The Essential Roles of Chaplaincy and Advanced Care Planning

Are you ready to gain valuable insights into Chaplaincy, Advanced Care Planning, and the importance of open and honest conversations about end-of life preferences?

Chaplain Marrisa Click is here to discuss the essential roles of chaplaincy and advanced care planning for aging adults. She also shares her personal journey into chaplaincy (which is very intriguing! Did you know they have Wilderness Chaplains?) and highlights the importance of spiritual and emotional support for individuals in the later stages of life.

Some Key Takeaways from our conversation you will hear as you listen to this episode are:

1.      Chaplains play a crucial role in providing peace, spiritual clarity, and comfort to individuals in the later stages of life.  They act as guides, helping individuals navigate the transitions and challenges that come with aging and declining health.

2.      Advanced Care Planning is a proactive approach to making decisions about future healthcare scenarios.  It involves having conversations with loved ones and choosing a healthcare agent who can make decisions on your behalf when you are unable to do so. 

3.      Advanced directives and POST forms are important documents in advanced care planning.  Advanced directives outline future medical decisions, while post forms are doctor’s orders for current healthcare scenarios.  These documents ensure that your wishes are respected and followed, even if you are unable to communicate them yourself.

The importance of Advanced Care Planning and the role of Chaplains in healthcare cannot be overstated. These conversations and preparations are not always easy, but they are essential for ensuring that our wishes are respected, and our loved ones are supported during times of crises. Having open and honest discussions with our families, we can alleviate stress and prevent potential conflicts.  It is never too early to start these conversations and make your wishes know.  Take time today to fill out an advance directive and consider discussing a post form with your doctor. Be proactive in our approach and we can empower ourselves and our loved ones to make informed decisions in the face of uncertainty.

Transcript

John: 0:10

[Mic bleed] Power, the podcast that

Erin: 0:11

and I'm Aaron. You're listening to connect and power the podcast that proves age is no barrier to growth and enlightenment.

John: 0:18

break down complex subjects into bite sized, enjoyable episodes that will leave you feeling informed, entertained, and ready to conquer the world. Our guest today will illuminate the essential rules of chaplaincy and advanced care planning, offering invaluable advice for aging listeners. Her mission is to bring peace, spiritual clarity, and comfort to those in the later stages of life. So whether you're an aging adult seeking to secure your future, a concerned family member, or anyone with a curiosity about aging and planning, she is here to provide the answers you need. She is the Oncology and Palliative Care Chaplain at St. Alphonsus Regional Medical Center and the Bereavement and Bluebird Health. Our guest believes in helping people make meaning out of the transitions in life that they find themselves in. And she's also a board certified chaplain. with national recognition achieving the 2018 world class award in hospice care. Let's warmly welcome our guest Chaplain Marissa Click. Welcome.

Marissa Click: 1:23

Thanks for having me.

Erin: 1:24

Yeah. Welcome. We're such a pleasure to have you. I know that when we met not too long ago, you had so much amazing information that we were like, Oh my gosh, this is a gold nugget to share with everybody. So thank you so much for being here.

Marissa Click: 1:39

Happy to be here.

John: 1:40

So we'd love to, uh, hear your story, how you got into the industry and, you know, what led you down the path of becoming a

