Advance Directives

Vaya Health encourages the individuals we serve to create instructions about the physical health, mental health, substance use, or intellectual/developmental disability treatment they want to receive if they become unable to make decisions about their care.

The forms used to do this are called advance directives. The NC Secretary of State provides forms you can use to create advance directives that meet the requirements of state law.

You are not required to use the NC Secretary of State forms to create an advance directive. North Carolina law allows individuals to use other forms that meet certain requirements. However, if you prepare your own advance directive, you should be very careful to make sure it includes everything that is required by state law.

When you create an advance directive, you must complete the form and then sign it with two qualified witnesses and a notary public watching you.

If you wish to complete any of the documents mentioned in this section, you must do so and sign them while you still have capacity, understand your condition and your treatment choices, and are able to make your wishes known. Keep a copy in a safe place and give copies to your health care agent, any alternates, your family, treatment team, doctor, and the hospital where you are likely to receive treatment.

You can also arrange to have advance directives filed in the NC Advance Health Care Directive Registry the Secretary of State maintains. There is a $10 fee to register an advance directive. This includes registration, a revocation form, registration card, and password.

If you think the laws governing the advance directives have not been followed correctly, you have the right to file a grievance with the NC Division of Health Service Regulation or with Vaya. Even if you do not want to file these forms as legal documents, completing the questions on these forms will help you plan for a crisis and think about what kind of treatment you would want.

If you have questions or need help related to advance directives, you can call Vaya’s Member and Recipient Service Line at 1-800-962-9003, 7 a.m.-6 p.m., Monday through Saturday.

In North Carolina, there are different types of advance directives you can use to make your wishes known in the event you are unable to make decisions for yourself. The types are:

1. The psychiatric advance directive, also known as the advance directive for mental health treatment
2. Health care power of attorney, which provides medical/physician orders of life sustaining treatment
3. Advance directive for a natural death, also known as a living will

The psychiatric advance directive (PAD) or advance directive for mental health treatment is a legal document that states the instructions for mental health treatment you would want to receive if you are in a crisis and unable to make decisions for yourself. Your service provider or care manager should be able to help you develop this document. The instructions give information about:

• What you think helps calm you
• How you feel about seclusion or electroconvulsive therapy
• What medicines you do not want to take
• Which doctor you want to be in charge of your treatment

You can make these decisions in advance for any situation in which you are unable to communicate your wishes about your care and provide specific instructions to be followed by a physician or psychologist. The instructions you include in the PAD will be followed if a physician or eligible psychologist determines that you are incapable of making and communicating treatment decisions. Your instructions may be overridden if you are being held in accordance with civil commitment law.

If your provider does not agree with any parts of the advance directive, they must provide (in writing) why they disagree, include detail from the law that allows the objections, and describe the medical conditions involved. You may choose to see a new provider.

A health care power of attorney allows you to designate someone who can make decisions for you if you are unable to make your own choices about treatment. This document gives the person you designate as your health care agent powers to make health care decisions for you when you cannot make these decisions yourself or cannot communicate your decision to other people. You should discuss your wishes about life-prolonging measures, mental health treatment, and other health care decisions with your health care agent. Except to the extent that you express specific limitations or restrictions in this form, your health care agent may make any health care decision you could make yourself.

An advance directive for a natural death, which is usually called a living will, is a document that tells others what kind of care you want and whether you want to die a natural death if you are incurably sick and cannot receive nutrition or breathe on your own.

Be sure to keep a copy in a safe place and give copies to your family, your treatment team, your doctor, and the hospital where you are likely to receive treatment. You can also have your advance directive filed in a national database or registered with the NC Advanced Health Care Directive Registry for a $10 fee. This includes the registration, a revocation form, registration card, and password. You can use the revocation form at any time if you change your mind and your directives.
If your provider does not agree with any part of the advance directive due to a “matter of conscience” or personal objection, they must provide (in writing) why they disagree, include detail from the law that allows the objections, and describe the medical conditions involved. You may choose to see a new provider. Your instructions may also not be followed if you are being held in accordance with civil commitment law.

Your advance directives are active until you cancel them. You may cancel or change your advance directives at any time unless you have been declared incompetent. If you cancel or change your advance directives, be sure to communicate the change to anyone who has a copy.