According to a 2025 Pew Research Center survey, more than half of U.S. adults ages 60 to 69 do not have a living will or advance healthcare directive. Even among those in their 70s, about 36% have not yet completed these critical plans. In other words, a significant number of older adults are leaving important healthcare decisions to chance – or to family members who may be unprepared to make them.
Advance care planning is the process of thinking through, documenting, and communicating your wishes for future medical care. It helps make sure your healthcare aligns with your personal values and desires, even if you can not communicate them yourself. Just as importantly, it can spare your loved ones from the anguish of making high-stakes medical guesses during an already difficult time – reducing uncertainty, stress, and potential conflict at a moment when families most need to be united.
In recognition of National Healthcare Decisions Day on April 16, explore what advance care planning means and begin taking steps to create a plan.
Start by Thinking About What Matters Most to You
Advance care planning begins with self-reflection. Think deeply on what “quality of life” means to you and the types of care you would or would not want to receive.
Consider questions like:
- What activities are essential to my happiness? For some, it is the ability to recognize and interact with family; for others, it is mental clarity or physical independence.
- What are my primary goals for care? Do you prioritize longevity at all costs, or to remain comfortable and free of pain?
- What are my fears? Many people worry about being kept alive on machines indefinitely or losing the ability to live at home. Identifying these fears helps you articulate what you want to avoid.
The goal of this phase is to establish a set of guiding principles. Rather than trying to make decisions in the abstract, you are building a framework: “If I become seriously ill and cannot speak for myself, here is what I would want my loved ones and doctors to understand about me.” When your values are clear, the clinical decisions that follow become easier to navigate.
Talk About Advance Care Planning with Loved Ones and Providers
People often steer clear of advance care planning because it brings up difficult emotions. But sharing your wishes is an act of kindness: it gives your family clarity when decisions have to be made quickly or during a medical emergency.
Below are a few conversation starters you can use:
- “I have been thinking about what I would want if I were ever seriously ill, and I want to talk about it with you.”
- “I was reading about advance directives and realized I have never told you what I would want. Can we talk about that?”
- “My doctor mentioned I should have an advance care plan, and I want to be clear with you about what is important to me”
It is equally important to talk with your doctor or healthcare team. In fact, advance care planning is covered by Medicare as part of your annual wellness visit. Your providers can help you understand how your current health may affect future care decisions. They can explain specific medical interventions – such as CPR, mechanical ventilation, and feeding tubes – and help you understand what outcomes to anticipate with each. They can also ensure that your advance directives (more on that in the next section) are added to your medical record so they are accessible to other providers in an emergency.
What Advance Care Planning Documents Do You Need?
Once you are comfortable with your decisions, it is time to put them in writing by creating an advance care directive. These are legal forms that record your healthcare preferences and designate who can make medical decisions on your behalf if you are unable to do so. The two most common documents are:
- A living will: This document explains the types of medical care you would or would not want under certain circumstances if you cannot speak for yourself. It may address treatments such as CPR, breathing support, feeding tubes, dialysis, and comfort-focused care.
- A healthcare proxy form (AKA power of attorney for healthcare). This document names the person who will make medical decisions on your behalf if you cannot.
There are also supplemental orders you can add to your advance directives. For example, a Do Not Resuscitate (DNR) order tells medical staff that you do not want any life-support measures to be attempted if your heartbeat and breathing stop. Although your living will might state that CPR is not wanted, a DNR order on your medical file can more clearly indicate your preference to avoid all interventions. Similarly, other types of orders like Do Not Intubate (DNI), Do Not Hospitalize (DNH), Physician Orders for Life-Sustaining Treatment (POLST), etc. are more useful for people in a senior living facility or hospital to provide staff with clear medical orders in addition to your advance directives.
Legal requirements for advance directives vary by state, so you need to use the forms specific to where you live. Resources like CaringInfo and The Conversation Project offer state-specific advance directive forms, and lots of guidance to help you decide, discuss, and document your advance care plans.
A Note on Choosing Your Healthcare Proxy
Selecting your healthcare proxy is one of the most important decisions in advance care planning. This person is your voice when you cannot speak. You may be inclined to simply choose the person you love most or your oldest child, but the best proxy is the person best suited for the task.
Look for someone who is:
- Trustworthy: You must be certain they will follow your wishes, even if they personally disagree with them. The role of a healthcare proxy is to speak for you, not for themselves.
- Calm Under Pressure: Medical crises are emotional. You need someone who can process information clearly when things get difficult.
- Assertive: They must be comfortable talking to doctors and advocating for your care plan if the medical team suggests a different course of action.
Once you have chosen someone, sit down with them and have a conversation about what matters most to you and how you would like things to be handled. Do not assume they know what you would want. Be sure to name an alternate proxy as well, in case your primary choice is unavailable when needed.
Who Should Know About Your Advance Care Plans?
Advance directives are only effective if they can be found when it matters most. Too often, these documents are tucked away in a locked safe deposit box or a lawyer’s filing cabinet – places that are inaccessible on a Sunday night in an emergency room.
To ensure your plan is followed, provide copies to:
- Your designated healthcare proxy and your alternate.
- Your primary care provider and any specialists you see regularly.
- Close family members or friends who are likely to be notified in an emergency.
- The administrative or nursing staff if you reside in a senior living community.
Keep your original documents in an easy-to-find location at home, such as a bedside drawer or kitchen cabinet. Consider also keeping a digital copy or a “ICE” (In Case of Emergency) note about their location on your phone.
When to Update Your Advance Care Plans
Advance care planning is not a task you check off once and set aside. Your preferences, health status, and relationships will evolve over time, and your plan should reflect that.
Consider revisiting your advance care plan after any of the following:
- A new diagnosis or significant change in your health
- A change in living situation, such as moving to a care community
- The death or incapacitation of a named healthcare proxy
- A change in marital status or a shift in your family relationships
- Any significant change in your personal values or desires
Even without big changes in your life, reviewing your plan now and then is a good idea to make sure it still feels right to you.
