How do I build an advance care plan — and actually use it?

Most families have the basics covered.

There are insurance cards tucked into a wallet, medication lists taped inside a kitchen cabinet, and perhaps even a will stored safely away. Those are all important pieces of the puzzle.

But if a medical emergency happened tomorrow, would everyone know what your loved one actually wants?

Would the doctors know who should make medical decisions if your loved one couldn't speak for themselves? Would family members agree on the next steps? Or would everyone be trying to make difficult decisions in the middle of an already stressful situation?

When a crisis happens, the greatest challenge often isn't the medicine. It's the uncertainty.

Advance care planning helps replace uncertainty with clarity. It gives your loved one a voice, even if they are unable to speak for themselves, and it gives your family confidence that they're honoring the wishes of the person they love.

Most importantly, it shifts decision-making from moments of crisis to moments of calm.

Advance care planning begins with conversations

One of the biggest misconceptions about advance care planning is that it's simply about completing legal forms.

In reality, the paperwork comes later.

The most important part begins with conversations.

Before anyone signs an Advance Directive or names a healthcare proxy, it's important to understand what truly matters to your loved one. These discussions are rarely about medical terminology. They're about values, priorities, and quality of life.

Rather than focusing on complex healthcare decisions, start with everyday questions.

If you became seriously ill and couldn't recover, where would you want to receive care?

Would you prefer to remain at home if possible?

If eating became difficult, would you want every available medical intervention, or would comfort become the priority?

Who do you trust to make decisions if you cannot?

These questions don't have to be answered in one sitting.

In fact, they shouldn't be.

Advance care planning is an ongoing conversation that evolves as health, circumstances, and personal preferences change over time.

Healthcare providers, nurse practitioners, social workers, and palliative care teams can all help guide these discussions and explain what different medical choices actually mean.

Choosing the right decision-maker

One of the most important decisions your loved one will make is choosing someone to speak on their behalf if they lose the ability to make medical decisions.

This person is often called a healthcare proxy or medical power of attorney.

Many families automatically assume this should be the oldest child or closest relative.

That isn't always the best choice.

The ideal healthcare proxy is someone who can remain calm under pressure, communicate effectively with healthcare providers, and most importantly, carry out your loved one's wishes, even if those decisions are emotionally difficult.

Being a healthcare proxy is not about making personal choices.

It's about honoring someone else's.

Once this person has been chosen, introduce them to the primary care physician and make sure their information is documented in the medical record.

It is equally important to identify a backup decision-maker in case the primary person is unavailable when an emergency occurs.

Finally, make sure the entire family knows who has been selected.

Clear communication today can prevent unnecessary conflict tomorrow.

Talk through real-life situations

Many caregivers feel uncomfortable discussing serious illness because the medical language can seem overwhelming.

One of the best ways to overcome that uncertainty is to ask healthcare providers to describe realistic scenarios.

Instead of wondering what CPR or comfort care actually involves, ask.

What would CPR likely look like for someone of this age and health condition?

If another serious infection occurs, what treatment options would be available?

What would choosing comfort-focused care actually mean on a day-to-day basis?

These conversations are not about predicting the future.

They are about helping your loved one make informed decisions that reflect their personal values rather than fear or uncertainty.

As you have these discussions, write down preferences in simple, everyday language.

For example:

"I want to remain at home whenever possible."

"I want treatments that give me a meaningful chance of returning to the life I enjoy."

"I value comfort more than aggressive treatment if recovery is unlikely."

These statements provide valuable guidance when difficult decisions need to be made.

Put the plan in writing

Once your loved one has clarified their wishes, it's time to document them.

Complete your state's Advance Directive or Living Will forms and ensure they are signed according to your state's requirements.

If you're unsure where to find these documents, your physician's office, hospital social worker, or local agency on aging can point you in the right direction.

Copies should be stored in several locations.

Keep one in your care binder at home.

Provide copies to your healthcare proxy and backup decision-maker.

