What are the 3 types of advance directives

While some people create a will and trust including advance directives when they are healthy, others do not do so until they are receiving care and caregivers realize these documents are lacking. Others aren’t even aware of advance directives until crises arrive. This post answers the question, what are the three types of advance directives, for both New Hampshire and Vermont residents.

Advance directive laws are not uniform across states and people sometimes get conflicting information from family and friends, depending on where they live. For example, in some states, the person you choose to advocate for you with healthcare professionals is called power of attorney. In others, such as Vermont, it’s called having an agent. (More on Vermont- and New Hampshire-specific advance directives below.)

What are advance directives and why are they important?

Advance directives include legal documentation such as a living will, power of attorney and do not resuscitate (DNR) orders.

The directive documents identify who will make decisions if the patient is unable to and who will be involved in their final care. Directives can also be used to clarify wishes for funerals, memorial services and what happens with the patient’s remains after death.

Professional caregivers often assist patients with advance directives. Trained staff guides patients through the legal forms, helps with decision-making and generally reassures patients and their families about expectations in the final days and hours.

Completing the forms is an important step, as they not only specify what medical treatments a patient wants to have, but also which ones they do not want to have.

Taking the right steps

Don Freeman is the advance care planning coordinator for Brattleboro Area Hospice in Vermont. Taking Steps Brattleboro is a program that assists Vermont residents with creating a written health care plan (advance directive).

“Your agent has a big responsibility to ask the tough questions of healthcare professionals … Be very careful about who you’re choosing,” Don advised. “Sometimes we find through conversations that someone may have more than one child they are considering as an agent, and they don’t want to show favoritism. We help determine the best person to advocate for you while being respectful of the relationships.”

Don said his team asks questions about value systems to help determine where someone is  with their life priorities. “We also ask about their experiences with others who have died. Did that person have advance directives? Once we get people talking about it in terms of values, it sets the stage as to why it’s important to have one,” Don said. He said these talks take away the medical situation and humanize it. “That then flows to medical choices.”

Advance Directives in Vermont

Don said Vermont uses three main forms:

• A two-page agent form that can be completed in about 30 minutes
• The six-page short form, which is the one most people choose
• The 24-page long form, which helps if someone has psychiatric illness in their background or someone is in the middle of an end-of-life crisis

There’s no timeframe for completing the forms, though Don encourages people to choose an agent aka advocate first, just in case something unexpected occurs. He reminds people that the challenges that arise with no advance directives are within families of younger people when an unexpected health crisis occurs. It’s never too early to have an agent.

Taking Steps Brattleboro offers its services at no charge to Windham County residents and also to NH residents of the border towns of Chesterfield and Hinsdale. Those interested in assistance can call 802-257-0775.

Advance Directives in New Hampshire

There are several advance directives that families might encounter, and the Foundation for Healthy Communities website has downloadable advance directive forms. These are forms completed by adults over the age of 18 while they are capable of preparing them, but they only come into play when the patient loses their ability to make medical decisions on their own.

Directive and medical intervention forms include:

• A living will: This document delineates the limits of medical intervention the patient would accept for prolonging life.
• Durable Power of Attorney: This document allows the patient to designate who will make healthcare decisions if/when the patient becomes unable to make them.
• Portable Do Not Resuscitate: When you are outside of a healthcare facility, this document tells healthcare providers not to try to restart your breathing or heartbeat in the event that  your heart stops beating or you stop breathing.
• The Five Wishes document specifies medical and legal directives and also includes pain management, family reconciliation, comfort issues and spiritual needs. It can be used as a guide and workbook, but it is not considered a legal document in New Hampshire.

Beginning the conversation

When some people hear the words “advance directives,” they may want to immediately change the subject or shut down. Programs such as The Conversation Project and Talk of a Lifetime encourage people of all ages to talk about their end-of-life wishes prior to a health crisis.

Talk of a Lifetime offers questions to get people thinking and talking about what’s really important, such as:

• What is a life lesson you learned that you think would be helpful to pass on to the younger generations of our family?
• Fill in the blank: I was so proud after I _______ .
• What is the best advice your parents (or grandparents) ever gave you?
• What is the thing you would love people to remember about you most?
• What is most important to me in my life?
• What makes my life meaningful?
• What sort of quality of life would be unacceptable to me?
• Who is best positioned to speak on my behalf?

You might be surprised at how easily talking about happy memories can blend into discussing advance directives. It’s not morbid. It’s productive and will ultimately help your family through some trying times.

Knowing how to honor loved ones’ wishes when they cannot speak for themselves is one of the bravest and most loving things someone can do. Helping someone down the path of creating advance directives is a key step in that.

This post answers the questions:

What is an advance directive

What are the 3 types of advance directives in NH

What are the 3 types of advance directives in VT