Preparing End-of-Life Paperwork: 4 Legal Documents That Every Older Adult Needs

i-careThe end of life, that final journey for every one of us, is a time for solemnity, grief, reflection, and joy. Because death has always been a tricky area for us, it may be hard for many to imagine that one can feel a sense of joy in end-of-life planning. Yet Irvin Yalom, a renowned therapist and author, suggests that facing death can enrich our lives by allowing us to live more purposefully and to appreciate the life we have more deeply.

Denial, of course, is the most common way that we humans have protected ourselves from the near-inconceivable end to our existence. The modern experience of dying, however, is different and perhaps more complicated than it was only a generation ago. Advances in medical technology lead us to believe that we can fight against death, with our physicians leading the charge. In his book Being Mortal, Atul Gawande writes that we cannot always rely on the doctor to lead the way. The two unfixables, aging and death, must be addressed by the older individual, their families, and friends. Planning for death can also be a time of bureaucracy, confusion, and paperwork. When an aging loved one is reaching the end of their life’s journey, whether due to illness or natural causes, there are medical and legal concerns that need to be taken care of in advance so that their life story can have as good an ending as possible, not only for the individual but also for their loved ones.

Too often, we see families with additional stress piled onto their emotional load because they didn’t anticipate problems or have the proper paperwork completed. It’s true that we can’t anticipate everything that will happen near the end of a loved one’s life, but we can be sure that there will be sad and difficult issues that arise. Attempting a discussion about end-of-life can trigger many complex emotions. Thoughts of death have a way of isolating people. Sharing real feelings, however, is a way of connecting with the person who is preparing for death. As Robert Anderson writes in his book I Never Sang for My Father, “Death ends a life, but not a relationship.” Making sure that everyone feels connected is an important first step before one introduces the legal and bureaucratic paperwork.

While they’re still able, you should encourage your loved one to fill out four key documents that take care of important end-of-life decisions and—just as importantly—set up a process in which other decisions can be handled compassionately, easily, and fairly.

Durable Power of Attorney Form

When a person is mentally incapacitated or otherwise unable to convey their wishes (if they’re in a coma, for example), they enter a strange state of legal limbo. At this point, an ordinary, or nondurable, attorney loses the power to make decisions on their behalf, meaning no one would have the legal power of attorney for medical or financial decisions. This is why an older adult needs to think about designating someone with durable power of attorney who is legally allowed to execute decisions and speak on behalf of the incapacitated party.

Such decisions include details about handling investments, managing money, and making medical decisions if called upon. This person can be an attorney, a child, or other loved one. You can also decide to appoint multiple people in this role, splitting responsibilities between the “medical power of attorney” and the “financial power of attorney.” When deciding who gets durable power of attorney, it’s important to choose people you can trust and who have your best interests in mind. For a financial power of attorney, this often means going to a fiduciary who is legally required to protect your interests.

It’s important to talk to your aging loved one about this before they reach a point where any wishes could potentially be interpreted as invalid due to their mental state. This will ensure that the best wishes of the person facing the end of their life are met and that any decisions in the final days go as smoothly as possible.

Living Will

A living will, also known as an advance directive, is a way for your parent or loved one to dictate the kind of care that they want—or don’t want—as they approach the end of their life. It gives them agency over treatment, including medical procedures such as resuscitation, in case they are unable or deemed unfit to voice their decisions. This ensures that the wishes of your loved one are met in their final days, even if they’re unable to convey them.

A living will generally includes stipulations for specific care, including the use of defibrillators, pain medication, breathing tubes, feeding or hydration tubes, or any kind of dialysis. These decisions deserve thoughtful consideration. For example, you may decide that being artificially fed is fine, since it means your body still desires food, but that artificially saving dying organs is wasteful.

Preparing a living will now is also helpful to prevent ugly fights between siblings or spouses over treatment decisions. One of the most difficult situations a family can face is when one child wants to continue treatment for their parent and another thinks it’s kinder to let them go. A living will, drawn up with explicit details during a time of mental fitness, can lessen the likelihood of family disturbances, arguments, and unhappiness.

Health Care Proxy

A health care proxy can be anyone who is legally empowered to make health-related decisions on another person’s behalf. While an advance directive is important, they rarely cover every situation—if they are broadly worded, there might be a thousand nuanced decisions they won’t cover. A durable power of attorney might be able to make financial decisions but not health ones, depending on the scope of the power granted. So the health care proxy can make decisions that aren’t covered by either form, including everything from approving different treatments to approving diets.

A proxy is usually granted the legal right to decide discharge and admittance matters at the hospital, make decisions about treatment, and hire and fire medical staff. Given the scope of this, it’s important to choose a health care proxy in advance, even if it can be difficult. Sit down with your family and your loved ones and have an honest and open conversation about who can best handle the responsibility, both logistically and emotionally. Having a frank discussion about health-related decisions and setting clear guidelines now removes a source of fighting and tension during illness, a time already fraught with emotional difficulties.

There are universal forms for this, but some states like New York and Illinois require special forms.

Medical Information Release Form

The medical field is understandably marked by a concern for privacy. Most medical information can only be released directly to the patient and not to family without the patient’s permission. This is why a medical information release form is so important, because it allows a spouse or a child access to key medical records. If this isn’t done and an aging loved one is suddenly judged unfit to make decisions, it could be months before your legal standing is established.

It’s always a good idea to have this, if only so loved ones can help with medicine or a treatment regime. This should be updated at least every year and should be updated right away if your loved one begins to have mental difficulties. Paperwork like this keeps you in the loop. There’s no standard form, so ask doctors or insurance officials for the specific paperwork you’ll need for your loved one.

No one likes thinking about paperwork or making legal decisions during the end of life. It makes those final moments a time of possible bitterness and confusion, instead of a reflection and celebration of a life well lived. But by handling key medical and legal documents ahead of time, the time you spend with your loved one can be about love, not red tape. Remember, endings matter.

To learn more about navigating the challenges of end-of-life care, contact us at Institute on Aging.

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Dr. Patrick Arbore

Dr. Patrick Arbore, ED.d, is the Director and Founder of the Center for Elderly Suicide Prevention and Grief Related Services. A nationally recognized expert on suicide and a powerful advocate for mental health services for older adults, Dr. Arbore is a role model for living life with true compassion. He's an experienced presenter and has held seminars and workshops on topics relevant to older adults’ mental health.

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