Federal law protects your ability to create a legal document with your wishes for end-of-life care and requires nursing homes to honor those wishes. But the parameters of such a document are controlled by state law, so it's crucial to know the laws in your state and to use an appropriate form. The most common instructions in advanced directives concern whether or not you want to be kept alive indefinitely by artificial means like intravenous feeding and artificial respiration.
Features
An advance directive is a hybrid legal document. It essentially combines a living will with a health-care power of attorney. Like a living will, an advance directive allows you to specify what sorts of end-of-life medical treatment you want to receive, such as artificial respiration. Like a power of attorney, the document also appoints someone to make unforeseen medical decisions in the event you are incapacitated. This person is called your health-care agent.
Execution
Like most other legally binding documents, an advance directive must be signed and witnessed. People that might be responsible for providing care under the directive, such as doctors and nursing home staff, cannot be witnesses. Many states prohibit anyone related to you or who might have an interest in your estate from serving as a witness. Ideally, also, the designated health-care agent will be someone other than a doctor or health-care provider. State laws on who can serve as a health-care agent differ.
Planning
You may wonder why you can't simply tell your doctor your views on end-of-life medical treatment and leave it at that. In reality, a health-care advance directive is not intended to be a substitute for careful planning with your doctor and family. It's purpose, though, is to be sure your decisions are contained in a formal document that will increase the chances of your wishes actually being carried out. Ensuring your nursing home has a copy of the directive and that primary care providers understand your wishes is also crucial.
Health-Care Agent Authority
The types of instructions you can leave to your doctors and other health-care providers varies by state. Your health-care agent will be there to fill in the gaps, making decisions such as whether to authorize transport from the nursing home to a hospital or hospice, provision of pain medication and access to your medical records. The power to make these decisions, however, only comes into effect when you've been declared mentally incompetent or incapacitated by your doctor.
PSDA
Under the Patient Self-Determination Act (PSDA), nursing homes are required to provide you with information on advance directives at the time of your admission. This obligation, however, simply consists of your decision-making rights under state law and does not require an actual directive be drafted and executed. If you already have an advance directive, the nursing home must note that fact in your record and may not discriminate against you based on its contents. If you don't already have one, a document containing sample state-specific advance directive forms is available from the American Bar Association (ABA).
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