Advance care planning 101
Many of us spend a lot of time planning for the future, from making preparations to travel, buy a house, have a baby or chart a career path. Yet when it comes to what kind of health care we might want in the future, particularly in the event of a catastrophic illness or injury, it’s common to put off decision-making. In fact, only about one in three U.S. adults have completed any kind of advance directive.
April 16 is Health Care Decisions Day, a national and state observance designed to help jump-start your advance care planning journey. Learn about the main components of a plan and how to create one — it’s easier than you think.
What is advance care planning and why do you need to do it?
Advance care planning is a process that involves thinking about, discussing and writing down what’s important to you — your values and goals as well as your preferences for care in medical situations where you may not be able to communicate those preferences. An important step in the process is sharing this information with your loved ones and your health care providers.
Advance care planning is not only for those facing the end of life — everyone 18 and over, even those in good health, should have an advance care plan. Why? Unexpected accidents or illnesses can happen to anyone, at any age. Should such an emergency happen to you without an advance care plan in place, the people you care about may be left to make medical decisions for you. This is an emotionally stressful situation for all involved, and may lead to decisions that do not match up with your values or wishes.
“Participating in advance care planning ensures that your voice can be heard, even if you’re unable to speak for yourself,” says Kara Jovag, outreach coordinator for Program of All-Inclusive Care for the Elderly (PACE) and former advance care planning program coordinator at MultiCare. “It can also give the people you care about peace of mind because they know they would make the right decisions for you.”
What’s in an advance care plan?
In Washington state, there are two types of legal documents — also known as advance directives — that can be used to create an advance care plan: a health care durable power of attorney (DPOA-HC) and a living will. A DPOA-HC allows you to name a health care agent: a person who can make health care decisions for you if you can’t make them yourself.
“At MultiCare, we recommend that all adults begin the advance care planning process by completing this DPOA-HC,” says Jovag. “It will help you understand why you need a health care agent, what authority they would have and what things to consider when choosing someone to be in this role. It also has sections that help prepare your health care agent to make decisions that would align with your goals and wishes.”
If you don’t complete a DPOA-HC, then Washington state has a hierarchy that determines who will make medical decisions for you if you can’t.
“That hierarchy is not always a great option,” Jovag says. “For example, a spouse would still be called upon to make decisions even if you were separated. In the case of a parent, all adult children have to agree on medical decisions, and most of us can think of families where adult siblings don’t get along. Filling out a DPOA-HC ensures the person you want is advocating for you.”
The second document involved in advance care planning is a living will, which details what kind of medical treatments and other types of care you would or would not want if you were incapacitated. However, a DPOA-HC, like this one — created in conjunction with the Washington State Medical Association and Honoring Choices Pacific Northwest — may be a better choice than a living will.
“Our DPOA-HC specifically addresses the rules and laws for Washington state,” says Jovag. “This document is also more comprehensive than most living wills and has less strict witnessing requirements, allowing most health care staff to serve as a witness when signing the document.”
Both a DPOA-HC and a living will only go into effect if you are unable to speak for yourself. While you can hire a lawyer to draw up an advance directive for you, our DPOA-HC is free.
It’s important to note that a general durable power of attorney document does not cover appointing a health care agent — only a DPOA-HC can do that.
Advance care planning tips
Start the conversation now. Talking to your loved ones about your preferences in case of illness or injury can be tricky. The people you care about may feel uncomfortable about the topic, but the approach and attitude you bring to the conversation matters.
“Traditionally, people think about advance care planning as planning for death, and that often leads to discomfort, anxiety and fear,” says Jovag. “If you approach it as preparing for future health care and how you want to live, people are less reluctant to participate.”
Not every concern or issue is likely to be resolved in one conversation. Plan for a series of conversations over time.
Share your plan. Once you complete advance directives, don’t leave them tucked in a drawer or safe where no one can find them. Share copies with your loved ones, your health care agent and your health care providers. You can even keep a copy on your phone so it’s always with you.
Review your plan regularly. Just because your preferences have been documented doesn’t mean you’re stuck with them. You can revoke your advance directives at any time and complete new ones — just be sure to share the new versions with the appropriate people.
“Advance care planning is not a one-time event,” Jovag says. “Your goals and values will likely change over time, so it’s important to review your advance care plan regularly, once a year or so, and update the documents as needed.”
