Advance Directives

Everyone is different. This is especially true about making choices in our medical care. If you were injured or very sick and unable to speak for yourself, it could be difficult for your family and doctors to know what choices you would make for yourself. Talking about these things while you are well is a gift to the people who care about you. If they ever have to make difficult decisions, they will be comforted by knowing what you would have done.


Your choices may change over time, so talk about these things often, and update your Advance Directive when needed.

When a loved one is ill, incapacitated or nearing end of life, it’s vital that his or her wishes are known. Honoring a family member’s preferences regarding financial decisions and care is best ensured through legal documentation.

The two most important legal documents that make certain your family member’s wishes are carried out are: a power of attorney, or POA, and an advanced care directive. Ensuring that all members of the health team know who has ACD and POA is also necessary.

About ACD

In a medical emergency or at end of life, it may be impossible for your loved one to make a solid decision about health care. For that reason, it’s a good idea to do some advance care planning and have an advance care directive, or ACD, created.

An ACD is a legal document that becomes effective only if your loved one is deemed incapacitated and becomes unable to speak for himself or herself. This could be the result of a disease that causes dementia, such as Alzheimer’s, or it could be the result of a stroke or other severe injury or disease that makes decision-making difficult or impossible.

ACDs allow your loved one to specify how he or she would like to be treated should medical issues arise. Some of these possible decisions include the need to use cardiopulmonary resuscitation or CPR, a ventilator or artificial feeding and hydration.

An ACD can also instruct as to what type of comfort care your loved one desires. For instance, such instructions can include your family member’s wishes for medication for pain, constipation, nausea, or anxiety. Comfort care may also include counseling for emotional and spiritual issues.

About POA

A power of attorney is a legal document that allows someone to act on behalf of an individual who is unable to make sound financial decisions. Creating a financial POA allows your loved one to ensure that his or her wishes will be honored should good decision-making become impossible.

The person who gets POA is essentially a substitute decision-maker. He or she may be stepping in because the person has dementia, a traumatic brain injury or a mental illness. Generally, a POA is durable, which means that it continues to remain in effect, no matter the state of the person.

It’s advisable to create a POA before your loved one becomes incapacitated and unable to make sound financial decisions. If a POA isn’t created in advance, you may have to go to court to become your loved one’s legal guardian. This is a lengthy and expensive process. In the meantime, your loved one’s financial status could be in jeopardy.

Notifying the health care team regarding ACD and POA

So that decisions about your loved one are made in a legal manner that reflects his or her wishes, it’s important that your health care team knows exactly who holds ACD and POA. The person who has power of attorney and/or advance care directives is someone who your family member trusts to make the best decisions.

So that there is no confusion, it’s best to list this person in writing and see that everyone on the health care team knows. Make it clear that only those who are listed as having ACD and POA are to give any instructions about the care of your loved one.

An ACD and POA are critical documents that help ensure that your loved one enjoys medical care that is just as he or she would like. Discover your loved one’s instructions and who he or she would like to oversee them, and everyone can be assured that all will go as planned medically and financially.

For additional information, please contact:

Riverside Care Navigation 757-856-7030

Talking about your wishes

*Five Wishes

*Five Wishes is a complete approach to discussing and documenting your care and comfort choices. It's about connecting families, communicating with healthcare providers, and showing your community what it means to care for one another. Five Wishes charges a small fee to download or order the Five Wishes advance directive document. Your Riverside Provider can also provide you, at no cost, with the Five Wishes advance directive document.

You can communicate your own choices and reduce the stress on people who care about you by writing an Advance Directive. This is about your own values, not filling out forms, so take some time to reflect on the things that are important to you, and talk about them with the people who are close to you.

How to get started

If you have questions or if you would like to receive an Advance Care Planning workbook by mail, contact Michelle Carter, RN, Clinical Liaison/Advance Care Planning Facilitator at 757-316-5680.