All adults urged to complete advance directives   

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Jennifer Fairbank, chair of the Rhode Island Health Care Association and administrator of Kindred Health Care and executive director of South County Nursing and Rehabilitation Center

Jennifer Fairbank, chair of the Rhode Island Health Care Association and administrator of Kindred Health Care and executive director of South County Nursing and Rehabilitation Center

Approximately 9,000 people are cared for daily in Rhode Island’s skilled nursing centers. For some, their stay is a short-term admission following a hospitalization. Others rely on the 24-hour, long-term care that they need to help manage a chronic illness or debilitating condition that precludes them from remaining at home.

The caregivers in skilled nursing centers do an extraordinary job of helping people regain their best selves, but as in any health care setting, residents and families should be prepared for unexpected health events. As a nursing center administrator, I’ve seen countless people come through our doors unprepared for what could lie ahead. Few have prepared advance directives, which let their loved ones know their preferences should they become unable to express them to our staff. Such decisions should include thoughtful conversations between family members prior to a crisis.

Advance directives guide loved ones and health care providers by specifying how an individual wishes to be treated in various scenarios. All adults, not just older adults or those with serious medical conditions, should complete advance directives.  I’ve witnessed the trauma and anxiety inflicted on families when the preferences of their loved one were not made clear, and they are faced with the burden of decision making without clear direction.

With that in mind, I’d like to issue a challenge. April 16 is National Health Care Decisions Day.   Make your health care preferences known in person to your family and in writing.

There are different types of advance directives, each covering specific wishes. Most people have heard of DNRs – do not resuscitate orders. Without a DNR, medical personnel will automatically attempt to resuscitate a patient regardless of the likelihood of success or of a meaningful recovery. It’s critically important to have a DNR if you would not want to be resuscitated.

A living will is a legal document that specifies the kind of medical or life-sustaining treatments you do or do not want in the event you are unable to make or communicate your own decisions, but it is only usable for certain health care conditions.

The most comprehensive and flexible document — the durable power of attorney for health care — allows you to appoint someone you know and trust to make health care decisions for you if  you become incapable of doing so. When the person is appointed, you can give the individual detailed written information about your wishes and beliefs, and if you should become incapacitated, they will have the flexibility to address whatever medical situation may arise. After the durable power of attorney is signed, you are free to revoke it at any time, and the document takes over only in the event you are incapacitated and a health care professional documents your incapacity.

Finally, a letter of instruction covers other matters such as directing individuals to important documents or accounts or appointing caregivers for children or pets. You can also specify memorial or funeral instructions.

Those are not easy decisions but in the unlikely event that you become incapacitated, having made and communicated them will help make a difficult situation a little easier. Social workers in our skilled nursing centers are always available to guide you through the process and help you access the forms you need.

Jennifer Fairbank is executive director of the South County Nursing and Rehabilitation Center in North Kingstown. Contact her at or (401) 294-4545.

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