Plan Ahead for Your Medical Care

woman putting hand on elderly man's shoulder

Do your loved ones and medical providers know what type of medical treatment you prefer? By planning ahead, you can ensure you receive the medical care you want, avoid unnecessary suffering, and relieve caregivers of decision-making burdens during moments of crisis or grief. You can also help reduce confusion or disagreement about the choices you would want people to make on your behalf.

What Is an Advance Directive?

An advance directive is a legal document that explains how you want medical decisions to be made if you cannot make them yourself. This directive lets your healthcare team and loved ones know what kind of healthcare you want or who you want to make decisions for you when you can’t.

Julie Hodne“Advance directives help you protect your right to make medical choices that can affect your life,” said Manning Regional Healthcare Center Education Coordinator Julie Hodne, RN. “They help your family avoid the responsibility and stress of making difficult decisions on your behalf. Advance directives also help your physician by providing guidelines for your care.”

Why Are Advance Directives Important?

All patients have rights, including privacy, informed consent, and access to information about their condition and treatment options. Advance directives help protect these rights if you become unable to communicate due to an injury or illness. They can also limit life-prolonging measures when there is little or no chance of recovery.

Under the Patient Self-Determination Act (PSDA), healthcare providers are required to inform patients of their rights regarding advance directives upon admission to a facility. This ensures that patients are aware of their options and can make informed decisions about their care. For example, advance directives can help patients decide if they want:

  • Cardiopulmonary resuscitation (CPR)
  • Artificial nutrition or hydration
  • Intubation, ventilators, or dialysis
  • Pain control and comfort care
Let Your Values Guide Your Decisions

When creating your advance directives, consider what is most important to you. Discuss your feelings with your family, physician, religious leader, or legal counsel to determine what is best for you. This might include:

  • Avoiding pain and suffering
  • Maintaining independence in decision-making
  • Ensuring your family is not burdened with difficult choices
  • Aligning your care with religious beliefs
  • Being surrounded by loved ones at the end of life
Types of Advance Directives

The most common types of advance medical directives include:

  1. Living Will: Outlines your wishes regarding life-sustaining treatment.
  2. Durable Power of Attorney for Healthcare: Designates a person to make medical decisions on your behalf if you become unable to do so.
  3. Do Not Resuscitate (DNR) Order: Specifies that you do not want CPR if your heart stops, or you stop breathing.
  4. Health Care Instructions: Provides detailed guidance about specific treatments or interventions.
How to Obtain and Complete Advance Directives

Advance directive forms vary by state, so you should consult your state’s health department, legal resources, or healthcare provider for the appropriate documents. For example, in Iowa, you can obtain forms from the Iowa State Bar Association.

To receive the form by mail, send a self-addressed, stamped envelope to:
Iowa State Bar Association
625 E. Court Avenue, Des Moines, Iowa 50306

Include your full name, address, and date of birth. You can also print and download the form online. Once you have the forms:

  1. Put your wishes in writing and be as specific as possible.
  2. Review your advance directives with your family, physician, and power of attorney (POA).
  3. Sign, date, and have them witnessed and notarized as required by your state.
  4. Keep a copy in a safe place and provide a copy to your physician for your medical records.
  5. Ensure your POA and a trusted relative or friend have copies.
  6. Review and update your directives regularly, especially after major life events (e.g., marriage, divorce, or a change in health status). Inform your physician, family, and POA of any changes.
IPOST: An Additional Consideration

For individuals who are frail, elderly, or have a chronic critical medical condition or terminal illness, the Iowa Physician Orders for Scope of Treatment (IPOST) form may be beneficial. The original IPOST form should be kept with the person it applies to. You can discuss this option with your medical provider and find more information through the Iowa Department of Public Health.

Get Help with Advance Directives

“If you need help preparing your advance directives or if you would like more information, contact your legal counsel, healthcare provider, or any hospital, hospice, home health agency, or long-term care facility,” Hodne suggests. She reminds everyone, “Planning is the key to protecting your rights!”

Additionally, Medicare covers advance care planning discussions during annual wellness visits, so take advantage of this opportunity to discuss your wishes with your healthcare provider.

By taking these steps, you can ensure that your medical preferences are respected and that your loved ones are spared the burden of making difficult decisions on your behalf. Planning ahead is a gift to yourself and those who care about you.

MRHC Wound Care Clinic Receives Dual Awards

Manning Regional Healthcare Center (MRHC) is pleased to announce that the Wound Care Clinic has received two outstanding achievement awards from RestorixHealth. They are the recipients of the Clinical Distinction Award and Excellence in Patient Satisfaction Award.

These awards recognize wound centers that have demonstrated exceptional success by meeting or exceeding national healing benchmarks, including a 90% healing rate and 32 median days to heal, and a national patient satisfaction benchmark of 96%. The MRHC Wound Care Clinic has received these awards multiple times in addition to a Center of Excellence award in 2019.

