It can be hard to think about the long term when there are so many changes in our daily lives. But the COVID-19 pandemic has shown us just how important it is to plan for the future.

Most Older Adults Haven’t Planned for the Future

Take this story as an example: An older woman has been struggling with obesity, diabetes, and heart disease for years. Normally, this woman’s daughter accompanies her to appointments with the endocrinologist, cardiologist, primary care doctor, and physical therapist. When she was admitted to the hospital with respiratory distress, she was unable to speak for herself and, given restrictions on visitation, her daughter could not be in the room.

Unfortunately, the older woman did not have legal paperwork documenting her medical wishes and her family did not discuss advance care planning. So the health care professionals had to resort to a stressful phone call to discuss options — ICU, IV fluids, mechanical ventilation — with a family that was ill-prepared to participate in decision-making.

New research shows that most older adults have not planned adequately for the future and that current physical distancing recommendations have only made the ramifications more challenging.

During so much uncertainty amid the pandemic, one thing all adults can prepare for is to control who speaks for them if they become unable to speak for themselves. These can be tough decisions to make and talk about, but the best time to plan for future health care choices is before a medical crisis occurs.

Does Your Loved One Have a Health Care Agent?

There’s no way to tell if a sudden illness could leave your loved one seriously ill — which is why it’s critical that they have chosen a health care agent.

Also known as a health care proxy, a health care agent is someone who knows what matters most to your loved one, the treatments they want, and the treatments that match their goals and values. The agent can support your loved one with complex medical decisions as well as make decisions for them in the future only if they become unable to communicate their own decisions. 

Many aging parents name an adult child as a health care agent, but others choose someone outside the family, such as a close friend or even a professional third party.

If your loved one doesn’t have a health care agent, encourage them to choose someone they trust to serve in this role. It should be someone who can follow their wishes and make decisions in difficult moments, such as stressful times, differing opinions, and crisis situations.

Here are some questions that your loved one can explore with their health care agent:

• What is most important for you to live well?
• What personal, cultural, or spiritual beliefs do you have, if any, that would impact your care?
• What do you want if you become very ill? For example, would you want your medical care to focus on living longer, maintaining current health, or comfort care?
• What worries you most about the situation? What fears do you have?

Talking about advance care planning in light of COVID-19 is only the first step. Once the conversation is had, completion of an advance directive helps to ensure that your loved one’s wishes will be recognized and honored.

Does Your Loved One Have an Advance Directive?

Once your loved one has thought about their priorities for medical care and treatment options, it’s important that they not only share their wishes with you, your family, their health care agent, and their health care team. They should also make sure to record their decisions and preferences in a legal document called an advance directive.  

Part of the advance directive is officially designating who your loved one has chosen to be their health care agent as their legally appointed health care representative, known as a medical power of attorney or a power of attorney for health care. If your loved one hasn’t named a power of attorney (POA) and they become incapacitated, their health care decisions may be made for them by one of these people: 

• A court-appointed guardian
• A close friend
• An adult relative
• Their spouse
• Their adult child
• Their adult sibling

The other part of the advance directive is called a living will. A living will tells your loved one’s medical team and your family what treatments they want to receive or refuse and under what conditions. When your loved one’s wishes are spelled out in a living will — and it is determined that they’re unable to make their own medical decisions — their physicians and health care agents are legally required to follow all directives.

If your loved one doesn’t already have an advance directive, the National Hospice and Palliative Care Organization has a list of advance directive forms for every state. Especially in the COVID-19 era, an advance directive can provide peace of mind and control when everything in the world seems uncertain.

Next Steps After Creating an Advance Directive

Once your loved one has completed their advance directive document, make sure the following people have copies:

• Their primary and alternate health care agents
• Their doctors (ask if their providers can scan and upload the form to their medical chart)
• Any family members, friends, or other important people in their life

This helps ensure that everyone knows and understands your loved one’s end-of-life care preferences before they are dying. It’s a good idea to note on each copy where the original is stored in case a health care provider or any other entity requires it for any reason.

Need help keeping track of your loved one’s important documents? This Legal & Financial Document Locator is intended to be a helpful tool for use at home to organize your loved one’s legal and financial records. Download it, print it, and fill it out. There are numerous blank spaces provided so you can personalize your list.

Once completed, provide copies to a few trusted family members as well as your loved one’s lawyer and their power of attorney to have in case of an emergency. By keeping all the most important medical, legal, and financial details in one place, you and your loved one won’t have to scramble to find it or remember it during a crisis.