Families often hear "advance directive" and "living will" used as if they meant the same thing. They're related, but not identical, and the difference matters when you're trying to make sure a parent's wishes will be followed in a hospital or emergency.
Advance directives are legal documents that give instructions for medical care and take effect only if a person can't communicate their own wishes. The two most common are the living will and the durable power of attorney for health care1. This guide explains each document, how they work together, what DNR and POLST forms add, and how to help your parent complete them in a way that actually helps when the time comes.
Advance directive vs living will: the short answer
An advance directive is the general term for any written instructions about future medical care. A living will is one kind of advance directive. The other main kind is a durable power of attorney for health care, which names a person to decide for your parent1. Many states combine both into a single advance directive form.
| Document | What it does | Who signs it |
|---|---|---|
| Living will | Says which treatments your parent would want or not want, and when | Your parent, with witnesses or a notary as the state requires |
| Durable power of attorney for health care | Names a health care proxy or agent to make decisions | Your parent, with witnesses or a notary as the state requires |
| Advance directive (combined form) | Often includes both of the above | Your parent |
| DNR order | Tells medical staff not to attempt CPR | A doctor, with your parent or their agent |
| POLST or similar form | Turns wishes into portable medical orders for serious illness | A health care professional, with your parent or their agent |
So the answer to "Does my parent need an advance directive or a living will?" is usually: an advance directive that includes both a living will and a health care proxy.
What a living will covers
A living will tells doctors how your parent wants to be treated if they can't make their own decisions. It can say which common medical treatments they would want, which they'd want to avoid, and under which conditions each choice applies1. Medicare describes it as covering treatments if life is threatened, such as dialysis, breathing machines, resuscitation and tube feeding, and whether your parent wants to donate organs or tissues2.
- CPR. Attempts to restart the heart and breathing.
- Mechanical ventilation. A breathing machine, sometimes for a short time and sometimes long term.
- Tube feeding and IV fluids. Nutrition and hydration when a person can't eat or drink.
- Dialysis. Cleaning the blood when the kidneys fail.
- Comfort care. Pain relief and other care to keep your parent comfortable, which can be given whatever other choices they make.
- Organ and tissue donation. Whether they wish to donate.
A living will can't foresee every situation. That's why most people pair it with a health care proxy who knows their values.
The health care power of attorney
A durable power of attorney for health care names a health care proxy, sometimes called an agent, representative or surrogate, to make medical decisions when your parent can't. The proxy should know your parent's values and wishes. It can be chosen in addition to or instead of a living will, and it helps in situations no one can predict, like a serious accident or stroke1.
- Choose someone who will follow your parent's wishes, even if they'd choose differently.
- Pick someone calm under pressure and able to talk with doctors.
- Name a backup in case the first choice can't serve.
- Make sure the proxy has a copy and knows where the original is.
This is a separate document from a financial power of attorney, though some people name the same person for both. Our guide to power of attorney for an elderly parent explains the financial side.
DNR, DNI and POLST: medical orders
Advance directives express wishes. Medical orders turn some of those wishes into instructions that emergency and hospital staff follow right away.
- Do not resuscitate (DNR). A DNR order in the medical chart tells staff not to attempt CPR if the heart and breathing stop. Even if a living will says no CPR, the NIA notes it helps to have a DNR order in the medical file, because without one, staff will try every effort to restart the heart1.
- Do not intubate (DNI). Tells staff your parent doesn't want to be put on a breathing machine1.
- POLST. A portable medical order form, known by different names in different states, for people with a serious illness or frailty. A health care professional fills it out with the patient or their agent, and it travels with the person between home, hospital and nursing home3.
A POLST isn't for everyone. (Your parent can raise any of these documents at the Medicare Annual Wellness Visit, where providers offer to discuss advance directives.) It's meant for people whose doctor wouldn't be surprised if they died within the next year or so. For a healthy older adult, an advance directive is usually enough. For a closer comparison, see DNR vs. POLST.
What happens without an advance directive
If your parent can't make decisions and has no advance directive, state law decides who speaks for them. That's typically a spouse, then adult children or parents. An unmarried partner who isn't named as proxy could be left out, and in some states a close friend can help if there's no family1.
This can work fine in close families. It can also lead to painful disagreements among siblings at the worst possible time, or to decisions that don't match what your parent wanted. When a parent can no longer make decisions and has no documents, families sometimes need to go to court; our guide to guardianship of an elderly parent explains that process.
How to help your parent complete an advance directive
- Start with a conversation. Ask what matters most: being comfortable, being at home, living as long as possible, not being kept alive on machines. The NIA calls these conversations the most important part of advance care planning1.
- Get your state's form. Each state has its own rules and forms. Free state-specific forms are available online4, and hospitals, doctors' offices and Area Agencies on Aging often have them too.
- Talk with the doctor. Medicare Part B covers voluntary advance care planning as part of the yearly Wellness visit, and in some other situations2.
- Sign it the right way. Follow your state's rules for witnesses or a notary. A lawyer isn't always required.
- Share copies. Give copies to the proxy, the doctor, the hospital your parent uses and close family. Keep the original somewhere easy to find, not in a locked safe deposit box.
- Review it regularly. The NIA suggests reviewing advance directives at least once a year, and after a major event like a move to another state or a big change in health1.
When your parent enters a hospital, nursing home or hospice that takes Medicare or Medicaid, federal rules require the provider to give written information about advance directives and to note in the record whether your parent has one5. Bring a copy with you.
Advance directives and dementia
Dementia makes timing critical. Many people don't realize that Alzheimer's and related dementias are terminal conditions, and people in the later stages lose the ability to make even simple decisions. Advance care planning early in the disease lets your parent take part directly in decisions about their future care1.
If your parent has just been diagnosed, make this a priority while they can still understand and sign. A person with mild dementia may still have the capacity to complete an advance directive; their doctor or a lawyer can help judge that. Our guide to the early signs of dementia and the stages of dementia care needs can help you plan ahead.
Will the wishes be followed?
An advance directive is legally recognized, but it isn't a guarantee. Doctors and the proxy will do their best to respect it, but some situations are complex, and it may be unclear what your parent would want. A provider may also decline to follow a directive that goes against their conscience, the institution's policy or accepted medical standards. In that case, they must tell the proxy right away and consider transferring care1.
The best protection is a proxy who has talked with your parent in depth. A written document plus a person who understands the "why" behind it works far better than either alone.
Common mistakes to avoid
- Signing and filing it away. If no one can find the document in an emergency, it can't help.
- Vague wording. "No heroic measures" means different things to different people. Be as specific as your parent can be.
- Not telling the proxy. A proxy who learns of the role in the emergency room is at a disadvantage.
- Skipping the DNR or POLST when one is needed. For a seriously ill parent, a living will alone may not stop emergency CPR.
- Never updating it. Wishes change with health, and so can the right person to name.
A short family meeting where your parent explains their choices, with the proxy present, prevents most of these problems.
If your parent moves to another state
Many states honor advance directives made in another state, but rules differ. If your parent moves, especially to be near family or into senior living, review the documents and consider completing the new state's form. It's a small step that avoids confusion later. Our guide on moving a parent to senior living covers the other paperwork to update.
