You know you should have advance directives drafted as part of your estate plan, but what do they address?
Learn why they are essential essential estate documents and what protections they provide.
What is an advance directive?
According to the National Library of Medicine, an advance directive is a legal document that outlines your decisions about end-of-life care ahead of time.
An advance directive allows you to to tell your family, friends, caregivers and healthcare providers exactly what you want when you cannot make your own healthcare decisions.
In fact, there is research that shows that people who document their end-of-life care in an advance directive are more likely to receive the kind of care they want at the end of their life than people who don’t.
When should you think about advance directives?
Advance directives are not for aging adults only.
The truth is that a medical crisis can hit at any age.
Thus, you can draft an advance directive at any point in your life and you most certainly have permission to change it around as you please.
However, since this blog focuses on the elderly and helping them live their best lives, a lot of the information here will pertain to that.
Decisions that could require advance directives
Decisions that require an advance directive come up when emergency healthcare decisions to keep you alive come up.
These would include:
- The use of CPR (cardiopulmonary resuscitation). If you stop breathing suddenly or you are found with a low or irregular pulse, you may receive CPR. During CPR, emergency technicians and other healthcare professionals will have to push repeatedly on your chest to get your heart beating again. A side effect of CPR include broken ribs. CPR is also usually less effective in older adults who have multiple health conditions.
- The use of feeding machines which will deliver nutrition to your stomach mechanically when you are in an unconscious state.
- Ventilator (life machine) use to help you breathe while unconscious. A tube is connected from the life machine to the patient down the throat and into the trachea. Because this is uncomfortable, the patient will be sedated with medicine. If a patient is going to be kept on a ventilator for a long time, a tracheotomy will have to be performed. During this procedure, doctors will create a small hole in the neck and into your trachea (breathing tube).
- Comfort care during end of life. Comfort care is anything you would like done to relieve discomfort during end-of-life care. This includes administering pain medicine.
- Organ or tissue donation. You can draft an advance directive that communicates what you want to happen to your organs after you die. People with peculiar conditions have sometimes donated their organs to research to advance the quest to find effective treatments.
How to draft advance directives (and what should be in them)
First, talk with your doctor
Now let’s talk about how you draft an advance directive.
The first step is to think about what kind of care you would like to receive in an emergency medical situation.
I advice that you have this conversation with your doctor and another loved one present. This will ensure that you understand the underlying medical reasons for your advance directive.
Medicare or your private health insurance may cover advance directive planning appointments like this.
During this chat with your doctor, your medical history as well as your family medical history will help in the decision-making process.
Consider what is important to you
During your advance directive planning, it is also important to consider your values and what is important to you.
Perhaps during a medical emergency it would mean a lot to you to kept alive as medically possible because you want to attend a grandchild’s wedding.
Or perhaps you would like to take a picture with your great-grandchild before it’s all said and done.
You are absolutely allowed to include this in your planning process.
As a caregiver or loved one, it is important that you listen
The truth is that none of us like to think about death.
Planning for it is even more uncomfortable for a lot of people.
As a caregiver or the loved one of an elderly person, while the conversation surrounding advance directives is uncomfortable, I encourage you to listen.
Don’t become critical or think that end-of-life care talk will somehow hasten the death of your loved one.
Paying attention to their wishes communicates that you care about a subject your loved one cares about and will help them draft an advance directive they are happy with.
Once the discussions are done, put everything in writing
Time to write everything down.
And as a matter of fact, an advance directive comprises of a few documents.
- A living will
- A durable power of attorney
- Other advance care planning documents
A living will is the document where you communicate your choices and preferences concerning healthcare decisions if you are unable to make them.
A durable power of attorney is the legal document where you declare who your healthcare proxy is. A healthcare proxy is a person makes healthcare decisions on your behalf. You can declare a healthcare proxy in addition to or instead of your living will.
Other advance care planning documents could include anything from the decision to not resuscitate (DNR) in particular instances versus others.
A lawyer can help you create these documents but it is not necessary.
Some states have their own advance care planning documents you can download and fill out.
You can also use the Eldercare Locator website- this is a government website- or call their number at 1-800-677-1116 to help you locate advance care planning services in your locality.
It is best to have this document witnessed and stamped by a notary public for extra authenticity.
The advance directive should then be kept in a safe place.
Don’t forget to let a trusted friend or loved one (possibly your healthcare proxy) know where you have your advance directive kept.
Talking about death is uncomfortable.
However setting up an advance directive that spells out your wishes for end-of-life care will avoid confusion and conflict later on.
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