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On this page:
- What is advance care planning?
- What are advance directives?
- Who needs an advance care plan?
- What happens if you do not have an advance directive?
- Will an advance directive guarantee your wishes are followed?
- Other advance care planning decisions and forms
- How can you get started with advance care planning?
- How to find advance directive forms
During an emergency or at the end of life, you may face questions about their medical treatment and not be able answer them. You may assume your loved ones know what you would want, but that’s not always true. In one study, people guessed nearly one out of three end-of-life decisions for their loved one incorrectly.
Research shows that you are more likely to get the care you want if you have conversations about your future medical treatment and put a plan in place. It may also help your loved ones grieve more easily and feel less burden, guilt, and depression.
What is advance care planning?
Advance care planning involves discussing and preparing for future decisions about your medical care if you become seriously ill or unable to communicate your wishes. Having meaningful conversations with your loved ones is the most important part of advance care planning. Many people also choose to put their preferences in writing by completing legal documents called advance directives.
What are advance directives?
Advance directives are legal documents that provide instructions for medical care and only go into effect if you cannot communicate your own wishes.
The two most common advance directives for health care are the living will and the durable power of attorney for health care.
- Living will: A living will is a legal document that tells doctors how you want to be treated if you cannot make your own decisions about emergency treatment. In a living will, you can say which common medical treatments or care you would want, which ones you would want to avoid, and under which conditions each of your choices applies. Learn more about preparing a living will.
- Durable power of attorney for health care: A durable power of attorney for health care is a legal document that names your health care proxy, a person who can make health care decisions for you if you are unable to communicate these yourself. Your proxy, also known as a representative, surrogate, or agent, should be familiar with your values and wishes. A proxy can be chosen in addition to or instead of a living will. Having a health care proxy helps you plan for situations that cannot be foreseen, such as a serious caraccident or stroke. Learn more about choosing a health care proxy.
Think of your advance directives as living documents that you review at least once each year and update if a major life event occurs such as retirement, moving out of state, or a significant change in your health.
Who needs an advance care plan?
Advance care planning is not just for people who are very old or ill. At any age, a medical crisis could leave you unable to communicate your own health care decisions. Planning now for your future health care can help ensure you get the medical care you want and that someone you trust will be there to make decisions for you.
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Advance care planning for people with dementia
Many people do not realize that Alzheimer’s disease and related dementias are terminal conditions and ultimately result in death. People in the later stages of dementia often lose their ability to do the simplest tasks. If you have dementia, advance care planning can give you a sense of control over an uncertain future and enable you to participate directly in decision-making about your future care. If you are a loved one of someone with dementia, encourage these discussions as early as possible. In the later stages of dementia, you may wish to discuss decisions with other family members, your loved one’s health care provider, or a trusted friend to feel more supported when deciding the types of care and treatments the person would want.
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What happens if you do not have an advance directive?
If you do not have an advance directive and you are unable to make decisions on your own, the state laws where you live will determine who may make medical decisions on your behalf. This is typically your spouse, your parents if they are available, or your children if they are adults. If you are unmarried and have not named your partner as your proxy, it’s possible they could be excluded from decision-making. If you have no family members, some states allow a close friend who is familiar with your values to help. Or they may assign a physician to represent your best interests. To find out the laws in your state, contact your state legal aid office or state bar association.
Will an advance directive guarantee your wishes are followed?
An advance directive is legally recognized but not legally binding. This means that your health care provider and proxy will do their best to respect your advance directives, but there may be circumstances in which they cannot follow your wishes exactly. For example, you may be in a complex medical situation where it is unclear what you would want. This is another key reason why having conversations about your preferences is so important. Talking with your loved ones ahead of time may help them better navigate unanticipated issues.
There is the possibility that a health care provider refuses to follow your advance directives. This might happen if the decision goes against:
- The health care provider’s conscience
- The health care institution’s policy
- Accepted health care standards
In these situations, the health care provider must inform your health care proxy immediately and consider transferring your care to another provider.
