Advance care planning: Start the conversation |

Advance care planning: Start the conversation

Tamera Manzanares
Northwest Colorado Visiting Nurse Association

Advance planning. Advance directives. Living wills. These terms tend to raise a lot of questions: How are they different? Which one do I need? Why do I need it?

The latter question, while difficult, is the most important. It begins the process to help ensure our wishes for medical care will be respected if we cannot make those decisions for ourselves. Not surprisingly, it’s a process many people are reluctant to undertake.

While the vast majority of people believe it’s important to talk with loved ones about end-of-life care and to have one’s wishes put in writing, only about 25 percent of people actually take those steps, according to a 2012 study by the California HealthCare Foundation.

Learning about the types of medical decisions and making your preferences known, can take considerable decision-making burden off loved ones and also prevent expensive treatment or procedures you may not want.

The first step is to think about, in the event of a healthcare crisis, what kind of end-of-life care you would or wouldn’t want. Decisions may involve emergency treatments to keep you alive such as CPR, ventilators, artificial nutrition and comfort care.

It can be helpful to talk to your healthcare provider about how your present health may influence your health in the future. Five Wishes is a document that can guide you through the personal, emotional and spiritual considerations around various health emergency scenarios. It can also serve as a living will in many states, including Colorado. More information, go to

The Conversation Project is another resource to help you plan talks with your loved ones about your wishes for end-of-life care. A Conversation Starter Kit is available at

When you feel secure in your medical treatment decisions, document them in an advance directive. There are two parts: Medical Durable Power of Attorney and a Living Will.

A Medical Durable Power of Attorney appoints a substitute decision maker or healthcare agent (sometimes called a healthcare proxy) to make medical decisions for you in the event you are incapacitated. Make sure your agent understands what your wishes are, what you consider to be acceptable and when you would say no.

A Living Will is a document you sign telling doctors to stop or not start life-sustaining treatments if you are in a terminal condition and can’t make your own decisions. Other advance directives are available to cover more specific medical issues or procedures not covered in the basic living will. A CPR directive is a good one to include.

In Colorado, your final advance directive documents must have your signature and that of two witnesses. Some states require your signature be notarized.

Keep your advance directives in a place that is easy to get to – not a safe deposit box. Give copies to family members, your healthcare provider and anyone likely to be involved in your medical care. Take copies to with you when you check in to a healthcare facility for inpatient or outpatient procedure. You may want to make a card for your wallet indicating that you have an advance directive and where it is located.

“Your Right to Make Healthcare Decisions,” an advance directive guide and documents for Colorado, is available at (search “medical decisions).

This article includes information from the National Institute on Aging,

Tamera Manzanares is Marketing Coordinator at the Northwest Colorado Visiting Nurse Association. She can be reached at or 970-871-7642. Northwest Colorado Visiting Nurse Association, based in Craig and Steamboat Springs, recently began providing Home Health and Hospice services in Grand County.

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