The Comprehensive Advance Care Planning Guide

Many of us find it difficult to talk about death, and sadly many people relate Advance Care Planning with end-of-life care, and try to avoid the subject. It is not until you are touched by a tragedy, or you become ill yourself that you realise the importance of making plans in advance.

Not only does advance care planning improve your own care, but it helps your family and loved ones manage your needs when you are unable to do it for yourself.

In this comprehensive guide, we are going to explain how to create your own Advance Care Plan and how to make sure your doctors and loved ones can help you live life on your own terms.

We will explain the legal jargon and things you need to look out for, and we will clear up a couple of myths and misunderstandings.

We have also included links to valuable templates, work books and guides at the end of the article.

ACP is shorthand for Advanced Care Plan

Because medical staff love acronyms, and because it’s a mouthful to say, it’s worth knowing that “Advance Care Planning” is often simply called an “ACP”.

But I’m not Dying

Advance Care Planning is not just for people who are nearing the end of their life. ACP covers much more, and is important at any time of your life.

Many of us think we are bulletproof and that we are going to live forever. Others don’t want to talk about their mortality. The reality is that most of us will get sick and need medical care within the next 10 years, and for most the event will come as a complete surprise.

Sadly, you never know when an emergency will occur, and you don’t need to actually die to need an ACP. In the case of an unexpected medical emergency (eg car accident, stroke, head injury, pedestrian accident, choking on food, bicycle accident, falling, complications after surgery), you may end up in intensive care without the ability to speak for yourself.

The New Zealand ACP Cooperative’s clinical lead, Dr Barry Snow, sums it up well when he says:

Dr Barry Snow

Dr Barry Snow

“We all potentially have lots of time to think, talk and plan, yet for many families this conversation does not happen, or if it does, then only when someone is very unwell and unable to make a decision. We think we have lots of time until we don’t, so it’s really important that we start those conversations today”

If you haven’t had the conversation, your medical team will be left to decide for you.

What would you want medical treatment to do for you? Keep you comfortable, control your pain and treat any other unpleasant symptoms while allowing a natural death to occur? Or prolong your life with life support, surgery, drugs, drips and feeding tubes? What if you had little hope of returning to what you would consider to be ‘a good life’. Would this be what you would want?

History

The “living will” is the oldest form of an Advanced Care Plan. It was first proposed by a lawyer in Illinois, USA in 1969. Luis Kutner co-founded Amnesty International less than 8 years earlier, and also created the concept of a living will. Because this form of “will” was to be used while an individual was still alive, it was dubbed the “living” will.

Luis Kutner

Luis Kutner – The creator of the Living Will

By the late 1980s most people were still not aware of the living will concept, and very few people actually completed one. It was discovered that the slow uptake was due to the lack of support from health care providers and medical organizations. With increasing public pressure, the “Patient Self-Determination Act of 1990” was put in place. It required health care institutions to better promote and support the use of living wills. It was at this time that the name was formally changed to an “Advance Directive”.

As living wills and advance directives became more common, several issues were identified, and the terms “Health Care Proxy” and “Medical Power of Attorney” were introduced into law around 1991. These terms resulted in the concept of allowing someone to speak on your behalf – and it also gives this person the power to make real-time decisions in actual circumstances, rather than relying on fixed decisions made in advance.

Over the next couple of years, the focus shifted from the importance of physical treatments and medical procedures, onto the values and goals of a patient. The idea was to better understand and honour a patient’s wishes. This resulted in the term “Medical Directive” being introduced by Massachusetts General Hospital and Harvard Medical School. The Medical Directive is a six page document that covers six different scenarios for advance medical decision making.

Five Wishes

By 1996, the “Five Wishes” directive was developed and introduced in Florida. It combined a living will, a health care power of attorney and also addressed matters of spirituality and comfort care. This became the foundation of what we now call an Advance Care Plan.

