Dan called me to his room. He looked perplexed and asked "who are all these people Barbara?"
I looked around the room. On the walls there were posters of various people and events. On his dresser were pictures of his mother, late partner and various friends who were no longer alive. The sun was shining through the windows, and there was gentle music playing in the background.
It seemed to anyone looking at the scene that Dan and I were alone. But were we?
I looked at Dan, smiled, and said "Dan, these are your guides." He smiled and relaxed back on the pillows, closing his eyes. "Oh good. I thought they would never get here. It's almost time isn't it?"
"Yes it is. Are you ready?"
"Yes ... it's been a long time." I looked out the window into the court yard. Dan had been living at the hospice for longer that I had been there.
When I arrived 3 years earlier, he had filled me in on what it was like to have AIDS. He taught me about the culture, what it was like to watch all of your friends die and wonder when your turn was coming.
Dan's question was not unusual. I had heard various renditions of the same question over the years prior and since Dan's death. By the time I met Dan, death was not a stranger to me - professionally and personally. I had seen and experienced things that science cannot explain and indeed many just dismiss.
Living creatures are made up of energy. It's our Spirit or Soul I suppose. We can feel it. Often times we can see it. We know when it's there, and we know when it's gone. Occasionally, we are blessed to see it leave.
Dan, Greg, Paul. Shelly, Claudia, Michael, Steve, John, Mitch.
These are just some of the countless names of men and women who taught me how to live while dying.
Years previous to this, I was introduced to Indian poet Rabindranath Tagore. This poem touched me deeply as I still had unfinished business around my fathers death when I was 16. I still carry this poem with me today.
Peace, my heart, let the time for parting be sweet.
Let it not be a death, but completeness.
Let love melt into memory and pain into songs.
Let the flight through the sky end in the folding of the wings over the nest.
Let the last touch of your hands be gentle like the flower of the night.
Stand still, O Beautiful End, for a moment, and say your last words in silence.
I bow to you and hold up my lamp to light you on your way.
Rabindranath Tagore, poem 61, published 1914 in “The Gardener”.
A week later, I watched Dan smile and then saw his Spirit leave his body and move on to what is next. His guides gently leading the way.
Thank you Dan.
Barbara C. Phillips, NP, is the founder of NP Business™ and Nurse Practitioner Business Owner™, and works with NPs to get started and grow their own business. To learn more and to become a member of "Nurse Practitioner Business Owner," visit Nurse Practitioner Business Owner.
What do you mean I can't find out about my husband's accident injuries? Why can't we move my mother to the nice nursing-home down the street? The Health Insurance Portability and Accountability Act or HIPAA caused two of my clients to live through these very situations.
A husband and wife were involved in a terrible automobile accident. The husband was seriously injured. His wife wanted to make certain that the needed medical attention was given to her husband. The wife could not get any medical information from her doctor. Even though she was the wife, the new HIPAA law and regulations prevents her from receiving medical information without specific written authorization!
In another case, an elderly widow lady became incapacitated. Her two children wanted to place her in a nursing home so that she would receive adequate care. Even though they had a living will and health-care power of attorney for their mother, they were required to go to court and be appointed her guardians so that they could place their mother in the health care facility.
What is the HIPAA Law all about?
The HIPAA Law in a Nutshell
HIPAA took effect on April 14, 2003.
This legislation applies to virtually every physician, nurse, pharmacist, dentist, and health care provider in the nation. It impacts everyone's access to health care information.
What does this privacy act mean? The regulations stress that health care providers must limit health information to those who are intended to receive it. This means health care information cannot be released to any unauthorized person. This may mean you may not be able to receive medical records for your spouse or parent.
HIPAA Violation Penalties
The penalties for health care providers are staggering. For each disclosure violation, there is a $100 fine. If the violation is knowing, there are criminal penalties of a $50,000 fine and up to one year in prison. If information is provided or obtained under false pretenses, there is $100,000 fine and up to five years in prison. If the wrongful sale, transfer or use of the information was for commercial advantage, there is a $250,000 fine and up to 10 years in prison.
How does this affect you? To ensure an easy transition, you must have the appropriate medical release language to comply with HIPAA in three of your estate planning documents.
Documents to Update
The documents which need to be updated are:
- Your Living Will and Health Care Power of Attorney
- Your Living Trust
- Your Durable Power of Attorney
What if I do nothing?
You may be forced to sign the doctor's or hospitals forms in a stressful emergency situation. These documents may not reflect your choices and may contain confusing legal and/or medical terminology. Or you may be unable to sign anything and may repeat one of the above scenarios.
If your documents were created before 2003 and have not been amended since, have your attorney review them for HIPAA compliant language. Are you missing some or all of these documents? Make an appointment today!
About the Author:
Advanced health care directives are written instructions that communicate your wishes regarding care and treatment should you no longer be able to make your own health care decisions. Some directives are broken down into two parts - a Living Will and a Health Care Power of Attorney (HCPOA). The exact language and type of document will vary depending upon the laws in your location.
Basically a Living Will allows certain treatments to be withheld or withdrawn if using them will only prolong your dying process; or if you are unconscious (and in a vegetative state) and there is no hope for recovery. An example of treatment may include feeding tubes or resuscitation if you heart stops working.
If you are unable to make health care decisions, either temporarily or permanently, a HCPOA allows you to appointment someone to make them on your behalf. It is in your best interest to choose someone who understands thoroughly your desires and is willing to honor your requests. Should you not designate a decision making person(s), generally your legal next of kin will be looked for to make that decision for you. Caution - please note that it is your “legal” next of kin who will be making decisions, and not necessarily your significant other of 25 years. In today’s world, this is another very important reason to have these documents in place.
From the standpoint of a health care provider who has worked from intensive care to hospice to primary care, I cannot stress enough the importance of having these documents completed...NOW. One never knows when one will have need of them, and these documents will save you and those that love you much grief and suffering.
In many cases, you can obtain forms from your health care provider. Forms are also readily available online. A simple online search using "Advanced Health Care Directive" on google pulled up 680,000 pages. You can break that down further by including your state/country.
Once you have these forms filled out, signed, witnesses, and perhaps even notarized, make several copies and put the original in a safe place. Make sure that the person/persons whom you have designated as your decision maker have a copy of the document, as well as your health care provider, hospital, and anyone else who needs one. Please make sure that everyone involved knows your wishes.
And remember, should you change your mind . . . just fill out a new form. The most current form is always the valid one.
For over 26 years, Barbara C. Phillips, MN, NP has been involved in health care. Now, as the founder of OlderWiserWomen, LLC, that experience and passion is focused on Women who want to experience the freedom, magic and wisdom of successful aging. She can be reached through http://www.OlderWiserWomen.com..
We are pleased to announce that Caring Connections, the web site of the National Hospice and Palliative Care Organization, provides free advance directive documents and instructions for each state.
Instructions for downloading your state's advance directive documents, including instructions for completing each document, are included. Again, there is no charge for these documents.
To download your state's advance directive documents via Caring Connections, click here: free advance directive documents.
If you would like to be added to the NHPCO's mailing list and receive end-of-life care information, please click here: end-of-life care information.
If you choose to use any of these documents in your own estate planning, make sure you follow your state's requirements for execution, including the number of witnesses required and whether your signature needs to be notarized. Although an attorney is not required, you may wish to consult with an attorney if you have any questions or concerns.
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