Other advance care planning forms and orders
You might want to prepare documents to express your wishes about a single medical issue or something else not already covered in your advance directives, such as an emergency. For these types of situations, you can talk with a doctor about establishing the following orders:
- Do not resuscitate (DNR) order: A DNR becomes part of your medical chart to inform medical staff in a hospital or nursing facility that you do not want CPR or other life-support measures to be attempted if your heartbeat and breathing stop. Sometimes this document is referred to as a do not attempt resuscitation (DNR) order or an allow natural death (AND) order. Even though a living will might state that CPR is not wanted, it is helpful to have a DNR order as part of your medical file if you go to a hospital. Posting a DNR next to your hospital bed might avoid confusion in an emergency. Without a DNR order, medical staff will attempt every effort to restore your breathing and the normal rhythm of your heart.
- Do not intubate (DNI) order: A similar document, a DNI informs medical staff in a hospital or nursing facility that you do not want to be on a ventilator.
- Do not hospitalize (DNH) order: A DNH indicates to long-term care providers, such as nursing home staff, that you prefer not to be sent to a hospital for treatment at the end of life.
- Out-of-hospital DNR order: An out-of-hospital DNR alerts emergency medical personnel to your wishes regarding measures to restore your heartbeat or breathing if you are not in a hospital.
- Physician orders for life-sustaining treatment (POLST) and medical orders for life-sustaining treatment (MOLST) forms: These forms provide guidance about your medical care that health care professionals can act on immediately in an emergency. They serve as a medical order in addition to your advance directive. Typically, you create a POLST or MOLST when you are near the end of life or critically ill and understand the specific decisions that might need to be made on your behalf. These forms may also be called portable medical orders or physician orders for scope of treatment (POST). Check with your state department of health to find out if these forms are available where you live.
You may also want to document your wishes about organ and tissue donation and brain donation. As well, learning about care options such as palliative care and hospice care can help you plan ahead.
How can you get started with advance care planning?
To get started with advance care planning, consider the following steps:
- Reflect on your values and wishes. This can help you think through what matters most at the end of life and guide your decisions about future care and medical treatment.
- Talk with your doctor about advance directives. Advance care planning is covered by Medicare as part of your annual wellness visit. If you have private health insurance, check with your insurance provider. Talking to a health care provider can help you learn about your current health and the kinds of decisions that are likely to come up. For example, you might ask about the decisions you may face if your high blood pressure leads to a stroke.
- Choose someone you trust to make medical decisions for you. Whether it’s a family member, a loved one, or your lawyer, it’s important to choose someone you trust as your health care proxy. Once you’ve decided, discuss your values and preferences with them. If you’re not ready to discuss specific treatments or care decisions yet, try talking about your general preferences. You can also try other ways to share your wishes, such as writing a letter or watching a video on the topic together.
- Complete your advance directive forms. To make your care and treatment decisions official, you can complete a living will. Similarly, once you decide on your health care proxy, you can make it official by completing a durable power of attorney for health care.
- Share your forms with your health care proxy, doctors, and loved ones. After you’ve completed your advance directives, make copies and store them in a safe place. Give copies to your health care proxy, health care providers, and lawyer. Some states have registries that can store your advance directive for quick access by health care providers and your proxy.
- Keep the conversation going. Continue to talk about your wishes and update your forms at least once each year or after major life changes. If you update your forms, file and keep your previous versions. Note the date the older copy was replaced by a new one. If you use a registry, make sure the latest version is on record.
Everyone approaches the process differently. Remember to be flexible and take it one step at a time. Start small. For example, try simply talking with your loved ones about what you appreciate and enjoy most about life. Your values, treatment preferences, and even the people you involve in your plan may change over time. The most important part is to start the conversation.
How to find advance directive forms
You can establish your advance directives for little or no cost. Many states have their own forms that you can access and complete for free. Here are some ways you might find free advance directive forms in your state:
- Contact your State Attorney General’s Office.
- Contact your local Area Agency on Aging. You can find your area agency phone number by visiting the Eldercare Locator or by calling 800-677-1116.
- Download your state’s form online from one of these national organizations: AARP, American Bar Association, or National Hospice and Palliative Care Organization.
- If you are a veteran, contact your local Veteran’s Affairs (VA) office. The VA offers an advance directive specifically for veterans.
