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At Home Care Assistance, when understanding our clients and their family dynamics, we take a holistic and comprehensive approach to putting together their care plan. Yes, our service offering is providing high-touch home care, but we do so in the context of the larger issues of future planning that are crucial to comfort and peace of mind at the end-of-life.

Of all the things that most of us postpone, end-of-life planning must be at the top of the list. Who wants to think about the end of their life when it hasn’t happened yet and could be years away? The sobering fact is that an accident or illness can happen at any age, and scrambling to put end-of-life documents in place during a time of crisis can lead to family conflict and disagreement over your wishes.

Not only is advanced planning complicated, but to make things more challenging, every state has different names for similar documents. Still, the goal is the same — to allow you to state what you or your family member wants for healthcare interventions and who is designated to carry out those wishes. The documents we will discuss will also serve a dual purpose of guiding your family during times of medical and financial need. We will conclude with some tips on having these challenging conversations about pre-planning with your loved ones.

Advance Directives

The term advance directives cover a group of documents that ensure your medical treatment decisions are followed if you are no longer able to communicate. The inability to communicate could be due to severe dementia, a medical event, or unconsciousness. These documents should be reviewed yearly or as often as needed according to your changing health or family status.

  1. Living Will
    A living will is a document that outlines the specific medical treatment you want and don’t want if you are unable to communicate. In some cases, you may prefer to let a trusted family member make those medical decisions outlined in your healthcare power of attorney. For urgent or unusual circumstances, such as for a terminally ill or very frail older adult, you may want to consider a Physician’s Order for Life-Sustaining Treatment (POLST). A doctor must sign the POLST (or MOLST in some states) to be valid.
  2. Healthcare Power of Attorney
    This document designates someone as your health care proxy or power of attorney to make any medical treatment decisions if you cannot make them for yourself. In some states, the healthcare power of attorney will act as a HIPPA release allowing you to obtain healthcare information to assist in a loved one’s care. Some healthcare power of attorney documents also allow you to designate a legal guardian should you be deemed incapacitated.
  3. HIPPA Release A release of your rights under the Health Insurance Portability and Accountability Act (HIPAA) allows the loved ones you designate to access your medical information. Some healthcare entities will require a separate release for each facility.

Estate Planning Documents

Estate planning documents allow you to designate someone to make financial decisions on your behalf if you cannot while alive or after your death.

  1. Financial Power of Attorney
    You may need a financial power of attorney for your aging parent sooner than you think, and without it, you will be immobilized in your efforts to help. For example, imagine if your parent has dementia and succumbs to fraudulent activity or a scam. It will be tough to intervene on their behalf without legal authority.
  2. Will
    You can create a will to ensure all of your property, money, investments, and other possessions are given to the people you choose. A handwritten will is acceptable in some states, but you should check the legal status of such a will with an estate planning attorney. Understandably you may be confused about the difference between a will and a trust.
  3. Trust
    There are different types of trusts, but the primary purpose is to allow you a vehicle in which to place all of your assets to avoid probate court. The trustor or grantor is the person who sets up the trust, and the trustee is the person or entity responsible for managing those assets according to the wishes of the trustor.
  4. Funeral and Burial Arrangements If you don’t designate what burial arrangements you want after death, it can cause family conflict. Not everyone holds the same values and principles around death and dying. If you want a cremation, you should put it in writing. The same goes for an earth burial. Spell out any specific funeral services or celebrations. Some people opt for a pre-paid plan to lock in pricing and take the burden off of their loved ones left behind.

How to Have the Conversation

Getting things started with end-of-life planning can be rocky. It is almost always better to start the conversation as early as possible while your loved one has the capability and capacity to make decisions. Let’s start with some tips for starting and continuing the conversation.

  • Be Respectful
    You may encounter resistance when beginning discussions of end-of-life planning. Resistance may be due to a reluctance to talk about the end of life. Reassure your loved one that you don’t think they are about to die! You simply want to discuss ways to ensure that their wishes are honored. It is not about taking away their independence. Many people don’t understand that discussions alone are irrelevant. Everything must be in writing. Discussions are a means to an end: the creation of written documents that express the person’s wishes in as much detail as possible.
  • Give Examples
    A general conversation about advance planning and beneficiary designations might not be productive: give specific examples of situations where you may need to step in to advocate for your family member in case of an accident or illness. These examples will create possible scenarios that will clarify the value of end-of-life planning.
  • Have Several Conversations
    Try not to expect to build Rome in a day. End-of-life planning is complicated and emotional. Accept that the process will take patience and anticipate having several conversations, but keep the ball rolling.

Sharing the Information

Now that you and your family have completed the hard work of getting end-of-life documents in place, where should they go? If you have the option of an online portal to keep these documents safe and accessible, it can be a great way to give access to family members in a time of need. Many advance directives have a contingency person if the primary designated person can’t perform their duties. That person needs access as well.

Paper copies are also a must for healthcare providers and hospitals. Every healthcare provider needs a copy of the advance directives. Also, consider copies of all financial documents for a financial advisor and estate planning attorney. If the advance directives are locked away in a safe and the designee is out of town during an emergency, that could create a significant problem.

End-of-Life Planning for Peace of Mind

Home Care Assistance believes in empowering our clients and partners to make the best decisions possible throughout the lifespan. Working closely with our clients and other professionals, we encourage everyone to start end-of-life planning as soon as possible to ensure peace of mind.


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About the Author(s)

Danielle has been a social worker for 18 years, and has been serving the home care community for the last 9 years. Danielle’s clinical background helps her to guide families through the home care process, and she is devoted to being a resource for all patients and families.

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