Introduction to Strategic Advance CARE Planning and NOW Care Planning


“Strategic Advance CARE Planning”
—if your mind
is still sound.



A Seat at the Table

“Now CARE Planning”
—for patients now incapable of completing a Living Will.

GOALS

➨ To have a peaceful and timely transition based on your personal preferences
➨ To minimize your pain and suffering, and being a burden on others
➨ To avoid prolonged dying if you ever reach an advanced stage of dementia or similar condition
➨ To reduce loved ones’ conflicts with self and with others as they advocate your “end-of-life wishes”

Strategic Advance Care Planning (patent pending) is for people whose minds are sound. The protocol describes end–of–life conditions, lets patients make specific advance treatment decisions based on possible future suffering, and guides them to put a strategic plan in place to effectively overcome possible future challenges.

PLAN NOW, DIE LATER®
TO LIVE LONGER


Now Care Planning (patent pending) is for patients whose mind is no longer sound and do not have an effective living will. Family members compare their substituted judgments to see if they agree that the patient, given his/her current condition and prognosis, would certainly refuse all interventions that prolong dying and suffering.

Both protocols use a patient decision aid named, "My Way Cards®." Traditionally you could consider each of the about 50 conditions one-at-a-time, decide if it is likely to cause severe suffering, and put these real, jumbo-size illustrated cards in appropriate stacks on a kitchen or dinning room table. Now you can go digital and/or mobile: You can efficiently use the living will generating program on your computer, tablet, or cellphone, and click on the treatment you prefer, one-condition-at-a-time.


My Way Cards for Natural Dying - Cover

It's easy to follow this STEPS:

If your mind is still sound, use Strategic Advance Care Planning:

To begin, generate your Natural Dying—Living Will by using “My Way Cards.” Make decisions for about 50 conditions—one condition at a time.

Then, let a counseling provider ask you to explain in detail, “what” treatment you want “when.” Memorialize your interview on a video recording.

Finally, put in place a set of effective strategies designed to motivate future physicians and others to honor your end–of–life wishes.

If you are confident that your Advance Care Plan will be effective, you can then fulfill this goal:  “Plan Now, Die Later® To Live Longer.”

If you’re seriously ill relative’s mind is not sound, use Now Care Planning:

To begin, generate your substituted judgments; that is, make the decisions you believe your relative would have made, by using “My Way Cards”—one condition at a time.

Then you and the others who knew the patient well in the past, discuss your substituted judgments. If you all agree, go on to the next step.

Finally, ask for consultations and implement the strategies needed to motivate physicians and others to honor these end–of–life wishes.

If you are confident, by sharing this difficult decision with others who all agreed on “what” your relative would want “now,” then you can minimize your emotional stress as you effectively relieve your relative’s suffering.

Four examples of the 50 My Way Cards::

My Way Card 4.5

I do not use bathrooms. I let my clothes get wet and dirty. Others must change my diapers.

[_]Feed & Treat [_]Natural Dying [_]Proxy to Decide Later


My Way Card 2.6

I very often have severe pain. But I cannot say what bothers me. Doctors don’t see my pain. They do not treat my pain.

[_] Feed & Treat [_] Natural Dying [_] Proxy to Decide Later

My Way Card 6.3

Doctors and medicines can keep me alive, but cannot make me feel better. I will get sicker until I die.

[_] Feed & Treat [_] Natural Dying [_] Proxy to Decide Later


My Way Card 3.1

When I see my close family members or best friends, I do not know who they are. I cannot enjoy them. I do not respond. I just sit there.

[_] Feed & Treat [_] Natural Dying [_] Proxy to Decide Later

Stanley A. Terman, PhD, MD

Psychiatric Alternatives and Wellness Center
Medical Director, CEO of Caring Advocates


www.CaringAdvocates.org
DrTerman@gmail.com

PH: (415) 237-0377;
FAX: (415) 484-1944

3030 Bridgeway, Suite 107
Sausalito, CA 94965

3611 Sacramento Street
San Francisco, CA 94118

2240 Encinitas Blvd., Ste. D, #334
Encinitas, CA 92024
800 647 3223 or 760 431 2233;
FAX: 888 767 6322

To read a short BIO, use this link:
caringadvocates.org/pawc/DrTerman

To view videos on Advance Care Planning, learn about our training program, and read professionals’ and patients’ testimonials:
visit: caringadvocates.org/acp/

If you want to forward someone the LINK to this e-brochure, you can copy it from here: caringadvocates.org/acp-brochure.php

Dr. Stanely Terman

Stanley A. Terman is a board-certified psychiatrist and bioethicist, has an MD from U. of Iowa and a PhDfrom MIT. To help psychiatric patients, he prescribes medications only when necessary. His approach to psychotherapy can include strategic, existential, psychodynamic, cognitive behavioral, and meta-cognitive, as well as couple therapy. He actively appreciates people’s dignity by respecting that they want to change and they need to be accepted.

