If you have ever been admitted to a hospital and been asked whether you have an advance directive, there is a reason that question comes up.
The Patient Self-Determination Act (PSDA) is a federal law that requires certain healthcare organizations participating in Medicare or Medicaid to inform adult patients about their healthcare decision-making rights. The requirement applies to adult patients receiving care at those organizations, not only to people who personally have Medicare or Medicaid coverage.
Congress enacted the PSDA in 1990. The U.S. Department of Health and Human Services (HHS) explains that the law was primarily designed to improve information and education about advance directives. It did not create one national advance directive or establish identical rules across the country.
What Does the PSDA Require Healthcare Organizations to Do?
The PSDA applies to hospitals, skilled nursing facilities, home health agencies, hospices, and certain other organizations that participate in Medicare or Medicaid.
Covered organizations must provide patients with written information about their healthcare decision-making rights and their policies concerning advance directives. They must also document whether a patient has an advance directive. When a patient has one, the organization must follow the state’s laws governing advance directives.
For example, state law may address when an advance directive takes effect, who can make healthcare decisions for a patient, and how healthcare providers should respond to the patient’s instructions.
The requirements go beyond individual patients. Covered organizations must also provide education about advance directives to their staff and communities.
The law protects patient choice as well. A healthcare organization cannot condition care on whether someone has an advance directive or discriminate based on whether a patient has completed one.
The PSDA gives patients information and a choice. It does not require anyone to complete an advance directive in order to receive care.
Why Does State Law Still Matter?
The Patient Self-Determination Act is a federal law, but advance directives remain closely tied to state law.
That can seem confusing at first.
The PSDA requires covered healthcare organizations to tell patients about their healthcare decision-making rights under state law. Individual states determine many of the rules governing advance directives.
That helps explain why forms, terminology, and requirements can vary across the country.
There is no single federal living will or healthcare power of attorney that everyone in the United States completes. An advance directive must instead work within the laws that apply to the individual.
The PSDA creates the federal framework for providing information and recognizing these rights within certain healthcare settings. State law provides many of the details about how advance directives work.
If you are creating or updating healthcare directives, an attorney can help you understand the requirements that apply where you live.
What Happens When You Enter a Healthcare Facility?
The PSDA helps explain why advance directives may come up during what otherwise feels like routine admission paperwork.
A hospital may ask whether you have an advance directive. You may receive written information about your healthcare decision-making rights. The facility may also explain its policies regarding advance directives.
Being asked the question does not mean someone expects you to need the document during that particular hospital stay. It is part of how covered healthcare organizations address advance directive rights.
You also do not have to create an advance directive on the spot simply because someone asks whether you have one.
The larger purpose is awareness. Patients should know that they have healthcare decision-making rights before a situation arises in which those rights become especially important.
Why Does Your Medical Record Matter?
The PSDA includes another practical requirement. Covered healthcare organizations must document in a patient’s medical record whether that person has an advance directive.
That puts the existence of the document on the healthcare provider’s radar.
However, there is an important difference between knowing an advance directive exists and having access to the directive itself.
A notation in a medical record does not necessarily give a healthcare provider all of the instructions contained in the document. It also does not guarantee that the person you chose to make healthcare decisions has a current copy.
That makes document access an important part of planning.
Healthcare providers need access to your directives when they become relevant to your care. The person you have chosen to make healthcare decisions should also know how to access them.
If you update a document, you also want to make sure an outdated version is not the one people continue to rely on.
The PSDA requires covered healthcare organizations to document whether an advance directive exists. Having the document accessible when it is needed is a separate part of planning.
Why Did the Law Include Education?
The Patient Self-Determination Act was not limited to requiring a question on a hospital admission form.
Education was part of the law from the beginning.
HHS describes the PSDA primarily as an information and education mandate. Along with informing individual patients, covered organizations must educate their staff and communities about advance directives.
That broader requirement is significant.
A legal right is more useful when people know that it exists. Someone who has never heard of an advance directive may not know that they can document future healthcare wishes or choose someone to make healthcare decisions when they cannot make those decisions themselves.
Healthcare professionals also play a role. Staff members who understand advance directives are better positioned to recognize that a document exists and follow the policies that apply within their organization.
The PSDA helped bring those issues into the healthcare setting rather than leaving advance directives entirely outside the conversation until a crisis occurred.
Knowing Your Rights Is Different From Being Prepared
The Patient Self-Determination Act helped make information about advance directive rights part of healthcare. It requires certain organizations to inform patients, maintain policies, document whether directives exist, and provide education.
Those requirements serve an important purpose.
Knowing that you have a right to create an advance directive is different from actually being prepared if someone needs to rely on it.
Preparation may involve talking with people you trust and working with an attorney to put the appropriate documents in place. It also means thinking about how your completed directives will be available if they are needed.
An advance directive can only provide its intended guidance if the appropriate people can access it when necessary. That may become particularly important during an emergency away from home or outside your regular healthcare system.
Legal Directives helps address this part of the process. Through our Medical Access Program, members can securely store their completed healthcare directives for 24/7 access. Members also receive an Emergency Wallet Card that connects to their stored healthcare directives, three emergency contacts, and other important information.
Ready to securely store your completed healthcare directives so they can be accessed anytime, from anywhere? Learn more about our Medical Access Program or contact our team with questions.
U.S. Department of Health and Human Services (HHS/ASPE), “Advance Directives and Advance Care Planning: Legal and Policy Issues.” Read the full article here.