piece of paper. It's it's came up with a question when I was doing my clinical
work. Um, there was a question that they uh EMTs uh showed up and the gentleman had do not resuscitate tattoo on his body. No, >> I'm just asking. And it was just interesting. I'm like, well, does that mean it's a legal? You know, this is a
do not resuscitate tattoo. Uh, you know, I'm just kind of throwing that out here as a little bit of interesting. >> I appreciate the question. What the hell were my son and he was telling me a lot of people were getting tattoos and unfortunately
it doesn't show up in the law that way or the protocols that way that a tattoo will do it. Um, so I think as that I'm sorry I looked up the chief I you're so minimized it's hard for me to see. I think his comments were they need to have the paper. They actually need the
form on the document in their hand. Um and again cuz we what and the other point that he made was that person could change their mind, you know, and not get the tattoo. >> So that's why it's important to have these papers updated and really easily
available for anybody um that needs to to find them. Thank you. I've also been asked lately if people sometimes take a picture on their phones of their healthcare proxy and is that valid? Again, it's not in
the law. The law is not saying that that that first responders and hospital folks can accept it. um that becomes a choice of the usually what I'm hearing from the hospitals if they can download that onto
a piece of paper from your phone then they have the form right and then they can honor it but again we're still at a point where you have to use the paper and we have to show that paper and give that paper to others. Any other thoughts about this?
Okay. Sorry for so much wording and language. We're trying to give you both both sides of of this. So, I really appreciate the comments about how this actually works. So, here's the online choices healthcare proxy. You can use any healthcare proxy you want. Anyone that comes from your doctor, your
hospital, we put this up on uh our website so that people can have it for free. It comes in um um 16 languages right now. Um and I I want to I'm sorry it's so little here, but one of the
things about our healthcare provides one page and it's simple. Um I can just run through it fast, but as you can see, number one is you put your name down, your address. That language underneath it is just sits the law in Massachusetts
say this is a valid healthcare proxy. In number two, you put down the name of your agent. Who did you pick? What's their name and address? How did how do people contact them? So any way, you know, this is your document. You can put
down anything you want here. Somebody has a Instagram or somebody has a an email. Phone numbers are best, but we find people have very different ways to be contacted these days. Number three is if you can pick a backup person or an
alternate healthcare agent, terrific. And that means if um your if your first healthcare agent can't be found, that alternate agent kind of steps up and is able then to help you. But a lot of people can't choose an alternate. So
that's okay. You can just leave it blank. It's great to have two if you can. And number four, that's just giving your authority. That's saying I have the right to make any and all decisions about my care and I'm giving that right
to my agent. And if there are things you want to limit or give some instructions, you can write them in here. Um but all but if you don't if you just feel like you're you know you want to give your agent the power to make those decisions,
you leave it blank. And then the simple thing now is in five and six. This is the only trick to this document. You're going to sign a date, but before you do that, you need to have two people standing next to you to anybody who's 18 and above to act as a
witness. And all the witness is doing, it can be anybody in that room, can be a witness to say, I'm watching this person sign this form. They look to be about 18 years old. Um, nobody's making them do it. and and and they look to be a sound
line. You you don't have to do much to that. But the so how it works is if this was my healthcare proxy, I'd have two people standing next to me as witnesses. I would sign it and date it. I take a pen to witness one. They put their name in there. They take a pen to witness
two. Put their name in there. You have a valid healthcare. Now, one other thing to know is that witnesses can be anybody, but they can't be the person you choose as your agent or your alternate agent. So, you can't
be a witness and an agent at the same time. So, that's the only trick to this document. And so, and you can see how easy it is to do. Number seven is just optional. Some of our doctors have said they really like to know if the
healthcare agent accepted the job. if we talk to our agents about what we want for care. So sometime after you um do this document, you can ask your agent if they want to sign it. Um don't have to, but we're finding that the um the
doctor's not going to like it. Questions about the question? Um, very easy to do and right on our website. Okay. And now I'm going to go back to the first responder because this is what uh Darling asked me to do. We're always
very aware of working with DMS and the protocols what they have to follow um when they're on scene. And we help to develop this this law. So it's very close to me. This part of the protocol. So if they let's just do it this way.
