Are improvements to healthcare directives necessary and possible? The answer is an emphatic YES! As a trusted advisor, you can blaze the trail for your clients.
In the past three decades, a relatively low percent of adults have completed a healthcare directive. So what shortcomings are impeding the national acceptance of advance care planning?
10 obstacles often cause clients to stumble.
By addressing these 10 frequent missteps, attorneys can play a vital role in shaping a healthcare directives approach that ensures clients will prepare for future healthcare decisions—and do it in the most effective way that’s right for them and their families.
The 10 most common obstacles—and strategies to overcome each one—include:
1. Treating healthcare directives as simply a form to complete. The most compelling purpose of a healthcare directive is to foster conversations about future healthcare decisions—conversations with loved ones, healthcare providers and healthcare agents. The form is merely the trigger. Yet without coaching, a client might treat the completed form as a checked “to-do.”
Strategy: Emphasize the conversation more than the form.
2. Focusing on checking boxes on the form. A well-written healthcare directive incorporates 1) values and beliefs, 2) an expression of what quality of life means to your client, 3) meaningful treatment guidelines that establish boundaries for medical care, as well as 4) needs for emotional and spiritual support through the end-of-life journey. A checked “Do Not Resuscitate” box does not sufficiently support, guide and comfort healthcare agents and loved ones who are struggling with difficult choices.
Strategy: Encourage clients to express treatment guidelines, values and beliefs instead of merely checking boxes.
3. Treating healthcare directives as “an afterthought” to the estate plan. Many estate attorneys find it difficult to coach clients regarding the completion of a healthcare directive. Conversations become more emotional, relational and intimate, which can be very uncomfortable for an attorney whose craft is the intellectual application of wealth and tax expertise.
Strategy: Consider building a referral relationship with a local social who could coach your clients through advance care planning conversations.
4. Accepting the choice of healthcare agent without probing. The choice of healthcare agent is often made instinctively—for example, choosing one’s spouse or eldest child—without fully considering the necessary skills needed to fulfill the role. Attorneys have a responsibility to respectfully question the selection, and also to explain the gravitas of the role
Strategy: Respectfully explore his or her choice of healthcare agent with your client.
5. Treating the process as complete without having a family meeting. Preparing loved ones to honor the principal’s wishes is essential, and that requires sharing these preferences in advance, before the crisis. As a value-adding experience, an attorney can offer to facilitate a family meeting.
Strategy: Offer to facilitate a family meeting to assist a client in sharing his or her wishes with loved ones.
6. Assuming the directives are “part of the file” in the “attorney’s vault.” Clients can mistakenly assume they should contact their attorney in a crisis, yet timely medical decisions hinge on immediate access to the healthcare directive.
Strategy: Clients should be advised to ensure that they—and their chosen healthcare agents—have ready access to the document, either online or via paper copy. Storing a copy on the refrigerator is crucial for an older adult, as that is where EMT’s will look. A copy in one’s glove compartment is also helpful.
7. Allowing a directive to be more than 5 years old without revisiting the content. Healthcare directives should be considered a living document. Because things change, as their attorney, you should trigger a routine review to ensure the principal’s current views are indicated in the documents.
Strategy: Develop a tickler system to notify clients “It’s time to review your healthcare directive.”
8. Approach healthcare directives as an individual task instead of a family opportunity. Healthcare directives are as much about preserving a family’s unity and relationships as they are about ensuring the patient receives the desired care. A well-written directive can prevent family arguments about treatment choices. Attorneys can persuade clients to invite other family members to engage in the process so that everyone’s wishes are understood.
Strategy: During the family meeting (#5 above), encourage all participants to create their own healthcare directives.
9. Using a living will approach that includes only “I don’t want _____” statements. Healthcare instructions allow the principal to articulate all the care she wants to receive, as well as the care she does not want to receive. The broader perspective helps loved ones and medical teams positively approach the patient with the desired care, while still setting boundaries for undesired care.
Strategy: Encourage clients to express the care they desire, as well as care they do not wish to receive.
10. Treating a healthcare directive as something that is only relevant for the 60+ generations. Incorporate healthcare directives with clients of all ages. An attorney friend commented that she insisted her children sign a healthcare power of attorney on the day of their 18th birthday.
Strategy: Invite clients of all ages to complete a healthcare directive.
When you blaze the trail for healthcare directives by employing these strategies, your clients will be grateful.
