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

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Presentation on theme: "Total Joint PREP Class Knee Replacement T. Andrew Israel, MD Luther Midelfort Orthopaedic & Sports Medicine Center."— Presentation transcript:

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 l l Recognize knee replacement is a reliable operation to relieve pain and restore function. l l Describe what to expect of the knee replacement procedure. l l Discuss the risks of knee replacement surgery.

3 Goals of your knee replacement l l Improve your quality of life l l Relieve your pain l l Restore function (knee movement, alignment) l l 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 Implant materials Metal and plastic are used l l The metal is usually a cobalt-chrome alloy. l l 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 l l Made in front of the knee, usually from above the kneecap down to bump on shin bone l l Length of the incision depends on the thickness of soft tissue l l Surgeon will make the incision long enough to see the area around the knee l l Surgical techniques continue to improve as technology advances l l Surgeon will use techniques to spare muscle

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

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

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

14 Blood Clot Prevention l l You are at risk of a blood clot after knee surgery. l l You will receive medication (warfarin or aspirin) after surgery to prevent blood clots. l l TED hose should be worn for 3 weeks after surgery, you may remove these at night. l l 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 l l High risk (>20%) if no treatment l l Clots can go to the lungs and be fatal l l Your risk is reduced to <1% if treated with medication, squeezers l l Getting out of bed and walking helps to prevent blood clots

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

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

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

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

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

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

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

24 Questions or Concerns?

25 Joint PREP Class P atient R esource and E ducation P rogram

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.

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!

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.

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

30 What not to bring to the hospital Valuables/Jewelry 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

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

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.

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

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.

36 Leg Squeezers – SCDs

37 Going to the Operating Room

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

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.

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

41 Pulse Oximeter

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

43 Pain Management

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

45 Continuous Passive Motion Machine (CPM)

46 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!

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

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!

49 Elevation of your leg Elevate knee above hip and toe above knee to decrease swelling and pain

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

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

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 drivers license! Practice in a safe area.

53 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

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!

56 Joint PREP Physical Therapy Total Knee Replacement

57 Home Preparation Become familiar with exercise handout Become familiar with exercise handout If you have a walker, practice using it and make sure you can get through your house with it. If you have a walker, practice using it and make sure you can get through your house with it. Become familiar with exercise handout Become familiar with exercise handout If you have a walker, practice using it and make sure you can get through your house with it. 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 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 Therapy Goals Includes in/out of bed, getting out of a chair, walking and stairs 2. Independence with an exercise program to continue at home 1. Independence with mobility

60 Therapy Goals Contd 3. Learn appropriate use of walking devices such as walker/crutches Can bring your own to hospital to make sure its sized correctly and get familiar with its use

61 Goals Continued 4. Your family member or friend should be available on the 2 nd or 3 rd 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 Range of Motion contd 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 Exercise after Discharge WALK! WALK! Continue with exercises from hospital Continue with exercises from hospital Outpatient PT if ordered by your surgeon Outpatient PT if ordered by your surgeon 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 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 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 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 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 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 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

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

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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 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

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

80 Questions or Concerns? Thank You!

81 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 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 : 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 companys approval. Once you and your Doctor decide you will proceed with surgery you should : 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 companys approval.

84 Insurance Verification continued Insurance plans vary in what is required to authorize your surgery. 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. Our insurance notification may not be enough. Some plans require you to call too. Many Medicare Advantage plans require prior authorization. Many Medicare Advantage plans require prior authorization. Your insurance company may take days to complete this process. Your insurance company may take days to complete this process. Insurance plans vary in what is required to authorize your surgery. 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. Our insurance notification may not be enough. Some plans require you to call too. Many Medicare Advantage plans require prior authorization. Many Medicare Advantage plans require prior authorization. Your insurance company may take days to complete this process. 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. Doctor decides when you are ready for discharge to the next level of care. The next level of care might be: The next level of care might be: ־ home with or without Home Care ־ Nursing home ־ Rehabilitation Hospital ־ Transitional Care Unit/Swing Beds Doctor decides when you are ready for discharge to the next level of care. Doctor decides when you are ready for discharge to the next level of care. The next level of care might be: 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. 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. 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. Check your insurance to see if it limits who you can use. The usual hospital stay is 3 nights and 4 days. 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. 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. Check your insurance to see if it limits who you can use.

87 Options for continuing care once you can leave the hospital 1. Transitional Care Units or Swing Beds 2. Skilled Nursing Facilities 3. Home Care options 4. Home with outpatient services. 1. Transitional Care Units or Swing Beds 2. Skilled Nursing Facilities 3. Home Care options 4. Home with outpatient services.

88 Transitional Care Units Bloomer, Barron and Osseo Transitional Care Units are owned by Luther Midelfort. 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. 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. Medicare pays for your transitional care stay like it would if you went to a nursing home. Bloomer, Barron and Osseo Transitional Care Units are owned by Luther Midelfort. 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. 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. 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. 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. Can provide closer medical monitoring and more intensive rehabilitations therapies than regular nursing homes. Transitional Care Units (also referred to as Swing Beds) provide continued skilled nursing and rehabilitation care after your hospital stay. 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. 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. 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: Eau Claire area skilled nursing facilities include:ClairemontDove Oakwood Villa Syverson Area nursing homes offer a range of services from short term rehabilitation stays to long term medical and residential care. 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: Eau Claire area skilled nursing facilities include:ClairemontDove Oakwood Villa Syverson

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

92 Medicare Skilled coverage Medicare requires the following to pay for your nursing home or transitional care stay: 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. Medicare requires the following to pay for your nursing home or transitional care stay: 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: 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 Medicare will pay for home care services: 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. 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 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. Allow you to identify the person you wish to be your decision maker if you are unable to make your own decisions. Written documents that tell your Doctor what you want for care when you are unable to speak for yourself. 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 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. 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 Social Services Luther Hospital Chaplaincy Luther Hospital Chaplaincy Your personal attorney Your personal attorney Luther Hospital Social Services Luther Hospital Social Services Luther Hospital Chaplaincy Luther Hospital Chaplaincy Your personal attorney Your personal attorney

96 2 types of Advance Directives Declaration to Physicians or Living Will Declaration to Physicians or Living Will The Power of Attorney for Health Care The Power of Attorney for Health Care Declaration to Physicians or Living Will Declaration to Physicians or Living Will The Power of Attorney for Health Care 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. 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. 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 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. This document also lists what you want in different situations when you are unable to speak for yourself. With this document, you appoint a family member or friend to follow you wishes and act as your health care agent. 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. 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 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. 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. You should always keep the original document. Copies can be given to family members. Copies can be given to family members. A copy can be brought to your doctors office or to the hospital to be kept in your medical record. A copy can be brought to your doctors 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. 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. Decision making becomes easier when these discussions have taken place and your wishes are clear. You should always keep the original document. You should always keep the original document. Copies can be given to family members. Copies can be given to family members. A copy can be brought to your doctors office or to the hospital to be kept in your medical record. A copy can be brought to your doctors 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. 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. Decision making becomes easier when these discussions have taken place and your wishes are clear.

99 Questions or Concerns?


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