5wishes

5 Wishes has now been adopted by most US states

Wish 1The Person I Want to Make Care Decisions for Me When I Can’t
This section is an assignment of a health care agent (also called proxy, surrogate, representative, or health care power of attorney). This person makes medical decisions on your behalf if you are unable to speak for yourself.
Wish 2The Kind of Medical Treatment I Want or Don’t Want
This section is a living will—a definition of what life support treatment means to you, and when you would and would not want it.
Wish 3How Comfortable I Want to Be
This section addresses matters of comfort care—what type of pain management you would like, personal grooming and bathing instructions, and whether you would like to know about options for hospice care, among others.
Wish 4How I Want People to Treat Me
This section speaks to personal matters, such as whether you would like to be at home, whether you would like someone to pray at your bedside, among others.
Wish 5What I Want My Loved Ones to Know
This section deals with matters of forgiveness, how you wish to be remembered, and final wishes regarding funeral or memorial plans.

The Five Wishes was a huge success, and in 1998 the American Bar Association and medical experts created a national version. It has now been translated into 27 languages and is also available in Braille and online. More than 18 million documents have been distributed worldwide.

Other countries

Each country tends to have its own unique version of the Advanced Care Plan or Living Will. And even though the versions often appear to be different, they cover the same guiding principles and are applicable anywhere.

Note : It is essential that you use a local version if you intend to sign and witness the Advance Directive or Health Directive page(s). These pages relate to ‘Do Not Resuscitate’ orders, and are only legally binding in the country and/or states they are designed for.

With regard to overseas adoption of Advance Care Planning, Queensland led the charge for Australia, by implementing the Powers of Attorney Act of 1998 and the Guardian and Administration Act of 2000.

In 2005, England and Wales allowed people to make an Advance Directive or to appoint a proxy under the Mental Capacity Act 2005. However, the rules are very strict and in 2010 the Wealth Management Solicitors, Moore Blatch, highlighted that the demand for living wills had trebled in the two years previous. This led to the British government stating in 2010:

govuk

Every adult with mental capacity has the right to agree to or refuse medical treatment. In order to make their advance wishes clear, people can use a living will, which can include general statements about wishes, which are not legally binding, and specific refusals of treatment called “advance decisions” or “advance directives”.

In 2008, The “Advanced Care Planning in Canada Project” was founded, and following the Inaugural International ACP Conference in April 2010 hosted in Melbourne, New Zealand started working on a collaborative approach resulting in the New Zealand “National Advance Care Planning Cooperative” being formed.

On July 28, 2009, Barack Obama became the first United States President to announce publicly that he had a living will and to encourage others to do the same. He told an AARP town meeting,

barack obama

Barack Obama has a Living Will

“So I actually think it’s a good idea to have a living will. I’d encourage everybody to get one. I have one; Michelle has one. And we hope we don’t have to use it for a long time, but I think it’s something that is sensible.”

Getting Started

You will find several links to various advance care plans at the end of this article. We suggest that you start with a document that is from your home country. Most of the documents can be prepared by following these 5 steps.

Step 1 – Thinking and Contemplation
This is where you think about the values and beliefs that are important to you. You need to think about what makes life meaningful to you and what situations might make it seem pointless.

Spirituality and religion play an important part in many people’s lives and can give great comfort in times of stress and difficulty. For some people their cultural needs are also important.

Think about what makes you happy, gives you pleasure and joy and what you like to spend time doing. Maybe you like to be close to people or pets, or maybe you like peace and quiet. Do you have any hobbies and interests, and things you like to do every day?

You should also consider things that may worry you. For example, how and where you would like to be cared for, how you feel about being stuck in bed, or being by yourself or feeling that you are a burden to others. Some people struggle with balancing their privacy and the need to help loved ones get through.

Step 2 – Managing Medical Care
You are entitled to have a good understanding of your current health status and future medical treatments, and your healthcare providers will always try to make you feel comfortable.

There are several conditions that require special consideration when preparing an Advanced Care Plan. You should discuss these with your doctor or healthcare provider – especially if you want them excluded as part of your plan.

Your choices may differ between – you have a good chance of recovering vs remaining in long term care or being terminally ill. Consider in what circumstances you would want the goal of medical care to switch from prolonging life to comfort care. Your ACP can include different wishes for each circumstance.

