What Paperwork Should I Have In Place as an Older Adult?

In all likelihood, you’ve heard terms like “advanced directives,” “health care proxy,” and “living will” thrown around. From a distance, it can seem overwhelming to understand the documents you need to have in order as you age, but it’s actually a very straightforward process. We’ll walk you through what you need to know.

Which Concepts Matter?

Six main concepts come up frequently as it relates to “getting your paperwork in order” and aging. While it takes time to think through your preferences, they’re all easy to fill out — at the end of the article, we’ll link to places where you can do it online.

Here are the main concepts. We’ll walk you through each of them below.

• Advanced Directives
• Health Care Proxy (aka Health Care Agent)
• Power of Attorney
• Living Will
• Do Not Resuscitate (DNR) Order
• Medical Orders for Life-Sustaining Treatment (MOLST)

Advanced Directives

Advanced directive(s) is an umbrella term describing the process and documents wherein you express what you would like done to you by doctors and other health care providers should you become temporarily or permanently unable to express those wishes. The phrase “advanced directive” is often used quite loosely. It’s the most common way to describe this general topic, process, and the stack of associated documents.

Health Care Proxy (aka Health Care Agent)

Your health care proxy is the person you entrust to make healthcare decisions for you should you be unable to do so. The process of assigning this role is simple and straightforward and does not require an attorney, but it should involve (1) some very serious thought as to who you pick and (2) a frank and open discussion with that person as to what your preferences are. Ideally, you should have an alternate proxy as well.

To assign a health care proxy, there are simple forms available online. In most cases, you can also designate a healthcare proxy right in your doctor’s office, with forms that are widely available and typically require only a witness.

Power of Attorney

Power of attorney is a legal document that allows a person you appoint to act in your place for financial purposes if and when you ever become incapacitated. While your health care proxy will make medical decisions, your power of attorney will make financial decisions.

An important note about a power of attorney: This role is essentially legalized identity transfer. All official entities of the state and commerce recognize your power of attorney as you for all intents and purposes. It’s important to be incredibly careful who you choose.

Living Will

A living will is a document that describes what specific actions you’d like taken in various circumstances should you become incapacitated. It’s important to note that a living will is no substitute for a health care proxy, but rather a “companion document” that provides more specificity for that person and a doctor, and should reinforce the wishes you’ve conveyed to them in actual discussions.

While it’s important to have a living will, it’s equally important to understand some of the limitations — mainly that they can foster misconceptions about the way medical emergencies play out in actuality. No two medical circumstances are exactly alike, and rarely does one encounter a situation in which a rigid and formulaic document can provide airtight advice on how to proceed in a way that is “on point.” The bottom line: You need a health proxy whose decision can be informed by a living will, but it’s impossible to plan for every eventuality.

Do Not Resuscitate (DNR) Order

A DNR order is a very specific kind of advanced directive which speaks to what you’d like done in the event of an “arrest” (such as if your heart stops beating or you stop breathing). In these instances, without aggressive treatment, you would perish immediately, and attempted resuscitation often involves medical equipment things like paddles, defibrillators, and ventilators.

DNR orders are typically used in health care facilities like hospitals and nursing homes because medical staff and equipment is readily available. But they’re important to have in every setting, should something ever happen outside of the house and medical assistance be called. It’s smart to keep two copies of your DNR order visible and accessible — one in a wallet or bag and one on your fridge or somewhere else it would be found.

Medical Orders for Life-Sustaining Treatment (MOLST)

A MOLST form, or Medical Orders for Life-Sustaining Treatment, is a critical document used in many states to outline a person's preferences for end-of-life medical care. Note that it has different names and levels of significance in different states, so it’s important to look up how your state treats it.

Unlike an advanced directive, which provides general guidance, a MOLST form translates an individual's wishes into medical orders that healthcare providers are legally bound to follow.

It not only can include the patient's wishes regarding resuscitation (like the DNR) but also outlines preferences for other life-sustaining treatments. This can include the use of ventilators, artificial nutrition and hydration, antibiotic use, and other medical interventions.

The MOLST form is designed to follow the patient across settings – from their home to the hospital, nursing home, or hospice care – ensuring that their care preferences are known and respected in any medical situation. Having a MOLST form is particularly important for individuals with serious health conditions or those at a significant risk of a medical emergency, as it ensures that their care aligns with their values and desires, even if they're unable to communicate.

While not everyone may need a MOLST form, it's a crucial tool for ensuring that one's end-of-life care preferences are clearly documented and respected.

How to Be Prepared and Avoid Issues

How can you avoid guardianship or similar kinds of hot water for you or a loved one in the event of a loss of decision-making ability?

With regard to health care decisions, the most important thing is to designate a health care proxy. Let them know that you’ve cast them in that role, and walk them through your written preferences.

As it relates to handling money and finances, the most important thing is to appoint a power of attorney. Think about it this way: If you were in the hospital for a month and could not think or communicate clearly, what would happen to your financial world? It’s likely that your landlord would still want the rent, the car leasing company will still want its payment, and the electric company will still want their cash if you want the lights to stay on. How will money from your checking account get to your mortgage holder? How would someone get into your safety deposit box? How will someone get your mail? Anywhere your signature and/or identification is required will be inaccessible.

Your designated power of attorney will have the ability to transact financial and other related business as if they were you. If you’ve picked your power of attorney carefully, and prepared them well, they should have a good sense of what you want to happen in your financial world should you be unable to run it. It’s important that they also know what you have and where you have it. We recommend having a document summarizing all bank accounts (location, number, approximate amount), retirement accounts, life insurance policies, and all other relevant documents one would need to get your financial house in order. A digital repository like LastPass is a good place to store this, in addition to keeping physical copies in a safety deposit box.

Choosing Your Health Care Proxy and Power of Attorney

Sometimes the same person serves as both health care proxy and power of attorney; sometimes not. For example, if an adult child is especially facile with finances, they might serve as the power of attorney and cede the health care proxy role to another sibling who is more familiar with those matters (like a physician). The most important thing is to make sure (1) the person you’ve selected knows you’ve tapped them for this role and (2) what you’d like them to do should they have to assume it. When possible, it can be wise to have the same person do both to avoid any conflicts or disagreements related to care decisions.

Once you’ve made your decisions, it’s essential to communicate them to your loved ones — not just those who will play a role, but everyone. Some of the stickiest situations come up when a person has concealed their choices or hasn’t addressed why they appointed one sibling instead of another and feelings get hurt. It’s much better to get things out in the open and have everyone on the same page.