1. Total Joint PREP Class Knee Replacement
T. Andrew Israel, MD
Luther Midelfort Orthopaedic & Sports Medicine Center

2. Goals for you and your family attending this class
Recognize knee replacement is a reliable operation to relieve pain and restore function.
Describe what to expect of the knee replacement procedure.
Discuss the risks of knee replacement surgery.

3. Goals of your knee replacement
Improve your quality of life
Relieve your pain
Restore function (knee movement, alignment)
Increase activity

4. Knee Arthritis
Loss of cartilage leads to narrowing of the joint space.
See the bone spur formation?

5. Knee Arthritis
As the cartilage wears, bone spurs develop which can cause stiffness

6. Surgical Technique -Resurface the bony surfaces with metal and plastic
-Balance the ligaments
-Restore alignment and motion (straighten the leg)

7. Metal and plastic are used
Implant materials
Metal and plastic are used
The metal is usually a cobalt-chrome alloy.
The plastic is UHMWPE or “poly”.

8. Implants -The end of the femur is capped with a metal component.
-The end of the tibia may have a metal plate or plastic.
-A plastic spacer goes between the metal cap and plate.

9. Implants
If the back of the kneecap is worn, it is resurfaced with a plastic button

10. Surgical Technique Incision
Made in front of the knee, usually from above the kneecap down to bump on shin bone
Length of the incision depends on the thickness of soft tissue
Surgeon will make the incision long enough to see the area around the knee
Surgical techniques continue to improve as technology advances
Surgeon will use techniques to spare muscle

11. Day of Surgery
Your surgeon will meet you in SurgiCenter to initial your knee and answer final questions.
Family can wait with you in the SurgiCenter.
You will go to the Operating Room (OR) first, then to Recovery (PACU).
Surgery lasts 1-2 hours, recovery 1-2 hours.
Finally, you will go to the Med-Surg Unit 4500.

12. Post-op Therapy
Physical & Occupational Therapy is important for a good outcome.
Your participation will improve your result
You may have a machine that bends the knee – called a CPM.
Therapy starts the day after surgery
Get you out of bed
Bend the knee!
Straighten the knee!
Walk with a walker

13. Other Doctors
Additional Doctors take care of non-orthopedic issues (such as high blood pressure or diabetes).
If you have an Internal Medicine doctor here they will see you after surgery.
If your regular doctor does not see patients in the hospital, a Hospitalist will see you after surgery.
If you are not getting a medication you think you should, please ask.

14. Blood Clot Prevention
You are at risk of a blood clot after knee surgery.
You will receive medication (warfarin or aspirin) after surgery to prevent blood clots.
TED hose should be worn for 3 weeks after surgery, you may remove these at night.
SCD (calf squeezers) are used when you are in the hospital and should be worn whenever you are in bed.

15. Risks of Surgery Blood Clots
High risk (>20%) if no treatment
Clots can go to the lungs and be fatal
Your risk is reduced to <1% if treated with medication, squeezers
Getting out of bed and walking helps to prevent blood clots

16. Risks of Surgery Infection
You will get antibiotics at the time of surgery and for 24 hours after surgery.
Surgeons, assistants and scrub techs wear “spacesuits”.
Using all precautions, risk of infection is ~1%.
Infection may occur months or years after surgery.
An infection may mean removal of your implants.

18. Risks of Surgery Blood loss
Tourniquets are used during surgery.
There may be some bleeding into the knee after surgery.
Your surgeon may use a drain in the knee and give you some blood back.
Your blood count will be checked each morning after surgery.
If you have symptoms from a low blood count, you may need a blood transfusion.

19. Risks of Surgery - Stiffness
It is painful to move the knee after surgery and some people get stiff.
You need to work hard to prevent stiffness.
Work on both getting the knee straight (0 degrees) and bending the knee (90 degrees.)
Goal is more than 90 degrees flexion by the first week
If you have limited motion at 6 weeks, your surgeon may need to perform treatment under anesthesia.

20. Risks of Surgery Need for Revision
We encourage patients to wait as long as possible before knee replacement.
Implants wear with time…
~90% of implants last 12 years
Revision surgery may involve changing the plastic or changing one or both metal parts.
Revision surgery is more challenging with a more difficult recovery.

21. Risks of Surgery Medical Complications
Surgery is a stress to your body.
Heart and lung problems, stroke, stomach problems, constipation all may occur.
A physical with your regular doctor and an EKG are required before surgery.
Despite precautions, unforeseen medical complications may still occur.

