The Choices Bank project is a collaborative project among Missoula-area health care institutions to create an electronic repository for advance health care directives. The Bank will store advance directives, in the form of living wills and durable powers of attorney, on a secure website that will be accessible to authorized individuals. Portals to deposit advance directives from the public for the Choices Bank will be developed at 22 area health care institutions in Western Montana, which serve more than one-quarter of Montana's population. The Choices Bank will use off-the-shelf hardware and software to make the latest copy of a person's advance directive universally accessible to anyone with security clearance, from anywhere, at anytime. Health care providers are required by law to ask patients if they have advance directives, but are not required to assist patients in storing or retrieving the directives. The Choices Bank project will be a community-based effort to use technology to make advance directives accessible to family members and health care providers at the time they are needed.
The Missoula Demonstration Project: The Quality of Life's End (MDP) is an organization dedicated to improving the quality of life for dying people and their families. A community task force organized by MDP identified access to advance directives as a significant barrier to honor health care choices at life's end. The task force has developed the concept of the Choices Bank to address this barrier. The project will significantly improve the current plight of seriously injured or ill people and their families. These families are thrust into stressful decision-making roles and conflict within families is prevalent when patients cannot communicate, and evidence of their wishes cannot be found. In a two-year study of the medical charts of deceased persons, MDP found that fewer than 50% of those who were reported to have advance directives actually had them in their charts. This is because people store their directives in locations such as law offices or banks, where they are inaccessible evenings, weekends, or holidays. The Choices Bank project, with its 22 portals located in familiar community health care facilities, will make it significantly easier for people to get their advance directives written and stored in a manner that will make them accessible when they are needed. Choices Bank will implement relatively inexpensive software and hardware; this will facilitate its replication by other communities who want to ensure that their citizens' wishes are honored at the time of their death.
The partners include the Missoula Demonstration Project, Missoula's two hospitals, Western Montana Clinic and its satellites, Missoula Aging Services, Partners in Home Care, Nightingale Nursing Services, and a faith community.