  • Cardiopulmonary resuscitation (CPR)
  • Chemical Code (drugs to restart the heart)
  • Ventilator Support
  • Continuous Positive Airway Pressure (CPAP) and Bilevel Positive Airway Pressure (BiPAP)
  • Dialysis for Renal (Kidney) Failure
  • Total reliance on a feeding tube
  • IV fluids
  • Blood transfusions and Blood products
  • Use of Antibiotics
  • Surgery
  • Hospitalization
  • Diagnostic tests
  • Pacemakers and defibrillators

Detailed description of these can be found at American Hospice.

Step 3 – Managing End of Life
For some people remaining in hospital at the end of their life would be the last thing they would want. Many people would prefer to go home and be in familiar surroundings towards the end.

There are medical procedures that keep you alive or delay death. Sometimes treatments can be both helpful and harmful. They may keep you alive, but not conscious, or make you a bit better for a short time, but cause you pain. Your ACP allows you to decide if this is what you want. Often a signed Advance Directive form is required to ensure that these wishes are carried out. Talk to your healthcare provider about this.

Your ACP also allows you to record the people you would like near you and your spiritual and cultural needs.

  • Have you considered organ and tissue donation? Donated organs and tissues can help others live and to have an improved quality of life.
  • Do you want to leave your body to science? There are often specific processes and forms that need to be completed.
  • Do you have any rituals you would like performed when you pass away?
  • Is it important where your body is kept?
  • Do you have any special funeral preferences?

All of these things can be described in your ACP.

Step 4 – Talking Things Through
It is important that you talk about, and share your Advanced Care Plan. Unless other people know about it, you take the risk that your wishes will not be carried out.

If you want to appoint someone as your enduring power of attorney, you will need to discuss your choices with them so they understand what you want and why.

It can be especially difficult to talk with family about death and dying, and we discuss this at length later in this article. If you don’t want to talk about it with your family, you should at least let them know who you have selected as your enduring power of attorney, so they know things have been taken care of.

Step 5 – Taking Action
Now it’s time to put things in place. While you can prepare an Advanced Care Plan by yourself, you might like to consider working with a healthcare professional to help you write things up properly. If you want to include an “Advanced Directive” you will need them to witness and sign the document.

When you are done, you can share copies with your family, doctors, healthcare professionals and your power of attorney.

And don’t forget that an ACP is a living document. You can change it at any time (as long as you are competent at the time), and we suggest that you revisit it regularly – especially if your life or health status changes.

How to talk to healthcare providers

healthtalk

Talking with Healthcare Professionals

Talking with your doctor or healthcare professional is something you should do before an ACP is required.

Health professionals don’t normally bring up the topic unless you initiate the conversation, or they feel you should have a plan in place. So don’t be concerned about wanting to discuss it – the chances are that they were waiting for you to start the conversation anyway.

When you discuss your ACP:

  • Ask your doctor to explain treatments and procedures that may seem confusing
  • Talk about pain management options
  • Let your doctor know about your privacy preferences and whether you want your health status and prognosis shared with your family
  • Make sure your doctor is willing to follow your directives. (The law does not force doctors to withhold treatment if they disagree with your wishes for their own ethical or moral reasons)
  • Ask if they will let you know if the treatment stops working – so you can make informed decisions
  • Give your doctor a copy of your completed plan. Makes sure your doctor knows the contact details for your enduring power of attorney or the person you have elected to speak for you
  • Let your doctor know that you have discussed your wishes with your family and your elected person

How to talk to your loved ones about your ACP

familytalkIt’s up to you to take the initiative and start the discussion. Your family or loved ones are not likely to raise the issue for you. Opening the conversation can be difficult, as most adult children will try to avoid the subject if it is bought up by mum and dad.

One way to approach the subject is to start the discussion in the context of a recent event. Maybe it was an article in a newspaper, a movie on TV, or something that happened to a family member or friend.

If it’s because of your own illness or health concern it will be more difficult. However, your family will come to appreciate the fact that you are prepared to talk about a subject that they may have been avoiding (or unaware of) until now. In this case it is often best to be honest and explain that is the reason you are bringing it up.

If you belong to a church or a support group, sharing your personal values, spiritual beliefs or views about what makes life worth living (and not worth living) can start the conversation.