Marissa Click: 1:48

Mm hmm. Yeah. I'm part of a faith tradition. Most chaplains have their own personal religious background. not always, but for the most part they do. And so I was heading down the pastoral path at first. I became a Christian, out of high school and was connected to a non denominational Christian church in Nevada where I grew up and really, connected with that community well because, I just fit. I felt like I found a community there that I hadn't really experienced before. And so I was doing a lot of leadership things. They were really... Breathing into life these skills that I didn't really know that I had until someone started encouraging me in those. And so I was kind of leading. worship for the youth group and planning, mission trips. And along the way decided, I think ministry is where I want to be. I didn't want education to be a barrier, so I decided to go to seminary. So while I was in college, I was studying, religious studies, which is just learning about all the different kinds of religions. And one of the classes I took was the Bible as literature. And so it was really challenging because I was a baby Christian myself, having a lot of really deep theological discussions about, this sacred text that Christians uh, And so luckily, I was living with a family at the time as their live in nanny, who were graduates of Emanuel Christian Seminary in Tennessee. And I would come home every day, and I'd have all these questions about faith, and the Bible, and how do you live your life well, if these things are true or not. And instead of giving me answers, they just gave me better questions. They would just keep asking me more things so that I could come to the conclusions for myself. And I really loved that model of spirituality and faith formation. So I thought, I'm going to go to school where they went to school because that was really great. I ended up going to Emanuel Christian Seminary out in Tennessee. And... While I was there, I was thinking I was going to still do traditional pastoral ministry in like a church setting and was working in a church out there. And things just kept not working out. I dealt with some sexual harassment at the church and, along the way of trying to get ordained, my home church in Nevada said no because they, didn't believe in women in ordained ministry. And that was really, it was really hard to hear because these were the people who encouraged all of these leadership skills, but they didn't want to, bless me in that way with the actual paper saying, yes, you are meant for leadership and ministry and all of this. So I actually had a chaplain in seminary and, she was amazing. She is the reason that I'm in chaplaincy today. Her name is Heather Holland, and she's great. and she was like, from the get go, Oh, no, no, no, no. You're not meant for traditional pastoral ministry. You're a chaplain. You need to go do chaplaincy, and that's gonna be great. we had some different people, like different groups would come and and talk to us as seminarians about different ministry opportunities. So one of the groups was, Christian ministry in the National Parks. I did a summer in the National Parks with them as a chaplain and led college students and connected people. Our main focus was on building relationships with the staff because working in National Parks can be really, um, it's a really transitory kind of position and, You make and break relationships pretty quick because you just have a season together, right? So, there's a lot of, drug use, and there's a lot of, sexual promiscuity, and there's a lot of, questioning of, of life. Because when you don't have technology, because you're out in the middle of the wilderness, you start asking really big questions about yourself, right? we would also do, Like church services at some of the camps so that when people come and travel to the national parks, they can have a religious service if they want. So that was pretty cool, I loved it, but it still wasn't quite right. And so at the seminary that I went to, we, had the opportunity to do what's called clinical pastoral education. just like nurses and doctors have to do residencies and education. In the setting, before they become, licensed. chaplains have to do that too. And that was part of the requirements at my seminary. Was that everybody has to go through, a semester of clinical pastoral education. And I absolutely fell in love. It was the exact right fit. I worked at a hospital that was a trauma one center. So, That means it's a lot higher acuity kind of care. they often have a burn unit and it's a educational like teaching facility. there's just a lot more requirements for it and so you see a lot. they also have pediatrics and just the whole gamut of healthcare that could be in a facility. And I just learned so much and really felt I belonged. that same kind of sense of community that I got when I first And so I continued, another full year residency of clinical pastoral education, and that really launched me on the path into chaplaincy.

John: 7:48

Wow. What an amazing story.

Erin: 7:51

and just in that little bit learning, the park and recs, I had no idea. Yeah, The national parks.

John: 7:58

Wow, what a better place to, to, have, have spiritual growth surrounded by mountains and trees. that's talking my language.

Erin: 8:07

say when she mentioned that I was like, Oh, that's John right there. I think that's why we looked at each other. When

Marissa Click: 8:13

And I think it's common, like I said, when, when we tune out the things around us, right? When we don't have the distractions of technology and the responsibilities of work and family that we love having. Right? We choose to have those, but they can be a burden at times. Or, burden maybe isn't the right word, but

Erin: 8:34

Distraction maybe.

Marissa Click: 8:35

Distraction. Yeah. another responsibility. Something that's just, it's pulling your time, right? You only have so much of time and it has to be kind of navigated and where you're going to put it. And So when you don't have those things, and you're in a landscape that is really big, that makes you question how small you are compared to the universe, right? I think it means that people start asking those deeper questions that get lost in the day to day hustle.

Erin: 9:13

That's like John and I were trying to have better daily habits because our time is so limited and we're like trying to read books to educate our minds and just little things here to improve ourselves to improve for everybody else that you serve all day long, right? Can you explain what a chaplain's role is in the healthcare sitting, particularly with our aging adults and then how you can support their emotional and their spiritual needs?

