Five Benefits of an Advanced Healthcare Directive

I visit with individuals (and their partner/family-friends) nearing the end of their lives several times a week. For some, it is because of a recent diagnosis; for others, it is long life (age or cognitively related); and for others, they have been through all the rounds of treatment (in many cases, several times), and they do not want to go through the experience again. My point is this: Every person is different because every person's life is different; therefore, every person's life and death should be honored differently.

What pains me most in these meetings is that the patient/resident and their loved ones are often wholly unprepared for the journey. Approximately 18 to 36 percent of the US population has an Advanced Healthcare Directive (AHD) (AP, 2010). The lack of an AHD leaves the decisions about how one dies up to the system they are in or drops the burden of this decision on often unprepared or uninformed family members. For example, 70 percent of Americans express a wish to die at home, 25 percent do (CDC, 2005).

Community palliative and hospice care is one of the most misunderstood (or least well-informed) services offered through all healthcare or independent/assisted living communities. It warrants another post offering thoughts on the best way to review and select these services. However, for now, I'll offer this: 1.71m people were beneficiaries of hospice care (2021), about 43 percent of the eligible people (NHPCO, 2023). Of the 1.71m, approximately half utilized hospice for 17 days or less, and 75 percent for less than 79 days (NHPCO, 2023). It is a substantial offering that gets primarily left unused; I'll offer this: Hospice is a way to live the remaining days of your life supportively.

The Conversation Project (https://theconversationproject.org/ ), in collaboration with the Institute for Healthcare Improvement (IHI), funded a project through the 2010's. Pertinent to this post, their findings "90 percent of Americans say it is important to discuss their own and their loved one's wishes for end-of-life care, only 30 percent actually do." I could continue with many other data sources that express the importance of having this conversation, being prepared with an AHD, and developing an awareness of how you (or your family) might utilize palliative or hospice services. However, it may not be a data (thinking, logical) conversation but a conversation of the heart. If so, please allow me to offer these five benefits of an AHD for you and your loved ones:

1. Clear Communication: An AHD guides the individual's medical treatment and end-of-life care preferences. This clarity reduces confusion and potential conflict among family members regarding what the person would have wanted.
2. Peace of Mind: Knowing that their loved one has expressed their wishes in advance can bring peace of mind to family members. They can feel reassured that they are honoring the person's wishes and providing the care and support they desire, even if they cannot communicate their preferences later.
3. Reduced Burden: When people have outlined their preferences in an AHD, it lessens the burden on family members to make difficult decisions during a crisis. Instead of grappling with uncertainty, they can focus on providing comfort and support to their loved ones.
4. Family Unity: Having an AHD in place can promote unity among family members by providing a framework for decision-making. It can help prevent disagreements and tensions when family members have differing opinions about medical treatment.
5. Empowerment: Involving family members in discussions about healthcare directives can empower them to be advocates for their loved one's wishes. It encourages open communication about end-of-life preferences and fosters a sense of agency in respecting them.