Best Practices for Advance Care Planning

Most of us don’t really want to think about death and dying. Yet, the topic is critical and relevant to us all.

It’s also important to have the conversations early, long before there’s a need. Otherwise, you risk needing to have difficult and complex conversations when there’s little time and emotions are running hot.

Advance care planning is exactly what the name suggests – you’re planning for future healthcare needs. Doing so includes your own research, conversations with family members, and legal paperwork.

We’ve talked about advance care planning from a variety of angles, including the different types of documents and things to consider with a Power of Attorney. Today, we’re highlighting tips and tricks to ensure everything goes as well as possible.

As you can probably imagine, no one can predict or control how a person dies. Advance planning makes things easier and less stressful, but there are certainly still challenges. A death doula can help with some of these aspects, providing emotional support and guidance to families.

Best Practices for Advance Care Planning

Start Planning Early

As mentioned before, it’s best to begin advance planning long before you think you need to. After all, illnesses and accidents can happen suddenly, so it’s best to be prepared.

Some issues can also prevent a person from making decisions when they need to, like when someone is in a coma or they’re in the later stages of dementia.

What’s more, advance planning takes time and concentration. There’s a surprising amount of paperwork involved, especially if you’re setting up a living will, Power of Attorney, legacy arrangements, and are also looking at financial planning. That’s not even counting any documentation that’s specific to the organization, like onboarding forms and HIPAA authorization forms.

It’s incredibly difficult to get this paperwork organized when you’re sick. Some people in this position find themselves exhausted and overwhelmed until even the most basic paperwork takes three or four times as long as it should to get completed.

Getting things organized early reduces much of the stress – and you can always change some specifics later if you wish.

Make Sure the Paperwork is Correct

It’s important to double-check all paperwork to ensure everything is correct.

Part of this is signing/witnessing/notarizing the documents. The exact rules here vary depending on the state, so you’ll need to know what’s required for your location. Consider the people who sign the documents too. For example, the witness for a PoA typically can’t be the person named within it.

The specific documents matter as well, especially for a PoA. Here, you’ll want to think about:

• The type of PoA: A healthcare PoA gives your proxy authority over medical decisions, while you’ll need a separate PoA for financial or legal decisions.
• When it comes into effect. A PoA can come into effect at once or only when the principal loses capacity.
• Durability. A non-durable PoA stops as soon as the principal loses capacity, which isn’t helpful for healthcare.

Finally, make sure that each piece of paperwork is valid in your state.

Consider POLST Forms

POLST stands for Physician Orders for Life-Sustaining Treatment. These forms are created in consultation between a physician and patient, and help to guide treatment.

They’re similar to a living will, except that they translate wishes into actionable medical language. There are also systems in place to ensure these forms transition well between different forms of care, promoting consistent treatment. 

The forms have various names depending on the state, but all follow similar patterns. These include:

• POLST: Physician Orders for Life-Sustaining Treatment
• POST: Physician Order for Scope of Treatment
• MOLST: Medical Orders for Life-Sustaining Treatment
• MOST: Medical Order for Scope of Treatment
• COLST: Clinician Orders for Life-Sustaining Treatment

Think of these forms as an extra layer of security. They reduce the risk that end-of-life wishes aren’t overlooked, especially in emergency situations.

POLST forms are most relevant to seniors and people with serious medical conditions. People who are young and in good health shouldn’t need to worry about these forms.

Choose the Right Agent

The agent, or proxy, is crucial for making healthcare decisions when you cannot. This makes it important to choose the right person for the role. Ideally, you’re looking for someone who:

• Knows you well
• Is organized enough to manage multiple appointments and pieces of paperwork
• Is resilient and can handle emotional challenges
• Has similar values to your or is willing to follow your wishes despite differences in values
• Lives nearby or is willing to move for the duration

For more details, check out our detailed post on choosing the best healthcare proxy.

Revisit Plans Regularly

Advance planning isn’t something you do just once. Your plans will need to be revisited as you age and your life circumstances change.

At the very least, your advance directives should be updated every 10 years. Ideally, you should also be updating them whenever there’s a major life event, like births, deaths, marriages, divorces, and significant diagnoses.