Marissa Click: 9:38

Yeah, so um, First there are lots of different kinds of chaplains as I mentioned a little earlier Most chaplains have their own spiritual or religious preferences. So let me suss that out a little bit. I believe that everybody is spiritual. right? We all have things in our life in which we make meaning and value. It's kind of those things that give our lives a higher purpose. right? That's being spiritual. for some people that might be their family. For others, maybe it's their work. Some people like to connect with nature, like you all. but for some, And that connection to their spirituality comes through religion. So religion has a certain set of beliefs, but mostly it's the practices around those beliefs. That guide and shape our lives, right, the ways in which we choose to function in the world have these kind of, rules, for lack of a better word. And chaplains have their own personal spirituality or religion, but we in healthcare especially have ethical guidelines that say that we are available to people of all traditions and no tradition. there are chaplains that are Buddhist chaplains, there are Muslim chaplains, there are Christian chaplains, there are chaplains who don't have a religious background, there are humanist chaplains. But the, the goal that chaplains have is to meet people where they are. And when you come into the hospital, or you start having changes in your health, that can cause a lot of strife. Again, You start asking a lot of questions about yourself, and your family, and what's important. And that's why having a chaplain can be helpful, because we can act as guides, right? And there's a lot of transitions that happen when you have a health crisis. People might start asking questions like, why me? Why did this happen to me? There are a lot of questions about fairness. Where is God in the midst of my suffering? Why me and not somebody else? People start to wonder, Who am I if I don't have XYZ in my health? And those are really big and scary things to be wondering when you're already in a really transitory time in your life. right? when you're trying to cope with Maybe you're aging and your body isn't doing all the things that it used to do so easily. Or your mind isn't as sharp as it once was. Or the experience that you're having isn't what other people are experiencing, I'm thinking of people with mental health issues or those experiencing dementia or Alzheimer's who are seeing things or hearing things that Maybe other people can't in that moment. And that can be really lonely if you don't have somebody who's willing to sit in that with you. You know, as much as our families love us and support us, they want to fix it. Right? The doctors want to fix it. And so, there's always an agenda. And that agenda can maybe be a good one. But sometimes we need space to work it out for ourselves. And so having someone who can sit in it with you, who can ask better questions, and help you come to the conclusions that you need to come to, to be okay with whatever you're going through, that's the heart of chaplaincy. And so, when we meet people, I get, I get that, question a lot of Oh my gosh, am I dying? Because everybody thinks chaplains are only here when you're dying, which is not true. We do come when people are at the end of their life. but not always. And so the majority of our time is actually spent just getting to know people and, and helping them navigate this new experience or Maybe they need to tell their story. And we're big collectors of stories and we love listening. Maybe somebody needs a ritual to help get them through, right? We have rituals in society all the time. coming of age is a big time of rituals, where we might shower somebody in gifts or they have to perform some kind of test to move from childhood to adulthood. And so we have those same kinds of rituals when we have health changes, too. And so we help navigate those things. we're also, ethical team members. And so when there are ethical questions that come up in healthcare, which happen, we might be on the team that's trying to help advocate and bring additional perspective to the group that's trying to make the best decision for somebody. So it's pretty broad. All the things that we do.

John: 14:57

What triggers, triggers the, Um, discovery that there's a chaplain available. Say I go into the hospital or somebody I love goes in the hospital and they have just been diagnosed with something or they are, feeling themselves having to. can come to the realization that their health is, is, really declining. And they're concerned with that. How do they know that there's, there's a chaplain available? How do they know that? Because most of the time, yes, if somebody comes on to hospice care, that's part of the disciplinary team, right? That comes out to take care of them. But however, in the hospital, are chaplains available for everybody and at what? time can they say, Hey, I'd like to see a chaplain or is there a chaplain available at what time does that, that occur?

Marissa Click: 15:48

Yeah. So in most hospitals, Every hospital's gonna have a little bit, different protocol or staffing, but most hospitals are required to have a chaplain. And chaplains are available just about all the time. At least at, at St. Al's we have coverage 24 7, 365. And so most of us will just round and visit and introduce ourselves and ask, right? So I go door to door. If you're in the hospital on my unit, there's a good chance you're going to meet me at some point.

John: 16:20

How great.

Marissa Click: 16:21

others, other places might have protocols about if you've been there for, a certain amount of time, right? The longer you're in the hospital. Maybe that means that you're experiencing more setbacks or more decline. That's a good reason for a chaplain to be triggered. sometimes when people have really high acuity needs, those areas of the hospital might get more, more support than other areas. Right, so I'm thinking ICU or oncology. Or, the emergency department, because those can be really trying areas of the hospital. doctors, there's usually in the electronic medical records of, of facilities, there's usually ways to trigger a referral, anybody can ask for a chaplain at any time, it's part of the rights that we get as people when we become patients. And anybody can ask and a referral can be put in.

Erin: 17:23

I'm learning a lot today.

John: 17:26

I think we learn a lot with every podcast. We do. I'm

Erin: 17:31

I didn't know there was a difference with pastoral and chaplains. so advanced care planning, I don't really know what that is. I have a clue, like you got a plan for the future, but really what is advanced care planning? How does it work? Where do you get started? The importance of it for our aging adults and maybe how it supports them and their family. If you could just briefly explain or share with us.

