The Blog to Transform Advanced Care

Advancing Care through Innovation, Observation and Collaboration.

By: Kacy Ninteau, Policy & Advocacy Intern, C-TAC

For individuals living with serious illness and their families, the fear of not having their wishes for care heard and respected during an emergency can be overwhelming. Talking about preferences for treatment and filling out an advance directive are steps that can be taken to relieve this fear, but some may feel that they do not have the tools they need to get started.

In 2018, Community First, a non-profit focused on building a sustainable medical and social service system which provides high-quality care for all residents of Hawai’i Island, saw the need to give people the confidence to begin planning for their end-of-life medical care. Since then, Community First volunteers have reached over 1,500 people through their monthly workshops, which focus on completing and/or updating the Hawaii Advanced Health Care Directive as well as having the conversation with their loved ones. Participants can either fill out their documents on the same day as the workshop and have them witnessed on-site or they can take them home and come back two weeks later to have them witnessed then. Either way, participants are given five copies of their advance directive to share with their providers and can then feel relieved that someone will be able to advocate for their wishes in the face of a medical emergency. 

As the COVID-19 crisis continues, access to advance care planning services is more important than ever before. However, safety concerns and physical distancing requirements are a barrier for programs like Community First. Volunteers for Community First rose to the challenge this spring by shifting their workshops to a Zoom platform. Still, they needed to get creative in order to deliver the same level of service. For example, volunteers work with participants who are not comfortable with the Zoom technology and those without printers receive a copy of the advance directive in the mail. 

Before the COVID-19 pandemic, the small core of volunteers at Community First were only able to reach residents in East Hawaii, the community where the program is located. One benefit of the transition to the on-line workshop is that the services are now available to residents on the other side of the island in West Hawai’i. 

While Zoom has provided an innovative way to continue holding their workshops safely, it is nearly impossible to witness advance directives and make copies in this way. A Community First volunteer then had the idea to hold drive-thru witnessing events where participants from East Hawaii could have their completed documents reviewed for completion and accuracy, witnessed, and copied by volunteers, all without leaving their vehicle. They used the parking lot of the local Office of Aging, where Community First events are usually held, which has a copy machine for copying the signed advance directives. Amy Hamane, a volunteer with the program, noted that the event was “fun and [Community First] is the only one providing this service now as we follow strict COVID-19 safety precautions.” 

This Community First program can serve as a model for delivering high-quality advance care planning services outside of formal health care settings, especially now when it’s potentially dangerous for patients to enter those spaces. Witnessing requirements have long been a barrier to advance directive completion because it can be difficult to find witnesses outside of one’s family who qualify. Using volunteers at the drive-thru events means that participants don’t need to worry about this step. Their work shows us that, even now, there are ways for communities to come together and do advance care planning, helping residents feel more secure in their plans for future health care.

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