You’ve doubtless heard of advance planning and advance care planning. They’re crucial topics, especially for seniors and anyone with significant health problems.
Yet, we too often ignore or put off conversations about the future. It’s easy to think that there’s plenty of time later. Or, the idea is simply too big and scary.
Despite the fear, end-of-life conversations can make things better. They provide clear information about what people want and don’t, which then makes things easier for family members and medical staff.
There’s even something empowering about the topic. The process gives you a voice in your own future. It can even give you inspiration about what your life should look like now.
What is Advance Planning?
At its heart, advance planning is simply planning for the future. The process involves thinking about what you want and might want, while putting things in place to ensure your goals are met.
Advance care planning is one aspect of this, which focuses on planning for your future healthcare needs – including the way you want to die. The process includes thinking and talking about the future and also completing some legal documents, such as a durable power of attorney and a living will.
Advance planning isn’t just something for the old or sick.
It’s a crucial process for everyone, regardless of age or health. The process can be clarifying and empowering, while ensuring your wishes are met.
For those who find advance planning a scary idea, Five Wishes is a great place to begin. This was the first document to combine personal, emotional, and spiritual needs along with the traditional legal and medical wishes. It was also carefully developed, to make it a legal document in almost every state.
Why Does Advance Planning Matter?
Advance planning is critical because health status can change suddenly.
Sometimes an accident or a sudden illness leaves someone incapable of making decisions for themselves. If you haven’t engaged in advance planning, your loved ones may have no idea of how you wish to be treated.
Other times, a person might still be capable of making decisions, but they’re dealing with the physical and emotional challenges of disease progression. This creates a challenging situation, as some decisions require a surprising amount of energy and paperwork.
Another issue is that the American medical system has a treatment-focused mindset. This often means that doctors are trying to keep people alive for as long as they can, even if quality of life is compramised in the process.
Advance planning allows you to make informed decisions about the level of treatment and when you might want to focus on comfort measures instead. It also gives you time to research and ask questions early. This way there’s no rush to make a decision and you can really think things through.
Types of Advance Planning
Advance Directives
Advance directives are the most famous aspect of advance care planning. These are essential for documenting the types of treatment you want and don’t want.
There are two main aspects to an advance directive – Power of Attorney and Living Wills.
Living Wills
A living will provides details of a person’s desires for future medical treatment, for cases where they are no longer able to make such decisions themselves.
This often focuses on life-sustaining treatments, such as mechanical ventilation, tube feeding, and CPR. Through a living will, people can choose which types of treatment they’re willing to accept, which they’re not, and under which situations.
Other areas may be considered as part of the living will, such as pain management and comfort care.
Power of Attorney
Power of Attorney is the other area to consider. The term refers to a legal document, where you designate someone to act on your behalf in legal, financial, and/or healthcare matters.
This person is sometimes known as your healthcare proxy, agent, or even just your power of attorney.
Power of Attorney paperwork is as important as a living will, perhaps even more so. That’s because your living will can’t possibly cover every possible healthcare situation. It also doesn’t consider any changes to your wishes and perspectives over time.
Having someone to advocate for you gets around some of these challenges. Your healthcare proxy can also ensure that healthcare staff actually know your wishes – as living will paperwork can easily get missed, especially in the middle of an emergency situation.
Financial and Legal Planning
Advance planning isn’t limited to healthcare. Many people also focus on the financial and legal side of things.
Financial planning is most powerful when done early, as good plans help ensure that you have the finances needed for any situation. This is crucial due to the expense of some types of support, like in-home caregivers and assisted living.
Beyond putting money aside for the future and perhaps investing, there are some specific types of financial and legal planning that you may want to consider.
Creating a Will
Having a will is an essential part of advance planning. Here, you’re deciding how your assets should be distributed and naming your beneficiaries.
It’s essential to review and update the will regularly, especially when there are major life events, such as the birth of a child, a marriage, a divorce, or a significant diagnosis.