To attain the goal of a peaceful, timely dying, Dr. Terman developed Strategic Advance Care Planning with input from clinical, bioethical, legal, pastoral colleagues, and patients. He also created Now Care Planning for incompetent patients who no longer can complete a living will.

Dr. Terman welcomes Medicare beneficiaries although he is a voluntarily unenrolled provider. Medicare is likely to reimburse patients based on its set “allowable amount.”

For patients who cannot travel come to Dr. Terman’s office in Sausalito that offers handicapped parking and wheelchair access or his San Francisco office, Dr. Terman uses private & secure InterviewByInternet.com, which is HIPAA-compliant.

Call (415) 237-0377

DrTerman@gmail.com


Advance Care Planning colleagues:


Nate Hinerman, PhD, is Associate Professor and Chair of Psychology in undergraduate programs at Golden Gate University. He is also a psychotherapist, specializing in advance care planning, and grief counseling. He organizes international conferences on death, dying and bereavement, and leads local organizations devoted to the expansion of hospice and palliative care services.

Michele Senbertrand is a Geriatric Advance Practice Registered Nurse Practitioner, Psychotherapist and Elder Care Manager. She had 16 years of experience advocating and caring for elderly in New York City before moving to the San Francisco Bay area, where her practice will increasingly focus on advance care planning.


For an under 6–minute video about Strategic Advance Care Planning, see youtu.be/WyCjSKl-Zfc 
For a 3 1/2-minute video about psychotherapy, see youtu.be/X5xqEkFk_Yc

Now Care Planning-Advanced Dementia or severe suffering-timely, peaceful dying if NO Living Will.
— Abridged Version. 13:15 min. youtu.be/iXA7J7QIiyU
— Full Version. 26:30 min. youtu.be/bY4Bd6Z824M

 

Brief Introductory Videos

 

  1. For Dementia & All Terminal Illnesses–Effective Strategic Advance Care Planning or Now Care Planning. 5:45 min. Link

    A brief introduction to two innovative ways that make it possible to control the last chapter of life to attain the goal of a timely and peaceful transition for patients living with Advanced Dementia and/or severe terminal suffering.
  2. Now Care Planning-BRIEF INTRO-Advanced Dementia, suffering-timely, peaceful dying if NO Living Will. Link 5 min. June 2017.

    This “Brief Intro” explains the clinical need, the goal, and the benefits of Now Care Planning for family members and for patients who face the challenges of Advanced Dementia or severe terminal suffering. Watch this video to decide if your situation is similar to the challenges for which Now Care Planning was designed. If so, view the full version of the video and/or contact Dr. Terman or another Advance Care Planning counselor to discuss your options.
  3. Now Care Planning-for Advanced Dementia, severe suffering-timely, peaceful dying if NO Living Will. Link 26:13 min, FULL VERSION. June, 2017

    This full video debunks three common myths about Advance Care Planning and includes a poignant story about a relevant mercy killing/suicide, quotes from health care professionals that exemplify why some oppose Natural Dying, and the sad saga of a woman whose five-year dying ordeal illustrates why Advanced Dementia can be a most cruel, most burdensome, and horribly long way to die.
  4. Now Care Planning-Abridged-for Advanced Dementia, suffering-timely, peaceful dying if NO Living Will. Link  13:06 min. June, 2017.

    For viewers who feel 26 minutes is too long and 5 minutes is too short, the abridged version of this video describes some challenges and provides some glimpses about how Now Care Planning works, and viewing it may suffice to decide whether or not to contact an Advance Care Planning counselor.
  5. An Ironclad Strategy for Advanced Alzheimer's Dementia and Unbearable End-of-Life Pain. 7 min. Link
    (The YouTube title is Your Ironclad Strategy. Sort cards / Consult Physician, Record Videos & Empower proxy / Store online.)

    This video highlights the effective components of the strategies that Caring Advocates has been using for several years.
  6. Living with Advanced Dementia—What is it really like? Feb 4, 2017 13:50 min. Link

    Excerpts from several videos that poignantly illustrate why Advanced Dementia is such a cruel, burdensome and potentially long disease. Examples in this video make intense efforts to complete Advance or NOW Care Planning reasonable.
  7. Why Dr. Terman dedicates his psychiatric/bioethics career to Plan Now Die Later to Live Longer. 6:30 min. Link

    On this video, Dr. Terman openly and frankly reveals the basis for his motivation to make this area, his life’s mission.
  8. Training Professionals on Counseling for Advance Care Planning for any disease, including dementia. 2:50 min. Link