Some people spend a lot of time in more than one state. If that's your situation, consider preparing advance directives using the form for each state, and keep a copy in each place, too.
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Do you need a lawyer to create advance directives?
Not necessarily. A lawyer can help but is not required to create your advance directives. However, if you have a lawyer, you should give them a copy of your advance directive. If you need help with planning, contact your local Area Agency on Aging. Other possible sources of legal assistance and referral include state legal aid offices, state bar associations, and local nonprofit agencies, foundations, and social service agencies.
There are also organizations that enable you to create, download, and print your forms online, but they may charge fees. Before you pay, remember there are several ways to get your forms for free. Some free online resources include:
- PREPARE for Your Care: An interactive online program that was funded in part by NIA. It is available in English and Spanish.
- The Conversation Project: A series of online conversation guides and advance care documents available in English, Spanish, and Chinese. The Conversation Project is a public engagement initiative led by the Institute for Healthcare Improvement.
If you use forms from a website, check to make sure they are legally recognized in your state. You should also make sure the website is secure and will protect your personal information. Read the website’s privacy policy and check that the website link begins with “https” (make sure it has an “s”) and that it has a small lock icon next to its web address.
Some people also choose to carry a card in their wallet indicating they have an advance directive and where it is kept. Below is an example from the American Hospital Association (PDF, 40KB).
Sign up for e-alerts about healthy aging
For more information about advance directives
Administration for Community Living (ACL)
202-401-4634
https://www.acl.gov
American Bar Association
800-285-2221
www.americanbar.org
CaringInfo
National Hospice and Palliative Care Organization
800-658-8898
caringinfo@nhpco.org
www.caringinfo.org
The Conversation Project
866-787-0831
https://theconversationproject.org
National POLST
202-780-8352
info@polst.org
www.polst.org
OrganDonor.gov
Health Resources & Services Administration
www.organdonor.gov
PREPARE for Your Care
info@prepareforyourcare.org
https://prepareforyourcare.org
Department of Veterans Affairs
877-222-8387
www.va.gov/geriatrics
This content is provided by the NIH National Institute on Aging (NIA). NIA scientists and other experts review this content to ensure it is accurate and up to date.
Content reviewed: October 31, 2022
FAQs
What is Advanced Care planning and Advanced Directives? ›
Advance care planning means having conversations and making decisions about the care you'd like in future with your healthcare team. If you're unable to make decisions in the future, health and social care professionals can make sure your wishes are still followed.
What are advance care directives in the care plan? ›An Advance Care Directive is a way to say what healthcare treatments you would like to have or refuse, should you be in a position where you are seriously ill or injured and unable to make or communicate decisions about your care and treatment.
Is Advance care planning same as advance medical directive? ›Advance Care Planning (ACP) often involves completing legal documents such as the Advance Medical Directive (AMD).
What are 3 examples of advance directives? ›- The living will. ...
- Durable power of attorney for health care/Medical power of attorney. ...
- POLST (Physician Orders for Life-Sustaining Treatment) ...
- Do not resuscitate (DNR) orders. ...
- Organ and tissue donation.
- Living Will. A living will is a written document that specifies what medical treatment you would or would not want in the event you are in a terminal condition or a persistent vegetative state. ...
- Power of Attorney. ...
- Health Care Instructions.
What to Include in Your Advance Directive. The name and contact information of your healthcare agent or proxy. Answers to specific questions about your preferences for care if you become unable to speak for yourself. The forms and questions asked vary a bit from state to state.
What are the 5 steps of Advance care planning? ›- Evaluate quality of life. ...
- Have a conversation with your loved ones. ...
- Identify a loved one who can make decisions. ...
- Talk with your health care provider. ...
- Complete the paperwork. ...
- Adjust as the medical condition changes.
What are advance directives? Advance directives are legal documents that provide instructions for medical care and only go into effect if you cannot communicate your own wishes. The two most common advance directives for health care are the living will and the durable power of attorney for health care.
What are some examples of when Advance care planning might be used? ›Advance care planning enables an individual to think about what they would like to happen to them in the event that they lose the capacity to take informed decisions about their care. Examples of such decisions include: The use of intravenous fluids and parenteral nutrition. The use of cardiopulmonary resuscitation.
