What Is an Advance Directive? Planning for Long-Term Care with a Living Will and Health Care Proxy

An advance directive is a legal document that provides instructions and wishes for your medical care and indicates who can make decisions for you if you cannot communicate. Advance directives include living wills and durable power of attorney designations for health care.

The legal standards for living wills and power of attorney vary by state. Your estate planning attorney or estate planning software can help you cater your documents to your state’s requirements, or you can search and download your state’s forms online.

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Living will

Living wills specify the medical treatment you want — or don’t want — if you’re unable to communicate. They can include preferences for resuscitation, ventilation, feeding tubes and comfort care, as well as postmortem organ and medical research donations ^[0]

Living wills tend to follow a general template, but you can add more detail regarding specific medical situations. For example, if you’re at risk for cardiac arrest and don’t want CPR performed, you can state that in a living will.

Durable medical power of attorney or health care proxy

A durable medical power of attorney or health care proxy gives a trusted person authority to make medical decisions on your behalf if you can’t communicate. This person can advocate for you in a hospital and ensure that the preferences in your living will are honored.

This type of power of attorney should be durable, meaning it stays in place if you become incapacitated. Having a proxy is especially helpful if medical standards change or you’re in a situation your living will doesn’t specifically cover ^[0]

» MORE: How to choose a health care proxy

Combination document

A combined advance directive document can combine your living will and power of attorney designation, plus other preferences for comfort and end-of-life processes.

A popular option in the U.S. is Five Wishes, created by the nonprofit organization Aging with Dignity. It’s available to fill out online and has provisions for all 50 states ^[0]

• The person you want to make care decisions for you when you can't. This information is the basis of your health care proxy or power of attorney document.

• The kind of medical treatment you want or don't want. This information is the basis of your living will.

• How comfortable you want to be. These are your preferences for pain management, hospice care, grooming and bathing.

• How you want people to treat you. This includes visitation preferences such as prayer, touch and location.

• Your wish for what you want your loved ones to know. This includes burial preferences, desires for mourning and how you’d like to be remembered.

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Here are three different ways to create an advance directive.

1. Hire an estate planning attorney. An estate planning attorney can help you create an estate plan, including your advance directives.

2. Use estate planning software. Make sure the product you choose explains how to make the document legally valid in your state and includes all the possible options you need.

3. Find a free or inexpensive form. 

   • AARP, an interest group for people over 50, and Everplans — a service that helps people organize their essential documents — offer links to free forms for each state. Be sure to confirm with an estate planning attorney that forms meet your specific needs comply with the rules in your state. 

   • Five Wishes offers an interactive printable version of their directive for $5 and a fully-online version for $15. 

   • Prepare for Your Care, an online resource that helps people make medical decisions, offers free forms with clear instructions and specific questions about your quality of life and values.

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Here’s what to do once you’ve completed your forms:

1. Sign your documents. Some states require you to sign your forms in front of witnesses to make them legally valid, and in some you’ll have to get the documents notarized ^[0]

   Caring Info. What is an Advance Directive?. Accessed Sep 21, 2023.

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2. Give copies to your doctor and health care proxy, plus close family members and your attorney, if you have one. Ask your doctor to add the forms to your electronic health record so other providers can access them in an emergency.

3. Consider carrying a card in your wallet, like the one from the American Hospital Association, with information on your advance directives.

4. You can officially register your advance medical directive in some states, though it’s not required.

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• You can change your advance directives at any time, as long as you’re of sound mind. 

• Create a new document, rather than amend the original document. Completing a new directive will automatically revoke your previous version.

• Update your family, doctor and attorney with the new information and destroy the original documents.

• You may have to pay a fee to make changes and register a new form if you’ve registered your advance directive with your state.

• Review your advance directive around every 10 years, or if you receive a new medical diagnosis or change your marital status.

» MORE: Read what can happen if you die intestate (without a will)