Sometimes the fact you are drawing up an ACP, a living will and a power of attorney for health care is enough of a reason. If you have selected a healthcare power of attorney, informing your family of your person(s) of choice, and the reasons why, can be used to initiate the discussion.

No matter how you choose to begin, it’s important to approach the conversation with sensitivity. People cope with end-of-life issues in many different ways.

Explain that you are doing it because life is uncertain, and that it is impossible to foresee every type of circumstance or illness that might occur. It’s also important to realize that you need to cover every topic at once.

Talking with Others about Their ACP

fathertalkSometimes you may need to open up the topic with an older or seriously ill family member. It will probably be because you are concerned about their age or health, and want to make sure that things are taken care of.

While it can be difficult to open the conversation, most people will be surprised about how open the person will be to talking about it. Even if the person is actively fighting an illness, you can discuss the topic in the context of how you can help them continue the fight if they end up in hospital.

Here are a few helpful pointers to keep in mind as you plan for having this conversation:

Plan for the conversation
Find a quiet and comfortable place that is free from distraction. Respect the person’s privacy and select a place where you can have a private one-on-one discussion.

Ask Permission
People cope with these types of issues in many ways. Asking permission to discuss this topic assures your loved one that you will respect his or her wishes. Some ways of asking permission are:

  • “I would like to talk about how you would like to be cared for if you got really sick. Is that okay?”
  • “If you ever got sick, I would be afraid of not knowing the kind of care you would like. Could we talk about this now? I would feel better if we did.”

Know What To Expect
Remind yourself that you have initiated the conversation because you care about your loved one’s wellbeing. They may be going through difficult times and may not want to talk about it at first.

Allow your loved one to set the pace. Make sure you focus on being warm and caring. It may be a long time since your loved one has had a reassuring hug or comforting touch.

Turn off your phone and give them your full attention. Reassure them and make sure you spend more time listening than talking – this discussion is all about the needs of your loved one.

It is really important to verbally acknowledge the life choices of your loved ones, even if you don’t agree with their choices. This is not a debate, and is very important to them.

There will be a lot to talk about. If the conversation is difficult, the following three questions are the most important.

  • If you were diagnosed with a life-limiting illness, what types of treatment would you prefer?
  • Have you named someone to make decisions on your behalf if you become unable to do so?
  • What can I do to best support you and your choices?

You may also like to point them to the Advance Care Planning kits. The kits have been carefully worded and are full of information. They can gently guide someone through the topic. Maybe you want to let them fill in the book and then catch up again later to talk about what they wrote. If they still don’t want to talk about it, you can suggest that they give a copy to their doctor or healthcare provider, or store it in a safe place, so it is available if it is ever needed.

Understand that it is normal to encounter resistance the first time you bring up this topic. Don’t be surprised or discouraged; instead, plan to try again at another time.

Selecting a Healthcare Power of Attorney

power of attorneyA healthcare power of attorney is someone you designate to make medical decisions for you if, at some future time, you are unable to make decision’s yourself.

There are lots of different words that can be used instead of a Power of Attorney. Examples include your Proxy, Surrogate, Elected Person or Agent. In some cases the words have specific legal meaning – but in terms of an Advanced Care Plan, they all carry out very similar functions.

Your power of attorney can be a close relative or friend, but should be someone who knows you well, and is someone you trust. In most countries, your agent can make decisions any time you lose the ability to make a medical decision, not just decisions about the end of life.

You need to select a person (and a backup) who will be able to make fast and rational decisions when you are unable to. They need to be unafraid of asking questions, and they need to have the strength to advocate on your behalf. You must also select them when you are legally competent.

This person should be someone who:

  • Knows you well
  • Is calm in a crisis
  • Understands how you would have made a decision if you were able to
  • Can make the decision that you would have wanted – even if it would not have been their personal choice
  • Is not afraid to ask questions and will advocate to doctors
  • Can reassure and communicate with your family

Once you have selected your Healthcare Power of Attorney, it is important that you have a conversation with them to make sure they understand what your wishes would be.

Make sure you explain what you are asking of them, and explain why you picked them. Talk to them about your values and quality-of-life preferences, as well as your treatment and medical options.