What are the 2 major challenges with advance directives? ›Problems with Advance Directives
For example, an older adult may not fully understand treatment options or recognize the consequences of certain choices in the future. Sometimes, people change their minds after expressing advance directives and forget to inform others.
Who completes an advance care plan? ›
Some people feel they need help from their nurse or doctor to fill in an ACP, but you can also complete one yourself. You can write your own or use the document provided by Dying Matters. Once completed you should keep a copy yourself and give a copy to anyone who's involved in your care.
When should advance care planning be used? ›Advance Care Planning generally happens if someone has a serious illness, but you can plan ahead for your future treatment and care at any time in your life.
What two types of advance directives are used in the health care setting? ›Making your advance care wishes known. There are two main elements in an advance directive—a living will and a durable power of attorney for health care. There are also other documents that can supplement your advance directive. You can choose which documents to create, depending on how you want decisions to be made.
What are three types of advanced directives and how they effect care? ›Advance directives generally fall into three categories: living will, power of attorney and health care proxy. LIVING WILL: This is a written document that specifies what types of medical treatment are desired. A living will can be very specific or very general.
What is another name for advance directive? ›A medical or health care power of attorney is a type of advance directive in which you name a person to make decisions for you when you are unable to do so. In some states this directive may also be called a durable power of attorney for health care or a health care proxy.
What is the main purpose of an advance directive? ›Health care advance directives are legal documents that communicate a person's wishes about health care decisions in the event the person becomes incapable of making health care decisions.
What are directives examples? ›Structural Directive
This type of directive is used to make changes in the layout of the DOM. Elements can be added or removed, hence changing the structure of the DOM. An example would be *ngIf(adding or removing element from DOM) or *ngFor(lists elements of every iteration).
[11] For a living will to "go in effect" or be enacted, it usually requires two physicians to declare the patient to be terminally ill, suffering from an incurable illness, or in a permanent comatose state; however, state laws can vary.
What are the 2 main purposes served by the advance directives form in the state of Maryland? ›An advance directive allows you to decide who you want to make health care decisions for you if you are unable to do so yourself. You can also use it to say what kinds of treatments you do or don't want, especially the treatments often used in a medical emergency or near the end of a person's life.
What are the 4 key steps to care planning? ›- Patient assessment. Patient identified goals (e.g. walking 5km per day, continue living at home) ...
- Planning with the patient. How can the patient achieve their goals? ( ...
- Implement. ...
- Monitor and review.
What are 3 important elements of an effective care plan? ›
A care plan consists of three major components: The case details, the care team, and the set of problems, goals, and tasks for that care plan.
Who are the most likely to fill out advance directives? ›Patients ages sixty-five and older had a significantly greater completion proportion of any advance directive (45.6 percent; 95% CI: 40.6, 50.8), compared to younger adults (31.6 percent; 95% CI: 28.4, 35.0) ( p < 0.001 ) (data not shown).
What are some frequently asked questions about advance directives? ›- What are end-of-life decisions? ...
- What is a terminal condition? ...
- What is life-sustaining treatment? ...
- When should I make an advance directive? ...
- How will my doctor know that I have an advance directive? ...
- Does the doctor have to follow my advance directive?
An advance care directive involves documenting your preferences for future care yourself. It can include your values, life goals and preferred outcomes, and directions about care and treatments. You can also formally appoint a substitute decision-maker in an advance care directive.
What are the goals of advance care planning? ›The goal of Advance Care Planning is to ensure that your treatment wishes are known and honored. Learn more about your rights to make medical decisions.
What is the difference between a care plan and an advance care plan? ›The difference between ACP and planning more generally is that the process of ACP is to make clear a person's wishes and will usually take place in the context of an anticipated deterioration in the individual's condition in the future, with attendant loss of capacity to make decisions and/or ability to communicate ...
What are the negatives of advanced care planning? ›Advance care planning can also oversimplify the decision making process, as such decisions are inherently personal, will change of time, and are influenced by a range of sociocultural and health literacy factors.
