One of the courses I’m taking in my master’s studies is Elder Law and I’m OBSESSED with this topic. Recently, we engaged in the topic of advance directives and I wanted to share some of the high points with you because they are just too darn important to keep to myself. Assembling your advance directives — including a living will, healthcare power of attorney and DNR or POLST order — is one of the most important steps you can take in designing a workable Grand Plan, both for yourself and the people you love. So, let’s talk a quick minute about the whats and hows of why that is.

Let me first send you to the National Council of Aging’s web page called “Getting Your Affairs in Order Checklist: Documents to Prepare for the Future.” This is a really helpful place to begin the process. It will tell you all about the importance of advance directives and fill you in on a lot of other critical information including a handy checklist for getting your affairs in order, a list of documents you need to have in place, who can help you get your affairs in order and other decisions that can be tackled in advance, before crisis hits and the wheels fall off your bus.

The next thing you need to know about advance directives (something I did not understand before taking this course) is that you can draw up your own advance directives without the input or expense of an elder law attorney. You need a good lawyer on your side to design documents like a last will and testament, durable power of attorney and a trust, but you don’t really need one to complete a healthcare power of attorney, living will or Do Not Resuscitate (DNR)/Provider Orders for Life Sustaining Treatment (POLST) documents. It may smart to work with an attorney to make sure your healthcare power of attorney and living will drafts meet the standards of the state in which you live, but it’s not required. The DNR and POLST are actually prescribed by your physician, so definitely no lawyers needed for that!

Here are the key differences and applications of these four advance directive documents, according to my little ChatGPT friend who helps me decipher complex topics:

1. Living Will

• Purpose: Specifies your preferences for end-of-life care, such as whether you want life-sustaining treatments like ventilators or feeding tubes.
• Decision-Maker: No designated decision-maker. The document directly expresses your wishes.
• Scope: Focuses mainly on specific treatments in terminal or irreversible conditions.
• Activation: Activated when you are terminally ill, in a permanent vegetative state, or otherwise incapacitated and unable to communicate.
• Flexibility: Less flexible. It only addresses the scenarios explicitly stated in the document and may not account for unforeseen situations.

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2. Durable Power of Attorney for Health Care (Healthcare Proxy)

• Purpose: Appoints someone to make healthcare decisions on your behalf if you are unable to do so.
• Decision-Maker: Your appointed healthcare agent or proxy makes decisions for you.
• Scope: Broad. It covers all healthcare decisions, not just end-of-life care, and includes decisions about treatments, doctors, and healthcare facilities.
• Activation: Activated when you are incapacitated and unable to make decisions, regardless of whether the situation is life-threatening.
• Flexibility: More flexible. The agent can make decisions in a variety of circumstances, including unforeseen medical situations.

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3. Do Not Resuscitate (DNR) Order

• Purpose: Instructs healthcare providers not to perform CPR or other resuscitation efforts if your heart stops or you stop breathing.
• Decision-Maker: The order is typically signed by you and your doctor, but it does not appoint a decision-maker.
• Scope: Limited to resuscitation measures (CPR, intubation, etc.). It does not address other medical treatments or conditions.
• Activation: Activated when your heart stops or you stop breathing, typically during a medical emergency.
• Flexibility: Very limited. It only covers situations where resuscitation is needed.

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4. Physician Orders for Life-Sustaining Treatment (POLST)

• Purpose: Medical orders that specify your preferences for a wide range of life-sustaining treatments, including resuscitation, intubation, feeding tubes, and more.
• Decision-Maker: The form is filled out by you and your healthcare provider. It does not appoint a decision-maker.
• Scope: Broad. Covers a variety of medical treatments and interventions for seriously ill or frail individuals.
• Activation: Activated immediately once signed by your doctor, and it applies in all medical settings.
• Flexibility: Less flexible. It is a medical order, so healthcare providers are required to follow it exactly unless it is formally updated.

Confused already? Don’t be. This is the easiest, smart thing you’ll ever do.

If you’re feeling ready to get this advance directive chore off your to-do list, then your next stop should be this AARP web page on Advance Directive forms. It links you to advance directive forms and rules for your state. As a resident of Jacksonville, FL I clicked on the state of Florida and got to a page managed by CaringInfo, a program of the National Hospice and Palliative Care Organization (NHPCO), a national consumer engagement initiative to improve care and the experience of caregiving during serious illness and at the end of life. The editable PDF package includes Florida-specific advance directive forms and instructions for preparing an advance directive that meets state requirements. Follow the directions for witness signatures and notarization, and you’ll be set with your advance directives!

The last step is probably the most important one however, and that is to communicate your wishes to your family, friends and medical providers — especially the people you may have named in these directives! — during ongoing, loving and direct conversation. Make sure everyone is on the same page about what you want when you can’t articulate it for yourself. This is critical, so I’ll say it again: TALK TO YOUR PEOPLE. Make it very clear your intentions so there’s no grey area to muddle through when you’re hooked up to a machine and people are freaking out.

And one final thought: put these documents in a safe, portable, easy to locate place and TALK TO YOUR PEOPLE about where they can find them. These documents won’t do any good if no one knows where they are. More specifically, these documents should not be stored in a lock box. Don’t do it! My professor specifically warned us about the challenge of getting legal access to a lock box that indicates who has access. So, no lock boxes! With the DNR, POLST and living will forms, make sure they are scanned into your medical record or are on file with the hospital where you are being treated.

Drawing up, communicating and safely storing your advance directives are among the most loving, generous acts you can do for your people. Plus, it’s pretty easy to do if you have a computer and enjoy talking to friends and family. Do it today!