Only about one in three American adults has any advance directive in place. Among adults over 65, the number is better — closer to half — but that still means roughly 25 million seniors have no legal documents telling doctors or family members what to do if they can’t speak for themselves. The consequences of that gap can be devastating: family members forced to guess what their loved one would have wanted, siblings arguing in hospital hallways, and medical teams providing aggressive treatment that the patient never asked for.
This isn’t something anyone wants to think about. But having these documents in place is one of the most genuine acts of love you can give your family. It removes the burden of impossible decisions from the people who care about you most. This guide walks through the five key documents, explains what each one does, and gives you a practical path to getting them done. Questions along the way? Send them to [email protected].
The Five Documents Every Senior Needs
There are five core documents that make up a complete advance directive plan. You may not need all five, but understanding each one helps you make informed decisions about which ones matter for your situation.
1. Living Will (Advance Healthcare Directive)
What It Does
A living will spells out your preferences for medical treatment in situations where you cannot communicate — typically end-of-life scenarios or conditions involving permanent unconsciousness. It tells your doctors whether you want or don’t want specific interventions.
What It Covers
A living will typically addresses:
- Mechanical ventilation — do you want to be kept on a breathing machine?
- Artificial nutrition and hydration — feeding tubes and IV fluids when you can’t eat or drink
- Dialysis — kidney function support
- CPR — cardiopulmonary resuscitation if your heart stops
- Comfort care — pain management and palliative measures
- Organ donation — your wishes regarding tissue and organ donation
When It Takes Effect
A living will only activates when two conditions are met: (1) you are unable to communicate your wishes, and (2) you have a qualifying medical condition as defined in the document (typically a terminal illness or permanent unconsciousness). It has no effect while you can speak for yourself.
Do You Need a Lawyer?
For most people, no. Free living will forms are available from your state health department, Five Wishes (fivewishes.org), and AARP. The form must be signed and witnessed (and in some states, notarized). An elder law attorney is recommended if your situation is unusual — for example, if you want to specify treatment preferences for particular conditions like dementia or advanced cancer.
2. Healthcare Power of Attorney (Healthcare Proxy)
What It Does
A healthcare power of attorney (also called a healthcare proxy or medical power of attorney) names a specific person — your “healthcare agent” — to make medical decisions on your behalf when you cannot make them yourself. This person speaks for you in real time, responding to situations your living will might not have anticipated.
Why It Matters
A living will can’t cover every possible medical scenario. Your healthcare agent fills the gaps, interpreting your values and applying them to real-time situations. For example, if you develop an infection while recovering from surgery and your living will doesn’t address antibiotics in that context, your healthcare agent decides.
Who to Name
Choose someone who:
- Knows your values and will honor them even if they disagree
- Can handle pressure and make tough decisions under stress
- Lives close enough (or is available enough) to respond quickly
- Is willing to serve in this role — ask them directly before naming them
Name a backup agent in case your first choice is unavailable. Do not name co-agents (two people sharing the role) — it creates conflict and delays.
When It Takes Effect
In most states, a healthcare POA takes effect only when a doctor determines you lack capacity to make your own decisions. Some states allow you to make it effective immediately (meaning your agent can act even while you’re competent, with your permission). Check your state’s law.
3. Financial Power of Attorney (Durable POA)
What It Does
A financial (or “durable”) power of attorney gives a trusted person — your “agent” or “attorney-in-fact” — the authority to handle your finances if you become unable to manage them yourself. This includes paying bills, managing bank accounts, filing taxes, handling real estate transactions, and dealing with insurance.
Why “Durable” Matters
A standard power of attorney ends if you become incapacitated — exactly when you need it most. A durable power of attorney explicitly states that it remains in effect even if you lose mental capacity. Without the “durable” designation, the document becomes useless at the moment it’s most needed.
Scope Options
You can grant broad authority (covering all financial matters) or limit the POA to specific tasks. Common choices include:
- Banking and bill payment
- Real estate transactions
- Tax filing
- Investment management
- Insurance matters
- Government benefit applications (including Medicaid)
Do You Need a Lawyer?
More so than with a living will, yes — particularly if you own property, have investments, or want to limit the agent’s authority. A poorly drafted financial POA can be rejected by banks and financial institutions, or worse, can give too much power to someone who misuses it. Expect to pay $150 to $500 for an attorney to prepare this document.
Safeguards
- Require your agent to keep detailed records of all transactions
- Name a separate person to review the agent’s actions periodically
- Consider a “springing” POA that only takes effect when you’re declared incapacitated (though some institutions resist these)
- Never name someone you don’t trust completely — financial POA abuse is a leading form of elder exploitation
4. Do Not Resuscitate (DNR) Order
What It Does
A DNR is a medical order — signed by a physician — that instructs healthcare providers not to perform CPR (chest compressions, defibrillation, intubation) if your heart stops beating or you stop breathing.