Why would a physician not honor an advance directive? ›Advance directives are legally binding, so doctors have to follow them. False. Advance directives are legally recognized documents and doctors must respect your known wishes, but doctors can always refuse to comply with your wishes if they have an objection of conscience or consider your wishes medically inappropriate.
Why do most people not have advance directives? ›"Many people don't sign advance directives because they worry they're not going to get any care if they say they don't want [cardiopulmonary resuscitation]," says Courtright. "It becomes this very scary document that says, 'Let me die. ' "
Who should initiate advance care planning? ›Although the provider who engages in this discussion with the patient regarding ACP need not be a clinician, ideally it should be a health care provider who is able to work in collaboration with the medical team and who can provide information about prognosis and outline the medical options and their benefits and risks ...
Who initiates advance care planning? ›
The outpatient setting is ideal for developing an advance care plan, and the primary care physician is well situated to initiate the discussion. A survey of 883 patients sheds light on the opinions and preferences of patients and physicians.
Does the patient have to be present for advance care planning? ›Does the patient have to be present? NO. While it is preferable that the patient be present and participating, the ACP discussion can be between the physician or qualified health professional and the family member or surrogate.
What is advance care planning and why is it important? ›Advance care planning is about doing what you can do to ensure that health care treatment you may receive is consistent with your wishes and preferences should you be unable to make your own decisions or speak for yourself.
Which are common components of an advance directive for healthcare? ›Advance directives consist of (1) a living will and (2) a medical (healthcare) power of attorney. A living will describes your wishes regarding medical care. With a medical power of attorney you can appoint a person to make healthcare decisions for you in case you are unable to speak for yourself.
What are three types of directives? ›The three types of directives in Angular are attribute directives, structural directives, and components.
What is the difference between a health care proxy and an advance directive? ›In the case of a Health Care Proxy, a trusted loved one will be given the responsibility. However, with an Advance Directive, your decisions regarding medical intervention and end-of-life preferences are clearly stated in a legally binding document rather than a living person.
What is the difference between advance care planning and advance directive? ›The directive is a formalised version of your advance care plan . It outlines your preferences for your future care along with your beliefs, values and goals. Having an advance care directive means you can also formally appoint a substitute decision-maker for when you can no longer make decisions yourself.
What are the kinds of advance directive? ›- Living will: Expresses preferences for medical treatment and end-of-life care.
- Durable power of attorney for health care: Designates a surrogate decision maker.
- Living will. A living will is a document that lets you outline your end-of-life care preferences. ...
- Medical power of attorney (POA) ...
- Advance healthcare directive. ...
- Psychiatric advance directives.
The most common types of advance directives are the living will and the durable power of attorney for health care (sometimes known as the medical power of attorney). There are many advance directive formats. Some follow forms outlined in state laws, others are created by lawyers or even the patients themselves.
What are directives and its types? ›
...
There are four types of directives in Angular,
- Components directives.
- Structural directives.
- Attribute directives.
- Custom Directive.
What is advance care planning? Advance care planning involves discussing and preparing for future decisions about your medical care if you become seriously ill or unable to communicate your wishes. Having meaningful conversations with your loved ones is the most important part of advance care planning.
What is Advance care planning and why is it important? ›Advance care planning is about doing what you can do to ensure that health care treatment you may receive is consistent with your wishes and preferences should you be unable to make your own decisions or speak for yourself.
What are the 5 steps of advance care planning? ›- Evaluate quality of life. ...
- Have a conversation with your loved ones. ...
- Identify a loved one who can make decisions. ...
- Talk with your health care provider. ...
- Complete the paperwork. ...
- Adjust as the medical condition changes.
Within scientific literature, five different underlying goals of ACP prevail: respecting individual patient autonomy, improving quality of care, strengthening relationships, preparing for end-of-life, and reducing overtreatment.
What is the most important advantage of an advance directive? ›It helps others know what type of medical care you want. An advance directive also allows you to express your values and desires related to end-of-life care. You might think of it as a living document—one that you can adjust as your situation changes because of new information or a change in your health.
What is the advantage of an advance care directive? ›It outlines your preferences for your future care along with your beliefs, values and goals. Having an advance care directive means you can also formally appoint a substitute decision-maker for when you can no longer make decisions yourself.