Advance Care Planning for Dementia and Serious Mental Illness


Live webinar was held April 13, 2016 (1:30-2:45 US East Time Zone)

Additional resources available at the bottom of the page


This training program was intended for staff and students from many levels, disciplines, and settings (both facility and community-based), including staff involved in providing long term care (e.g., nursing staff and administrators), as well as behavioral health staff who work with older adults.

Additionally, staff from Adult Protective Services, home health, adult day healthcare, respite care, area agencies on aging, Emergency Department staff of acute care hospitals, hospital discharge planners, and others serving older adults could benefit from the training.


Staff participating in this webinar will be better trained to recognize and respond to geriatric mental/behavioral health issues before costly inpatient treatment becomes necessary, or anyone has been placed at risk of injury. For those situations necessitating inpatient treatment, trained staff in the facility and community will be better prepared to work together to facilitate psychiatric hospitalization with minimal distress to the older adult and those family members and professions involved in his/her care.


After the webinar, participants will be able to:

1. Recognize what mechanisms can be used to plan ahead for one’s care

2. Articulate what is required to make a valid advance directive in Virginia

3. Describe benefits of advance care planning for those with dementia and/or serious mental illness, including what kinds of crisis-relevant information can be recorded in an advance directive

4. Explain how a person can plan for their care in the event of their objection while incapacitated

5. Identify what may be required to obtain treatment for an incapacitated person when an advance directive has not been made by a person

6. Identify and distinguish the various types of legal authority for substitute decision-making for health care treatment


Certificates of attendance are issued upon completion of an exit survey corresponding to the webinar.*

*Upon completion of the webinar, attendees have one week to submit the exit survey and receive a certificate.



John E. Oliver, Esq


John E. Oliver, Esq, City of Norfolk.

John E. Oliver, Esquire, has served for 31 years in the Chesapeake City Attorney’s office, first as an Assistant City Attorney and later as a Deputy City Attorney. During that time, he was legal counsel to several City departments and agencies, including the Chesapeake Community Services Board, the Chesapeake Department of Human Services and the Chesapeake Interagency Consortium.

He was a former member and chairman of:
• The Local Human Rights Committee
• Southeastern Virginia Training Center and Chairman of the State Human Rights Committee
• Virginia Department of Mental Health
• Mental Retardation and Substance Abuse Services (now DBHDS)
• The Governor’s Advisory Board on Child Abuse and Neglect
• The Virginia Guardianship Association
• The CHIP/Healthy Families Program in Chesapeake

He is currently on:
• The Virginia Bar Association task force on HJR 680 (Juvenile Insanity Defense)
• The steering committee for the For Keeps Initiative, the task force on the mental health needs of children and adolescents as part of the Virginia Commission on Mental Health Law Reform
• The task force that drafted the changes to the Health Care Decisions Act (HCDA) recommended to the General Assembly by the Virginia Commission on Mental Health Law Reform

Mr. Oliver currently spends part of his time in private law practice, with a focus on representing children as guardian ad litem in child custody and abuse and neglect cases. He also represents adults alleged to be incapacitated in guardianship cases and individuals in involuntary commitment hearings.

He is a contractor with the Institute of Law, Psychiatry and Public Policy (ILPP) which works on mental health law reform initiatives. He has also recently contributed to the SJ 47 Joint Subcommittee’s study of Virginia’s mental health system for the Virginia General Assembly.

He is Co-editor of the ILPP’s electronic journal, “Developments in Mental Health Law.”

Mr. Oliver is the recipient of the VACSB’s Gartlan Award, the Trustee of the Chesapeake Assistance Trust.


Heather Zelle, JD, PhD


Heather Zelle, JD, PhD, Clinical Psychologist, Institute of Law, Psychiatry, and Public Policy, University of Virginia

Dr. Heather Zelle is an Assistant Professor of Research with the University of Virginia Department of Public Health Sciences and a clinical psychologist at the University of Virginia Institute of Law, Psychiatry, and Public Policy.

