Many people feel unprepared for death — and that’s natural. While it’s hard to prepare for something you’ve never experienced, planning for death can help ensure you and your loved ones’ needs are met at the end of your life.
It’s never too early to start this process, and the sooner you begin, the more time — and likely, mental clarify — you’ll have to craft your final wishes and arrangements. Below are the steps you should take to ensure your legal, financial, medical and personal affairs are in place to prepare for the end of life.
[READ: Taking Over Affairs for an Aging Parent in Mental Decline.]
1. Prepare End-of-Life Documents
Planning ahead for your end-of-life care can give your future self — and loved ones — less to worry about when the time comes. Planning is not light work, however, so you may want to be focused and motivated before you start the process.
Once you’re ready, pull out your pen and paper — or laptop and keyboard — and prepare to create and organize a lot of paperwork. Important end-of-life documents include medical and financial papers, as well as wills and personal notes for family members.
Some paperwork you should create includes:
— Advance care directives, which are legal documents in which you state your wishes for medical treatment if you cannot communicate these yourself
— A will, which is a legal document describing how you want your assets to be distributed after your death
— A list of your financial accounts and assets (including outstanding loans)
— A list of your passwords or login details to key accounts (bank, insurance, loans)
— Records of your health history and list of major medical conditions, surgeries and medications
— Statement declaring your medical power of attorney, which is a legal form that appoints someone else to make medical decisions for you if you cannot make these on your own
— Statement declaring your financial power of attorney, which legally appoints someone else to make financial decisions, such as decisions pertaining to your assets or property
[READ: What to Say to Someone Who Is Dying]
2. Prioritize Advance Directives
Advance directives are some of the most important documents to assemble before you die. These directives can include living wills and health care proxies, documents that outline how you want to be cared for at the end of your life and who you want to represent you and your wishes when you cannot communicate these yourself. Your doctors should refer to and respect your wishes on these documents.
Some people’s advance directives are long and detailed, while others keep them brief and simple. In an advance care directive, you can express preferences on end-of-life decisions like:
— The person you want to be your surrogate decision-maker, who you trust to make decisions about your health if you are near death and cannot communicate
— Wishes regarding whether or not to “prolong life”
— Wishes regarding organ donation
— Wishes regarding your funeral and after-death services
Dr. Brian D. Madden, a primary care physician and the medical director of palliative care at Providence Saint John’s Health Center in Santa Monica, California, explains that advance directives help guide your end-of-life care but are not “binding.”
“They are meant to be a guide for your surrogate, not an absolute,” Madden says. “As physicians, we would reference this as evidence of your preferences and attempt to align our recommendations with what it says, but we would still need a decision from your surrogate after a reasonable discussion about what outcomes are possible and likely.”
He adds that the language used in advance directives is often simple and generic, rather than specific and direct. For instance, an advance care directive may elicit statements such as to or “not to prolong life,” which is not the same as an immediate do-not-resuscitate order.
You will sign the end of the document when you are satisfied with your responses. Depending on what state you live in, you may not need to work with an attorney to complete an advance directive — although it can help. However, you may still need one or two witnesses to co-sign your directive, stating that you were thinking clearly at the time of signing and were not forced to sign the form.
[READ: How to Choose and Questions to Ask a Hospice Provider Near You]
3. Choose Your Surrogate
Your surrogate is the person you choose to communicate your medical wishes for you at the end of your life. They may also go by terms like health care proxy or surrogate decision maker, named by a type of advance directive called a durable power of attorney for health care.Whatever the official name, this person will serve as your spokesperson — and should be someone trust.
Your doctor may be required to certify that you’re incapacitated before your surrogate can step in.
While you’re still able to communicate, it’s important to inform your designated spokesperson of your wishes so they can effectively advocate on your behalf when the time comes. This can include accepting or declining medical interventions surgeries, tests, blood transfusions, advanced life support and other treatments and interventions on your behalf. The decisions they make should be based on your personal wishes, so be sure to communicate these verbally and/or in your advance directive.