Keeping your will updated ensures you’re ready for any situation. So, even if there’s a sudden illness or accident, everything is in place and set up for the next steps.
Developing Trusts
You may also consider developing a trust. Trusts can be effective tools for asset management, helping to protect you and make everything more straightforward.
You’ll generally need a financial advisor and a lawyer when developing a trust to ensure that everything is set up well and functions as intended.
Long-Term Care Insurance
As the name suggests, long-term care insurance is designed to cover long-term care, such as the costs of nursing homes, assisted living facilities, in-home care services, and the like.
Specific benefits, premiums, and eligibility all vary depending on the insurer and the plan.
Of course, this approach won’t work well for everyone. Some may find the premiums too expensive, while others may be ineligible due to pre-existing conditions or other factors.
If you’re considering this type of insurance, be sure to read all the rules and criteria carefully. Make sure the policy is going to do what you want it to before you start paying into it.
Legal Advice
Regardless of your plans, it’s important to check with a local lawyer. Legal factors vary considerably depending on location and situations. They also may not be what you expect, so it’s worth being certain.
For example, a lawyer will be able to tell you whether your current advance directives and estate plans will withstand legal scrutiny or whether there are other steps you need to take.
You could also talk to them about any complexities you anticipate, like if family members are constantly bickering and are likely to contest some of your decisions.
Legal advice is particularly important if there is any suggestion of cognitive impairment. In particular, someone with a degenerative cognitive condition like dementia will lose the capacity to make decisions for themselves in the future. As such, it’s important to get everything organized early, so there can be no doubt about the senior’s understanding and abilities.
Practical Arrangements
There are also practical arrangements to consider, like your preferences for your funeral and any memorial, any type of legacy project, and what you want done with digital accounts.
While planning your funeral might sound morbid, doing so can be surprisingly meaningful. You get to think about how you want to be remembered and what matters the most in your life currently.
There’s another benefit too – having funeral plans makes everything easier for children and family. Otherwise, they may need to make crucial decisions about your burial and funeral while you’re ill or when they’re grieving, which makes an already difficult situation even worse.
Other Areas to Consider
DNR
A Do Not Resuscitate (DNR) order is a common piece of paperwork, which simply says that you shouldn’t be resuscitated if your heart stops beating or if you stop breathing.
This matters, as resuscitation efforts can be aggressive and even fracture or occasionally break a person’s ribs. And, if you’re already nearing the end of your life and are focused on quality of life, forced resuscitation could be very undesirable.
POLST
POLST stands for Physician Orders for Life-Sustaining Treatment. Like a DNR order, this is a medical order that tells physicians details about life sustaining treatments.
This form takes the features of your advance directive and translates it into specific medical orders, ones that can be quickly recognized and followed when needed.
However, the type of form, the language, and some specific details vary between states and facilities. Even the name of the form can differ, with some being known as MOLST (Medical Orders for Life-Sustaining Treatment) or POST (Physician Orders for Scope of Treatment).
Emotional and Spiritual Planning
Advance planning normally focuses on practical issues, you can make plans in other areas as well. This includes looking at your emotional and spiritual needs.
Some advance care paperwork includes questions about these topics to help think about and record the type of support you might need. Five Wishes is one example of this. It’s powerful, as it includes regular PoA and living will questions, alongside those about emotional and spiritual wishes.
You could also think about the types of emotional and spiritual support that could help your family. For example, would it help to have some members of your church checking in regularly? What about extended family?
What About Guardianship?
Guardians perform many of the same roles as a PoA agent. The big difference is that they’ve been appointed by the court, rather than being someone the senior has chosen for themselves.
Guardianship is normally the last resort, as it can significantly restrict your autonomy. Plus, the appointed guardian may not know much about your wishes, so they may not act as you would wish.
That said, guardianship can be relevant in some specific situations.