22. Risks of Surgery Anesthetic Complications
You will meet the Anesthesia providers the day of surgery.
They will discuss anesthetic options such as; general, spinal, epidural, nerve blocks.
Nausea and vomiting are common but more serious side effects or complications may occur.
Please tell the anesthesia provider of any past experience with anesthesia.

23. Summary
Knee replacement is a reliable operation to relieve pain and restore function.
As with any operation, there are associated risks.
All of the precautions we take are to minimize risk and provide for a “routine” operation.
The purpose of this talk is to provide you with information about knee replacement.

24. Questions or Concerns?

25. Patient Resource and Education Program
Joint PREP Class
Patient Resource and Education Program
Welcome to our Joint PREP class. PREP stand for Patient Resource and Education Program.
My name is__________________ from the Orthopedic center. I will be hosting today's program.
Today our presenters will be Dr._____________ one of our Orthopedic Total Joint Reconstruction surgeons Myself ________________Physical Therapy ________________ Occupational Therapy ________________RN Case manager/Social Services_________________
There will be time after each presentation to ask questions.
We have pens if you would like to take notes. There is a space for notes in the back of the Mayo total joint booklet in your folder.
There will time to ask questions after each presenter.
We will be having a break after the nursing presentation.
Restrooms are located outside the door on your left.
At this time I'd like to introduce Dr.__________________
As we greet the pts. & family/friend as they arrive, point out the refreshments, give them a name tag and have their family/friend make their name tag. Check and see if they brought their folder and if not give them a new one.

26. Goals for you and your family
Discuss steps to take to get ready for the surgical procedure.
Discuss what to expect of the surgical experience.
Identify what you need to do to achieve the best outcome.
Recognize why it is important for you to participate in your plan of care.
Thank you Dr. ________________
As we continue this afternoon we will :
Read slide bullets

27. Plan Ahead
Finish any planned dental work at least 2 weeks before your surgery date.
Plan for your return home.
Identify who will take care of you after surgery.
Plan for about 2 weeks.
Simplify meals. Plan for 2 weeks of easy or no
preparation meals.
Prepare your home now- take notes today
and get started!
There are things you can do to prepare for you surgery.
Finish any planned dental work at least 2 weeks before your surgery date.
Have your teeth in healthy condition. Bacteria in your mouth may enter your bloodstream and cause infection in the new joint If you have current work being done plan to finish before your surgery.
Plan for your return home
Identify who will take care of you after surgery. Plan for about 2 weeks. This is 24 hours every day of the week.
If you do not have someone who is able to care for you after surgery social services will discuss options with you.
Simplify meals. Plan for 2 weeks of easy or no preparation meals.
Prepare your home:
If upstairs bedroom: prepare room on main floor, or arrange things to go upstairs only once a day.
Remove throw rugs and clutter from traffic paths
Arrange bedroom for extra space to get in/out of bed with assistive devices
Place sturdy chair that is easy to get up from.
Prepare your home now- take notes today and get started

28. Plan Ahead Appointments:
Regular doctor for pre-surgery;
Blood work, EKG, Physical exam, discuss medications.
Surgeon for final discussion and update.
Stop smoking – talk to your regular doctor to get help.
Call your surgeon if you get a fever, cold, infection or rash before your surgery date.
Read slide. There is a stop smoking brochure in your folder for more information.

29. What to bring to the hospital
Loose comfortable clothing
Comfortable nonskid walking shoes
Personal items
Copy of your advanced directives
Insurance cards
Medication list, inhalers, C-PAP mask
Any assistive devices you have
Prepaid long distance calling card (optional)
Your Total Joint Replacement information folder
Loose comfortable Clothing: Jogging suits or sweatpants
Comfortable non-skid walking shoes: Velcro closures or elastic laces are handy.
Personal items; toiletries, books, magazines
Copy of your Advance Directives
Insurance cards
Medication list, inhalers, C-PAP mask
Any Assistive devices that you already have. Bring your walker, or crutches.
Prepaid long distance calling cards (optional)
Your Total Joint Replacement information folder from class.
We will be using this folder though out your hospital stay

30. What not to bring to the hospital
Valuables/Jewelry
Credit cards, check book or large sums of money
Your medications (except inhalers)
-All Valuables/jewelry, even your wedding band if it comes off easily
-Credit Cards, check book or large sums of money
-Your medications- except inhalers

