Have you been thinking about filling out an advance directive? According to the National Institute on Aging (NIA), advance-care planning, or making plans about your health care in the event of a medical crisis, is an important step at any age. Advance-care planning consists of:

  • Learning about the medical decisions that might need to be made in the event of a medical crisis (near the end of life)
  • Considering these decisions
  • Letting others know what you prefer (often by putting your plans for these decisions into a written advance directive)

What is an advance directive?

According to NIA, an advance directive is a legal document that goes into effect only if you are incapacitated and can’t speak for yourself. In this type of situation (maybe because of disease or severe injury), an advance directive can help others know what medical care you’d like, and lets you record your values and desires that relate to end-of-life care.  NIA suggests thinking of an advance directive as a “living document”—a written document that you may adjust as long as you’re able to.

The National Institute on Aging (NIA) says there are two elements in an advance directive:

  • A living will
  • A durable power of attorney for health care

There are also other documents than can supplement the advance directive or stand alone; these documents may include a DNR (do not resuscitate) order, or discuss organ and tissue donation, dialysis, and blood transfusions. Note that laws about advance directives and related documents may vary among states.

What health-care decisions might be included in an advance directive?

According to NIA, there may be a time near death when physicians believe that a cure is no longer possible, and decisions may relate to:

  • Cardiopulmonary resuscitation (CPR) to restore a person’s heartbeat; defibrillation (electric shocks) and medicines might be used as a part of this process
  • Use of a ventilator (a machine that forces air into the lungs through a tube) to help a person breathe
  • Tube feeding (artificial nutrition) and/or intravenous (IV) liquids (artificial hydration), sometimes used when a person cannot eat or drink
  • Comfort care (usually anything according to a person’s wishes, including giving medication for pain, to help soothe and relieve suffering)

What is a living will (a type of advance directive)?

According to the National Institute on Aging (NIA), a living will is a written document (an advance directive) that helps your doctors know how you’d like to be treated in the case you are dying or expected to be permanently unconscious and can’t make decisions about emergency treatment. You may include details about the health-care decisions described above, indicating which ones you’d want and wouldn’t want and the conditions for each choice.

What is a durable power of attorney for health care (a type of advance directive)?

According to NIA, a durable power of attorney for health care is a legal document in which you appoint someone you trust to make health-care decisions for you when you can no longer speak for yourself. Your proxy is also referred to as a surrogate or health-care agent. You might choose a spouse, child, or other family, or even a close friend or member of the clergy. Depending on the laws in your state, you may be able to choose a proxy in addition to or instead of a living will. There may be unforeseen situations (like a major car accident), when a durable power of attorney for health care might help you be more specific about your desired medical treatment decisions than a living will. Note that laws about durable power of attorney may differ among states.

What is the Medicare coverage of advance-care planning?

Medicare Part B (medical insurance) covers advance-care planning, if you choose to have it, as part of your yearly “wellness” visit. This is voluntary planning for care in the case you become unable to speak and choose treatment for yourself. During this time, you may talk about an advance directive with your health-care professional, and he or she may be able to help you fill out the forms if you’d like. If you have Medicare Part B, you will be eligible for advance-care planning and you won’t have to pay anything if the provider accepts Medicare assignment. Please note that Medicare may also cover this service as a part of medical treatment; if it’s not part of your yearly “wellness” visit, the Medicare Part B deductible and coinsurance may apply.

How do you get an advance directive?

According to Medicare.gov, you can get an advance directive from your health-care provider, attorney, local Area Agency on Aging, or state health department. There is also local help for Medicare beneficiaries and their families at the State Health Insurance Assistance Program (SHIP).

What should you do with your advance directives?

According to Medicare.gov, once you have your advance directives, you should consider:

  • Keeping the original copies where they can be easily found
  • Giving copies of them to your health-care proxy, health-care providers, hospital, nursing home, family, and friends
  • Carrying a card with you that says you have an advance directive
  • Reviewing your advance directives every year