“We are proud to be recognized for the quality of care our wound center provides our patients,” said RestorixHealth’s Area Program Director and MRHC Wound Care nurse, Kendra Tiefenthaler, RN, BSN. “This achievement reaffirms our commitment to patient experience and optimized outcomes, which can only be accomplished with the effort and dedication of our staff and providers and support from the hospital. We look forward to continuing restoring health and improving the quality of life – and access to care – for the patients we serve.”

The Wound Care Clinic is dedicated to optimizing outcomes and preventing lower limb loss in patients with non-healing wounds. The approach to wound care is aggressive and comprehensive, coordinating traditional and advanced therapies and techniques that are proven to reduce healing time and improve healing rates.

Manning’s clinic is staffed by Dr. Thang Luong, DO, and Kendra Tiefenthaler and supported by Elaine Macumber, RN, Courtney Grabill, RN, and Amanda Blum, RN. Courtney Rupiper, PA-C, covers wound care needs when Dr. Luong is out. Integrating a team of wound care professionals optimizes patient care while offering the most advanced healing options for hard-to-heal wounds.

The MRHC Wound Care Clinic is held every Thursday. For more information about treatment plans or to schedule an appointment, please call 712-655-8100.

About RestorixHealth
Committed to excellence in wound care, RestorixHealth is the wound care solutions company providing programs, services, products, and education across the care continuum. From developing and operating wound centers in partnership with hospitals, through supporting long-term care facilities with education and supplies, to providing in-home care, RestorixHealth’s solutions increase access to care, reduce hospital admissions, lower or avoid direct care costs, and most importantly, improve patient outcomes and quality of life. For more information, visit www.RestorixHealth.com.

Pelvic Floor Therapy Available at MRHC

MRHC is pleased to announce the addition of pelvic floor therapy services, now available with occupational therapist Amy Osbahr, OTR/L.

This specialized therapy is designed to help individuals of all ages strengthen and improve the function of their pelvic floor muscles, addressing common concerns such as urinary incontinence, pelvic pain, postpartum recovery, and post-surgical rehabilitation.

“Pelvic floor dysfunction is a common condition that sometimes gets brushed off as being normal for many women,” said Osbahr. “Nearly 50% of women suffer from some sort of pelvic floor dysfunction and 1/3 of women postpartum. Although common for women, it is not normal. However, there are treatment options to improve these issues. Pelvic floor therapy can be up to 80% effective in improving the quality of life for these conditions.”

Pelvic floor therapy can be beneficial for men and women who struggle with pain, incontinence, or other pelvic health issues. Women often seek therapy for pregnancy-related changes, menopause symptoms, or recovery after surgery, while men may need treatment for bladder control issues or post-prostate surgery rehabilitation. Through guided exercises, relaxation techniques, and personalized care, patients can regain strength and control over their bladder, bowel, and core strength, improving daily function and reducing pain.pelvic floor

Osbahr is certified in many areas, from neurological rehabilitation (for conditions like strokes, cerebral palsy, and multiple sclerosis) to orthopedics (managing joint replacements, wrist pain, sprains, fractures, arthritis, and more). She is also trained in pediatric therapy, ASTYM treatment, blood flow restriction Therapy (BFR), LSVT-BIG Parkinson’s management, lymphedema treatment, and vestibular rehabilitation. Osbahr can perform workstation and ergonomics assessments as well as custom wheelchair assessments.

To schedule an appointment with Osbahr, call (712) 655-8298. Most insurance companies do not require a referral for pelvic floor treatment, but it is recommended that patients check with their insurance provider to verify coverage.

 

Mikasia Jacobsen’s Journey to Becoming a “Great Iowa Nurse”

Mikasia Jacobsen

Mikasia Jacobsen

MRHC is proud to celebrate Mikasia Jacobsen, BSN, RN, for being recognized as a “2025 Great Iowa Nurse.” This award recognizes nurses who go above and beyond to ensure safe, compassionate care for their patients, improve the health of their communities, and serve as role models for everyone they work with. With a lifelong passion for healthcare and helping others and an unwavering commitment to her patients, Mikasia has made a significant impact at MRHC.

When asked what makes a “great nurse,” Mikasisa reflected, “I believe all nurses are great nurses. But for this award, I think it means going above and beyond—not just showing up, completing tasks, and clocking out. It’s about helping wherever I am needed, whether at work or home, not just in my designated role.”

Inspired by Family and First Responders

Mikasisa ‘s journey into nursing began at a young age, shaped by the influence of her grandmother, an ER nurse, and her first-responder parents.

