Patient Guide: Advance Care Planning & Financial Planning

1. What is Advance Care Planning?

Advance Care Planning (ACP) is a conversation between a patient and their loved ones about:

• Treatment preferences
• Goals of care
• Choosing a trusted person to make medical decisions if the patient cannot

The goal is to ensure your wishes are understood and respected if you cannot speak for yourself.

Important: Advance Care Planning should be done when the person living with dementia still has capacity to make decisions. If they are already unable to understand these topics or make these decisions, and no advance care planning had already been done, then usually decisions would be assigned to the next of kin per state laws.

2. Advance Directive

An Advance Directive is the legal document that records your ACP decisions.

Purpose

1. Document your healthcare choices and goals of care.
2. Name a surrogate medical decision maker – the person who makes medical decisions when you are unable (physically or cognitively).

Other Terms for Surrogate Medical Decision Maker

• Durable Power of Attorney (DPOA)
• Medical Power of Attorney (POA)
• Health Care Proxy / Health Care Agent
• Surrogate Medical Decision Maker

Living Will

• A lay term for an advance directive, though technically they are slightly different.
• Living will only encompasses parts about your healthcare decisions and goals of care, usually does not name a medical POA.
• Often created during estate planning with an attorney.

Key Points

• Any state-approved template can be used for advance directive.
• No lawyer is required; it can be completed for free.
• Must be signed by a witness (free) or notarized (optional, at cost).

Templates & step-by-step guides: https://prepareforyourcare.org/en/prepare-for-your-care/advance-directive/advance-directive-welcome (Choose your state, then “Download a blank form”)

3. POLST Form

POLST (Physician Orders for Life-Sustaining Treatment) is different from an advance directive.

Used when someone is near or at the end of life, usually in palliative care or hospice.

https://capolst.org/wp-content/uploads/2017/05/POLST_Form.pdf

4. Financial Decision Making

Financial and medical decision-making are separate.

Financial Power of Attorney (POA)

• Makes decisions about paying caregivers, assisted living costs, medical expenses, and managing assets.
• Other terms: Fiduciary, Trustee, Guardian.

Important Considerations

• Identify a financial POA early, while the person still has decision-making capacity.
• Choose someone trustworthy, capable, and willing to act.
• Multiple people or a professional fiduciary can be appointed if needed.
• Example: Exchange Bank (CA) offers financial fiduciary services.

Potential Conflicts

• Disagreements may arise on how funds are used.
• Extreme cases can involve financial abuse.

5. Medical & Financial POA: Best Practices

• Ideally, name both a Medical POA and Financial POA.
• They can be the same person or different people.
• Should be chosen while the patient still has capacity.
• Trusted, capable, and willing individuals are essential.

If no suitable person is available:

• Medical POA: Legal team, prior physician, or independent organization (e.g., Sageeldercare.com, enAble Age Gracefully, Seniors at Home).
• Financial POA: Bank or professional fiduciary service.

6. Estate Planning

• Includes wills, trusts, and asset management.
• Helps transfer property and assets while planning for assisted living or nursing home placement.
• Consider an attorney if assets are complex, or use standardized forms (e.g., RocketLawyer) for simpler cases.

Proper estate planning ensures:

• Compliance with MediCal / health insurance rules
• Protection of income for a spouse
• Smooth management of assets and care costs

7. Key Takeaways

• Start advance care and financial planning early.
• Document your wishes with an Advance Directive
• Choose trusted and capable Medical and Financial POAs.
• Use available resources and templates—no lawyer required, but attorneys are helpful for complex estates.
• Regularly review and update documents as circumstances change.
   

Also: Practical Information for Emergencies

Emergency Preparedness Checklist

Consider keeping the following information together in a folder or binder so caregivers and family members can access it quickly in an emergency.

Emergency Contacts
☐ Primary caregiver
☐ Backup emergency contact
☐ Medical Power of Attorney / Health Care Agent
☐ Close family or friends who can help

Medical Information
☐ Primary care physician and specialists
☐ Pharmacy contact information
☐ Current medication list
☐ List of medical conditions and allergies
☐ Preferred hospital (if applicable)

Legal Documents
☐ Advance Directive
☐ POLST form (if applicable)
☐ Medical Power of Attorney documentation
☐ Financial Power of Attorney documentation

Insurance & Identification
☐ Identification (driver’s license or ID)
☐ Medicare and insurance cards

Financial & Professional Contacts
☐ Financial advisor or bank contact
☐ Attorney or estate planner
☐ Care providers or home care agency

Important Access Information
☐ Location of important legal documents
☐ Password access plan or password manager