Frequently Asked Questions

Here are a few answers to our most common questions

What is advance care planning?

Advance care planning (ACP) is a process for any adult 18 years of age that occurs over a lifetime so your healthcare choices can reflect your current values, beliefs, and goals for managing your health. The most impactful gift of ACP is the conversation! Continued conversations help clarify and define an acceptable lifestyle consistent with what matters most to the individual over their lifespan. It gives an individual a say in their care. The plan only works if the plan works for them. 

What is an advance directive (AD)?


  1. ​​An AD is a written document in which you specify what type of medical care you want in the future, or who you want to make decisions for you, should you lose the ability to make decisions for yourself.  There are three types: designation of Patient Advocate (AKA: Durable Power of Attorney for Health Care [DPOAH]), a living will, and a do-not-resuscitate declaration. There is also a declaration of anatomical gift, that takes effect after death. An AD can record future healthcare preferences that define an acceptable lifestyle as defined by the individual.     
  2. The only “legal” AD in Michigan is the declaration of the Patient Advocate. 


  1. An AD is a written document or oral statement in which instructions are given by an individual expressing their desires concerning any aspect of their health care or health information, and includes, but is not limited to, the designation of a health care surrogate, a living will, or an anatomical gift. 
  2. A “Living Will” or “Declaration” is a witnessed written document or oral statement voluntarily executed by an individual expressing one’s instructions concerning life-prolonging procedures and can include wishes for Do-not-Resuscitate. An AD can record future healthcare preferences that define an acceptable lifestyle as defined by the individual.

What is a Patient Advocate?

A Patient Advocate is/are the individual(s) chosen to speak on behalf of a person when they are no longer able to speak for themselves. This role can be activated and deactivated. This role is also referred to as a Durable Power of Attorney for Healthcare, proxy, surrogate decision maker, healthcare agent, among others. Titles vary geographically.

Where will my advance directive be honored? 

  1. Currently laws do not permit “legal” use of AD’s in a state other than where one lives and creates it. It is recommended if people live in 2 states or travel frequently to a different state(s) that AD’s are created for those states. Practically, an out-of-state AD will minimally be a part of the conversation if it is available. 
  2. It is best practice to have your AD’s uploaded into your local electronic health record in the health system you typically use and a state level Health Information Exchange, an example, MiHIN Statewide Registry or AD Vault. This allows your AD’s to be available beyond your local community and to other health systems. 
  3. Keep a copy with you when you travel to optimize their use.
  4. Ensure your Patient Advocate(s) have the most recent copy of your AD(s).

How will a Facilitator/Instructor continue to be updated with new information/materials? 

  1. CHS will remain a resource to all Facilitators and Instructors certified through CHS. New information/materials will be disseminated in the appropriate manner for the location where you perform your Facilitator role.
  2. Additionally, Instructors certified in Respecting Choices® (RC) are invited to quarterly networking/informational calls by RC. 

What is the pricing of the various courses and offerings?  

  1. Facilitator course costs are variable dependent on prior training of attendees, if any. Cost will be determined and provided through the registration process prior to submission of payment.  All classes are currently being held virtually or in-person as requested.
  2. Instructor course costs appears during your registration process prior to submission of payment.
  3. Design and Implementation costs are provided during the registration process prior to submission of payment.
  4. Consultative services are provided during the registration process prior to submission of payment. There may be additional charges, as agreed upon, if additional evaluation and assessment is requested.  
  5. Disease specific Group education classes are $75 for the group plus travel costs, if any.

Close the Loop Webinars are included in Facilitator course costs.  If you have not enrolled in a Facilitator course with CHS, the cost is $10/pp to join.

How long does ACP implementation take?

  1. Successful ACP implementation timelines differ for each organization. Typically, implementation occurs in waves. Begin with a small test in a defined population or location (microsystem) to discover what works best and revise processes prior to rolling it out to the entire organization. Leadership, competing priorities and level of commitment to implement an ACP system are factors that directly impacted timelines. 

Are all ACP implementation plans the same?

No.  Each organization will determine the best processes and resources for their environment and population(s) served. Consultation services assist you to discover best practice in your own environment while sharing what we know works best and how other organizations currently including ACP as part of good care have developed specific processes. 

The Implementation Plan is another form of a “process,” “policy,” “standard work flow” document.

How long is Instructor training?

One full 8-hour day. Competency criteria must be met prior to certification. It is recommended Instructors co-teach. This strategy furthers learning, builds confidence, and allows participants to learn from different people. While the material and structure of a Facilitator course is standard and consistent, Instructors bring different stories and perspectives to share.

How long does it take to have a First Steps® (FS), Next Steps™ (NS) or Advanced Steps (AS) facilitated conversation?

Typically, a FS® conversation takes 45-60 minutes including creation of an AD. Generally, to complete a NS™ or AS conversation will take around 60+ minutes. Prepping for the conversation, finalizing and processing of documents and referrals adds time.  Number of individuals in conversation and conversation dynamics will affect time element also.  

The entire conversation, however, does not have to occur in one setting.  Strategies to decrease time and utilize available resources for various components of the conversation are shared during the Design & Implementation phase of a robust ACP program being initiated in an organization and to a lesser degree during facilitator course.  Facilitator courses are designed for skill building vs. design of processes.

An online tool is being built that will assist in gathering the information in the Exploratory Phase of a conversation ahead of meeting with an individual to assist them with clarifying what care they want or don’t want. This will decrease the 1:1 time needed for the full conversation.

What is the benefit to including an ACP Facilitator in a conversation?

  1. Starting these vital conversations with loved ones is most often difficult and awkward. Knowing how to choose the right Patient Advocate for one is imperative to having wishes honored when that time comes.  Facilitators are trained in communication skills to support both the individual and the Patient Advocate to engage in a meaningful conversation. After a facilitated conversation, all know not only what decisions were made, but why.  
  2. Just as importantly, the facilitated conversation provides an opportunity for the Patient Advocate to ask clarifying questions so there is no doubt in their mind how to speak for their loved one if needed.
  3. Regularly, individuals have misconceptions about all of the situations that could present themselves along various disease trajectories, lack evidence-based facts surrounding healthcare choices and don’t come to a conversation with an understanding of how to put what matters most to them in context of healthcare decisions in a written document. 
  4. Moreover, the creation of advance directives that are clear enough to guide clinical decision making when that time comes requires education, practice, and skill development. | (517) 898-3847

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