She holds a bachelors in psychology from Lycoming College, a juris doctorate from Villanova University School of Law, and a doctorate in clinical psychology with a forensic concentration from Drexel University. She completed her clinical psychology internship at the University of Massachusetts Medical School/Worcester State Hospital. She is licensed as an attorney in Pennsylvania (voluntary inactive status) and as a clinical psychologist in Virginia.

Dr. Zelle has coordinated the research and implementation efforts regarding the integration of Advance Directives with Instructions for Mental Health Care into routine care in Virginia for the past three and a half years. She is the primary author of Virginia’s implementation manual for Advance Directives. She has presented on Advance Directives at several gatherings, including peer organization conferences, public mental health provider conferences, individual provider agencies, and more. Dr. Zelle is also one of the drafters of Virginia’s Advance Directive Facilitator Training and the principal trainer. Dr. Zelle’s previous policy and research experience include work for the Philadelphia Department of Behavioral Health and Intellectual disAbilities Services. Dr. Zelle’s past research has focused on several areas in forensic psychology, including comprehension of Miranda rights, judicial interpretation of legal capacities, and forensic assessment in juvenile and adult cases. She has co-authored several publications, including articles on Advance Directives in the journals Psychiatric Services and World Psychiatry, as well as chapters in the Handbook of Psychology: Forensic Psychology; Forensic Assessment in Criminal and Civil Law: A Handbook for Lawyers; and the APA Handbook of Forensic Psychology.


E. Ayn Welleford, MSG, PhD, AGHEF


Dr. E. Ayn Welleford, MSG, PhD, AGHEF, BA in Management/Psychology from Averett College, MS in Gerontology and PhD in Developmental Psychology from Virginia Commonwealth University.

Dr. Welleford has taught extensively in the areas of Lifespan Development, and Adult Development and Aging, Geropsychology, and Aging & Human Values. As an educator, researcher, and previously as a practitioner she has worked with a broad spectrum of individuals across the caregiving and long term care continuum.

As Associate Professor and Chair of VCU’s Department of Gerontology, she currently works to “Improve Elder Care through Education” through her Teaching, Scholarship, and Community Engagement. Outside of the classroom, Dr. Welleford provides community education and serves on several boards and committees. She is the Immediate Past Chair of the Governor’s Commonwealth of Virginia Alzheimer’s and Related Disorders Commission. Dr. Welleford is the proud recipient of the 2008 AGHE Distinguished Teacher Award.


Advance Directive
A witnessed written document, voluntarily executed by the declarant … or a witnessed oral statement, made by the declarant subsequent to the time he is diagnosed as suffering from a terminal condition… “to address any or all forms of health care in the event the declarant is later determined to be incapable of making an informed decision.”


  • An adult appointed by the declarant under an advance directive to make health care decisions for him.

Durable Do Not Resuscitate Order

  • A written physician’s order to withhold cardiopulmonary resuscitation from a particular patient in the event of cardiac or respiratory arrest. A durable do not resuscitate order is not and shall not be construed as an advance directive.


  • A person appointed by the court who is responsible for the personal affairs of an incapacitated person, including responsibility for making decisions regarding the person’s support, care, health, safety, habilitation, education, therapeutic treatment, and residence.

Incapable of Making an Informed Decision

  • The inability of an adult patient, because of mental illness, intellectual disability, or any other mental or physical disorder that distorts communication or impairs judgment, to make an informed decision about providing, continuing, withholding or withdrawing a specific health care treatment or course of treatment. The patient is unable to understand the nature, extent or probable consequences of the proposed health care decision, or to make a rational evaluation of the risks and benefits of alternatives to that decision.

Physician Order for Scope of Treatment

  • A physician’s order for scope of treatment (POST) is a communication of treatment preferences of a patient who is nearing the end of life and instructing health care provider to follow such preferences.

There is no one form that must be used in Virginia, so Advanced Directives can be tailored to each person’s needs. By way of example we have provided two forms that demonstrate the range of detail that can be included in an AD.

There is no one form that must be used in Virginia, so Advanced Directives can be tailored to each person’s needs. By way of example we have provided two forms that demonstrate the range of detail that can be included in an AD.