Because unanticipated situations could occur, they may need to make a decision based on what they know about your views, and what you think makes life worth living. These are not simple questions, and your point of view may change over time. You may need to discuss your ACP with them on multiple occasions as things evolve.

Some of the things you might like to discuss include:

  • Are there particular treatments you want to receive or refuse?
  • Do you have any concerns or requests about family or spiritual needs?
  • Would you want to receive mechanical ventilation, antibiotics, or tube feeding?
  • Under what circumstances would you want life-sustaining efforts to cease

Making sure your wishes are carried out

Of course, Advance Care Planning involves much more than simply filling out forms. To make sure your wishes are carried out, it is useful to understand your rights. For example, did you know that you, as a competent adult, have the right to refuse CPR, antibiotics or blood pressure tests? Or that you have the right to stop eating and drinking should you choose?

When it comes to end-of-life decisions, what you’ve put in writing will carry more weight than something you’ve mentioned in passing. Clear, written instructions will also make it easier for your substitute decision maker to act on your wishes. So write them down now!

dnr tattoo

Some people go to extreme lengths

Don’t worry about how you’ll feel in the future. You can always change your mind. If you can speak for yourself, you can make decisions about your care. You can also update your Advance Care Plan whenever you like. (We recommend reviewing, dating and initialing it at least once every three years.)

Make sure your substitute decision-maker can be reached in an emergency. Carry a medic alert wallet card. If you carry a cell phone, it’s also helpful to create an ICE (In Case of Emergency) contact and enter the telephone number of your substitute decision maker. In most hospitals, healthcare professionals are trained to look for contact information under this heading.

ice message

Mobile phones with ICE message

There is a comprehensive guide here – and we strongly recommend that you take the time to set this up: ICE Screen Setup

Family Issues

To ensure your wishes are followed, be certain that the person you appoint to be your healthcare power of attorney understands your wishes and WILL abide by them. They have the legal right to make decisions for you even if close family members disagree.

However, if close family members strongly disagree, they may find it extremely difficult to carry out the decisions you would want.

If you think your family may not agree, the following steps can help:

  • Discuss your wishes in advance with any family members that you think may disagree. Explain why you are making the decisions, and ask them to respect your wishes – even if it is difficult for them
  • Explain to your family who you have appointed as your healthcare power of attorney and explain why you have chosen them
  • Tell your family that you do not wish them to be involved with decisions about your medical care and give a copy of these communications to your power of attorney as well
  • Give your primary healthcare provider a copy of your written communications
  • Prepare a more specific written ACP. Make it clear in the document that you want your healthcare power of attorney to resolve any uncertainties. You can use the words “My healthcare power of attorney should make any decisions about how to interpret or when to apply my Advance Care Plan”.

An important part of communicating your end-of-life wishes is discussing with your loved ones what you may need from them if you are faced with a life-limiting illness.

The legal bits

You will often hear the terms living will, advance directive, medical directive, power of attorney, health care proxy and personal directive being used. In some cases (not all), these are legal documents with legally binding instructions and consequences.

Here are the definitions of some of the most important terms:

Advance Care Plans Definitions

Advance Care PlanThis written document is not legally binding. It sets forth your wishes on topics such as resuscitation, desired quality of life and end of life treatments including treatments you don’t want to receive. It is often combined with an Advance Directive and a Power of Attorney document (see the definitions below)
Advance DirectiveThis is a legal document that gives you a way of choosing specific treatments you would or would not want in different circumstances if you were no longer able to speak for yourself. It is the responsibility of your healthcare team to apply your advance care directive – providing they are confident that you fully understood what you were asking for, were free from influence or duress, and that you meant it to apply to the current situation. (Note : Read Myth 3 later in this article)
Living WillSame as an Advance Directive
Medical DirectiveSame as an Advance Directive
Personal DirectiveSame as an Advance Directive
POLSTPhysician Orders for Life-Sustaining Treatment. Used mainly in America. The POLST document provides explicit guidance to health professionals, and is used when death is expected within a year. Whereas an Advance Directive is a general indication of a patient’s wishes, a POLST is a set of medical orders with fixed instructions and expected outcomes.
MOLSTMedical Orders for Life-Sustaining Treatment. Another name for POLST.

