Advance Care Planning: How to Start the Conversation

Advance care planning is the process of deciding, and writing down, what medical care your parent would want if they couldn't speak for themselves, and who should speak for them. It usually involves five steps: thinking about what matters most, talking about it with family and the doctor, choosing a health care agent, putting it in writing, and sharing and reviewing it. The documents matter, but the conversation matters most. Medicare covers advance care planning discussions with a doctor, at no cost during a yearly wellness visit when the doctor accepts Medicare's payment.

Every holiday you think, "We should talk about what Mom would want." Every holiday, nobody brings it up. Then her friend from church spent three weeks on a ventilator while her kids argued about what she would have wanted.

The five steps

1. Think. What matters most to your parent? Being at home? Being free of pain? Being able to recognize family? Living as long as possible no matter what?

2. Talk. With family, so no one is surprised later, and with the doctor, so your parent understands their health and options.

3. Choose a health care agent. The person who will make decisions if your parent can't, plus a backup. See power of attorney for health care: your role as agent.

4. Put it in writing. In Utah, the Advance Health Care Directive lets your parent name an agent and write down their wishes. CaringInfo has the form. For how to write wishes that actually help, see advance directive living wills.

5. Share and review. Give copies to the agent, doctors, and hospital, and review after any big change in health.

How to start the conversation

Pick a calm moment, not a crisis. Then try one of these:

• "I read something about a family who didn't know what their mom wanted. I don't want that to happen to us. Can we talk about it?"
• "If you got really sick, what would matter most to you?"
• "Who would you want making decisions if you couldn't?"
• "Is there anything you'd never want, no matter what?"
• "Your doctor can walk us through this at your wellness visit. Want me to come along?"

Listen more than you talk. It doesn't have to happen in one sitting.

Getting the doctor involved

Medicare Part B covers voluntary advance care planning, including discussing and preparing an advance directive. During the Welcome to Medicare visit or the yearly wellness visit, there's no cost when the doctor accepts assignment. It can also be covered as part of other care, where the usual cost-sharing applies. Ask for it when you book the visit. For a seriously ill parent, ask the doctor about a POLST, which turns wishes into a medical order.

The documents, in one place

• Health care power of attorney and advance directive: see power of attorney and advance directives in Utah.
• What "durable" means: see durable power of attorney for healthcare.
• If your parent never signed one: see power of attorney medical.

When it's time to revisit the plan

• After a new diagnosis, or a big decline in health.
• After a hospital stay.
• After the death of a spouse, or a move.
• Every few years, even if nothing has changed.

If your parent is nearing the end of life, see what hospice for cancer patients looks like week to week.

Where help at home fits

Our Care Professionals don't make medical decisions, but they help your parent live the way they want for as long as possible: help with bathing, meals, medication reminders, and getting around safely, plus rides to the doctor visits where these conversations happen, so you don't have to take time off work. They notice changes in health or memory, then make sure our team and you hear about them, so the plan can be revisited before a crisis. See how everyday help at home works.

What to do next

1. Think about what matters most to your parent, and what matters to you.
2. Start the conversation with one of the questions above.
3. Book the yearly wellness visit, and ask for advance care planning.
4. Choose an agent, fill out Utah's form, and share copies.
5. Look at all our home care services, or see your exact price in 30 seconds.

Need help for someone in your family? See your price in 30 seconds, or call us to talk it through.

This article is general information, not legal, medical, or financial advice. Laws and forms change. Talk with a qualified attorney about your family's situation.