Let's say someone in your household is is uh um has a serious health issue and it may be you know their breathing is compromised their heart their respiratory their heart is in trouble you call EMS um and they come to respond
and and if anybody is there from EMS I'd rather you tell this story than me but please please contribute as we go. So they what is EMS going to do? Everything they can to get you um stabilized, to get you
treated, and to get you likely then if needed transported to a hospital. So what happens though if the health care agent is standing there? So say that I I'm in trouble here in my house. My husband has been appointed as my
healthcare agent. he is now going to speak for me and he's and what he has to do uh is he has to show the healthcare proxy. He has to put it in his hand and say I'm the agent. Here's the healthcare proxy and here's the decision I want to
make. If it's different than um than fully treating people, the agent can tell EMS um what those instructions are, but it's very important that they have a document in their hand on a scene. Okay?
So, what if EMS comes to your door, they're going to assume that the healthcare proxy is valid. They don't have to check it, right? Protocol. Um, but if I'm the but if my husband is that healthcare agent and he can give verbal
instructions as long as he has that healthcare proxy in his hand and he can say please treat her or you know what I'm going to refuse her I don't want you to transport her and he can do that or he if there's a mul form we'll talk
about that um he actually can give instructions to say follow that m form or don't follow that m form So this is just in in terms of the everyday average consumers in the room there. This is why it's really important
to have a healthcare proxy in your house. Have a copy. Have a couple of copies. Um so that you can always um give that to the first responders to say here's even if your agent isn't there say here's my healthcare proxy. You can
call this person. That's my agent right there. But if the agent is there, they can give some instructions for care. And does anybody want to comment on that? It's a little hard to translate this over um over a Zoom.
Did anything different happened than that? >> For the information, no straightforward. Did did you talk about um whether the healthare proxy said the only thing in the patient? >> That's what we're discussing. >> Yeah. >> All right. But as long as the if the
patient is still able to speak for themselves, we'll take the patient's word over the proxies. >> Right. Sorry, it's hard for me to hear you. Did you say the patient can talk for themselves? >> If the patient is still coherent enough to speak on their own behalf, we're going to go to the patient's wishes versus the proxy.
>> Absolutely. That's a good point. Um and that's not that's absolutely true. The first point, right? The person can always themselves say, "Here's what I want you to do. Here's what I don't want you to do." Is that correct? >> That's correct. Yes. What we're saying
is that if we show up on scene, there's a healthcare proxy, but the patient itself requests something different, we've got as long as the patient is in the right state of mind, can answer questions appropriately, all that kind of stuff. If they go against what the healthcare proxy says, it goes back to the actual patient.
>> Right. Okay. Terrific. Thank you for that comment. Right. Again, that goes back to our choice, right? What's your choice at that point? And as long as you're able to talk about it, that's great. A lot of times people may not be well enough to do that. And so, we want to get them to that healthcare agent as
as soon as possible. Um, but we and this is where it gets tricky. Um, we we work with a lot of people from EMS and we hear a lot of really tough stories about them doing their best job to get you treated and usually to get you to the next step to a hospital or where where
is needed. Um, and sometimes family can get involved and if there's a lot of family in the house, it can be difficult to say, you know, no, I want you to do this, no, do that. And there, you know, it complicates the problem. So again, if you can choose someone to be your agent,
then that person is the decision maker. If you can't make those decisions for yourself, now the the um it sounds like you all um have been through this and know it, but a lot of our communities don't have this information. They don't know if they need to have a healthcare proxy in their
hand or if the adult can't make decisions. So, um, again, it's terrific that you all have been through that. That's part of what we're trying to work with these days. So, this might be fun, too. If you have a healthcare proxy, this is a lollipop card that's been very
popular in the last few years around uh putting you can make it yourself and you can put it in your wallet. And basically what it says is I have a healthcare proxy so in an emergency call my healthcare agent. and it just gives you that extra degree of help. Um, we had a
gentleman call us recently who he was shopping in a grocery store and something fell and hit his head and EMS came to help him and he really couldn't focus. You know, he had a concussion. Um, so they looked at his wallet, not
only did they find his ID, but they found his wild card. And in that town um they very generously just uh the daughter's name his daughter's name was on the card saying the daughter wants the healthcare agents for me told the daughter and said your dad's here we're
taking care of him we're going to go to the local hospital you want to meet us there and it was such a great experience and so that's what's been happening with this card. So it's on our website and it looks like this. You can just download
it onto a regular piece of paper or print it on a regular piece of paper. It looks like that long rectangle. And then you fold it in three. And it shows you the instructions will show you how to fold it. First we sorry, first we cut out the rectangle. Then we fold it into
three. And on the inside you write your name and the name of your agent and some phone numbers. It's been a really great bridge to especially in communities to know let's look for the wildfire. Um,
>> so what if you or someone who's not able to >> just this is just a humble request for your wallet card. >> Sorry. on your form on the wallet card on the computer screen. Can people free type the information in or is it just
print only and handwrited? >> Just print only. Um, we need to get this bigger. So, it's on our website under the wild card and uh you just print it on a regular piece of paper and cut it out. >> Oh, no. That's understood. But if people had the option of typing the information
in, >> go ahead >> to make it more legible. Yeah, because with all due respect to everyone in society, handwriting is not uniform. >> So if people were able to type the information in >> clear
on the card, if it's legal, will they accept printed versus? >> Yeah, there need a signature on it. But if you're just looking to give information on this card, >> if they people could type the information in prior to printing.
