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  • Wiser Medicare

Advance Directives and Long-Term Care

If the Covid pandemic taught us anything about our health, it's that you never know when you might have a health issue, and there's great value in being prepared, no matter what your age.

And unless you've gone in for surgery of some type, there's a good chance you don't have advance directives in place.

What are advance directives? They are legal documents that explain how you would want medical decisions to be made if you're ever too ill to speak for yourself. They aim to avoid confusion at a time that will likely already be difficult.

In short, these documents let your family, friends and medical professionals know whom you designate to make decisions for you and what kind of healthcare you want.

Types of advance directives

The two main types of advance directives include:

A healthcare power of attorney (also called a healthcare proxy) names the person you trust to make medical decisions and speak on your behalf when you can't. You may also want to name a backup person if the first person cannot do so. This legal document gives the selected person this authority and gives you a place to write instructions.

A living will (also called an advance health care directive) lets your family and the medical professionals who treat you know which lifesaving or life-sustaining medical services you want and which you don't, including:

  • Resuscitation, whether through CPR or machines

  • Nutrition through tube feeding

  • Hydration through intravenous (IV) fluid

  • Help with breathing through ventilator use

  • Pain relief or other comfort measures

  • Tissue or organ donation after you die

An advance directive is not a Do Not Resuscitate (DNR) order. A DNR is a medical order that must be signed by a physician. It instructs paramedics and other emergency medical personnel not to perform lifesaving care, which they would otherwise always attempt. A living will goes much further in detailing the medical care you want or don't want, but you can add a DNR to your living will by having your doctor establish and sign one.

How are advance directives used with long-term care?

Someone turning 65 today has a 60-70% chance of needing long-term care services, whether unpaid or paid care in the home, nursing facilities or assisted living. Regardless of the stage of long-term care, advance directives are much more essential than in general populations because the person's condition is, by definition, more precarious.

Many people are hesitant to talk about long-term care because thinking about losing their independence makes them uncomfortable or because they can't afford most long-term care options. Unfortunately, those reasons won't keep the need at bay.

While long-term care planning may not get the attention it should, part of that planning should include the creation of advance directives. As a result, advance directives often aren't available, which puts an extra burden on loved ones as they try to figure out how best to care for you. Providing them with the tools to avoid misunderstandings or second-guessing about your care can be an invaluable gift to your loved ones.

Advance directives are an even more valuable gift to you. They are the one way you can be sure your care reflects your values and beliefs – including your ideas about what makes life worth living.

Takeaway action step: Decide to invest the time to prepare a healthcare power of attorney and a living will, whatever your age or health condition. Follow the steps below and, once signed, put the documents in a safe place, so you know that no matter what life brings, you will be cared for as you wish.

How can you get advance directives?

Each state has its own rules and regulations regarding advance directives. So, while you can find free downloadable samples of advance directives online, you may want to get them from more knowledgeable sources because of how important they can be to your care. Sources could include:

What should you do with your advance directives?

Advance directives are not something you want to keep secret or hidden – easy access will be vital if you are suddenly very ill or in a severe accident. Here are four suggestions:

  • Keep original copies of your advance directives with your other essential documents, but not where a trusted person cannot access them.

  • Make copies and distribute them to the person you selected as your healthcare proxy, your doctors, hospital, family members and close friends. They may need the originals to act, but at least they will know what they are looking for.

  • Put a card in your wallet announcing that you have advance directives, so healthcare providers will know to ask for them if you are in an emergency.

  • Revisit your advance directives each year so you can update them if anything has changed. Life throws curveballs; maybe you got divorced or had a falling out with a best friend, and you want your proxy willing to help.


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