What Is Advance Care Planning?

When it comes to healthcare, one of the most important gifts you can give your loved ones is knowing what matters most to you.

Advance care planning is the process of thinking about your future healthcare wishes and communicating those wishes to the people who may need to make decisions for you. It allows you to have a voice in your care, even if there comes a time when you are unable to speak for yourself.

At Butte Home Health & Hospice, we understand that these conversations can feel difficult. But planning ahead can provide comfort, clarity, and peace of mind for you and your family.

Advance care planning involves discussing and documenting the type of medical care you would want if you were unable to communicate or make decisions for yourself.

This may include talking about:

• What matters most to you when it comes to your quality of life
• The types of medical treatments you would or would not want
• Your wishes regarding hospitalization and emergency care
• Who you trust to make healthcare decisions on your behalf
• Your preferences for care if you are seriously ill or approaching the end of life

Advance care planning isn’t about predicting the future. It’s about making sure your voice is heard if circumstances change.

Important Advance Care Planning Documents

There are several documents that can help communicate your healthcare wishes. While they serve different purposes, they can work together to create a clearer plan for your care.

Advance Health Care Directive

An Advance Health Care Directive is a legal document that allows you to communicate your healthcare preferences in advance.

It can explain the types of medical treatment you would or would not want if you become unable to make or communicate your own healthcare decisions. It can also identify the person you want to make healthcare decisions for you if you are unable to do so.

Your directive may address your preferences regarding:

• Life-sustaining treatments
• Resuscitation
• Artificial nutrition and hydration
• Hospitalization
• Pain and symptom management
• End-of-life care

An Advance Health Care Directive helps your healthcare providers and loved ones understand your wishes and can reduce uncertainty during stressful situations.

Durable Power of Attorney for Health Care

A Durable Power of Attorney for Health Care allows you to designate a trusted person to make healthcare decisions on your behalf if you become unable to make them yourself.

This person may be called a healthcare agent, healthcare proxy, or surrogate, depending on the document and state terminology.

Choosing someone you trust is important. Your healthcare agent should understand your values and be willing to advocate for your wishes, even if making those decisions is emotionally difficult.

It’s important to have a conversation with the person you choose. Don’t simply name them without explaining what matters most to you.

You can say:

“If I can’t make my own healthcare decisions, I want you to speak for me. Here are the things that are most important to me.”

In many cases, an Advance Health Care Directive and Durable Power of Attorney for Health Care work together: one can communicate your wishes, while the other identifies who should help make decisions when you cannot.

Physician Orders for Life-Sustaining Treatment (POLST)

A POLST is different from an Advance Health Care Directive. While an Advance Health Care Directive communicates your wishes and identifies a healthcare decision-maker, a POLST is a medical order intended to guide healthcare professionals about specific treatments you want, or do not want, during a medical emergency or serious illness.

A POLST may address decisions such as:

• Whether CPR should be attempted
• The level of medical treatment you want
• Whether you want hospitalization or treatment in certain circumstances
• Medically administered nutrition, when applicable

POLST is generally intended for people who are seriously ill, have advanced illness, or have significant frailty and may be approaching the end of life. It is completed with a healthcare professional and should reflect a patient’s current wishes and medical situation.

Because a POLST contains medical orders, it can be especially important when emergency medical care is needed and there is little time to discuss treatment preferences.

How Is a POLST Different From an Advance Health Care Directive?

It can be helpful to think of them this way:

Advance Health Care Directive:
Communicates your healthcare wishes and can identify the person you want to make decisions for you if you cannot.

Durable Power of Attorney for Health Care:
Designates someone you trust to make healthcare decisions on your behalf when you are unable to make them yourself.

POLST:
Translates current treatment preferences into medical orders for healthcare professionals to follow, particularly for people with serious illness or significant frailty.

These documents are not necessarily alternatives to one another. Depending on your health and circumstances, you may benefit from having more than one in place.

Five Wishes

Another resource that can help individuals and families have meaningful conversations about future care is Five Wishes.

Five Wishes is an advance care planning document designed to help people express their wishes for care in a way that goes beyond medical treatments. It encourages individuals to think about what matters most to them and communicate those wishes to their loved ones.

The document focuses on five important areas:

1. The person I want to make care decisions for me when I can’t.
2. The kind of medical treatment I want or don’t want.
3. How comfortable I want to be.
4. How I want people to treat me.
5. What I want my loved ones to know.

These questions can encourage conversations about personal values, comfort, dignity, relationships, and end-of-life wishes.

For many families, Five Wishes provides an approachable way to begin conversations that can otherwise feel uncomfortable or difficult.

Five Wishes may be used alongside other advance care planning documents. Depending on your circumstances and where you live, certain legal requirements may apply, so it’s important to understand how the document works in your state.

Start the Conversation Early

Advance care planning isn’t just something to think about when someone is seriously ill. Adults of any age can benefit from considering their healthcare wishes.

A good time to start is when you are healthy and able to have an open conversation with your family.

You don’t have to discuss everything in one sitting. Start with a simple question:

“If you couldn’t speak for yourself, what would you want us to know about your healthcare wishes?”

This can open the door to meaningful conversations about what matters most.

Share Your Plan With Your Loved Ones

Completing the documents is only part of the process. The people who may need to use them should know that they exist.

Consider providing copies of your advance care planning documents to:

• Your primary care provider
• Your healthcare decision-maker
• Close family members
• Specialists involved in your care
• Your hospice or home health team, when appropriate

Keep your documents somewhere they can be easily found if they are needed.

It’s also important to review your wishes periodically. Your preferences can change as your health, circumstances, or priorities change.

Consider reviewing your plan after:

• A significant change in your health
• A new diagnosis
• A major life event
• Marriage or divorce
• The loss of a loved one
• A change in your healthcare decision-maker
• A change in your personal values or goals

Start the Conversation Today

You don’t need to have all the answers. You simply need to start the conversation.

Talk with your loved ones. Share your wishes. Choose someone you trust to speak on your behalf. Complete the appropriate documents. If you have a serious illness or significant health concerns, ask your healthcare provider whether a POLST may be appropriate for you. For more information, check out Enloe Health’s website at “Advance Care Planning” for frequently asked questions.

Planning ahead today can help your loved ones feel more prepared tomorrow.

This article is intended for educational purposes and is not legal or medical advice. Advance care planning documents and requirements may vary by state. Talk with your healthcare provider or qualified legal professional about your individual circumstances and wishes.