Advance Healthcare Planning: What You Need to Know
An advance directive is a legal document that dictates a person's health care preferences and is used in the event that they become incapacitated or unable to make their own medical decisions.
At any age, a medical crisis can leave somebody unable to make their own medical decisions. The National Institute on Aging explains that “advance care planning involves learning about the types of decisions that might need to be made, considering those decisions ahead of time, and then letting others know—both your family and your health care providers—about your preferences.” It allows people to plan for their own care and make their own medical decisions, while they’re still able.
Despite the importance, Gallup found that only 45% of Americans have advance care directives. If your care recipient does not have their advance directives in place, you should work with them to get this sorted out as soon as possible
What is an Advance Directive?
An advance directive is a legal document that spell out a person’s healthcare preferences and proxy, and is looked to for direction in the event that they become incapacitated or unable to make their own medical decisions.
The advance directive typically consists of two parts, the medical power of attorney and the living will. Together, they dictate how an individual would like their medical care to be handled at the end of their life.
Medical Power of Attorney
A medical power of attorney legally assigns somebody (often called the “healthcare proxy”) to make medical decisions on the patient’s behalf, should they become incapacitated. The health care proxy should always be somebody who the patient trusts to remain level headed and follow their wishes in an emergency. As the caregiver, you might be the logical choice as health care proxy for your care recipient.
Learn more about powers of attorney here.
The second part of an advance directive is the living will. The living will is a legal document that spells out what medical interventions or treatments the patient would or would not want at the end of life. In addition to dictating treatment plans for physicians, the living will can guide the medical power of attorney’s decision making by articulating the patient’s wishes.
End of Life Medical Decisions
When considering advance directives, your care recipient’s personal values and priorities are key. There are no right or wrong decisions, and wishes can change throughout one’s life. It is important that your care recipient explore the available end-of-life treatment options, and make the decisions that are best aligned to their wishes.
The National Institute on Aging offers guidance on things to consider: “Is your main desire to have the most days of life? Or, would your focus be on quality of life, as you see it? What if an illness leaves you paralyzed or in a permanent coma and you need to be on a ventilator? Would you want that? What makes life meaningful to you? If your heart stops or you have trouble breathing, would you want to undergo life-saving measures if it meant that, in the future, you could be well enough to spend time with your family? Would you be content if the emergency leaves you simply able to spend your days listening to books on tape or gazing out the window?”
Do-Not-Resuscitate Orders (DNRs) and Physician Orders for Life Sustaining Treatment (POLST)
A DNR and POLST are typically created alongside a physician when a patient has been diagnosed with a terminal illness or serious condition, and their end-of-life care is being proactively planned. While not technically part of an advance directive, they are often considered in conjunction because they all collectively dictate a patient’s healthcare wishes.
DNR orders prevent patients from receiving certain life-saving measures and medical intervention. They are often created for terminally ill or elderly patients who do not want to prolong their life, especially as quality of life decreases. They are created with a doctor and are typically only valid for patients in a hospital, though out-of-hospital DNRs can be created for patients receiving end-of-life care at home.
A POLST is similar to a DNR, but is more comprehensive. It is intended to standardize the way end-of-life planning is documented, and be “portable,” as opposed to tied to one hospital. The POLST can travel with the individual whenever they move to a new setting or see a new healthcare provider, thereby allowing for and promoting continuity of care. Like a DNR, a POLST is created with a physician.
If you’re considering if your care recipient could benefit from a DNR or POLST, we suggest speaking with their primary physician. They will be able to advise whether or not that’s currently appropriate.
Creating Your Care Recipient’s Advance Directives
If your care recipient does not have their healthcare directives in place, we recommend changing that as soon as possible. There are many free or affordable online services that they can use to create their medical power of attorney and living will. However, it is always a good idea to work with an estate or eldercare attorney if possible. An attorney can work directly with your care recipient to document their wishes, providing you and your family with valuable peace of mind.