Advance Directives – What You Need to Know

Resources for Families / Resources for Seniors

Have you talked to your aging parents about their end of life wishes?

Do you know if they have living wills, health care powers of attorney or do-not-resuscitate (DNR) orders?

“It’s a very tough, but necessary conversation,” said Teresa Steinfatt, Vice President of Business Performance at Tudor Oaks Home Care’s partner, the HomeCare Advocacy Network (HCAN). “Developing a plan and communicating it to loved ones before a crisis occurs, ensures that their wishes will be honored in the event they can’t speak for themselves.”

An advance directive is a legal document that goes into effect only if a person is incapacitated and unable to speak for themselves. It helps others know what type of medical care they want – or don’t want.

There are several types of advance directives:

A living will is a written document that outlines a person’s health care wishes for end-of-life care in the event something prevents them from clearly communicating their own values, wants and needs. Living wills typically tell health care providers what treatments the person does or doesn’t want when the individual is no longer competent to make important medical decisions.

A durable power of attorney for health care is a legal document naming a health care proxy – someone to make decisions when a person is no longer able to do so. Some people are reluctant to put specific health care wishes in writing. So, for them, a health care proxy might be the best option – especially is there is someone they feel comfortable talking to about their preferences.

A DNR (do not resuscitate) order tells medical staff in a hospital or care community that if the person’s heart stops, he/she does not want CPR or other life-support measures.

A DNI (do not intubate) order tells medical staff in a hospital or care community that the person does not want to be put on a breathing machine.

A non-hospital DNR order will alert emergency medical personnel to the person’s wishes.

Organ and tissue donation allows organs or body parts from a generally healthy person who had dies to be transplanted into people who need them.

POLST and MOLST forms provide guidance about medical care preferences in the form of a doctor’s orders. Typically, a person creates a POLST (Physician Orders for Life-Sustaining Treatment) or MOLST (Medical Orders for Life Sustaining Treatment) when they know they are near the end of life  and understand specific medical decisions might need to be made on their behalf. A doctor completes the order after discussion with the patient and family.

“Many people think advance directives are just for older people. However, experts say anyone over the age of 18 should, at the very least, make sure their loved ones understand what they want, or don’t want, in the event of a medical emergency,” Steinfatt said. “It’s also important to periodically review advance directives and update as needed. Your decisions about how to handle situations could change from age 40 to age 85.”

For more information about advance directives, visit the National Institute on Aging website at