Additionally, it’s a good idea to notify other loved ones about your choice of surrogate — especially if you suspect someone else is vying for the position. For instance, if you are married, your spouse may presume they are your surrogate. But, since this decision is up to you, you may have selected a sibling instead. Notifying both your spouse and your sibling of your decision can help everyone get on the same page and clear up any confusion about who should represent you at the end of your life.
4. Update Your Preferences as Needed
Wants and needs can evolve with time, so there is always a possibility that you change your mind about your end-of-life preferences. The good news is that as long as you can communicate, you can revise or update your advance directive.
“This document describes what you find acceptable or unacceptable should you be in a condition where you cannot speak for yourself,” says Dr. Akanksha Sharma, a board-certified neurologist, neuro-oncologist and palliative medicine doctor at the Pacific Neuroscience Institute in Santa Monica, California. “It should reflect how you feel at the current time, and (your best prediction of) how future you will feel.”
So long as you can communicate, you can talk to your doctor verbally about current or ongoing treatments, she adds.
“At the end of the day, what you say will always trump the document,” Sharma says. “But if you can’t speak or express yourself, it is important your loved ones know what you find to be a minimally acceptable quality of life and function.”
5. Consider If You Want More Advanced Medical Directives
If you want more control over end-of-life treatments than an advance directive can offer, consider filling out your state’s version of the Physicians Orders for Life-Sustaining Treatment, or POLST, or Medical Orders for Life-Sustaining Treatment form, or MOLST. These are effectively the same form, and are similar to advance directives in that offer a space for you to specify your end-of-life wishes.
The POLST and MOLST forms are different from advance directives in that they also contain more deliberate do’s and don’ts about interventions that you do or don’t want during emergency situations — such as if paramedics are called to your house.
Sharma explains that if paramedics are called, they would follow the directive given on the POLST or MOLST, and not the advance directive — as the advance directive is “generally not something that is easily accessible or portable, and not something that can be quickly reviewed in an emergency.”
If you have a POLST or MOLST form, she recommends placing pages one and two — which offer specific instructions for responders — in a visible location such as on your fridge.
POLST and MOLST forms are voluntary to complete, are for people with seriously ill — not healthy adults — and must be filled out and signed by a health care provider.
“A POLST or MOLST is part of your advance care planning documents but is not needed until or unless there are very clear restrictions you want to place on your care,” Sharma says.
She adds that you do not name a surrogate on a POLST or MOLST form, so it is important to specify this on an advance directives.
6. Consider Your Personal Legacy
In addition to legal and medical documents, it can be a good idea to create some more personal leave-behinds for family and loved ones. Sharma encourages people to engage in legacy planning, which can include assembling notes, letters, voice recordings, videos, stories and pieces of art for loved ones after you go.
“This can be a hard point to get to, but I wish more people thought about their legacy and what they will leave behind for their loved ones,” Sharma says.
“It is important to say the unsaid things, tie up loose ends, make sure the ones you love and care about know how you feel,” she says. “Legacy does not have to mean something grand or formal — it just means leaving a piece of you behind in people’s minds and hearts.”
When to Start End-of-Life Prep
Death is not only hard to prepare for, but difficult to predict. As such, there is no perfect time to assemble documents like your advance care directive. Still, doctors say sooner can be better than later.
“The challenge is knowing when death might be expected,” Madden says. “Medically, these documents are helpful at any time because you don’t know when you’ll need them.”
Once assembled, try not to let your documents or the idea of death consume you, Madden says. Whether or not death is looming, he encourages people to prioritize “learning how to live now.”
And unlike other parts of your end-of-life prep, he reminds people that soaking in the last bits of life “doesn’t require any extra paperwork.”
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How to Prepare for End of Life: Medical Planning and Paperwork originally appeared on usnews.com
