San Mateo Senior Home Care Blog

No Downside to Having Advance Health Care Directives

By Mitch Williams


As Seen in the Half Moon Bay Review (March 1, 2017)

Interacting with seniors on a daily basis, I continue to be astonished by how many do not have a proper Advance Health Care Directive (sometimes called advance directives) in place. This is usually due to a tendency to procrastinate, a natural aversion to discussing uncomfortable topics such as end of life, and lastly, a lack of awareness of the importance of having these documents in place now.

Recently, the Coastside Adult Day Health Center in Half Moon Bay hosted a seminar on this subject. Participants were encouraged to use this time to fill out advance directive forms and have them witnessed. So, exactly what are advance directives?

An advance directive is a document that allows a person to make provisions for health care decisions in the event that, in the future, he or she becomes unable to make those decisions for themselves.

There are two main parts of an advance directive — designation of a medical power of attorney and creating a living will.

A medical power of attorney (or health care proxy) allows you to appoint a person you trust to make medical decisions on your behalf if you become unable to make them for yourself. Before a medical power of attorney goes into effect, your physician must certify that you are unable to make your own medical decisions. In addition, if you regain the ability to make decisions, the agent cannot continue to act on your behalf.

Many states have additional requirements that apply only to decisions about life-sustaining medical treatments.

For example, before your agent can refuse a life-sustaining treatment on your behalf, a second physician may have to confirm your doctor’s assessment that you are incapable of making treatment decisions.

A living will allows you to clearly document your wishes concerning medical treatments at the end of life. This includes your choice about the level of intervention and treatment you wish to receive from medical professionals, as well as your wish regarding possible organ donation.

Before your living will directs any medical decision-making, two physicians must certify that you are unable to make medical decisions and you are in the medical condition specified in the state’s living will law (such as terminal illness or “permanent unconsciousness”). Other requirements also may apply, depending upon the state.

Advance directives are legally valid throughout the United States. While you do not need a lawyer to fill out an advance directive, your advance directive becomes legally valid as soon as you sign them in front of the required witnesses.

The laws governing advance directives vary from state to state, so it is important to complete and sign advance directives that comply with your state’s law. Also, advance directives can have different titles in different states.

Emergency medical technicians cannot honor living wills or medical powers of attorney. Once emergency personnel have been called, they must do what is necessary to stabilize a person for transfer to a hospital, both from accident sites and from a home or other facility. After a physician fully evaluates the person’s condition and determines the underlying conditions, advance directives can be implemented.

Some states do honor advance directives from another state; others will honor out-of-state advance directives as long as they are similar to the state’s own law. And some states do not have an answer to this question. The best solution is, if you spend a significant amount of time in more than one state, you should complete the advance directives for all the states you spend time in.

Advance directives do not expire. An advance directive remains in effect until you change it. If you complete a new advance directive, it invalidates the previous one. You should review your advance directives periodically to ensure that they still reflect your wishes. If you want to change anything in an advance directive once you have completed it, you should complete a whole new document.

What happens if you don’t have an advance directive?

You will receive medical care regardless of whether you have an advance directive. However, there is a much greater chance that you will receive the treatment you want if you have an advance directive to make your wishes clear.

If you cannot speak for yourself and do not have an advance directive, a physician will generally look to your family, friends or clergy for decisions about your care. If the medical center is unable to locate any family to act on your behalf, officials there may ask the courts to appoint a person (a guardian) who will make decisions for you.

The critical message here is this: If you want to control the types of care you receive after you no longer have capacity to make decisions, the time to determine that level of care is now. Don’t wait! There is simply no downside to planning ahead. Forms are available online, at the Coastside Adult Day Health Center, or at our Home Helpers office in Half Moon Bay.

Mitch Williams owns and operates Home Helpers Home Care and Home Helpers Healthcare of San Mateo County with offices in Half Moon Bay and San Mateo.

Home Helpers of San Mateo County is a locally-owned, trusted home health care agency and offers quality, compassionate senior in-home care services including home care assistance, personal care, companion care, respite care, Alzheimer's & dementia care as well as homemaker services in Burlingame, San Mateo, Half Moon Bay, Daly City, San Carlos, Redwood City, Belmont, Foster City, Hillsborough, Pacifica, Millbrae, Montara, and San Bruno.