“I remember doing a project in school about what I wanted to be when I grew up. My grandmother was a big inspiration. She was an ER nurse, and getting to dress up in her scrubs and play with her equipment is something I remember fondly,” Mikasisa shared. “And growing up with first responder parents definitely changes your perspective when experiencing it firsthand, compared to watching it on TV.”

Following in her family’s footsteps, Mikasisa joined the Carroll County Ambulance Service as a volunteer EMT in 2016. She completed her EMT in 2017 but then realized she wanted more. Her oldest sister, Taya Vonnahme, the director of the Recovery Center and ARNP at MRHC, encouraged her to pursue nursing. So, in 2018, Jacobsen earned her CNA and began working at MRHC.Mikasia in ER

“Mikasia has always been a caring person for others. She talked about the medical field when trying to decide what to do and loves the adrenaline and trauma of the ER, which seems to be a family trait,” said Vonnahme, MSN, RN, ARNP, CADC. “As sisters, we work well together, knowing each other’s strengths, weaknesses, and how we do things, which makes working in critical situations easier for each of us. We are all so proud of the nurse she has become and can’t wait to see what her future brings.”

With the support of her family and MRHC’s tuition assistance program, Mikasisa obtained her LPN in 2020, followed by her RN in 2021. In 2022, she was signed off as a Nurse Exempt Paramedic and completed her Bachelor of Science in Nursing (BSN). A year later, she stepped into her current role as House Supervisor at MRHC.

Mikasisa credits MRHC for playing a pivotal role in her career development. “MRHC is the only reason I became a nurse. Without their constant support, I don’t think I would have made it through nursing school, or the continuing education required afterward. If I have any doubts or issues, I know that those at MRHC are behind me, and I can fully rely on them when I need it.”

Thriving in Emergency Medicine

Now serving as an RN and House Supervisor, Mikasisa primarily works in the emergency room but also contributes to the Med/Surg unit, Specialty Clinic, and wherever she can help around the hospital. Known among her colleagues as the “ER Queen,” Mikasisa thrives in the fast-paced environment of emergency medicine.

“I love working in the ER because I can use my education and experience outside of the hospital to help my patients when they come in,” said Mikasisa. “Working in an ER can be very scary and unsettling, but I rely on my background, education, and co-workers to make sure we provide the best care in the most unfortunate circumstances. Knowing I am there helping them through these difficult times is more than rewarding.”

A Nurse Who Goes Above and Beyond

Mikasisa’s adaptability, leadership, and dedication to her job and patients make it easy to see why she was chosen as a “Great Iowa Nurse”, and she expresses immense gratitude for the recognition she has received.

“I can’t put into words what this award means to me. I am truly fortunate to work with our patients and my co-workers at MRHC every day,” Mikasisa reflected. “I appreciate more than I can say that I was selected for this award and hope that I continue to make MRHC proud as a great nurse.”

For those considering a career in nursing, Mikasisa offers honest and heartfelt advice: “Nursing is hard, and it requires dedication. It takes time away from family and friends, and you have to put others before yourself. But if you stick with it, one day, everything clicks. The struggles of nursing school, the extra classes, and the challenge of starting a new job all come together, and you’ll understand why nurses stay in this career. It truly is a rewarding profession.”

If you are interested in joining the MRHC team, visit www.mrhcia.com/careers or call (712) 655-2072 for more information.

Free Medicare Information Seminars at MRHC in 2025

Medicare event

Looking for Medicare assistance? MRHC is hosting free “Welcome to Medicare” seminars throughout the year on March 25th, May 27th, July 29th, September 30th, and November 25th from 7-9 pm for anyone interested in learning more about Medicare.

These seminars, offered by MRHC and the State of Iowa’s Senior Health Insurance Information Program (SHIIP), a free and confidential service, will cover Medicare Parts A & B benefits, Prescription Drug Benefits (Part D), Medicare Advantage Plans, Medicare supplement insurance, and tips to help individuals identify Medicare fraud, errors, and abuse.

Interested individuals should call (712) 655-2072 one week prior to the seminar to register. Attendees should enter through the Emergency entrance and follow the posted signs.

Nancy DannerEven if you do not yet qualify for Medicare, MRHC’s volunteer SHIIP Counselor, Nancy Danner, recommends that “the best time to start getting information is before you actually need it, so I advise thinking about it at least 6-12 months before someone turns 65 years old.”

Danner is also available every Wednesday at MRHC to meet with individuals by appointment. She can provide information to aid in Medicare decision-making and answer questions related to Medicare, benefits, plan options, claims, and how to guard against Medicare fraud. She will not provide recommendations for plans or agents but can answer questions and provide impartial information to help individuals make educated decisions.

Anyone interested in making an appointment with Danner can email shiip.counselor@mrhcia.com or call 712-655-2072. If a client is only wishing to talk on the phone, they may leave their phone number, and Danner will return their call.