If you have a PoA, also think about changes in the life of the person named in your document. For example, if an adult daughter recently got married or was promoted, she might no longer be able to act as your healthcare proxy.

Big life events could easily change your priorities, which then impacts the wishes in your advance planning documents.

Consider Various Situations

It’s easy to be somewhat idealistic about end-of-life.

One aspect of this is dying at home. This is the ideal for many seniors, giving them a familiar environment that’s away from the sterile nature of the hospital.

Yet, dying at home isn’t always possible. Sometimes there aren’t any family members to provide the needed support or the ones present don’t have the ability to do so. Or, the senior needs to go to the hospital for an emergency, then is too sick to be transferred back home.

Even if dying at home is possible, it won’t always be the right choice.

As we’ve discussed elsewhere, family members are responsible for most of the hands-on care when a loved one plans to die at home. The workload can be considerable and can mean someone spends most of their time acting as a nurse, rather than a son or daughter.

Home also lacks the specialized staff found in a hospital. Hospice is available and can provide support, but it takes time for them to get to you. Sometimes you just don’t get the help when you need it the most. 

In practice, home isn’t always the best place for dying and the hospital isn’t always the worst. Life is much more complex than that.

So, take the time to think about and discuss various situations. When might the hospital be the right decision? What happens if family members can’t provide the support needed? Think too about other unexpected situations. For example, what if the planned healthcare proxy isn’t available? What happens if there’s another family crisis at the same time?

You can plan for every situation, but thinking about possibilities helps you create a more robust plan for the future.

Communicate Well with Family Members

Regardless of your paperwork, it’s important to sit down and have honest conversations with friends and family.

This is crucial because your Living Will won’t cover every imaginable situation. Your healthcare proxy will generally need to interpret some of the wishes and apply them to events that happen. To do this well, they need a good sense of you, your wishes, and your values.

The more they understand, the better they can follow your wishes.

Having these conversations reduces the risk of conflict within the family, as everyone knows what you want and family members shouldn’t be second-guessing each other. The conversations may also make the healthcare proxy feel more confident and less stressed, as they know exactly what you hope for.

Have PoA-Specific Conversations

It’s also important to address the topic of your PoA.

Aging parents often choose to appoint one of their adult children as a proxy, which gives that child authority over healthcare decisions. The resulting imbalance of power between the proxy and other family members frequently leads to family conflicts.

Yet, there aren’t many other options.

Sometimes you can name two proxies who will work together, but you certainly can’t name your entire family. Having two proxies can cause issues anyway, as they’re unlikely to agree on every decision.

You can reduce the risk of conflict by talking to your family about why only one person can be the proxy and what your wishes are.

Address Denial

Denial is a familiar sight in end-of-life conversations. Sometimes family members are in active denial, while other times the dying person themselves may be.

Denial is tricky and can mean some people avoid end-of-life planning entirely. Yet, it can also be an important coping mechanism, one that helps people process death without getting overwhelmed.

Much of the time, there’s value in allowing people to process at their own pace, rather than pushing through their resistance.

However, if the person is very ill, it may be important to get some paperwork in place as soon as possible. Power of Attorney documents are the most crucial here, as these authorize someone else to make decisions on behalf of the individual. A Living Will is the next most crucial, as the information here can guide the healthcare proxy.

Sometimes a mental health professional or a spiritual advisor may be able to help people to process any denial and connect more with what’s happening. However, everyone’s journey is their own and people aren’t always able or willing to confront the topic of advance planning. 

Get Healthcare Staff On Board

If you’re already in a facility or a hospital, it’s worth getting healthcare staff onboard with your paperwork as soon as possible. This can include the following:

• Explaining who your healthcare proxy will be and the type of decisions you’re likely to want.
• Getting staff to examine your paperwork and tell you whether they expect any issues. For example, there may be other forms that need to be filled out that you won’t know about unless you ask.
• Getting your proxy to sit in on healthcare meetings and conversations while you still have capacity. This helps them be familiar with the process and healthcare staff, ensuring a smoother transition when the time comes.  

Final Thoughts

A few clear principles can be seen throughout this list – the importance of early planning, clear communication, and correct documentation.

Of course, you can’t guarantee that everything will go to plan. End of life is complex, as are family dynamics. All you can really do is plan well, then let the rest fall as it may.