Power of Attorney Definitions

Healthcare Power of AttorneyThis is a legal representative who can make decisions for you when you are unable to do it yourself. This needs to be legally documented in advance of it being required. This person has no powers while you are legally competent.
Durable Power of Attorney for health careSame as a Healthcare Power of Attorney
Healthcare AgentSame as a Healthcare Power of Attorney
Healthcare SurrogateSame as a Healthcare Power of Attorney
Healthcare Attorney-in-factSame as a Healthcare Power of Attorney
Healthcare ProxySame as a Healthcare Power of Attorney
Enduring Power of Attorney for Personal Care and WelfareThis term is used in New Zealand. It has the same definition as a Healthcare Power of Attorney. However, this person can’t refuse standard or life-saving medical treatment, or consent to medical experimentation.
Lasting Power of Attorney for Health and WelfareThis is a British term and has the same definition as a Healthcare Power of Attorney
Patient AdvocateThis is a person who can help and speak for a patient. They do not have the same legal rights as a Healthcare Power of Attorney

Note : In many of the ACP kits, you have the option of not naming a Power of Attorney. Instead, you can name someone who can “help” your healthcare team make the best decisions for you. It is always a good idea to name someone to take the lead. Obviously a legally appointed person would be best – but naming a person in your ACP can also be very beneficial.

Medical Definitions

Chemical CodeYou can request that your heart is not restarted with drugs. You can make your preferences known to your physician and they will record it in your medical record.
DNR OrderThis is a directive that you do not wish to be resuscitated by CPR or electric shock. You can make your preferences known to your physician without needing a living will or legal health directive. They can write the orders and put them into your medical record.
DNI OrderThis is a directive that you do not wish to be intubated (breathing through a tube down your throat). You can make your preferences known to your physician without needing a living will or legal health directive. They can write the orders and put them into your medical record.
Donating your bodyYou can donate your body to science. However, you will normally need to organize this in advance and fill in appropriate forms at your local medical university.

Other Definitions
<table

ExecutorAn executor has nothing to do with an ACP. They are used to administer will documents

The laws are different around the world (and often from state to state), so it is advisable to get legal advice if you want to ensure that your plan is strictly carried out.

An important distinction

Normally an ACP is not legally binding, and this is where an important distinction needs to be made.

Legislation in the US, New Zealand, Australia, Canada and the UK supports the right of patients to refuse unwanted medical treatments.

The good news is that with the support of this legislation, most medical professionals work to ensure that a patient has a quality and level of care that reduces stress and anxiety for patients and their loved ones when they need it most.

If you are unsure, a quick discussion with your doctor or health professionals will clarify the situation. Selecting a Healthcare Power of Attorney can also help to ensure your wishes are carried out.

When am I deemed “Competent”?

You are competent if you can understand the basic medical problem and can understand what the treatment is for, and the risks and benefits it will have.

You have to be able to weigh up the information. You need to be able to understand the alternatives and understand what would happen if you did not get the treatment.

It is important that you can recall the information and that you can tell the doctor (with words or actions) that your choices are your own.

Can people with dementia create an ACP?

People in the early stages of dementia should be supported to make as many decisions as possible to ensure their future care and support best matches what they would want.

Unfortunately people with the early stages of dementia may only have the capacity to complete some parts of Advance Care Planning. No matter how well intentioned, the parts they cannot complete cannot be done by others. Advance Care Plans can only contain decisions that the person was able to make themselves. These plans, however, can include giving other people the power to make decisions on their behalf, through a Healthcare Power of Attorney.

Myths

There are a lot of myths around Advance Care Planning.
scales
Myth 1 – Advance Directives are only for older people
False. It is true older people are most likely to use advance directives, but every adult needs one. You never know when an accident or injury might leave you temporarily unable to communicate.

Myth 2 – People should use their country or states official ACP kit
False. The ACP kit can be applied anywhere in the world. The Advance Directive part may be limited by the law of the country/state where it can be applied. However, the rest of the plan can generally be followed without issue

Myth 3 – Advance Directives are legally binding so doctors have to follow them
False. The decision to treat is based on the doctors own assessment at the time. A doctor is permitted to ignore a directive if they think it is medically inappropriate or for their own moral reasons

Myth 4 – Doing everything possible for someone means keeping them alive at all costs
False. Doing everything possible depends on the patients goals. Doing everything possible may simply involve managing pain and distress to facilitate a comfortable transition into a natural end of life.

