Leslie* and Heather* had never considered the possibility that their mother might one day no longer be around or able to communicate her medical care preferences. After all, their mom is a strong, proud woman who seemingly never faced a vulnerable moment in her life. She is also the family’s primary caretaker—not the other way around. But those days are quickly becoming distant memories, and now is the time to sit down and discuss advance care planning for their aging mother.
Needless to say, Leslie and Heather feel overwhelmed with questions and are unsure how their mom will react. What are mom’s wishes for future medical treatment? Has she even thought about it? What has she written down or communicated to someone else? Who should speak for her if she can’t speak for herself? How do they honor her wishes and minimize conflicts while preparing for the unexpected?
The sisters are not alone in their concerns. While advance care planning offers families a way to confidently answer these questions by communicating medical preferences before they are needed, statistics consistently reveal a mixed bag between those who engage in these critical conversations and those who continue to delay them. In fact, one poll indicates less than half of adults over 50 have formally documented their medical care preferences through living wills, healthcare powers of attorney, etc. As one can imagine, family members and healthcare professionals often find themselves unable to step in or agree on what makes the most sense when it matters most.
Imagine Achieving These Goals With Advance Care Planning
- Honor your loved one’s personal wishes
- Clarify instructions for family and healthcare professionals
- Eliminate disagreements among family members
- Reduce the likelihood of unwanted or unnecessary treatment
- Guide for family members on how to act during stressful or critical medical situations
- Clarity for end-of-life preferences
- Your aging loved one benefits from improved care
- Reduce unnecessary treatments or hospitalizations
- Peace of mind for everyone involved
One poll indicates less than half of adults over 50 have formally documented their medical care preferences through living wills, healthcare powers of attorney, etc.
Whether your family is beginning the process of advance care planning or revisiting existing plans, it is important to start those conversations sooner rather than later. We hope this guide will help.
The Basics of Advance Care Planning
On paper, advance care planning is the process of discussing and legally documenting an aging loved one’s medical and overall healthcare preferences should they die, fall ill, or become medically incapacitated. While no one enjoys talking about the day when they are no longer around or can’t make decisions for themselves, advance care planning ensures you or your loved one has a say in what happens next. The senior has peace of mind that their wishes will be honored, and family members have an official roadmap with clear rules and roles to go by.
More than defining clinical directives for family and healthcare professionals, advance care planning allows one to choose care consistent with their values and goals. It is a thoughtful process that ensures you or your loved one’s preferences are known and respected, allowing them to control their health and future. For instance, what does “living well” mean to your aging loved one? How do they feel about having to rely on breathing machines or feeding tubes? If given a choice, would they prefer to receive care at home, in hospice, or at a hospital?
Here are a few basic advance care planning documents that meet those needs:
- Living Will — As the name suggests, this document allows your aging loved one to outline their preferences for medical treatment (while they are still alive and competent) in case they cannot communicate their wishes. It typically addresses issues like life support, resuscitation, and other specific medical interventions and can be complemented by Medicare counseling to ensure all aspects of their healthcare plan are considered.
- Healthcare Proxy or Medical Power of Attorney — This is where your aging loved one designates a trusted person (you, a caregiver, or someone else) to make medical decisions on their behalf. This typically addresses decisions on treatment, procedures, and surgeries. It also allows access to medical records and communicating with doctors.
- Do Not Resuscitate Orders (DNR) — These are explicit instructions for not performing CPR if your aging loved one were ever to stop breathing or if their heart stops beating. Sometimes, loved ones do not want aggressive life-saving measures, often due to terminal illness, advanced age, or poor quality of life.
Advance care planning is the process of discussing and legally documenting an aging loved one’s medical and overall healthcare preferences should they die, fall ill, or become medically incapacitated.
Why Advance Care Planning Matters To Family and Caregivers
As a son/daughter, spouse, sibling, or outside caregiver, there is peace of mind in knowing your aging loved one has already expressed their wishes and provided a roadmap for them to carry out versus making that decision without any planning or consideration. The family member or caregiver knows what to do, how to do it, and when. Furthermore, it is an opportunity to collaboratively shape your loved one’s aging plan through thoughtful discussions. As a result, everyone feels like they are part of the process and understand their unique role when the time comes.
Sadly, many advance care planning conversations do not occur or happen until much later in life. The study referenced above sampled U.S. adults aged 50-80 about their advance care planning before and during the early months of the COVID-19 pandemic. Nearly three in five of those adults said they had talked to someone, though people aged 65-80 were more likely to do so compared to those between 50 and 64.
