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Healthy Aging

Riverside Team Members Lead the Way In Encouraging Patients To Talk Now About End of Life Care

April 16, 2015

Kicking off on Healthcare Decisions Day, Riverside team members across the region launched a campaign to not only encourage patients to talk about living wills, but also each other.

Newport News, Va –The conversation at any age is uncomfortable at best –telling loved ones how you want to be cared for at the end of life in the event you can't communicate your medical wishes on your own.

Across Riverside Health System that's true for both patients and team members.

"Before we can expect our patients to think through their wishes and have the conversation with their loved ones, we need to do it ourselves," said Dr. Kyle Allen, Riverside's Vice President of Clinical Integration and Medical Director for its Lifelong Health division. "This is an example of the Riverside family leading from the front."

This month, Riverside Health System teams throughout the Commonwealth recognized National Healthcare Decisions Day (April 16) with a massive public effort to highlight the importance of advance healthcare decision-making and how to set up an Advance Medical Directive, which outlines end of life medical treatment wishes. They also started having the conversation themselves and encouraged each other to have it, too.

This is in addition to Riverside's continued involvement in the Advance Care Planning Coalition of Eastern Virginia and its "As You Wish" program, an initiative encourage people to write their advance directives for health care throughout the year.

"It's hard to think about these things," said Dr. Laura Cunnington, Riverside's Medical Director for Palliative Care and Hospice Services. "The flip side is that it is so much harder if you haven't thought about it and someone has to figure out what they should do for you. You give them a gift by taking that burden away."

Making future healthcare decisions includes much more than deciding what care they would or would not want.

And not just for older adults.

Nathan Kottkamp, an attorney with McGuireWoods in Richmond who specializes in healthcare law and founded National Healthcare Decisions Day, said the issue of people lacking advance care planning is almost always preventable.

"The reality is it's not just end of life care and it's not just old people," Kottkamp said. "The cases that have driven laws are women in their 20s."

You could have a heart attack or be in a serious car accident that renders you incapacitated and unable to convey your desires for health care.

Talking about your wishes starts with clarifying what results you would want from your medical treatments, if something happened to you, because sometimes the burden of treatments can outweigh the benefits. No one can decide that for another person unless they have talked about it. That is why it is important to select an agent to express healthcare decisions if patients are unable to speak for themselves.

"Too many people are dying in a way they wouldn't choose," Allen said. "It leaves loved ones feeling burdened, guilty, and uncertain. Many of us fail to have 'the conversation' with loved ones about what those wishes are before treatment decisions must be made. By having and documenting 'the conversation,' we can assure ourselves of a richer life where our treatment preferences are respected, where our loved ones are comforted in the knowledge that we will receive the care we desire, and where our caregivers can be empowered to provide that care in the most effective and compassionate manner possible."

Not Just For The Aging

All adults should discuss and document their healthcare wishes in the event of a crisis. Accidents and acute illness can happen to anyone at any time, but far too few adults have done anything to plan ahead.

Only 25 percent of adults are estimated to have Advance Medical Directives completed and in place, said Carol Wilson, Riverside's Director of Palliative Care Services and Advance Care Planning. More so, only half of the adults who have an advanced illness have done the planning.

"In general, young people think about it less," Wilson said. "We all like to think we're immortal and this requires us to think about what we want, how we would want to be kept alive, if we would want treatment stopped and under what conditions."  

Psychiatric advance directives are also critical for people who have struggled with mental health issues, he said. Those directives can cover which mental health therapies have proven successful for the individual and classes of drugs to avoid or use. 

"The hardest part is often just raising the topic," Kottkamp said.

Obtaining The Forms

There's no need to use an attorney to complete these documents.

Free living will and healthcare power of attorney forms and information are available at riversideonline.com. Also, every Riverside hospital and physician's office can provide patients with more information about advance directives.

Already have an Advanced Medical Directive in place? Consider revisiting it and ensuring it still reflects your wishes.

Advance Medical Directives not only should be done by everybody, but should also be updated and revisited as you age, Cunnington said.

"What your Advanced Care Directive says in your 30s," Cunnington said, "could be different if you are in your 60s."


Every family is different. Some are accustomed to talking about death and dying. For those, the conversation may be easier to start. For others, consider the following tips to help start the conversation about establishing your Advance Medical Directive.

  • Piggy-back off of something you see on TV, read or current events. If a medical show has a dangerous medical situation in a plot line, for example, use that as a way to say, "If I were ever in that situation…" to get the conversation started.

  • After a doctor's appointment, tell your family your physician has asked you to talk about it as a way of ensuring all your medical paperwork is up to date. Be sure to say it isn't because of a recent diagnosis.

  • Tell your family you are completing your estate planning and while making a living will or Advance Medical Directive is not part of that, you want to ensure all your paperwork is up to date.

  • Tell your family this is a gift you want to give them and now is the time to do it.