Senior Lifestyles: Advance directives: What are they and who needs them?

Published 10:00 pm Monday, August 7, 2017

Many of us are procrastinators. We put off simple things like going to the dentist, changing the oil in our cars, having a physical exam, getting our eyes checked, and so many other things that just don’t seem to be critically important at the moment. So we put them off, often at our own peril.

One of those items we tend not to do is our advance directives. Simply defined, advance directives are the written instructions that we create to communicate our personal wishes should we become incapacitated and are unable to make our own health care decisions.

While most people would believe that this is more critical for older people, particularly those near the end of life, the fact is “stuff” happens, and it’s not age dependent. Automobile accidents, serious falls, sports injuries or an unexpected life-threatening illness are all events that could suddenly incapacitate you. Should any of these terrible things happen and impact your life at any age, the question, if you don’t have advance directives in place becomes, “Now what? Who speaks for me?”

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Despite cases like the disturbing Terri Schiavo story that long ago received national coverage as she remained in a vegetative state for years while her husband and her parents battled in court over what she would want if she was able to speak for herself, over 60 percent of American adults do not have advance directives in place. As someone who works with the elderly, that’s not just shocking, it’s actually a tsunami of potential disasters just waiting to happen.

In a 2011-2016 project study led by Katherine Courtright, MD, MS at the University of Pennsylvania, it was found that “… among more than 795,000 Americans who were part of 150 different studies, 63 percent had not completed any advance directive. Only 29.3 percent had completed a living will that contained specific end-of-life care wishes, and 33.4 percent had designated a healthcare power of attorney.”

Unlike younger people and many Boomers, we seniors no longer think in terms of being invulnerable or invincible. Most of us have seen the ravages of accidents and illness among our families and friends, and want to proactively have a voice in our own end-of-life care preferences. The way to do that is with an advance directive – the legal documents signed by you as a competent individual and used to guide care decisions if your poor health prevents you doing so on your own.

There are several documents and designations that may be made within advance directives. The most common include: creating a living will that states what lifesaving measures you want used to keep you alive, such as breathing machines; naming a power of attorney who may act on your behalf in situations you have stipulated in the document; naming a healthcare surrogate who has the authority to allow or disallow certain treatments or actions to keep you alive if death is imminent; and a financial surrogate who manages your money and investments.

One person, often a spouse, son, daughter or very close friend may be named to perform one or two or all of those functions or perhaps one person may be named to make healthcare decisions and another to oversee the financial decisions and conduct personal affairs.

It’s not easy having every possible contingency covered, but having the decision-making and control of finances managed by a trustworthy individual can save you and your family a great deal of anguish if you are ever incapacitated or end-of-life and care decisions have to be made.

Without advance directives, particularly a living will, “The treatments most Americans would choose near the end of their lives are often different from the treatments they receive. Unfortunately, this disconnect can lead to unnecessary and prolonged suffering. Advance directives remain the primary tool for people to communicate their end-of-life care wishes and appoint surrogate decision makers.”

This is just one aspect of life where the lessons taught in Scouting can and should be applied, “Be Prepared.”

Ron Kauffman is a consultant and expert speaker on issues of aging, Medicare and Obamacare. Ron is the author of “Caring for a Loved One with Alzheimer’s Disease,” available as a Kindle book on He may be contacted at 828-696-9799 or