Myth 5 – If I name a healthcare agent, I give up the right to make my own decisions
False. As long as you have the ability to do so, you are in charge of your own health decisions.

Myth 6 – If I am at home and my advance directive says I do not want to be resuscitated, first responders will not resuscitate me if I go into cardiac arrest
Usually False. This one is tricky. If you are terminally ill and do not want to be resuscitated, you should talk to your lawyer and health care provider about an out-of-hospital do-not-resuscitate order. You should also talk with your local emergency services to see if they will honour it.

Where to store your ACP

Where you store your advance care plan can be just as critical as preparing one in the first place. There are many places you can keep copies (or originals) of the documents, but there are a few important factors to consider when deciding where to store them:

  • They must be portable; they should be available wherever you are in the world.
  • They must be available in a timely manner.
  • They must be in a safe place, protected from theft, fire, flood or other natural disasters.

Here are some suggestions:

  • Make several photocopies of the completed documents.
  • Keep the original documents in a safe but easily accessible place, and tell others where you put them; you can note on the photocopies the location where the originals are kept.
  • DO NOT KEEP YOUR ADVANCE DIRECTIVES IN A SAFE DEPOSIT BOX. Other people may need access to them.
  • Give photocopies to your healthcare power of attorney and his/her alternate
  • Be sure your doctors have copies of your advance directives and give copies to everyone who might be involved with your healthcare, such as your family, clergy, or friends. Your local hospital might also be willing to file your advance directives in case you are admitted in the future.

There are services available that will store copies of your documents and can make them available on your behalf. This is a particularly effective way to store your documents to protect against theft, fire, flood or other natural disasters as well as for people who travel.

logoWishesKept is an ideal solution. Not only does it store your ACP, and copies of your will and healthcare proxy documents. It can also store hundreds of other facts that will help your loved ones when they need it most.

While an ACP covers everything related to your healthcare (mainly focusing on end of life or serious illness), it doesn’t store important information like your social media account details, bank accounts, loans, mortgages, insurance policies etc.

Wisheskept lets you organize your life and gives you a secure place where you can store everything important to you and your loved ones.
 
 

Conclusion

In some countries, Advance Care Planning is funded by the government or medical insurers. For example, in America, a large number of private medical insurers cover the cost of preparing an ACP. In New Zealand, the government provides a subsidy to doctors to complete an ACP with a patient – and if you are in hospital or hospice, your health professionals can often help complete one with you for free.

Although the process of advance care planning may seem daunting, it is well worth the effort. A person can feel more in control of the future, and more confident that decisions will be made in accordance with his/her wishes. A significant burden is lifted from the decision maker and family who are trying to sort through various treatment options for the one they love. Health care professionals caring for the patient can feel confident that they are following the directions of a patient they care about.

Plan templates, workbooks and guides (resources)

The following websites have resource kits and templates to complete your own Advanced Care Plan. We also recommend signing up for a free trial of WishesKept to store everything important to you and your loved ones in one place.

USA
http://theconversationproject.org/ (Includes kit for Alzheimers)

Five Wishes
https://www.agingwithdignity.org/

Canada
http://www.dyingwithdignity.ca/download_your_advance_care_planning_kit

New Zealand
http://advancecareplanning.org.nz/resources/

Australia
http://www.advancecaredirectives.sa.gov.au/forms-and-guides

United Kingdom
http://www.macmillan.org.uk/cancerinformation/livingwithandaftercancer/advancedcancer/advancecareplanning/scotland/advancecareplanninginscotland.aspx

If you are a healthcare professional and would like to add an extra resource to this post, please contact us or include them in the comments below, and we will add them to the list.

Create a FREE emergency letter
Answer a few simple questions to automatically create a letter you can give to your family and loved ones to tell them who to contact and what to do if you get sick or are no longer here.
It’s the perfect way to help the people that rely on you, and because it’s completely free, you have no excuse not to do it now.

You may also like