What is an Advanced Directive and why do you need one?

Whenever you check into a hospital or emergency room these days, chances are you’ll get asked if you have an advance directive – and often you may be asked to provide a copy. An advance directive (or living will) is a legal statement that outlines what you wish to happen if you find yourself hospitalized and unable to care for yourself. Think of it as your personal emergency contingency plan for life. And best of all, it’s free.

woman completing her advanced directive paperwork

When is a good time?

There’s an old expression: “There’s no time like the present.” This pearl of wisdom applies to advance care planning big time. Just because you feel young and spry today doesn’t mean you will tomorrow. You could have an unintentional injury just by crossing the road while on a walk or bike ride. And once you establish a good plan, it’s a good idea to revisit it every few years – your life changes over time, and your advance directive is a living, breathing document designed to fit your changing needs. For example, the person you want to be in charge if you’re incapacitated could change over the years, and you’d want your advance directive to reflect that.

What do you need to think about?

At Intermountain Health, we are strong believers in being prepared for the future. It’s a good idea to take an hour of your time now and decide what you want and then write those thoughts down as your advance care planning goals. Here are some important factors to consider:

  • Living arrangements – Where would you be most comfortable?
  • Assistance with daily tasks – Do you want a live-in caregiver or a visiting one?
  • Medication assistance – Who would you trust to make sure you get what you need when you need it?
  • Travel arrangements – Where would you want to go and how would you like to get there?
  • Financial affairs – How do you want your assets handled and by whom?

In addition to these broad concepts, you need to consider more specific concerns, such as:

  • Organ donation – Anything beyond what’s on your driver’s license.
  • Power of attorney – Who do you trust to be in charge?
  • Healthcare decisions – Which efforts do you want to be done, including: CPR, Ventilator, Tracheostomy/PEG tube, IV nutrition/fluids, and Hospice care.

Take your time sorting this out – don’t be in a hurry. And remember to be thorough – go back and review what you put down to see if it still makes sense the next day. You’ll be glad you did!

Get an expert opinion

When your washing machine breaks down, do you fix it yourself or do you call a professional repairman? Advance care planning is way more important than a washing machine, and it’s a good idea to discuss it with your primary care provider. Your doctor will have insight that reveals aspects you may not have considered, so it’s worth involving them in the discussion.

What’s a handy place to keep it?

No matter where you decide to file your advance directive and/or living will – in your safe, a filing cabinet, your lock box at the bank, or your sock drawer – make sure the person you name as your power of attorney (i.e., the person you name as being in charge) knows where it is and how to access it in an emergency. It’s also a good idea to provide a copy to your doctor and any specialists you’re seeing.

Which documents do you need?

There are several different documents that exist under the umbrella of advance directives, and they all do slightly different things. The challenge is to select the ones that work together to support your individual goals. Here’s a brief outline of these documents and what they cover:

  • Advance Directive / Living Will: This is the most common type, and it can be as simple as a few sentences or as complex as several pages. It can be drafted by an attorney, and it must be notarized and witnessed.
  • POLST (Provider Ordered Life Sustaining Treatment): This is a legally binding document signed by a healthcare provider to be honored by all providers working on your case.
  • Health Care Proxy: This comes into play in the event that your advance directive doesn’t quite cover your situation.
  • Durable Power of Attorney: Here you can name a person you trust to make non-healthcare decisions for you. This can be part of your advance directive or a separate document.

How much does it cost?

Completing an advance directive or POLST is free. An 80-day stay in the ICU can run you north of a million dollars. Medicare spends about a quarter of the dollars on people who are within their last 12 months of life, and around 40% of patients have no advance care documentation in place to cover palliative or hospice care. Taking the time to get your advance directive in order can save you and your loved ones from bankruptcy.

Part of being well is being heard.