31. The day before surgery A SurgiCenter nurse will call you to:
Review your medications
Tell you what medications to take and not take the day of surgery
Update your health history and review allergies
Review eating, drinking and smoking restrictions
Give hygiene instructions
Tell you what time to arrive at Luther Hospital
A SurgiCenter nurse will call you to:
Review your medications
Tell you what medications to take and not take the day of surgery
Update your health history and review allergies
Review your eating, drinking and smoking restrictions
Nothing to eat, chew or smoke after midnight. No mints, hard candy or chewing gum
Your surgery may be delayed if you eat anything after midnight
May have clear liquids up to 2 hours prior to the time of surgery:
Water
Clear juices without pulp such as apple juice,
Clear broth,
Clear Jello,
Black coffee or tea,
Popsicles
Give hygiene instructions
Take a bath or shower the evening before or the morning of surgery..
Shampoo hair - it may be a while before able to do this after surgery.
Do not shave your surgical site.
Tell you what time to arrive at Luther hospital

32. Day of surgery Take medications at home as instructed. Check in at
Luther Hospital
Registration
Desk.
Read Slide

33. Day of Surgery (continued)
You will be taken to the SurgiCenter
You will be asked your name and date of birth by everyone who has contact with you – this is done for your safety.
Family and Friends are welcome. Try to limit to 2 people on day of surgery.
Read Slide
Family/friends
Will be allowed to stay with you until you are taken to surgery.

34. SurgiCenter
Nursing admission in the SurgiCenter- We will ask you many questions and discuss your:
Medical history
Plan of care
Rights and Responsibilities
Safety
Anesthesia visit
Surgeon visit
Nursing admission in the SurgiCenter- We will ask you many questions and discuss your:
Medical history
Plan of care
Rights and Responsibilities
Safety
In the SurgiCenter
If you do have jewelry, remove and give to your family/friend.
Dentures, glasses and hearing aids may stay in place until you are taken to surgery.
Anesthesia staff will:
Discuss the type of anesthesia available for your procedure
Perform a brief examination
Start IV
Surgeon will:
Review the consent for your procedure and will sign your surgical site
Answer your last minute questions.

35. SurgiCenter (continued)
If ordered for your surgery: blood work, x-rays, clip hair at the surgery site.
Your personal items are stored and later taken to your hospital room.
Leg squeezers (SCDs Sequential Compression Devices) and TED hose are applied.
READ SLIDE
(Picture of SCDs on next slide)

36. Leg Squeezers – SCDs
This is a picture of the leg squeezers

37. Going to the Operating Room
The Surgery RN will take you to the operating room
Family/Friends
Will be directed to the main lobby Family Lounge
They should register with the volunteer and will be given a beeper and contacted when the surgery is finished

38. Operating Room (OR) Monitors Antibiotics Anesthesia Surgical scrub
Foley catheter
Time in operating room area
OR Staff will communicate to your family if the surgery is 2-3 hours
Staff will hook you up to equipment that will monitor heart, lungs, breathing and blood pressure throughout the surgery.
You will be given an antibiotic through your IV.
Anesthesia will be given to you
Once you are asleep:
An antibacterial scrub is done to your surgical site; this may leave your skin with a bluish or brownish color that eventually washes off.
A catheter will be placed in your bladder
You will be in the operating room area about 3 hours.
If the surgery is taking longer than 2 hours and not expected to finish soon, the Operating Room staff will try to call your family in the Family Lounge to let them know of the change in time.

39. Recovery Room/Post Anesthesia Care Unit (PACU)
You will be in recovery for about 1 hour.
You will have Monitors and Oxygen on
Your nausea and pain are monitored and controlled
When you are ready, you will be transferred to a hospital room.
When you are ready and nausea and pain are controlled (not eliminated),
you will be brought to your hospital room.
You will be in the PACU Recovery Room about one hour to make sure you are stable.