Marissa Click: 17:58

I like to think of advanced care planning as a gift. And I say that because there are many times in the hospital setting where some kind of tragedy has occurred, whatever that looks like, and we don't know as the medical team what this person would have wanted, and the family doesn't know either, they're stuck with making this huge decision for their loved one at a very heightened emotional time. Not knowing all of the terms that are being thrown out and the medical jargon that's being used, and it's really scary. So advanced care planning is really an opportunity for people to take away some of that fear and responsibility. By putting down in writing and having conversations with people about what they would want in future healthcare scenarios. And who they would want to speak on their behalf. So at the heart of it, it's a conversation. And then there's some details with paperwork. And so, things that are helpful for people to think through before they get to the details of putting things down in writing. In healthcare, we often just keep doing things to people. And there is this ethos, this belief system in healthcare that we want to fix it all the time, right? We want to make people better, that's why people get into healthcare, they want to help. But there comes a point in our lives where we can't fix it anymore. As amazing as medicine is, it still has limitations. It's still run by people who don't know enough, and technology will never get to the point where we can live forever. I don't know about y'all, but I've never met somebody who's gotten out of this world alive. And so at some point, we're all gonna die. And so, talking through what is important to you as a person, how do you define quality in your life? And quality can be defined in lots of different ways. For some people, quality might look like having their cognitive abilities. their abilities to have meaningful conversation and to recognize their loved ones and to understand what's being said to them. Other people might say their functional abilities are the most important thing. And those might be their ability to walk or... provide personal cares to themselves independently like showering, bathing, eating, going to the bathroom. And so if they lost those things, maybe that's not a quality of life that they would find acceptable. Other people might say, if they couldn't do their very favorite hobbies like Just, just end it then cause what's life worth living if you can't go fly fishing or something? And a lot of times when a nurse or a doctor or the medical team is, is talking to folks about their treatment options, we don't always think about, is this treatment option going to get me to that goal, to how I define quality? Because why would we choose a treatment? That doesn't actually get us to our goal. And so if we can prioritize our thinking to highlight those ways in which we define quality and then filter the decision making through that, we can often make better decisions that align more with who we are as people and what's important to us rather than just... continuing to do things for the sake of doing things. having these conversations isn't always easy, because it's, it has to be done with people, and as we know, everybody has a different perspective, different ideas of what's important, different belief systems that might be influencing the decisions that they would make. And so it can be vulnerable to bring those up with people that you care about because nobody likes to be judged. Nobody wants to hear that how they choose to live their life or how they choose to prioritize what's important to them is wrong. Or maybe not wrong, but it's just different than somebody else, right? That can be hard to be open to differences in perspective and experience. But that's why having the conversation is important because the other part of it is choosing someone to speak on your behalf to help make decisions based on what you said your goals are. And so you want to pick somebody that is gonna make those decisions even if they don't agree with them. that's kind of the, the starting point of advanced care planning.

John: 23:20

so when you select somebody and you have that person that's going to advocate for your, for you during that moment of crisis, it doesn't always have to be in the moment of crisis. we can, we can plan that and get a power of attorney for health, power attorney for finances and so forth. I think it's best that we all do that. Way early in our lives, right? Because we don't ever know when something could happen. and I, I love that you said it's a gift, too, because I do think it's not only a gift to the person that eventually will go through some sort of crisis, but it's a gift to their loved ones because it can create so much. tension and stress and in fighting within families when, they haven't selected somebody as a power of attorney and crisis hits. Am I correct on that?

Marissa Click: 24:13

Oh, you're very correct on that. And There are so many times in the hospital where somebody has maybe not chosen someone. And so in Idaho, at least every state has their own laws around this, but in Idaho, there's actually laws in place. It's the Idaho statute and there's a bunch of numbers after that I can't remember, but it dictates who can make healthcare decisions on your behalf and it, it has a very strict order. I think the order is if you have a guardian, then if you don't have a guardian, it goes to, a legally married spouse. So I'm going to emphasize legally married because the state of Idaho does not honor common law marriage. Legally married. then it would go to an adult child, And then siblings, parents, and then any other trusted adult. not uncommon for us to have maybe strained relationships with some family members at different times throughout our lives. if you have a strained relationship with somebody who is first in line in that Idaho statute and you haven't chosen a healthcare agent, that person's going to make decisions on your behalf. And if that's not who you trust to do that or who knows you well enough to do that for you, that can be really not great sometimes. the other part is, sometimes in some families, There are certain members of the family that kind of rise up and they're the doers in the family and they're the ones who want to take control. But maybe they're not the best person to make decisions. And so maybe you want, someone who's a little bit quieter or that you're closer to. And so again, if you don't put that down in writing, it can cause increased strife in your family as they're working through their own family dynamics. And. The role that they play in the family, some of this is also, in certain cultures, certain people speak on behalf of the family. if, if you're the person who is the spokesperson for the family, but you're the one in health crisis, then in the background, your family's having to reorder, who's going to be the new spokesperson or the head of the family. So it's really important to, to have this in, in place. there's never a bad time to start the conversation. I know I recently had this conversation with my husband. I'm 34 years old, don't really have a lot of health issues, but I see the worst case scenarios every single day at the hospital. And so, I made an advance directive. And it was hard to have the conversation with my husband because initially I didn't want to choose my husband to be my health care agent. Mostly because he's had some personal grief issues and family loss that still affects him today. And I was concerned that that would be too difficult for him to make those decisions. But we had a conversation and, yeah, it changed my perspective because of what he chose to share. And so it made me feel more comfortable having him be my person. And we had to hash out, all the details that come with those health care decisions and talk through them because he and I have different perspectives on what we would want.

Erin: 27:45

where do you start? Do you start with your lawyer? Do you start pulling stuff offline? Do you start with your doctor?

