Advance care planning is the process of discussing, determining and executing treatment directives - such as a Living Will, and appointing a health care proxy decision maker for care in the event that a person is not able to make medical decisions for him or herself. Advance Care planning can make a critical difference in your life, and the lives of your parents as they age, either in emergency situations or when facing end-of-life care situations.
To be most effective, advance care planning needs to be a comprehensive, ongoing process that includes your family and friends, your proxy, and your providers. Planning should reflect your elderly parent's personal values and beliefs, and be adaptable if circumstances change. Communication is the single most important first step in advance care planning. It is critical to consider what mom and dad want while they have time to think through the options clearly, and then to discuss the options and preferences with family.
While advance care planning may be difficult and emotionally charged, communicating your parent's wishes ahead of time decreases the chance of future conflict and takes the burden off the family. Several issues should be carefully considered for advance care planning.
Advance Planning Conversations
Values and beliefs. Personal concerns, values, spiritual beliefs or views about what makes life worth living are important issues to consider when developing an advance care plan.
Preferences. Most people have ideas about the ways they wish to face death and/or disability, but may be uncomfortable discussing them. Sometimes sharing your own ideas, if you are helping someone, or reviewing the situations of other family or friends who have been in relevant situations can help.
Health care proxy: Decide who mom or dad will appoint as their health care proxy (surrogate or agent) decision-maker. Appointing a single proxy is a very important decision. The person they choose as a proxy needs to be able to make decisions based on understanding and respecting their values and beliefs about care. Select someone who mom or dad believes will understand and be able to carry out their wishes even if they include denying life-sustaining treatments. Some parents have inadvertently put their families through agony by avoiding the subject.
Help with Planning. Many different kinds of professionals can assist you in creating advance directives that help ensure that your elderly parent's wishes will be respected. Elder law attorneys, social workers and members of the clergy are obvious examples. Some counselors and social workers – especially those who work for hospice services – are uniquely qualified to offer guidance at all stages of the advance care planning process.
Living Wills, Power of Attorney and Other Documents for Seniors
What types of Advance Care Planning Documents do you need?
- Advance Directive – Living Will and Medical Powers of Attorney Advance Directive is a general term used to describe two types of documents – living wills and medical powers of attorney. These planning documents allow you to convey the type of care you want if you cannot speak for yourself including the extent to which you want life-sustaining medical treatments, and who should make those decisions if you cannot. Advance directives are not only focused on what treatments you don't want, they also should include all of the treatments you do want.
- Living Wills (sometimes called medical directives) are written instructions for care in the event that you are not able to make medical decisions for yourself. Currently, 47 states and the District of Columbia have laws authorizing living wills. State law, however, can vary on signing requirements and other aspects of a living will, so it is important to check on your state's requirements when completing a living will.
- Power of Attorney (sometimes called a health care or durable power of attorney) is a document that appoints a particular person as a health care proxy or health care agent to make health care decisions for you if you are unable to do so yourself (not just during a terminal illness).
- A health care proxy is your substitute decision-maker. All 50 states and the District of Columbia have laws recognizing health care powers of attorney. Some specify the types of decisions that health care proxies can make.
- Do Not Resuscitate (DNR) is a physician's order that is written in a person's medical record indicating that health care providers should not attempt life-saving measures such as cardiopulmonary resuscitation (CPR) in the event of a cardiac arrest, a heart attack, or respiratory arrest. A request for a DNR can be included in your planning documents, or communicated directly to your physician. Also, most health care facilities have a Do Not Resuscitate order policy and forms that a hospital professional can help you with if you choose this option after being admitted to a hospital.
How to Make Sure Mom or Dad's Wishes are Carried Out
Here are some steps to insure that your parent's advance care planning is carried out:
- Complete a living will and a medical power of attorney. If possible, you should consult with an elder law attorney or other professional regarding specific state laws or regulations related to these planning documents.
- Ensure that your family and other important people in your life understand what your parent's wishes are, and what is included in these documents. It is particularly important to discuss your mom and dad's decisions with the individual who will be the health care proxy to be sure he/she is comfortable with that role, and can be available to carry out wishes.
- Keep your parents' planning documents easily accessible and in multiple places. Consider having mom or dad carry a wallet card. Give copies to family members, friends, the physician's office, and/or lawyer if appropriate. It is critical that the health care proxy has a copy, or can access a copy quickly, if there is an unexpected emergency.
- Review your parents' plans periodically to be sure they are still satisfied with their decisions, and the health proxy is still able and willing to be responsible for carrying out their plans.