40. Arrival in your Hospital Room
You will have…
Oxygen – to help breathing and healing
A foley catheter – to measure urine output
An IV – to give you fluids and medication
Incentive spirometer – to encourage you to take deep breaths to prevent congestion in your lungs.
A pulse oximeter – a device that fits on your finger to measure blood oxygen level
Read slide
Show incentive spirometer. This is used to encourage you to take deep breathes.
(Pulse Oximeter is on next slide)

41. Pulse Oximeter
This is a picture of the pulse oximeter monitoring your oxygen level

42. Arrival in your Hospital Room (continued)
We will check on you, take your vital signs
Start your Nutrition
Activity as you tolerate
Work together with you to keep you safe.
Help you with control of pain and nausea
When settled in your room, the nurse will
listen to your heart and lungs
check color, movement, and feeling in your surgical leg
tell you about your room and equipment used for your care.
Nutrition - Sips of water and/or ice chips --- then clear liquids if not nauseated
Activity
Bed rest
May stand at bedside if your doctor orders
Staff will reposition you every 2 hours to prevent pressure sores
Keeping you safe
You will need to tell us your name and birth date before receiving medicine or having a procedure i.e. blood tests
We will continue to help you with control of pain and nausea

43. Pain Management Read slide
While you have an IV in you may have a Pain pump. This allows you to safely give yourself pain medication through your IV. Only the patient should push the button for pain medication.
You may begin to take your pain pills by mouth when you are able.
Ask your nurse for pain medicine before your pain becomes too intense

44. After Knee Surgery We will care for your skin and incision
You may have a drain in your knee incision area
You may have a Cryo Cuff or ice pack on your knee
You will have a continuous passive motion (CPM) machine
We will care for your skin and incision
You may have a drain in your knee incision area
You may have a Cryo Cuff or ice pack on your knee
A CryoCuff is a device filled with cold water and placed on your knee to minimize swelling. (Show )
You will have a continuous passive motion (CPM) machine
CPM will be used to gently move your knee while you are in bed. (Picture next slide)

45. Continuous Passive Motion Machine (CPM)
Your leg rests in the lambs wool cradle as the CPM gently bends your knee.

46. You are a Partner in your care!
Post operative day ONE
Blood work
Medication
Pain control *Anticoagulation – Warfarin
Catheter and drain removed.
Nutrition as you tolerate
Activity-Physical Therapy and Occupational Therapy
Work together to keep you safe.
You are a Partner in your care!
Blood work - Blood will be drawn daily
Medication for Pain Control – Continue using pain scale to rate pain Anticoagulation with warfarin
Catheter and drain removed
Nutrition
If not nauseated, you will progress to your usual diet
Activity
Physical therapists and Occupational therapist will begin working with you
Up in chair for lunch and supper
Staff will continue to reposition you every 2 hours while you are in bed.
Keeping you safe
Call for assistance/Do not get up by yourself!
White Board
Plans for each day in the hospital will be on a white board in your room so you know what to expect each day. It will also be used as a communication tool for the nursing staff, Physical Therapy, Occupational Therapy and you and your family.

47. Post operative day TWO plan
The person who will be taking care of you after you go home needs to come to the hospital to learn about:
Safety
Incision care
Activity – Physical and Occupational Therapy
Medication for pain control and anticoagulation
The person who will be taking care of you after you go home needs to come to the hospital for about 2 hours to learn:
Safety
Incision care
Activity – Physical and Occupational Therapy
Medication for pain control and anticoagulation
Once you have began taking pain pills you may want to ask your nurse to bring pain pill at each meal (to prepare for therapy) and at bedtime
You may have problems with constipation, do what works for you or ask to keep taking stool softener and/or laxative if no bowel movement after surgery.

48. Day THREE/Discharge day.
Prepare for discharge to home or transitional care unit.
The person who will be taking care of you after you go home needs to come to the hospital again to learn about and get discharge instructions for:
Incision care
TEDS and how to keep swelling down
How to take pain medications correctly
Anticoagulation – Warfarin and blood work
Antibiotic coverage card
When to contact your Surgeon
You are a Partner in your care!
Day THREE/Discharge day
Prepare for discharge to home or transitional care unit.
The person who will be taking care of you after you go home needs to come to the hospital again to learn about and get discharge instructions for:
Discharge Instructions - Staff will go over discharge instructions
Incision care: we will provide you with a kit to take home with all the supplies you will need. (Show Kit)
Ted hose to decrease swelling- on during the day, off at night – for 3 weeks.
Medications: You will be given a list of medications you will take at home
Blood work: lab draws twice a week for warfarin for 3 weeks
Antibiotic coverage card: Will be given to you at discharge- show this card before having any dental work
You will be instructed of when and how to contact your surgeon for concerns

49. Elevation of your leg Elevate knee above hip and toe above knee
to decrease swelling and pain
Read slide ( Use pointer or point to the knee and toe elevation)

50. After Discharge
A person to care for you will need to be available 24 hours a day to:
assist you at home the first two weeks
drive you to appointments
encourage you in your therapy and progress
Read slide above…

51. Bathing You may shower when your incision is dry (no drainage)
Place a new dressing on the incision after shower
Do not submerge the incision in a bathtub, pool, hot tub, etc, until the incision is completely healed
Read slide
You can shower and allow soap and water to run over the incision and either air dry or pat dry.

