Jan, 2019! Time to Reassess Your Life Plan
Are you sure that you have planned sufficiently for your life? Start to do a real plan for your life in 2019, regardless of your current age or whether you are perfectly healthy or not. All of us know that in the REAL world, accidents or illnesses can hit anyone of us at any time, at any age, and in any part of the world. Most of you, my readers, will be thinking at this particular moment “Yeah, of course, I am aware. Therefore, I had bought not one but several insurance plans!” In response to that, I say “Excellent! Sufficient insurance coverage is crucial. Well done!”
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To add on, I will like to ask you “What about your Advance Care Planning?”
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Some of you may be thinking “Yes, my loved one with dementia had done that in the hospital/clinic.” Oops, that may be an inaccurate assumption on my side. You may be thinking “Advance Care Planning, what is that?”
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Advance Care Planning, ACP in short, needs you to think about and write a plan with ACTIONABLE information or instructions for your future health care as well as PERSONAL CARE, should an unexpected event happens causing you to be no longer able to make decisions for or speak for yourselves temporarily or permanently. This plan is not the same as any of the legal documents that some of you may have had in place, such as the will, the Lasting Power of Attorney (LPA) or Advance Medical Directive (AMD). Will is a legal document that kicks in after your death. An Advance Care Plan is a personal document that kicks in while you ARE still ALIVE but are no longer able to speak or make decisions for yourself. It is an important document that is accessible to your loved ones who may become your caregiver or your professional caregivers, as well as healthcare professionals like the doctors and nurses, etc. It directs and informs them how to provide daily care for you – to the extent on how you will like to be showered, how you will want your hair to be washed, your food preferences and music preferences, etc. – in summary, your wishes and preferences. Such will eliminate or reduce the frustration of having someone provides care to you not according to your liking. Hence, it is a CRITICAL but fluid plan to put in place if you are living with dementia but are still able to make your wishes known to others, or if you are still perfectly or somewhat healthy. It is fluid because you will be able to make changes and updates to your plan as often as you like, without having to go to a professional or incurring extra costs.
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Unfortunately, only a minority of people have such a plan today. To me, ACP is like the buying of insurance. Buying insurance is meant to assure and protect you against unexpected events in life. These unexpected events may or may not happen in your lifetime, yet you have started to ensure that you have covered all your bases with various insurance plans at a young age and when you are healthy. ACP, on the other hand, is meant to assure and protect you against the expected events in life – sickness and dying. It protects you against future frustrations, protects your loved ones against unnecessary conflicts about your future care provision, and assures you of care provision that will be according to your liking. However, many people believe that they are still too young or too healthy to think about advance care. I urge you to reconsider your stand. If you have a family history of hypertension, high blood cholesterol, diabetes, and/or dementia, you have a higher risk of being in a future position that you may be unable to speak for yourself due to these same diseases. We know that dementia is a progressive disease that not only robs the person of his/her memory, also the executive functions of his/her brain, including the person’s ability to perceive accurately, verbalise and talk, and make (informed) decision(s). Dementia will slowly take away one’s ability to make informed decisions and to speak, but you are yet to be at that stage if you are reading this article. MY DEAR READERS, I urge you to start your advance care planning today while you are still able to. If you are the adventurous type who likes to live life to its fullest, you have a higher risk of being in a future position that you may be unable to speak for yourself due to accidents. Even if you are the regular guy/girl-next-door, you also have the risk of being in a future position that you may be unable to speak for yourself due to sickness or accidents. So, spend some time in Jan 2019 using our ACP template and do a real plan for your life. Click here for your free ACP template now.
