Advance Directives Mean Less Costly Care

Q. My aunt died ten years ago without an advance directive. I will never forget the fight between her husband and the rest of the family about life saving measures before she died. He insisted that she would have wanted them, when the rest of the family said she would not. There is tension to this day, and family members who were once close can no longer be in the same room together.

My wife and I are in our mid-40’s and our friends are starting to get their planning done. My wife refuses to even talk about it, and changes the subject every time I bring it up.  She sees the topic as morbid, and doesn’t want to admit that we’re getting older and should start taking action on these things. The story about my aunt lingers in my mind, and I wouldn’t want the same thing to happen to us, or anyone else for that matter. What are some things I can say or do to convince her that we should really start our planning, sooner rather than later?


A. As you seem to be aware, Incapacity Planning, including an Advance Medical Directive, a General Financial Power of Attorney, a Real Estate Power of Attorney, and an authorization to disclose protected health information (HIPAA Authorization), is extremely important for everyone over the age of 18, as it communicates patients’ choices when they can no longer speak for themselves. Unfortunately, many of us are unwilling to get our planning in place or, like you wife, unwilling to even start the conversation.

On a national level, roughly 65% to 70% of nursing home residents have advance directives on file. These are some key points to reiterate why everyone should!

• Advance directives keep you in charge when it comes to decisions about medical treatment—even when you’re no longer capable of making those decisions.

• Incapacity planning also shows compassion for family and friends. When loved ones are left guessing, too often the result is guilt, uncertainty, and arguments. By making your wishes known, you can help your loved ones feel more comfortable with your chosen course of care.

• Advance directives help improve end-of-life care for nursing home residents while decreasing healthcare costs. Recent research shows that nursing home providers are missing out on opportunities to reduce unnecessary care and cut healthcare costs by not having residents’ advance directives on file.

Colleen Galambos, Ph.D., MSW is the researcher who recently completed a survey on Advance Medical Directives and how they mean less costly care. According to Galambos, “In the nursing home setting, some providers use aggressive end-of-life care, even if it is not in a person’s best interest or against a resident’s wishes. There is no reason for adults not to have an advance directive, and most nursing home residents should have an advance directive on file to ensure that they receive the type of end-of-life care they desire.”

Galambos also stressed the importance of nursing home residents’ families discussing end-of-life wishes and updating forms on a regular basis so no relative has “to guess about what type of care their loved ones want when they are no longer able to communicate their wishes.”

Why We Delay the Inevitable

According to research, 90% say talking with loved ones about end-of-life care is important, but just 27% have done so. Only 7% have had this conversation with their doctor and less than a quarter of us have put our wishes in writing, although 82% say it’s important.

As we grow older, most of us say we want control over our lives. We plan everything — getting married, having kids, traveling and even who’s going to take care of the dog while we’re gone. So, why is this where we draw the line?

For many of us, we don’t want to face the end-of-life. We don’t want to believe it is going to happen even though we all have a 100% mortality rate. But, we need to! When we let fear or anxiety stop us, we’re just shifting the responsibility to others. By not taking action, we are deciding that they are the ones who will one day make the decisions for us.

Getting the Conversation Started

Although it may be difficult or awkward to start the conversation, sharing your concern for your wife and communicating your beliefs and values can help set the right tone for the dialogue.

Regardless of why we put these decisions off, these are some tips on how to approach them:

1.Take it one step at a time and build from there. You don’t have to do it all at once.
2.Remind yourself it’s not only about you. By doing these things, you’re making your own decisions and taking this burden off your family.
3.Share your plans. Research shows that when we make our plans public, we’re more likely to do them because we feel more accountable.

Visit The Conversation Project website, co-founded by Pulitzer Prize-winning columnist Ellen Goodman to help families have these important end-of-life discussions. In a U.S. News and World Report video, she shares her compelling reasons for helping start the group and how important it is for all family members to sit down and talk. She also shares a “Starter Kit” to help families have the conversation.

Farr Law Firm Clients: Your Documents ARE ALWAYS Accessible with Docubank

Incapacity Planning documents only do what you want them to do if your loved ones know they exist and can locate them when needed. At the Farr Law Firm, we provide a service called DocuBank to ensure that that the Advanced Medical Directive and other healthcare documents you’ve completed through our firm will be very easily accessible when you need them most, such as when you are hospitalized.

DocuBank is an electronic storage and access service for healthcare directives and other vital health information, such as allergies, medications, and a list of your physicians. DocuBank stores all of your health information so it is available whenever needed. Read more about Docubank here.

Ready for Incapacity Planning?

Talking about end of life issues is an emotional and difficult task for most of us, and it is an important first step to making sure your wishes are clear. Once you have taken the step of speaking with your loved ones about your wishes, it is important to develop incapacity planning documents, including an Advance Medical Directive, to make your wishes legally enforceable. If you and your loved ones have not done Incapacity Planning, Long-Term Care Planning, or Estate Planning (or had your Planning documents reviewed in the past several years), now is a good time to plan and get prepared. Call us to make an appointment for an initial consultation:

Fairfax Estate Planning Attorney: 703-691-1888
Fredericksburg Estate Planning Attorney: 540-479-143
Rockville Estate Planning Attorney: 301-519-8041
DC Estate Planning Attorney: 202-587-2797

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About Evan H Farr, CELA, CAP

Evan H. Farr is a 4-time Best-Selling author in the field of Elder Law and Estate Planning. In addition to being one of approximately 500 Certified Elder Law Attorneys in the Country, Evan is one of approximately 100 members of the Council of Advanced Practitioners of the National Academy of Elder Law Attorneys and is a Charter Member of the Academy of Special Needs Planners.

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