Starting the conversation about end-of-life care with family and caregivers can be a difficult endeavor for some people. According to The Conversation Project National Survey (2013), 90 percent of people surveyed stated that talking to their loved ones about end-of-life care is important; however, only 27 percent had actually done so.

If you or your employees are among the majority who hasn’t yet begun advanced care planning, we hope the following information will be useful in initiating the process.

What are advance directives?
Advance directives are legal documents that outline, ahead of time, your decisions for end-of-life care and medical treatment. Advance directives are made to ensure that your wishes are carried out if you are ever unable to communicate with health care providers.

There are two types of directives:
• One is a Health Care Proxy or Durable Power of Attorney for Health Care, in which you authorize someone, the “proxy” or “agent” (often a family member), to make decisions on your behalf if you were to become incapacitated. The person named as the proxy or agent should be someone you trust to carry out your wishes. The health care proxy can be completed in your doctor’s office. Anyone who is age 18 and older, healthy or sick, should have a health care proxy.

• Another type of directive is a form that gives instructions for treatment. An example of this is a Living Will, which usually states in general terms what treatments a person does or does not want. More recently, there has been a movement to more specifically address problems and needs that might arise. These types of documents include The Five Wishes and Do Not Resuscitate (DNR) Orders.

What is the MOLST?
In Massachusetts, we have the MOLST (Medical Orders for Life-Sustaining Treatment). The MOLST is a standardized medical orders form, which should be filled out after you talk with your health care providers about your overall goals of care and wishes for different level of treatments. This is not technically considered an advance directive as it is a medical document signed by both you and your physician and is effective as soon as it is signed, regardless of your capacity to make decisions. However, it often is labeled under the heading of advance directives. (Source: molst-ma.org)

Completing advance directives
Often times, advance directives can be drawn up by an attorney at the same time as a last will and testament. Or, you can print the forms noted and complete them with your family or physician. Once your advance directives are completed, you should make sure your primary care provider has a copy of these forms. You should keep a copy for yourself in a place where it is easy for others to find. Also, give a copy of these forms to your designated health care proxy. Finally, be sure you discuss your treatment decisions and goals with your loved ones, so that they are informed and able to speak on your behalf.

It is important to note that you can change your mind about your advance health care directives and MOLST at any time by completing new forms with different instructions.

Resources
Many helpful resources and websites exist with information about advanced health care planning. Below is a list of links to these resources:
• nhdd.org
• massmed.org/healthcareproxy
• molst-ma.org
• theconversationproject.org
• caringinfo.org