Marissa Click: 27:53

Yeah, So this is a, it's going to be a multi part answer. So there are different kinds of So, depending on what kind of document you want to fill out, will determine where you want to start. So, as you mentioned, there's different kinds, like, there's financial power of attorney and there's medical power of attorney. Anything financial has to go through a lawyer. But, they can also do medical stuff too. So if you feel more comfortable going through your lawyer, you can go through your lawyer. I don't always recommend doing the healthcare stuff through a lawyer, only because you might have some specific medical questions that you want answered that a lawyer will not be able to, that's not within their scope. Financial stuff? Thousand percent. They're definitely going to know all the details that you need for the financial stuff. Medical, I would encourage having a conversation with your physician, again, depending on the type of document. So I'm not going to really talk about the financial power of attorney stuff, I'm going to focus on the medical. So there's two different kinds of advanced care planning documents for medical care. There's an advanced directive and there's a post form. So, an advanced directive is for future medical decisions. It's not for right now. A post form is for right now. an advance directive is really great to fill out for anybody at any time over the age of 18.

Erin: 29:35

And you get that from your primary care doctor?

Marissa Click: 29:38

You can get it from your primary care doctor. You can get it when you're in the hospital. if you've got home health coming to you, you can fill it out with them. Most healthcare entities will have advance directives. So there's two parts to an advance directive. There's the durable power of attorney for health care. So this is your health care agent, the person that you choose to make health care decisions on your behalf when you can't make them for yourself. Whether that's because maybe you're unconscious, maybe you've lost decisional capacity, which can only be determined by a doctor, but that could include, uh, maybe you've got some confusion, maybe you're demented and can't make decisions anymore, um, maybe some medication is altering your mental state and that can resolve, right? Capacity is always an ebb and flow, But at some point, you lose the ability to make your own healthcare decisions. And so your healthcare agent makes them for you. This person has to be over the age of 18, right? A legal adult has to be the one to make decisions. And again, you want it to be somebody that you trust to make decisions for you, even if they don't agree with them. And so having a conversation with them about your decisions is important. so some of the things your health care agent can do They have the ability to start or stop any treatment, medications, procedures. They can choose which health care agencies to go to and which health care professionals to see. They can access your medical records. for example, if you primarily get care at St. Al's, but something happens and then you go to St. Luke's, maybe St. Luke's needs your medical records. And So your agent can go to Al's and get them and bring them to St. Luke's. And then should you pass away, it gives your healthcare agent the ability to take care of your final arrangements. So like funeral home kind of stuff. an advance directive only gets triggered if a future healthcare scenario comes into place. And this is the scenario. Whatever illness or injury brought you to the hospital or is occurring gets evaluated by a doctor. And they feel like there's nothing more they can do to fix whatever is happening, even with artificial life sustaining procedures. And your death is likely. Or, you're in a persistent, vegetative state. Now that's different than brain death. People often ask, like, well, if I'm brain dead, just let me go. there are specific, tests that have to be done in order to determine brain death. And, in the United States... Brain death is death. And that can be really confusing for people because often when somebody has had brain death occur, they might still be on artificial life sustaining equipment that makes them look alive. right? Their heart might still be beating. They might still be breathing because they're on a ventilator machine that's breathing for them. And That can be hard for us because we, we think they're breathing and there's a heartbeat, they're alive. When in reality, based on legal definitions and these testings, that person, if they've been determined to be brain dead, is dead. So, I just want to clear that up because when somebody has died, there aren't any more decisions to make. They've died. Sorry, going back to the, scenario in which triggers your advanced care directive. so whatever illness or injury brought you in is no longer curable. We can't fix what's going on anymore. There's three options that you can choose from. And in all of these three options, the priority is going to be to make sure people have dignity and honor and that their symptoms are going to be managed. Right, we don't want to see people in pain or suffering, and we want to make sure that they're treated well. And so no matter which option is chosen, people are always going to be treated well. But those three options are, the first one, if I'm in that end of life scenario, I just want to focus on comfort. Don't do anything else to try to prolong the process or alter what's happening. Just let me go when it's my time to go and keep me cozy comfy in the meantime. There's a middle ground option which is keep me cozy comfy but I want some artificial life sustaining procedures like artificial nutrition and hydration. So a feeding tube or IV fluids. the third option is do everything. All aggressive cares, so that means going to an ICU level of care. That means if your heart or your breathing were to stop, they're going to do CPR, which could include both chest compressions, possibly defibrillation, which is where they shock ya. and it does include being put on a ventilator, so a breathing machine. At least I've never seen CPR be performed and somebody not be put on a breathing machine. So those are the three major options to choose from. There are several extra parts to the advance directive. Now There are areas where it talks about if you're pregnant, what would you want to do with your advance directive. If you're not going to be pregnant in the future, and that doesn't apply to you, don't fill that part out. for some, there's a section in there that talks about, if you don't have an end of life illness, a terminal illness, maybe you have a more chronic issue, uh, but you lose your cognitive abilities and your functional abilities, would you want to focus on comfort at that time? So that's a... Little caveat in there. There's a free text option in the advanced directive that you get to put whatever you think is important. So sometimes people will put in how they define quality. Again, this can be a great way to help guide your health care agent and medical team into choosing the best treatment options for you. if those treatment options aren't gonna get you to your goal, why would you choose them? Sometimes people will put, especially if they choose that second option where there's kind of a middle ground where they're choosing certain, artificial life sustaining procedures, maybe they'll put stipulations on that, I want a time limited trial of artificial nutrition with the goal of getting off of it, right? a time limited trial of, three weeks, and if... I don't make any progress or gain any weight, then withdraw that treatment and let me pass peacefully. Other people might put, if they've got certain, religious rituals or spiritual needs at end of life, maybe they'll put those in there. or if they want to put their final arrangements in there. and then finally, there's a section that talks about if you have a post form or not. I had said earlier, Advanced Directives are for the future, Post Forms are for right now. So POST stands for Physician's Order for Scope of Treatment. So it's actually a doctor's order. And so you have to have the conversation with your doctor for a POST specifically. Advanced Directives can be filled out with anybody. POST has to be with a doctor. at some point when somebody is hospitalized, They will, the doctor will often come talk to them about what they want their code status to be. So that's asking, if you're hard of breathing where to stop, do you want us to perform CPR and try to do everything to bring you back? Right? Including being on event or going to the ICU. And so that conversation around code status is what's happening in a post form. It's the same kinds of questions. If something happened to you, what would you want? But instead of being for the hospital setting, it's for out in the world, right? this is important because in our country, the default is full code, do everything. if somebody, Joe Schmo is walking down the street, and they fall down, their heart stopped, maybe they had a heart attack or something, and they get found, the default for us is we're going to try to do everything to bring them back to life, save their life. Perform CPR, blah blah blah. You call 911, EMS comes. do you fill that out before, or like at the same time as