In nearly every instance, those conversations had occurred only within the previous three months leading up to the study—clearly proving seniors wait longer than they probably should.
Another more recent study in December aimed to improve end-of-life planning for older adults by increasing documentation of their preferences. While the intervention successfully increased documentation, particularly among individuals with dementia, it led to a rise in potentially burdensome end-of-life care that either prolonged suffering or caused discomfort without significantly improving the quality of life for the patient. The study went on to recommend that future research focus on integrating advance care planning with comprehensive care models that prioritize patient-clinician communication and align with patients’ true preferences.
Nearly three in five of adults said they had talked to someone, though people aged 65-80 were more likely to do so compared to those between 50 and 64.
How Do I Start the Advance Care Planning Conversation?
- Choose the right time and setting — Find a quiet, relaxed environment where your loved one feels comfortable. At the same time, pick a place where there are minimal distractions. This could be your living room, but it could just as easily be a bedroom or with their primary doctor present at their office.
- Be positive — Emphasize that you love your aging loved one and that it is important to honor their values and wishes. Allow them to drive the conversation however fast or slow they want it to go. Steer your questions toward understanding their values and beliefs and talk through results that would make them happy.
- Initiate with sensitivity — Explain why you want to have this conversation and express your intentions. Let them know that you are coming from a good place and want to ensure they are taken care of.
- Be patient and listen — While we are sure you have plenty of questions and concerns, it is important during these advance care planning talks that you focus on listening more than you speak. Respect their concerns without judgment.
- Share what matters to you — Do not be afraid to let your aging loved one know how important it is to you that you are prepared for the future and their care needs.
- Share stories — Use real-life examples of people who didn’t plan effectively and what happened as a result. This is not an opportunity to scare your aging loved one, but they need to know how critical advance care planning is, even though the conversation is uncomfortable and a little heavy.
- Focus on their legacy — Ask them how they want to be remembered and what values they wish to pass down. This goes back to being positive throughout the conversation and putting them in the driver’s seat.
- Do not be afraid to start small — You may not convince your aging loved one that now is the time for advance care planning. This is OK but work hard to find a middle ground. For instance, perhaps start with only the medical power of attorney. Once they see how this one document benefits them, they may be open to more.
Once you have your loved one’s advance care planning documentation in place, the next step is to share those directives with their primary healthcare providers and review and update them regularly to account for new wishes or changes in healthcare needs.
Even if one or two family members or caregivers are involved right now, it is important to involve all family members in future decision-making. This will limit internal fighting and keep everyone on the same page—even if they are not chosen caregivers or decision-makers.
Additional resources are available for you or your aging loved one who wishes to learn more about advance care planning. The Senior Source is a tremendous resource for everything from caregiver support programs to classes that discuss key estate planning documents like wills, medical power of attorney and more.
The advance care planning conversation can overwhelm the caregiver, family members, and the aging loved one. However, approaching this conversation from a positive perspective and having a goal of ensuring your aging loved one’s legacy and wishes are honored can go a long way in ensuring everyone feels comfortable. When in doubt, plenty of resources help get you started.
Advance Care Planning Doesn’t Have To be a Taboo Topic
Advance care planning can feel overwhelming, especially considering that few people enjoy thinking about the day they are no longer around to care for their families. That said, it is necessary to ensure everyone feels comfortable in carrying out someone’s established wishes rather than making blind decisions on their behalf. Advance care planning documents like medical powers of attorney and a living will put everything in writing and provide a clear roadmap on how to proceed. Having the right team in your corner can also help. At The Senior Source’s Elder Financial Safety Center, we provide education, resources, training, and tools to help you with wills, insurance counseling, benefits assistance, and more.
The Senior Source in Dallas, Texas, is dedicated to supporting older adults. Our advocacy ensures that everyone’s rights are upheld as they age, and we strive for financial and emotional well-being for all. We prioritize providing high-quality, practical solutions to our clients, constantly focusing on growing our reach and impact within the community. When it comes to Dallas older adults, whether you are a family caregiver, a service provider, or a senior citizen, having a reliable resource is invaluable. We protect seniors and empower them to live their most purposeful lives.
Embrace the future of aging with us. Contact us at 214-823-5700 or complete the contact form to learn about our services. We are here to support you.
*Client names and/or photos may be changed to protect confidentiality.
