Expect the best, plan for the worst, and prepare to be surprised.” - Denis Waitley

Medical Directives

There are few things more valuable than peace of mind. Fortunately, when it comes to financial planning there are some relatively simple steps we can take to alleviate our fears and bring about the peace of mind we seek. One such step is to create an advance medical directive. The purpose of an advance medical directive is to ensure your healthcare wishes are carried out in the event of your incapacitation. Typically there are two parts: the health care proxy (also known as a durable power of attorney for health care) and the living will. A health care proxy is someone appointed to make medical decisions on your behalf. If you do not designate a proxy, many states will appoint your closest relative which may not be the person you want making important decisions regarding your health care. The living will is a document that details how you would like certain health care issues to be handled. These are mainly end-of-life concerns such as issuing a do-not-resuscitate order or utilizing an artificial breathing machine.

While it is very important to create advance directives, it is also important to ensure your relatives and your health care proxy know what to do with them. Hospitals and nursing homes are required to ask you if you have directives in place, however studies have shown that this alone is often not enough. In 2014, the New York Times reported that “Researchers at the University of California, Los Angeles, surveyed more than 800 seniors and found that advance directives were not available in the medical records of more than half of the subjects who said they had completed and given them to a health care provider.” Along with giving your advance directives to your physicians and health care agent, a good practice is to give copies to friends or family members who are likely to be near you in the event of an emergency. Have a thoughtful, specific conversation with them so that they know exactly what actions to take. Don’t assume that the directives will follow you to a new facility if you are transferred. Even a change in nursing staff can cause them to be overlooked. Your health care proxy should be trained to continuously ensure the living will is being seen by the appropriate person. When creating a living will, make sure you are as specific as possible. A living will with vague or general orders can be left up to the interpretation of the physician and in many cases that interpretation will not match the wishes of the patient. One should also be aware that a state’s advance directive does not always work in another state, so if you have moved recently you should update your directives.

POLST

An alternative to the traditional advance directives forms are Physician Orders for Life Sustaining Treatment (POLST). A POLST form is only intended for someone who is already seriously ill, but if that is the case it can significantly improve the chances of their wishes being carried out. The patient and the physician must sign the form which will then follow the patient regardless of which care facility they go to. It will become the first document in a patient’s clinical record.

If you are looking to create advance directives or a POLST, there are numerous resources to help you. Each state will have information online regarding its POLST forms and advance directives. If you are a Washington resident this information can be found via the Washington State Medical Association at wsma.org/POLST. There are other valuable resources online with excellent information such as The Conversation Project and Honoring Choices Pacific Northwest. There is even an app created by the American Bar Association called My Health Care Wishes which aids in the storage and transmittal of health care documents. But the best place to start is a phone call to your Advisor. We can assess your specific needs, and utilize both internal and external resources to achieve your goals. However you decide to approach this, we encourage you to act. We believe the sense of relief and peace of mind you receive will be well worth the time spent.

We encourage you to contact a Client Advisor with any questions.


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