52. Driving
Talk with your surgeon about when you will be allowed to drive again.
You must be:
off narcotic pain medicines to drive
able to sit in car comfortably
able to move foot from gas to brake pedal easily
You need a valid driver’s license!
Practice in a safe area.
Read slide

53. At your appointment we will:
A Follow-Up Appointment with your surgeon will be made days after surgery
At your appointment we will:
Remove your staples
Give you care instructions about your:
Incision
Bathing
TEDS
Assistive devices
Medications – warfarin and pain control
Joint replacement - dental procedures and antibiotics
Read slide

54. Questions or Concerns?

55. Start getting ready for surgery. Make your plans.
Watch the Total Joint Replacement Video at
Click on Medical Services,
then Orthopedics Center
Thank you!
Read slide and refer to web site card
Take a 10 minute break.
Rest rooms
Water to drink
After Break PT OT
RN Case Manager
After class THE END
Thank everyone for coming
If you have any question that come up after you leave today refer to the cards inside your folder for numbers to call…..

56. Joint PREP Physical Therapy Total Knee Replacement

57. Home Preparation Become familiar with exercise handout
If you have a walker, practice using it and make sure you can get through your house with it.

58. Physical Therapy Your therapy will start the day after your surgery
Activities include getting into a chair, walking and working on the exercises
Therapy will continue twice daily until goals are met or you are discharged from hospital

59. Includes in/out of bed, getting out of a chair, walking and stairs
Therapy Goals
Independence with
mobility
Includes in/out of bed, getting out of a chair, walking and stairs
Independence with an
exercise program to
continue at home

60. Therapy Goals Cont’d
Learn appropriate use of walking devices such as walker/crutches
Can bring your own to hospital to make sure it’s sized correctly and get familiar with it’s use

61. Goals Continued
Your family member or friend should be available on the 2nd or 3rd day after your surgery to become familiar with the exercises and any assistance that you will need at home.

62. Range of
Motion
Gaining full knee
extension
(straightening) Is
KEY!

63. Goal is 90 degrees of flexion (bending) by the
Range of Motion cont’d
Goal is 90 degrees of flexion (bending) by the
end of the
hospital stay

64. Range of Motion CPM (continuous passive motion)
You will use this machine while in the hospital

65. Exercise after Discharge
WALK!
Continue with exercises from hospital
Outpatient PT if ordered by your surgeon

66. Questions or Concerns?

67. Rehabilitation Services Joint PREP Occupational Therapy

68. Why Occupational Therapy?
Your occupational therapist (OT) is trained in the field of rehabilitation and is concerned about your safety in performing activities of daily living

69. Activities of Daily Living
Your OT will show and teach you ways to safely do your daily tasks
Dressing
Bathing
Toileting
Your goals for OT include:
Increased Independence
Increased Strength
Increased Mobility

70. Adaptive Equipment Reacher Sock aid Long-handled shoe horn
Your OT will help you order/purchase adaptive equipment if it is needed to assist you with dressing and bathing
Reacher
Sock aid
Long-handled shoe horn
Dressing stick
Elastic shoelaces
Long-handled bath sponge
Tub/shower chair or transfer bench
Raised toilet seat

71. Before surgery… Prepare your home with safety in mind
Remove throw rugs and clutter from traffic paths
Rearrange your kitchen so you can easily reach often-used items
Install grab bars in bathrooms

72. In the hospital…
Occupational therapy will begin the day after your surgery
You will be seen by your OT once a day

73. Day One
Your OT may…
Learn about your home set-up and help available to you at home
Begin home safety instruction
Discuss home equipment needs
Instruct you in an upper body exercise program

75. Day Two Your OT may… Practice with adaptive dressing equipment
Order dressing/bathing equipment as desired
Review upper body exercise program

77. Day Three Your OT may… Work with you on safety with room maneuvering
Help you practice getting in and out of a tub with the use of a tub bench or chair
Encourage you to participate in a bathing/dressing session to determine the level of assistance you may need

79. When you leave the hospital…
Keep SAFETY in mind!
Stay ACTIVE and INDEPENDENT!

80. Questions or Concerns? Thank You!

81. Social Services and Case Management
Joint PREP
Social Services and Case Management

82. Department Role
Social Services and Case Management staff can assist with:
-Insurance concerns
-Home Health Services
-Skilled Nursing Care
-Community Services and referrals
-Power of Attorney for Health Care
-Counseling and Advocacy

83. Insurance Assistance
Once you and your Doctor decide you will proceed with surgery you should :
-Pre-register at the front counter
-Notify your insurance company
-Get your insurance company’s approval.