Oh, I think I apologize. It's hard to hear because >> I'm trying not to yell in the middle of the crowd as well. I apologize. >> This is not good for me. >> So, we can probably type it in. Um, you know, we use it figure out right or
right legibly. Number one. Um, and it's not I do want I thought I heard the word legal and I do want to say that this is not legal at all. It's just information. That's all. So, um, nobody's really found except that we have found that for
for doctors in the emergency room and for first responders, it's just this is a quick way to know who the healthcare agent is, >> but you still have to have a healthare process to make this work. I think if I'm hearing you right I'm
sorry you're giving me an idea which is that maybe I'll even have a fill in one on the website so that we can type it. Is that >> you? Yes. >> Okay. It's a great idea. Thank you. Um I think we will we will graduate to doing
that as well. >> All right. Terrific. Um, so what if you're not able to choose a native and you think about 30% of the people in the in the state just can't. There's just no one to appoint. You live outlived
everybody and it's hard to know who to appoint. um or adults have a illness or disease which limits their decision decision making and they maybe can't fill out a healthcare proxy or we're finding with a lot of multicultural
families um they just prefer to start with a conversation about what do we do if if grandma gets sick and the family talks about it and then maybe we'll appoint the healthcare agent later. >> But what we say to these folks is if you
can't pay a that's okay. I don't it it would it's preferable but so what you also have another document here called the personal directive and this has been this is a personal document it's not legal right there no nobody actually has
to follow it when they see it although in Massachusetts we do have a law that says if your doctors know what you want the care they should do the best so in this um and it's not legal This is
where you write down what matters to you. You know what's important to you. Here's some instructions for care. Um so the first page needs a fill in the blank. You can tell people what's important. You can say things like, you know, if I get sick, this is the kind of
care I want. If I And then number two, you can tell other people who else do you want to know if you get sick. Give them a job. Take care of my cat if I'm in the hospital for a few days. That's how this person will directly work. On the second page is it's optional, but
you can write in things about your medical condition or what you want for care if you really get seriously ill and you have to make those decisions about CPR and other things. This doesn't mind your doctors. It doesn't say they have
to file it or first responders, but we have found that a lot of our older citizens who don't have a serious illness, they can't fill out a mulch form, this is the one place they can write down what they want for care. And
again, it's a it's a real um it's been working well as a document to talk about with families and friends to say, if I get really sick, this is what I'm thinking about. So, this is your personal directory or your personal statement. You signed it daily. Don't
need witnesses for this one. Um, if you can't pick an agent, it's a good thing to do. And then go talk to your doctors, your primary care doctors, and ask them to put it in your medical record so they know what you are. So, just I know we're running out of
time here, so I just want to get to the other documents quickly. The durable power attorney is another document you want to consider. This is a legal document. What you see on the right side is our fact sheet about what a durable power of attorney is in Massachusetts.