The approach is sometimes used when people are incapable of making their own decisions, but don’t have any advance planning paperwork in place. It can also be relevant when the PoA isn’t doing their role effectively or when they’re taking advantage.
Common Misconceptions About Advance Care Planning
It’s Only For Seniors and the Terminally Ill
Advance care planning is for everyone – old and young, sick and healthy. Unexpected illnesses and accidents can happen at any stage of life, so it’s important to be prepared.
You may even find the process empowering, as thinking about death can change the way you think about life. For example, in Briefly Perfectly Human, Alua Arthur talks about how facing the idea of death gave her a greater sense of direction and purpose. In short, thinking about death can help us see what we want our lives to be.
It’s Too Complicated
Tools like Five Wishes put advance planning into plain language, making it realistic for everyone. You don’t need to do this alone either. Friends, family members, or experts can help step you through some aspects of planning.
Plus, while there are some complexities, the benefits of advance planning far outweigh the issues.
It Only Focuses on End-of-Life
Advance planning isn’t just about death. It applies to a large range of decisions for the future, including those related to finances, chronic illness treatment, and more.
It Is Just Paperwork
While paperwork is a fundamental aspect of advance planning, there’s more to it than just that. It’s also important to have in-depth conversations with loved ones about what you hope for and the values that underlie your wishes.
Doing so is crucial because you will likely complete Power of Attorney paperwork as part of your advance planning. The designated person is responsible for interpreting and applying the wishes in your advance directive. This person should have a deep understanding of your wishes, as the advance directive paperwork cannot cover all possible situations.
How to Start the Conversation
Death is an uncomfortable topic that many people avoid as much as they can.
Yet, advance planning requires multiple conversations about death. How do you go about this?
We’ve covered specific conversation tips in another post, so we don’t dig into the topic too heavily here. The first step is simply to be gentle and gracious. Be aware that the topic may make family members uncomfortable. So, you may need to start with small conversations and give people the space to process in between.
There are also some fantastic tools for starting conversations, including The Death Deck, The Conversation Project, and Death Over Dinner.
Legal and Practical Considerations
Different Laws and Policies
As we mentioned earlier, laws around advance planning vary between states. There may also be differences in how advance directives and Power of Attorney play out in different facilities.
Because of this, it’s important to ask many questions. Learn as much as you can about what to expect, any limits of your authority, and your legal obligations.
Healthcare Provider Awareness
Healthcare providers might not be aware that someone has an advance directive or may not be able to easily access it. At the same time, healthcare settings are often hectic, with multiple staff members and the potential for emergencies.
Add all of that to the medical focus on extending life and it’s no surprise that some things get missed.
This is why having a designated Power of Attorney agent is so important. Doing so means there’s someone to advocate for the senior and make sure that their wishes are known.
It’s also important to connect with healthcare staff at any relevant facility, doctor’s office, and the like. The more people who know about your loved one’s wishes, the greater chance that these will be followed.
Things Won’t Be Perfect
Advance planning offers no guarantees. Despite your planning, a senior’s end of life could end up very different than anyone hoped.
For example, a senior might hope to die at home, but end up in a hospital due to a fall or health complications. If their health deteriorates from here, moving them back home may be completely unrealistic.
Or, a doctor might provide emergency treatment that’s against the patient’s wishes due to the rushed nature of emergencies.
The best you can do is talk about and plan for worst case scenarios during the advance planning stages. Doing so also helps everyone to adjust their expectations.
Final Thoughts
Advance planning sounds complicated, but it doesn’t need to be.
Often, it’s simply a matter of starting early, being gentle, and using the right tools. Five Wishes is fantastic here, as it is an all-in-one document that combines a living will and Power of Attorney, along with personal, emotional, and spiritual wishes.
The document also uses clear and straightforward language, so families should be able to understand and work through the questions without much difficulty. Five Wishes could also help facilitate some end-of-life conversations. Or, you use a tool like Death Deck to break the ice and get people thinking about end-of-life wishes.
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