84. Insurance Verification continued
Insurance plans vary in what is required to authorize your surgery.
Our insurance notification may not be enough. Some plans require you to call too.
Many Medicare Advantage plans require prior authorization.
Your insurance company may take days to complete this process.

85. During your stay
Doctor decides when you are ready for discharge to the next level of care.
The next level of care might be:
home with or without Home Care
Nursing home
Rehabilitation Hospital
Transitional Care Unit/Swing Beds

86. During your stay The usual hospital stay is 3 nights and 4 days.
Talk with your Case Manager about services you want after discharge as soon as possible.
Check your insurance to see if it limits who you can use.

87. Options for continuing care once you can leave the hospital
Transitional Care Units or Swing Beds
Skilled Nursing Facilities
Home Care options
Home with outpatient services.

88. Transitional Care Units
Bloomer, Barron and Osseo Transitional Care Units are owned by Luther Midelfort .
Other Transitional Care units include Durand, Stanley, Spooner, Hayward, and Medford to name a few.
Medicare pays for your transitional care stay like it would if you went to a nursing home.

89. Continuing Care Discharge Options
Transitional Care Units (also referred to as Swing Beds) provide continued skilled nursing and rehabilitation care after your hospital stay.
Can provide closer medical monitoring and more intensive rehabilitations therapies than regular nursing homes.

90. Nursing Homes (skilled nursing facilities)
Area nursing homes offer a range of services from short term rehabilitation stays to long term medical and residential care.
Eau Claire area skilled nursing facilities include:
Clairemont
Dove
Oakwood Villa
Syverson

91. Other nursing homes include but not limited to:
Chippewa Manor-Chippewa Falls
Wissota Health and Regional Vent Unit-Chippewa Falls
Cornell Care Center- Cornell
American Lutheran Home-Mondovi/Menomonie
Hetzel Care Center-Bloomer
Dunn County Health Care Center
Colfax Area Nursing home-Colfax
Dallas Health Care-Dallas
Pepin Manor-Pepin
Spring Valley Nursing Home- Spring Valley

92. Medicare Skilled coverage
Medicare requires the following to pay for your nursing home or transitional care stay:
1. You have a skilled nursing or rehab need (PT/OT)
2. You participate in therapies and show progress.
3. That you have a qualified 3 day stay at a hospital.

93. Home Care options Medicare will pay for home care services:
-if you are homebound
-if you have skilled nursing needs.
-if you have skilled therapy needs.
Medicare does not pay for:
Help with meals, grocery shopping, etc.
Shopping
Personal Care (bathing, dressing, etc.)
Housekeeping services

94. What are Advance Directives?
Written documents that tell your Doctor what you want for care when you are unable to speak for yourself.
Allow you to describe the type of medical treatment you would like to receive or not receive.
Allow you to identify the person you wish to be your decision maker if you are unable to make your own decisions.

95. How do you get an Advance Directive?
Luther Hospital Social Services
Luther Hospital Chaplaincy
Your personal attorney

96. 2 types of Advance Directives
Declaration to Physicians or Living Will
The Power of Attorney for Health Care

97. Power of Attorney for Healthcare
With this document, you appoint a family member or friend to follow you wishes and act as your health care agent.
Your Health Care agent will make decisions for you only when you are unable to make your own.
This document is recommended because it is much more flexible that the Living Will and gives health care providers a person to discuss your wishes with.
This document also lists what you want in different situations when you are unable to speak for yourself.

98. Safekeeping of Advance Directives
You should always keep the original document.
Copies can be given to family members.
A copy can be brought to your doctor’s office or to the hospital to be kept in your medical record.
It is important that you discuss your wishes with family and friends close to your.
Decision making becomes easier when these discussions have taken place and your wishes are clear.

99. Questions or Concerns?