Erin: 38:52

Do you fill that out before or like at the same time as the medical directive? Are they both filled out or is it separate or is it only, like how does it

Marissa Click: 39:00

work? I would say they're usually filled out separately. advanced directives, everyone should have. All the, I am gonna plug that, everybody should have an advanced directive At any age. Yeah. It's always good to have a post form. Not everybody needs one right now. Because again, it's not about future, it's about right now. if you're really thinking about, I'm gonna still go to the hospital to get care if something happens. I'm still gonna try to seek medical attention to fix whatever goes wrong. You probably don't need a post form right now because we're gonna do that anyway. But if there's a point in your life where maybe you have a lot of chronic illnesses or a lot of health issues going on where you've decided, I don't want to treat these anymore or... I wouldn't want to go back to the hospital anymore to seek care. And we know time is shorter, probably one to two-ish years based on your medical stuff that's going on. That might be a good time to talk about filling out a post with your doctor.

Erin: 40:09

Would you also do that if you didn't have one before, if you were to go on hospice, you would fill one out at the time?

Marissa Click: 40:15

Mm-Hmm?.Yeah. So. Mo, most of the time if you go to like a nursing home, or sometimes assisted livings, but mostly like nursing homes, they'll have you fill out a post. when you come on hospice, they're definitely going to have you fill out a post. again, because it's that doctor's order, and we know that you're terminal.

John: 40:38

I, love what you've, you've shared.

Erin: 40:42

That's a lot I didn't know. Cause we've talked about like the five wishes and he's filled his out. I haven't done mine

John: 40:48

Yeah. so Marissa, one thing that I've, I've really it's really. Reaffirm my belief system, and it's so important that if we want to alleviate a lot of stress, not only for ourselves or for others, it's really important to plan things early, because we live in such a reactive world, right? And so it's more and more It's so much more important to be proactive. And one of our, our tagline of our company is it's your life, your choice, right? And so we want to, we want to empower people. Type of control. But the only way you do it is by having those vulnerable, discussions by sitting down with your family and saying, gosh, I'm not trying to scare you or whatever, but let's have these discussions because we love each other. And we don't want that infighting and we don't want that stress to roll down on us. Is that correct? Is that what I'm

Marissa Click: 41:45

that what I'm gathering?

Erin: 41:47

on us. Is that correct? Is that what I'm gathering? Very correct. Yeah.

John: 42:06

can ask, Yeah, can ask to engage that discussion because like for instance, I'm going home very soon while Aaron's going with me for Thanksgiving and after the holidays, my dad is. My dad's 80 now, and, and my mother's getting up there in age two, and I don't even know if they've done their advanced directives, and, and they filled out any paperwork, and so it's really important, that balance of respect. But then also that balance of it's important that we have this discussion because, we all need to know. And it's not something that none of us have not thought about. what happens if dad gets ill or dad has a heart attack or something happens to mom? What's the plan? So what are some questions that you feel with your expertise that you could help our listeners? Start that conversation with their loved ones, maybe their husband, maybe their wife, maybe their children.