This is the legal document where you appoint someone you trust to manage and protect your financial matters. So your money, your property and business affairs. If you're not able to do that, then you can get some help. Um, and it
protects even, you know, if you have a small amount of money or or or property, it protects it. Um, and that that person you pick can help to if you get sick, they can help get you care and pay for
that care. So, this is a document we should consider. Um, Darlene, at this point, let's talk about if you have attorneys. I know a lot of council agents have attorneys coming in and maybe you can talk about this document. So the last two documents are those
medical orders that we talked about the comfort care do not resuscitate order. This or usually uh people just refer to CMR. This is what it looks like. This is the stakes form, right? And um uh it's a medical order, right? We can't do this
by ourselves. We talk to our doctor about our current medical condition. Um and usually it's when we've had a serious illness. and say, uh, what are the benefits of me getting CPR if my heartbeat and treated are are at risk of
stopping? Um, what are the risks of that given my medical condition? You talk about that with your doctor. You make the decision. If your decision is, you know what, I just want to be comfortable, but do not attempt
resuscitation. do not to to restart my heart if it if it stops. Um don't attempt uh to to help me with breathing. If that's your decision, then you do this form with your doctor, right? Don't recess and you sign it, your doctor
signs it. This is something that EMS can follow if it's this Massachusetts form, right? And u the only trick to this form these days is that a guardian can sign it. Now, a guardian is a different person. They're appointed by the court
um to to help make uh ordinary decisions for you about your health, but they need special permission from the court if they're going to sign this form. So, if that applies to anybody, um it's becoming more common that there are
guardians out there and and um they don't have the same power and agent has. And so as I said to you in the very beginning, if you can choose an agent now through a healthcare proxy, terrific. You can avoid any legal proceedings and any going into
proceedings later on. But you can see the guardian just doesn't have the same power as it. So everybody will look at this and assume it's valid. You know, if it's a valid form, it does have dates on it. It can have an expired date. This is something EMS will pay attention
to and other and other first responders, but just generally speaking, I think they know how to handle this. The problem we see with this is um um say um I need to go to the hospital for a quick procedure and I do a DNR at the
hospital. I do the hospital's do not resuscitate order. When I leave that hospital, that order isn't valid anymore cuz that was a hospital one. And a lot of people don't know that. They'll take that copy home and think it's real. Um,
if you want to do this form, it comes from the state. Um, this is the Massachusetts Department of Public Health form and this is the one that can last um, you know, can stay permanent for me. I just want to ask the if you're in the room if you have trouble with
that if that's a misconception um or you run into that >> misconception about what the dates or what was the question sorry >> so that I'm sorry that people come home with hospital DNRs that are no longer
valid but they haven't done this form yet >> we don't usually run into that issue um usually if we do run into that issue it would be would stop treatment and contact medical control to contact one of the doctors for you know which direction the lake is doing but normally
we don't have a problem with that because we don't want any from the hospital. >> That's good to know. But in some I think in some I don't know in some towns maybe where there's a big hospital sometimes they forget to tell people that once they leave the hospital that temporary
DNR is not not valid anymore. So again if you're in a state that you want to do this go talk to your doctor about it. talk about your care, what you want, and consign this form with them. This is the most common medical order for life sustaining treatment. It's
usually pink, but it doesn't have to be. It can be white. Um, same type of idea. Uh, this is a medical order you do with your doctor. Um, the the patient or a healthcare agent can sign this form to make it real. But first, you have a
conversation with the doctor and say, "Here's my illness. What are the benefits? What are the risks? If I if my heartbeat, if my breathing or in trouble tomorrow, um uh do I want CPR?" So, you
talk to your doctor about it. You make the decision saying, "You know what? I I want you to attempt it or I don't." Your doctor fills this out. This is their order. Um and you also talk about um ventilation, right? A lot of times you
you have to the heartbeat issue and the breathing go together. Um and if you want to have artificial uh if you want to be individual or have some artificial breathing mechanisms so that you can keep living,
keep going. You can say yes, I want it. No, I don't. Your doctor fills that out. Check the box. The third decision you make is do you want to be transferred to the hospital if you get sick. Um and again you decide that the doctor or
the clinician will check the box. The patient scientist the healthcare agent can sign this. The guardian cannot sign it unless the court has said they can. So if you know someone with a guardian um that's a little different but most patients can sign it and um the
healthcare agent can sign it. the clinician signs it and it becomes a valid order that everybody follows. Now, and again, this is where it gets tricky because in the field, I know that
um that uh uh sometimes families will may know that there's a murderer, but they may not want to follow when someone is sick, right? And really never sick. And I know that presents challenges for people who come to help you with the MS.
But that's why I go back to that first really important comment there about keeping these forms up to date. You know, keep looking at them. If you do this form, keep talking to your doctor about how your health is changing. Do your preferences change. Do you want to
change the form? You can do that. That form belongs to you. Even though it has to be filled out with a doctor, those are your choices. So, I can tell you more about that. Are there any issues from the first responders there that you want to make people aware of when it comes to the mold?
