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Where There is a Will You Still Need an Advance Directive

About 50% to 70% of Americans will die without a will.  So, you can imagine that the percentage without a “living will” or other type of “advance directive” is even larger.  I attended a program last month in which a local lawyer specializing in elder law, Eric Parker, shared a lot of useful information about the types of advance directives and answered some common questions people have about them.

With the holidays coming and everyone getting together, I get a lot of questions as a geriatric care manager about how to help an older adult or someone else with special needs.  The holidays may be a good time to have some discussions about what an older loved one really wants.  In very plain terms, this conversation – while potentially awkward – will help assure that others do not make the critical health care decisions for an older adult.  And, of course, these are discussions we do not have to be “old” to begin to have.

I start out by saying that I am a geriatric care manager, not a lawyer, and this is not legal advice.  But let me give you a brief overview of the legal documents you should consider having in place so that health decisions are in accordance with what your loved ones actually want.  If you want more information, I also will give you some Web resources to answer your questions.

First, a “living will” allows the writer to tell their doctor whether they want death delaying procedures used if they have a terminal illness or if they are unable to act.  This only works with incurable or irreversible illnesses, so it is limited. 

Second is the Gold Standard of advance directive, the “durable power of attorney for health care.”  It allows the individual to name a person who will make health care decisions on their behalf.  This can include refusing “life-saving treatment,” but it really is meant to take the place of the patient’s own decisions, so it covers a lot more than a living will.

Third, is the “do not resuscitate order” or DNR.  It is limited to dictating that the patient does not want CPR if the heart or lungs stop. 

Finally, the last one is not truly an advance directive, but it allows a family member to make certain health care decisions on behalf of the patient if there is no other advance directive.  It is called a “health care surrogate act.”

Now comes the hard part – determining what is best for your loved one.  And that is where good legal counsel is essential, but do your homework first.  Check out some of the following elder resources:

Eric Parker has a ElderLaw Blog with lots of helpful information

AARP about advance planning

Caring Connections has state-specific advance directive requirements

Rainbow Hospice and Palliative Care talks about advance directives

Charlotte Bishop is a Geriatric Care Manager and founder of Creative Case Management, certified professionals who are geriatric advocates, resources, counselors and friends to older adults and their families throughout metropolitan Chicago. Please email your questions to Charlotte Bishop.


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