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I am in my early forties with perfectly good health to-date, and I have completed my ACP. I had made known my preferences, opinions and decisions to reduce the need for my loved ones to second-guess all these should I become unable to decide or speak up one day. I firmly believe that I AM the best and only person who knows what I want for myself and should, therefore, take the responsibility of exercising my choices after careful deliberation when I am still healthy and in an excellent state of mind to make informed decisions. With my completed advance care plan, I had also talked about what I had written with my partner and my only son so that they are clear about my beliefs, values, wishes and preferences for my future health care and personal care matters. Both my partner and my son now understand that having a good quality of life is of great essence to me; therefore, I am assured that they will make the right care decision to make should I become unable to do so. They also know where they can refer to should they need instructions (the SOP, a term which some of us may be familiar with) on how to shower me, wash my hair and help me with my meals should I require them.
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I remember the incident of my late-grandfather, who hardly spoke after being diagnosed with dementia, refusing to shower for days. Naturally, the elderly man started to smell unpleasant with Singapore being warm and humid. My mummy, who was his caregiver, called me to complain that his dementia had gotten worse as he was increasingly aggressive and would raise his fist to my mummy and the helper when they tried to shower him. My grandfather had never smelled unpleasant or looked untidy for as long as I had known him. He had always been well-groomed in his long-sleeved white shirt and pants and styled his hair with Brylcreem after his shower. He even cut his hair at the Indian barbershop every fortnight until dementia robbed him of his independence. Hence, to me, it was very uncharacteristic of him not wanting to shower, even with dementia. I visited them with the aim of sorting this out. I told my late-grandfather that I would like to help him to take a shower and shampoo his hair using words and hand gestures so that he could understand better. He refused by waving his hand. I went on to explain to him that it was unpleasant to smell him. I repeated my request to shower him, and he finally relented and agreed without raising his fist. Ah, so he was resisting the shampooing of his hair. Applying my limited knowledge on how the barber would wash his hair after every haircut, I walked to the sink in the bathroom and demonstrated to him to bend over the sink while holding on to the two sides of the sink, and I would shampoo his hair just like the barber. He nodded his head in agreement. I realised that the newly-recruited helper had shampooed his hair like she was washing a car, allowing the shampoo water to flow down from his head down to his face, eyes, nose and mouth. She shampoos her hair in that manner, but that wasn’t how he liked his hair shampooed. The showing of his fist was meant to indicate his wish of not washing his hair since he was no longer communicative using words. My late-grandfather was not trying to be aggressive; instead, he was trying to defend himself against having others doing things to him that were not to his liking. This incidence showed the importance of indicating how you perform your personal care task so that caregivers will know exactly how to assist you in performing them in the manner that you are used to and are comfortable with. If only my late-grandfather had his ACP back then, this incident on being upset with the way the helper helped him in his hygiene care would not have happened. Hence, ACP is more than talking about end-of-life or death.
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In order to enable my loved ones to execute my advance care plan with ease, I had also done my LPA and AMD, so that they will have the power to make decisions about my care legally. You can assign this decision-making power to more than one person. To be fair to them, you need to discuss your beliefs, values, wishes and preferences with them in advance. According to Livingmatters.sg, the following are some deciding factors on whom to appoint as your voice:
Is the person willing?
Does the person know your goals, preferences, values?
Is the person willing to follow your known care wishes as much as possible in making decisions about your care matters?
Is the person able to make decisions under stress?
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With regard to my AMD, I remember my family doctor asking me “Are you sure that you want to do your AMD at this young age?” when I asked her to file my AMD back then. I answered her with a definite “Yes”, as we can never to be too young or too healthy to take responsibility for our own life.
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My readers, start 2019 by thinking about, stating and sharing your future care choices clearly, to significantly reduce the burden on your loved ones to have to make morally-difficult decisions like whether to resuscitate or not to when you no longer able to decide or speak up for yourself. ACP is an organic document, a work-in-progress until you are no longer able to work on it. Therefore, you can always change your mind about some of your decisions, make changes and updates to your plan and inform your loved ones. To-date, I have made one revision to my ACP since I started my ACP journey in 2014. Start working on yours today! Click here for your free ACP template now.