>> Uh, just regarding changes, uh, it involves getting a whole new form. Don't just cross off one section and say you changed your mind. You need an entirely new form. Now, if you're still conscious and able to talk to us during these situations, we'll honor your wishes,
but you can't just alter the form as we're sitting there. you need to get in a whole new one each time you decide to change something because as she had said this form yes it's good for you for your rest of your life but you can still change it at any point but if you do decide to change it you now need to do the whole new form over again and then
once you do get rid of the old one just get it out of the equation all together cuz if we see two that'll just confuse things we can look at dates which is >> thank you and remember that this is a medical order so you can't just cross it out and change This has to come from your your
doctor. They're it's their authority that they're saying to everyone else, okay, here's what my patient wants and my name is and you follow it. So, that's a great comment about um you know, if you change your mind, you can you can
change your mind as often as you want as long as you have that ability to make those decisions. Go change it with your with your question. Yeah, I was just questioning on the back of how is it now that the post form is going to be simplified.
>> Yeah, I'm going to show you. Um, would you like to see the form the post? >> Yeah, >> I'm going to skip this one cuz I'm running this. So the state uh and I'm personally very involved with this is going to
upgrade from that mold form to a new form called pulse. And pulse just simply stands for in this state portable orders for life sustaining treatment. And what that means is once you do this form it's yours. You can take it with you from
home to hospitals to nursing facilities to wherever you need it so that people always know what you want to prepare. That's what quarter means. So very simply, in the last couple of years, Massachusetts joined this national group, wonderful group, 45 states, all
thinking about end of life care like this. So our uh office of health and human services and the age folks, the aging independence folks are reading this new charge to update the form. We're going to use the national pulse
form kind of change from a one then a new form. Um and then an exciting thing here is they're creating a 24/7 e post pulse registry which means now we're going to have putting these forms completed forms kind of in the cloud
right in a registry so that EMS can easily go find them if you're in trouble or your emergency doctor can easily find them. they'll be in this registry. They can pull them down out of the registry and they can know your choices right away. So, instead of the paper form,
there's going to be a form that the clinicians can fill out um uh electronic online with you and then they'll they'll put it in this registry with your permission. You can opt out of the registry. You don't have to do it. You can put it in the registry or you can
just keep your paper copy. So, everyone's going to get a copy of put on your refrigerator and then again make as many copies as you want. That's okay. So, um that's the moving thing and that
should help us uh be able to know what people want and then ideally it it can help us too when we want to change our minds, you know, and and do a new form should be easier to do it that way. But mostly it's going to help your first responders to be able to see those
documents quickly. Just so everybody knows that the form I don't know if the form is simpler. Some people have looked at it because it's more complicated. I like it because I think it's going to help people have better conversations about this. And they're putting out educational modules
right now putting together training for old professionals and shimmering information. That's all that comes. You're not going to roll this out till 2627 2026 27. It keeps moving. Um, but one of the also the nice things I I know
you're not that close to other states, but you might have go to Rhode Island, you might be in New Hampshire and something might happen. The states are going to start to honor the forms across the state lines. Um, we still have a lot to work out on that, but we're working hard on it. There's a lot more
information on this on the new post website and you can go take a look at it. just type in multiple so you'll see it. I'm going to ask the the first responders in the room if they have any questions, but this is the new form. Um it's it might be a little crowded. Let
me just break it down for you really quickly. So, this is the form you do with your doctor, right? You don't have to have this. This is going to be in your doctor's hands. And it's mostly the same, but I think it's better once we get used to it. The first part is just
the patient information, right? Remembering that this is voluntary. You do not have to do this, but it certainly can help. Um, if you're not able to speak to your doctors or your providers, your first responders, this form speaks
for you. Um, your name and all your information goes in there. And then you can see a says cardio pulmonary assessation orders. So this is what the patient orders are. If the patient is has no pulse and is not
bleeding, right? So this is what you after a conversation with your doctor, you choose yes, I want CPR, the doctor checks the box or no, I don't want CPR. The doctor checks that box right on the form. So that for EMS and for first
responders, that's should be easier. It should be really quick information helping them to know what to do. Now, this is the part of the form that it it's going to take some thinking and some training, but but I think it's going to be really helpful. Um, there's
a section B now, not just yes or no to CPR, but what else do I want? Um, and these are the orders, treatment orders that the doctors will follow if somebody has a pulse or they're breathing. So, you get to choose, right? You have a
