Chapter 4
Module: Understanding Advance Directives in Long-Term Care in Kansas
Advance directives are critical legal tools that help ensure long-term care (LTC) residents’ healthcare preferences are respected even when they cannot communicate those wishes themselves. In Kansas, Social Service Designees (SSD) and Activities Directors (AD) are often part of the interdisciplinary team that supports residents and their families in understanding, executing, and honoring these directives.
What Are Advance Directives?
Advance directives are written statements by a competent individual that outline preferences for future medical care. They serve as a guide for healthcare providers and families if the person becomes unable to speak for themselves. Types include:
- Durable Power of Attorney for Health Care (DPOA-HC)
- Living Will
- Do Not Resuscitate (DNR) Orders
- Guardianships and Conservatorships
1. Durable Power of Attorney for Health Care (DPOA-HC)
Under the Kansas Power of Attorney Act (K.S.A. 58-650 to 58-665), a resident may appoint someone to make healthcare decisions if they become incapacitated. This document must:
- Be in writing, dated, and signed
- Include at least two witnesses (over 18, not related, and no financial interest)
- Or be notarized
- Clearly name a healthcare agent and specify powers granted
SSDs often assist families in understanding this option, providing referrals to legal assistance, and facilitating conversations with care teams.
2. Living Will
A Living Will allows residents to specify their wishes regarding life-sustaining treatments. Like the DPOA-HC, it must be in writing, signed, and witnessed or notarized.
Examples of what may be included:
- No life support in terminal or irreversible conditions
- Refusal of artificial hydration or nutrition
SSDs and ADs can help ensure that copies are shared with care providers and documented in the resident’s chart.
3. Do Not Resuscitate (DNR) Orders
A DNR is a medical order that directs providers not to perform CPR if a resident's heart or breathing stops. In Kansas:
- DNRs must be signed by the resident (or authorized representative) and a physician
- Must use the standardized form (K.S.A. 65-4942)
- Often printed on red paper and available at physician offices, hospitals, or Wichita Medical Research Foundation
A DNR may be revoked at any time by the resident.
4. Guardianships and Conservatorships
- Guardian: Appointed by a court to make personal and medical decisions
- Conservator: Appointed to handle financial matters
SSDs play a key role in identifying residents who may lack capacity and assisting with referrals to legal counsel for guardianship proceedings when appropriate.
Roles of SSDs and ADs in Advance Directives
- Provide educational materials and resources to residents and families
- Encourage residents to communicate their preferences clearly
- Ensure documentation is included in care plans and updated regularly
- Facilitate advance directive conversations with interdisciplinary teams
- Help create a respectful, person-centered environment for end-of-life planning
Legal & Ethical Responsibilities in Kansas
Facilities and staff must honor valid advance directives. According to Kansas law:
- Advance directives are legally binding
- All LTC facilities must inquire about and offer the opportunity to execute one upon admission
- Staff must receive training on how to respond to and honor directives