How It Differs from a Living Will
A living will expresses your wishes. A DNR is a physician’s order that emergency responders are legally required to follow. Paramedics and ER staff cannot act on a living will in an emergency — they need a signed DNR or POLST form.
When to Consider a DNR
A DNR makes sense when:
- You have a terminal illness and don’t want aggressive resuscitation
- You’re elderly and frail, and the trauma of CPR (broken ribs, potential brain damage from oxygen deprivation) outweighs the small chance of meaningful recovery
- You’ve discussed end-of-life goals with your doctor and resuscitation doesn’t align with them
For context: the survival rate for CPR outside a hospital is roughly 10% for adults, and outcomes decline significantly with age and frailty. Among patients over 80, CPR results in survival to hospital discharge in fewer than 5% of cases, and many survivors experience significant neurological damage.
Important Details
- A DNR must be signed by your doctor — you cannot write your own
- Keep the original in an accessible location (not in a safe or filing cabinet where paramedics can’t find it)
- Some states use non-hospital DNR forms or bracelets specifically for use outside medical facilities
- A DNR can be revoked at any time by telling your doctor
5. POLST (Physician Orders for Life-Sustaining Treatment)
What It Does
A POLST (called MOLST, POST, or COLST in some states) is a medical order form that translates your treatment preferences into specific, actionable doctor’s orders. It covers more ground than a DNR — addressing not just resuscitation but also levels of medical intervention, hospitalization preferences, and artificial nutrition.
Who Should Have One
A POLST is designed for people with serious illness or advanced frailty — not for healthy adults. Your doctor should discuss a POLST with you if:
- You have a serious, life-limiting illness
- You’re in a nursing home or receiving hospice care
- You would not be surprised if you didn’t survive the next year
How It Works With Other Documents
A POLST doesn’t replace a living will or healthcare POA — it works alongside them. Think of it as the operational version of your wishes: while a living will states your preferences in general terms, a POLST gives paramedics and hospital staff specific, immediately actionable orders.
The POLST form is printed on brightly colored paper (usually pink or green) so it’s easy to find in an emergency. It travels with you — from home to ambulance to hospital to nursing facility.
How to Have “The Conversation”
Getting the documents is the straightforward part. The harder part, for most families, is the conversation that comes before them. Here’s how to approach it:
Start with your own documents. If you’re an adult child encouraging a parent to create advance directives, go first. Complete your own and share them. It changes the dynamic from “you need to do this” to “we’re all doing this.”
Frame it as a gift. Advance directives aren’t about giving up or expecting the worst. They’re about making sure your family never has to guess what you would have wanted. That’s a gift — especially during a medical crisis when emotions are running high.
Ask open-ended questions. Instead of jumping to specific medical scenarios, start with values: “What matters most to you about the time you have?” “Is there a point where medical treatment would feel like too much?” “Who do you trust to make decisions for you?”
Don’t try to do it all in one conversation. Multiple shorter discussions work better than one long, emotionally draining session. Plant the seed, let it sit, and come back to it.
Involve the healthcare agent. Whatever you decide, make sure the person you’re naming as your agent understands your wishes directly — not just from a piece of paper, but from hearing you explain your reasoning.
Where to Store Your Documents
Advance directives are worthless if nobody can find them when they’re needed. Follow this storage plan:
- Give copies to your healthcare agent, your backup agent, your primary care doctor, and any specialists you see regularly
- Upload to your patient portal if your healthcare system offers document storage
- Keep the originals in an accessible location at home — not a safe deposit box (which may be inaccessible in an emergency)
- Register with your state if your state offers an advance directive registry
- Carry a wallet card noting that you have directives and where they can be found
- Tell your family where the documents are stored — in writing, not just verbally
State-Specific Considerations
Advance directive laws vary by state. Key differences include:
- Witness requirements: Some states require two witnesses; others require notarization; some require both
- Form requirements: A few states only honor their own official forms, while most accept any form that meets general criteria
- Portability: If you split time between states (snowbirds), consider completing directives valid in both states
- POLST availability: Not every state has a POLST program, and the form name varies (MOLST, POST, COLST)
- Default surrogate laws: Each state has a different hierarchy for who makes decisions if you don’t name an agent
The American Bar Association offers a state-by-state guide to advance directive requirements at americanbar.org. Your state’s health department website typically has free, state-specific forms.
This is one of those topics where doing something — even imperfectly — is infinitely better than doing nothing. A simple living will and healthcare POA, completed in an afternoon, can spare your family years of guilt and conflict. For related reading, our caregiving guide covers the broader picture of caring for an aging parent, and our aging in place guide addresses the practical side of staying home safely as care needs change.
Need help figuring out where to start? Reach out at [email protected] — we’ll point you to the right resources for your state.