    A very brief overview of the three-stage program that trains healthcare providers on how to provide Strategic Advance Care Planning and Now Care Planning to patients who need such counseling.
  9. How Dr Terman practices psychiatric psychotherapy May 16, 2017. 3:30 min. Link

    Dr. Terman explains his passion to help both younger and older adults with the challenges of life transitions. For example, this short video provides a glimpse on how he uniquely combines medications and innovative psychotherapies.
  10. Health care professionals can help patients avoid prolonged suffering & dying. 58 min. Link
    Q&A. How Professionals Help Avoid Advanced Dementia. 6:47 min. Link

    A lively, interactive presentation to members of an end-of-life coalition to encourage its members to consider training to provide counseling for Strategic Advance Care Planning, which includes papable details about examples of some strategies.
  11. Making Hard End of Life Decisions for Your Loved One. 11:30 min. Link

    Some nuts and bolts on how to use My Way Cards to make difficult end-of-life decisions for a patient who cannot make decisions him or herself.

Note: Several dozen additional videos are available a www.YouTube.com/DrTerman. Call or email to request our most current “List of Resources.”

professionals’ and patients’ testimonials:

 

Dr. Terman sent me excellent materials following the Nuffield Report, “Dementia: Ethic issues.” I am very impressed. It is an outstanding mix of the practical and theoretical to improve the lives and control of people with dementia."

— Dr. Tony Hope, Professor of Medical Ethics and
Founder of Ethox Centre, University of Oxford, England


In conversations with patients, advocates, and academics on navigating dementia, I always guide people to Caring Advocates, speaking highly of it as the ultimate gold standard in this area. Your system remains second to none.

—Barak Gaster, MD, Professor of Medicine, University of Washington, developer of workshops to teach primary care doctors to help patients and families navigate dementia.


Dr. Terman's wisdom, compassion, and nuts-and-bolts recommendations may seem controversial to some, but compelling to others... He offers comprehensive forms, medallions, cards, and suggestions for recording interviews that combine to provide a guarantee closer to 100% than any other [for] Advance Care Planning.

—Karl E. Steinberg, MD; Past President, California Association of
Long Term Care Medicine; Editor–in–Chief, Caring for the Ages.


Dr. Terman must be commended for examining…options of life and death. Also, the section (of his first book) on religion is just awesome. It held me spellbound with its depth of understanding of our differences and our commonalities as we debate the issue of life and death. If any work should be required reading, this would qualify. I have personally used its insights in working with families and seen how they can bring great relief in the struggle to make ‘their best’ end-of-life decisions.

— Dr. Cecil L. Murray, John R. Tansey Chair of Christian Ethics,
School of Religion, University of Southern California


Millions who will be suffering from Alzheimer’s and related dementias may receive treatment inconsistent with their preferences and values, treatment that may inflict longer and greater suffering. If you do not want this to happen to you, consider Dr. Terman’s unique Advance Care Planning tools that offers substantial advantages over all alternatives.

—Thaddeus Mason Pope, JD, PhD; Professor and Director, Health Law Institute,
Mitchell Hamline School of Law; Associate Editor, The Journal of Clinical Ethics


Dr. Terman devised a set of strategic solutions including ingeniously coupling a specially designed Advance Directive and a set of physician orders with adequate safeguards that reflect Dr. Terman's strong advocacy against ending life prematurely. Ironically, learning how to end life really empowers us to prolong our meaningful and enjoyable life.

—Ronald B. Miller, MD, FACP (deceased); Founding Director,
Program in Medical Ethics, University of California Irvine


As a Young–Onset, Early Stage Dementia patient, I completed the Natural Dying—Living Will that Caring Advocates offers. Completing the “Ironclad Strategy” helped me feel confident that others will honor my wishes so I do not need to hasten my dying now.

—Michael Ellenbogen, Alzheimer’s patient and advocate;
past Alzheimer’s Association Ambassador Program and
National Early-Stage Advisory Group; advocate for
UsAgainstAlzheimer’s and similar organizations


Dr. Terman not only advised my mother about her end-of-life options, he also made her feel secure that she would not have to opt for premature dying to avoid getting stuck in a miserable state like dementia or stroke, in which she could no longer ask for treatment to stop. He called this the “Ironclad Strategy.” I’ll never forget how peaceful I felt as my sister and I were “together” as Mom died. I was by her side, holding the phone that now connected my sister to Mom. Without Dr. Terman’s help, I doubt my sister would have ever have been able to make peace with Mom or feel peace with herself after Mom died. She has. We both have. My mother was able to die peacefully in her own bed with the undivided attention of her two closest relatives—her daughters. Who would not want that? I am so grateful that I fortunately found Dr. Terman to help us all attain a peaceful transition.

— Ellen C.  from Pasadena