Advance Care Planning Checklist

Getting Started With Advance Care Planning

Advance care planning is the process thinking and sharing your wishes for future health and personal care.  These decisions are based on your values, preferences, and discussions with family members and loved ones.  If you face unexpected debility or an illness that leaves you unable to discuss your wishes, do you know who will speak for you?  This short guide will help facilitate conversations between family and friends and to ensure your wishes are honored and respected.

Image of people holding hands

Step 1: Understanding Advance Care Planning

Advance Care Planning is a process that helps you:

• Think about what would be important to you if you were very ill.
• Learn about medical options.
• Learn how to make informed decisions.
• Choose a loved one to make decisions for you or to have a written document that states your wishes.

Tools/Links to Use:

Your Life, Your Priorities is a C&C booklet to help you and your loved ones clarify and honor your values and priorities.

Values Worksheet offers questions to consider when making decisions and preparing documents concerning healthcare preferences.

My Particular Wishes informs your physician, nurse or other care provider of your consent or refusal of certain specific therapies.

Understand Your End-of-Life Options provides information about the full range of choices.

Step 2: Exploring Your Values and Beliefs

Some people have strong opinions about what is important to them if they became very ill. Others may have certain things they would rather avoid. It’s important to tell people about your values and beliefs.

• What fears do you have about getting sick?
• If you were very sick, are there any specific kinds of treatments that you think would be too much for you?

Tools/Links to Use:

Sectarian Healthcare Directive is an addendum to clarify that your wishes supersede those of any institution’s religious policies, and that you wish to be transferred if any facility refuses to follow the preferences you’ve outlined in your advance directive.

Hospital Visitation Form gives unmarried couples hospital visitation authorization.

Assisted Living Facility (ALF) Rider is a contract rider for people who live in assisted-living facilities and would like to stay there until they die. This will ensure an individual’s home is suited to their choices.

Read about what a DNR and a POLST can do for you. Visit the national POLST website.

Step 3: Documenting Your Conversation

It’s important that medical professionals know what your values and wishes are. It is important to complete an advance directive or have someone you trust as your health care proxy. You should discuss your thoughts, concerns and choices with those close to you. And you might want to choose someone who is willing to speak for you when you cannot speak for yourself. Please talk to your family and friends now about what is important to you to live well.

Tools/Links To Use:

Letter to My Doctor helps communicate end-of-life wishes to physicians. Patients can make sure their doctor knows and will respect their wishes before it is too late.

Patient Notebook is a comprehensive tool for people who are experiencing medical difficulties to communicate with their families and caregivers about care, prescriptions, appointments and more.

Medicare update about Medicare reimbursing doctors for 30 minutes of advance care planning with patients.

How to Talk to Your Doctor About Your End-of-Life Options recognizes the importance of your medical providers understanding your priorities and values, and being willing to provide the level of care you desire. By explaining your preferences early, you are more likely to have an end-of-life experience consistent with your values.

How to Interview a Hospice offers tips on choosing between hospices. Many communities have numerous hospice providers, so it’s important to interview and select a hospice that respects your priorities and beliefs, and will honor your end-of-life care choices.

Understanding your End-of-Life Options visit for detailed handouts on the range of end-of-life options.

Understanding Medical Aid-in-Dying visit for more information on medical aid in dying.

Step 4: Revisiting the Conversation

Advance Care Planning is not just one single conversation but it is a process that takes place over time. You might change your mind over time. You might change your mind if your health changes, or because of other reasons. This is completely normal !