serious illness. you you talk to your doctors about the benefits and the risks of of these types of interventions like CPR and ventilation and you choose do you want to want full treatments? Do I want everything? Great. That's your choice. So what you what you're doing is
saying yes to CPR in the first part and then here you're saying give me everything you got. You know attempt to sustain my life by any medical needs you got. physical treatment or you can talk to your doctor about maybe you're in a different place and you just want some
treatments. Um you don't particularly want uh to be resuscitated but you want the best care you can get to be comfortable and to live as well as you can there. So you talk about getting selective treatments, you check that box
and there's going to be a lot more information about what that means and there's going to be a lot more education on that. So remember this is just a final form but you'll get a lot more information as we go. And for people who let's just say someone is really at the end of life they're in a hospice
situation where um that the doctors have already determined that they have 6 months or less to live or you know they're at that point where they're really just focused on being comfortable getting the best possible care to live every day as well as they can. you can
check that box of only do comfort care treatments. Now, these three things have worked so well in many of the other states around us. It's one of the reasons why we're bringing it into Massachusetts, cuz even though this looks like a lot right now, there's
going to be a lot of information before this. So, when you're ready to make those choices, you can. So, this is the the big part of the form. There are two more decisions in C and D. If you're talking to your doctor and you say, "Look, you know, can I can
I do some other things? If I get really sick, can we have dialysis? Can we uh work on infusions?" Whatever your doctor you decide, you can write it in there. But EMS may not be able to help with that. It really differs in every state.
And then for some people, they have to hit that decision of um do I want to have healthy nutrition? If I can't eat or drink or swallow anymore or what do I want my care providers to do. Now, these are optional. You don't have to do C and D. You talk about it with your doctor.
You see what's best. And then the rest of the form is pretty much the same. You sign it, your agent signs it, the doctor signs it. You got a valid. It's going to go into this registry so that it's always there for you. Um, they're also hoping that with these check boxes, it's
very straightforward about what the instructions are. Okay. So, I I know we're getting past time here, but uh I just want to open this up to anyone in the room who has some comments about this. Um, if the
responders have a comment, I know OEMS is working really hard on these protocols right now. Um, but it's always open for comment. I think uh from EMS side of this just uh documentation documentation documentation I can't say it enough if
you do not have these pages we cannot honor them okay we go into houses every day go to medicals every day and I hear every day all day I'm the person's healthcare proxy because I've been taking care of them for the last 6 months that's not legal I can't take
your advice because you tell me that you're a healthcare proxy, something like that, just so you know. Okay? So, if you want us to honor something, have the documentation there. And a lot of times, I fully understand if there's a lot going on, medical issues in the home, things like that. Oh, I have the
paperwork. I just don't know where it is. If we do not have the paperwork, we cannot honor what your requests are. Okay? So, if you have uh any one of these forms that you wish to present to us, please leave it in a spot that you know where it is at all times. you can
read, it's readily available to hand to us. Okay? And don't make copies of it, but you can make copies of it for separate files. So you have some we need the original one with the signatures on it and everything else. Okay? Thank you. >> Thank you for that comment. And I I
think it and tell you the truth, it comes down to as simple as that that uh you know, we have a great system in Massachusetts, which is if we don't tell people with these forms, don't treat me, they won't treat you. and they're going to treat you as best and well as they
can and that's what we want mostly. But if you come to the point where you want to limit someone, they need those document and these forms are good at any age. It's just not for us as an age there. Um
so it's just not for that. It's for young people as well. You know, people may um have uh some issues, but also too, you just you just don't know when life takes over, right? So these are important uh things you could share with the family. Um forms that can share or
put on the website. Um and it's just something to understand. It's it doesn't um I didn't mean to bring it in as a depression thing, you know, for everybody to but just to have that um be a hunter gatherer of information and to
understand what you're you have rights in certain cases um and what you can do to um have your rights um adhere to. So um I I thank you so much Alan for everything and um we do have forms and
also training and u March I believe we're going to see you again um for training in terms of some of the forms. >> Yeah. And you know making sure everybody has these documents. The hardest thing for the healthcare proxy is getting witnesses. So if we can help you happy
to do that. I thank everybody for your time. This is the first time we make everyday people the first resp. >> Thank you. I appreciate the all the information. It was helpful. So, thank you. >> Thank you so much everyone. Have a great
day.