If Not Now, When? – Advanced Care Planning

Advanced care planning is about planning for the ‘what ifs’ that may occur across the entire lifespan

- Joanne Lynn, MD

If you are like most adults in America, you plan and prepare for various major life events from attending post-secondary learning institutions to commitments in relationships and raising a family to eventually retiring from a career. Yet, only about one-third of adults plan for how they want their health care to be delivered when they become seriously ill even if they are getting older or developing other aging issues. In addition, at the present time, about half of the severely or terminally ill patients in the United States do not have an advanced care directive in their medical records.

The purpose of this article is to inform you of the benefits of having an advanced directive that outlines end-of-life care treatment so if/when the time comes and the respective individual is unable to speak for themselves and can’t make such decisions there is no uncertainly about their wishes.

What is advanced care planning?

Simply put, advanced care planning is deciding what services are essential to living well and meaningfully in your own life, and specifically what medical services would you like for your end-of-life.

For example, you may/may not want to go into a nursing home or may/may not prefer to live your final days in your own home with in-home care. Or you may/may not want to have cardio pulmonary resuscitation (CPR) if your heart stops or certain pain medications or feeding tubes.

Every adult can benefit from advanced care planning. There is great importance in spending some time evaluating your priorities about quality of life and different life-sustaining medical treatments and implications for either selecting or opting out of using various options.

Likewise, it is important to talk with your family members, physician(s) and other health professionals about your desires for medical care at the end of your life. These are not only positions to think about, but also need to be documented so all parties are aware of what is desired.

When is the best time to talk about advanced care directives?

The best time to talk about future health provisions is before a health care crisis occurs. Undoubtedly, accidents and serious illness can happen any time in someone’s life and thus, the sooner you are prepared, the better. In addition, sharing these decisions with others helps to ease loved ones’ burdens and uncertainty and making the decisions will help your wishes to be supported if/when the time comes.

You may think there is never a “good” time to talk about this subject. Yet you need to find time. You may want to talk during significant life events like the birth or baptism of a child or the death of a family member. Other opportunities that might work well are when drawing up a will or when estate planning or when major illness requires a family member to move into a nursing home or retirement community.

What are the other benefits of advanced care planning?

Medical professionals and health care researchers show that people who have talked with their family, physician(s) and others about their choices for end-of-life care had less fear, anxiety and personal worry. They felt more in control of their medical care and more hopeful and assured about their futures. Furthermore, they felt less guilty for their family members and thought their doctors had a better understanding of their wishes. And they had less concern over financial costs to sustain their “unknown” health care.

What paperwork is typically necessary for an advanced care directive?

Although expressing your wishes for any future medical care with others is helpful and legally binding, it is important to write down your wishes on specifically-designed forms to make it easy for all those involved to understand and implement your wishes.

The two written documents include the living will and the durable power of attorney:

A living will – A living will is a written, legal document that outlines the type of treatment you want under certain circumstances. This may include specific care options: CPR if respiratory arrest occurs, artificial feeding options, prolonged use of a respirator if breathing independently is limited, and blood transfusions, etc. You might want to address other issues, such as your desire that the family make peace, that you don’t want to bankrupt your surviving spouse and that you don’t want to incur excessive medical costs when there is no hope for a cure.
The durable power of attorney for health care – The durable power of attorney for health care allows you to name someone who has the authority to make medical decisions for you if you are unable to communicate your decisions.

Are there different state laws that need to be followed?

Yes, every state has its own laws regarding advanced directives, so it is important to ask a health care professional, social worker, another aging resource specialist or elder care attorney, etc. about the laws of your state.

The federal 1990 Patient Self-Determination Act requires hospitals, nursing homes, and other medical institutions that receive Medicare and Medicaid funding to provide written information about advanced care directives to all patients at the time of admission.

What steps do you actually go through to document an advanced care directive?

Obtain a living will form and a durable power of attorney for health care form from your health care provider and ask for assistance if needed.
Complete, sign and date the forms. (The forms are legal and it is not necessary to hire a lawyer to create them.)
Consult your health care professional, a social worker, another aging resource specialist or elder care attorney, etc. about the laws of your state. These laws may vary as to the necessity of having the signatures on the forms witnessed or notarized.
Provide copies to your family members and health care providers. Bring a copy with you if you are admitted to a hospital.

In conclusion

To have a voice in choices for our lives and to entrust these decisions to others if/when the time comes is essential for all of us.

By talking about the issue of advanced care preferences and finalizing our decisions in a documented way through both a living will form and a power of attorney health care form will offer you the assurance to live the remainder of your life in a more acceptable and peaceful manner.

Now is the time to talk about this important topic. If not now, when?