Marissa Click: 43:02

Yeah. So I think you're right. We are very reactionary. So being proactive is always great. I would say, it's good to think about how communication works in your family because every family is different, right? Some people are really direct and honest and just really dive deep into it. And they're not afraid of maybe, hurting some feelings a little bit because we got to get it done. Other families maybe want to like ease into it a little bit more, right? So think about that in your approach, right? Because it's it's all about approach. So for some, it might be starting out more broadly of hey, have you ever thought about what if you happen to have to live in a facility? What do you think that'd be like? Because it's less scary. Having, hypotheticals than saying, What do you, Aaron, want? And that can feel really, attacking. I've also found, doing it together, So instead of saying, Hey Dad, or Hey Mom, or whoever, You need to do this. Because we don't like being told what to do. It's saying, Let's have a conversation around this. there's this really, this is very silly. But there's this really fun game that I have that actually, you can play a game that talks about death and dying.

John: 44:24

I'm excited. Let's hear it. hear it.

Marissa Click: 44:27

And it's got, these little questionnaires on cards. And it's just a whole bunch of different stuff of have you ever thought about this before?

John: 44:34

Is this something you can buy? Yes, buy it. Do you know the name

Marissa Click: 44:37

of this? I'll have to look to remind, to tell you guys the name so you can put post it. But yeah, it's a little, it's just in a little box. I have it at my house. I didn't even think about, oh, I should bring this so that you guys can see it.

Erin: 44:48

It's like conversations that you have at dinner box, but it's conversations you have about,

Marissa Click: 44:54

death and dying. Yeah. yeah. I think the other part of having these conversations with people is really wanting to emphasize, this is coming from... A place of care and concern because we love you. We're not bringing it up because we want to make you feel uncomfortable or because we're trying to force you into doing something you don't want to do, but because when that time comes, because again it will, we're all going to be at that point in our lives at some time, We want to be able to honor you as a person. And we want to be able to make sure that we know what you want. And that our feelings and our emotions and our desires don't get in the way of that. I think that's a really great place to

John: 45:45

I

Erin: 45:46

I remember we were talking somewhere, or maybe I saw it somewhere, or read it. I think it was in a book we both read. Either way, it was pretty much Okay. You need to share this and express what you need. Cause if not, this person's going to put you here and this person's going to just pull the plug. And Oh yeah. Precious. yeah. I was like, Oh, that just is, but it's so true. If you don't plan, I just might pull the plug on you. If I had a bad day,

John: 46:19

and I There was a type of relief for me when I filled mine out, it was, it was strange going through it because I consider myself pretty healthy and don't go to the doctor very often and so forth. But there was a type of relief that came to me to know that I was going to share what I truly wanted with my life with with Aaron and give her a copy of that and know that it. My boys weren't going to be burned with this stress, that, that Aaron has such an amazing ability to say, gosh, these are your dad's wishes. these are not wishes. I wrote down on the sheet of paper. These are what he wrote. And we have to honor this. And there was a type of power. In knowing that I had gotten that done and with five wishes, the one that I did, it was free, it didn't cost a penny. sometimes you have to go see a lawyer for your financial power of attorney and there's costs associated with that. but it's things that we don't plan for, right? And if you don't plan early in your life, And now that I'm in my fifties, I see the importance of it. But if you don't plan early in your life and then down the road, you're on a fixed income and you don't have the money to hire an attorney, to resolve all these things, it can be a scary thing to even have a conversation about, right? Because some people fear money, but it is so important because it will destroy families. It will destroy connections, you

Marissa Click: 47:50

destroy families, it will destroy connections, doctor. they have the ability to bill your insurance for it. So they should be taking the time to have these conversations with you. You can also reach out to chaplains and social workers. Even if you're not in the hospital currently. This is always a resource to you, for free, that you can use anytime. You can get these documents from your primary care. in our state, the Department of Health and Welfare now owns them, and so there are forms online you can download. you can, search for, there's lots of different kinds of documents. So, like you guys have mentioned, Five Wishes. There used to be Honoring Choices that was here. so there's lots of options

Erin: 48:42

was one of my questions to you. Are there books people can read that can help them ease, that transitioning into the later, as we're getting ready to die, but then our what's available online, all the stuff that they families can use, or as an individual myself, I can go online and go, okay. And then to know that it's, it will be honored, I think, is huge, too.