Make sure your primary care physician has the most current version.

Many families also keep digital copies on their phones or in a secure shared folder that can be accessed quickly during an emergency.

Whenever updates are made, clearly label the newest version as "Current" and safely dispose of outdated copies to avoid confusion.

If your loved one is admitted to a hospital or long-term care facility, ask whether a POLST or MOLST form is appropriate.

These medical orders summarize important treatment preferences and travel with the patient across healthcare settings, helping ensure their wishes are consistently honored.

Review the plan regularly

An advance care plan should never be considered finished.

Health changes.

Medical treatments evolve.

People's priorities sometimes shift.

That's why reviewing the plan every year is so important.

Choose a date that's easy to remember, such as a birthday, anniversary, or the beginning of each new year.

Ask a simple question.

Do these choices still reflect what matters most?

If the answer is yes, you've confirmed that the plan remains current.

If the answer is no, update the documents and communicate those changes with everyone involved.

Regular review helps prevent confusion and ensures the plan continues to reflect your loved one's wishes.

You don't have to do this alone

These conversations can feel emotional.

That is completely understandable.

Talking about future healthcare decisions often brings uncertainty, fear, and sadness.

Remember that you don't have to navigate this process by yourself.

Your physician, clinic social worker, palliative care team, or other trusted healthcare professionals can help explain options, answer questions, and guide these conversations with compassion and clarity.

Seeking support isn't a sign that you're unprepared.

It's a sign that you're committed to making thoughtful decisions together.

Planning is an act of love

Advance care planning is one of the most meaningful gifts you can give your loved one and your family.

It doesn't remove difficult decisions entirely.

It simply ensures those decisions are guided by your loved one's own voice rather than by guesswork during a crisis.

Having these conversations today creates clarity for tomorrow.

It allows families to spend less time wondering what their loved one would have wanted and more time focusing on what matters most: being together.

As caregivers, we often spend our energy responding to today's needs.

Advance care planning reminds us that leadership also means preparing for tomorrow.

When you take the time to talk, listen, document, and revisit these conversations, you're creating a plan rooted in compassion, respect, and dignity.

That is one of the greatest acts of caregiving leadership.

If you found this article helpful, I invite you to subscribe to our newsletter for practical caregiving strategies, leadership insights, and evidence-informed resources delivered directly to your inbox. Together, we can build the confidence, systems, and support that help caregivers lead with clarity, compassion, and purpose.

Explore More from The Age of Caregiving

🎧 Listen on Spotify: https://lifecareleadhership.com/podcast

📺 Watch on YouTube: https://lifecareleadhership.com/youtube

📝 Read more on our Blog: https://lifecareleadhership.com/blog

LINKS

From Caregiver to Care Leader:
https://lifecareleadhership.com/from-caregiver-to-care-leader

Dementia Care Confidence:
https://lifecareleadhership.com/dementiacareconfidence

Workshops & Free Trainings:
https://lifecareleadhership.com/free-trainings

*Bio: Dr. Anna Thomas is a board-certified physician, TEDx speaker, workplace wellbeing strategist, and leadership coach who helps organizations strengthen culture, resilience, and performance in a changing world. As founder of LifeCare LeadHership and Workplaces That Care, she blends clinical insight with leadership development to teach practical tools for building supportive, care-ready workplaces. Her keynotes and trainings address workforce wellbeing, retention, burnout prevention, caregiving in the workplace, women's leadership, and navigating life and work transitions. As the creator of the CARE Framework, she equips leaders to support the whole person so teams stay engaged, healthy, and committed. Audiences appreciate her grounded delivery, relatable stories, and clear, actionable strategies. Learn more or book Dr. Thomas at www.workplacewellbeingspeaker.com.

The views and opinions expressed in this post are solely those of Dr. Thomas and do not reflect the views of any past or present employer. This content is for educational and informational purposes only and is not intended as medical or legal advice.