Marissa Click: 49:06

Yeah, there's this book by Hank Dunn called Hard Choices for Loving People. Now, I'm a little biased about this because it's written by a chaplain, right? So, I'm gonna plug it. But, it, it's really beautiful because there's a lot of, the science and the math and the medical. stuff, right? So he, he breaks down all the terminology, but he also gives you the statistics of how likely are these things to work based on, what other health issues you have or your age or other things like that. And that's, I think, helpful to know, but Hank really emphasizes that these decisions come from an emotional place. it doesn't matter how many facts and figures we have. We're always going to make them from a place of emotion. And so he talks about some of the emotion that is behind some of these decisions. So, for example, one of the most difficult issues I think people have is talking through artificial nutrition and hydration. So, different kinds of feeding tubes and IV fluids. Emotionally, that's difficult for us because... feeding people and giving them something to drink is how we show love and care. It is ingrained. It is societal. It is something we're raised with, right? The minute somebody walks into your home, what's the first thing you do? You offer them something to eat or something to drink. the idea of withholding food or water from somebody can be very emotionally difficult for us. Especially when it comes to the people that we love most. But the facts and figures talk about how, in the dying process, our body produces all of these enzymes and hormones that make it so that we don't feel hunger or thirst, right? There's this fear that we're going to starve our loved ones, but in reality, their body is going through a purging process and they're not going to feel hunger the way that you or I would feel it. Right, but emotionally, that's really hard to accept, So those are the kinds of things. That Hank Dunn talks about in his book, Hard Choices for Loving People. Great book if you're more of a reading kind of learner. Yeah. If you're more of a, like, practical action, like, we're going to get into the conversations, there's this website called planningmyway. org. And it's a step by step guide to help you work through the completion of advanced directives and how to have those conversations and things to think through as you're talking it out. And so it breaks it into four steps, right? So you've got you're thinking, like, what do I want? Right, we have to work it out for ourselves first. So it's like thinking, and then you're planning, and then having the conversations, and then completing the documents, right? Because that's the final thing. Always have the conversation first, that's always super helpful. For your medical team, it's great to have it in writing. And with our advanced directives, once you've gotten to that step where you've actually completed the form, in the state of Idaho, it just needs a signature. You don't have to have a notary or witnesses in the state of Idaho. Oregon has different, rules around that. Other states have different rules around that.

Erin: 52:45

You would just ask your doctor, Hey, what are the rules? Do I need to have it notarized? Or can I just sign it? Like, how do you know?

Marissa Click: 52:54

most of the forms will have it. laid out for you in it, right? So the, the Department of Health and Welfare Advanced Directive, it only has a signature line at the bottom. that's pretty clear.

Erin: 53:04

Yeah

Marissa Click: 53:05

so people always ask, what do I do with my documents once I've completed them? Alright, so one, make some copies. And give it to your healthcare agent so that they have it. Give it to your primary care doctor. And if you haven't had the conversation with them already, have the conversation with them about what you want and say, Here's my form. your hospital of choice, right? So wherever you tend to get hospital care or where you might get hospital care. And, if you have a lawyer, you could take it to your lawyer. That might also prompt you to start the conversation around financial power of attorney.

John: 53:40

oh my gosh, so much incredible information today. It's been really exciting having you here and sharing all this I've learned. I, and I know you as well, Aaron have learned so much about all of this and the importance of, having these. These things filled out in advance and, really planning, planning to, to, be less reactive in this world. So I know that Erin's got this question that she asks all of our guests, and I love the question too, because it's,

Erin: 54:11

you ask it? You don't ever ask

John: 54:13

don't. Okay. All right. I'm gonna ask it today. so Aaron and I love to travel and we've been some. Amazing places and we've done some incredible things. And so to kind of change the subject into something that we want to know about you as well as if you could do something or go some amazing place, what would be on the top of your adventure list?

Marissa Click: 54:37

Yeah, so I have to think about this for a minute, but when I hear adventure, I don't always think about going. Somewhere, I think about doing something. so, before the pandemic, I was starting to learn how to, play roller derby. So, I really want to get back into that because it was super fun. I'm not a very, like, physical person. I'm very, like, emotional and in my brain, but I'm not in my body a lot. And so, learning to, how to use my body

John: 55:09

And knock people down and skate past them and all that?

Marissa Click: 55:13

Yeah,

Erin: 55:13

I mean, okay, we, like you say, you go from this very emotional and compassionate, ah, I'm going to take my frustration out on you. Yes! That's

John: 55:22

just, I've never heard of a chaplain wanting to go smash people on a roller derby course, But that's wow. Two sides of you. I guess there's two sides to all of us. so thank you so much for being a guest today. I'm so glad that Aaron connected with you and, she was so incredibly excited. she's been talking about this since, since. we all were at that event and she just said, Oh my gosh, I can't

Erin: 55:46

wait it's a lot of a lot of good information for people to go more in depth into detail instead of just saying it's a post and it's a directive. what does that mean? And where do I start and really give me all the dirty details so I feel comfortable about it. So I appreciate you sharing that.

Marissa Click: 56:00

Yeah. Yeah. I've just been thrilled to be on the show. Anytime that I can offer. advice or guidance. I just want to help people. So any format that I can do that, I'm going to jump on.

Erin: 56:12

Yeah, thank you so much. I appreciate it. we'll

John: 56:16

Thank you for tuning in to another episode of Connect Empower. We want to express our gratitude to you for being part of our community, and we hope today's episode has provided you with valuable insights and inspiration to enhance your life and that of a loved one.

Erin: 56:31

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John: 56:52

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Erin: 57:07

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John: 57:27

I'm John.

Erin: 57:28

I'm Erin. Until next Wednesday.