Healthcare Archive

Many people understandably want to keep their living will and health care power of attorney forms in a secure place. But if these documents are locked away in a safe deposit box, they won't be much help if you're unexpectedly hospitalized. Here are some people who should have copies of your advance directives and some other places where they should be filed.

• Your health care agent and any alternative agents. All should have a copy of your health care power of attorney (and your living will, if you have one). In an emergency, your agent may need to fax the documents to doctors or a hospital.

• Your doctor. A copy of your advance directives should be in your file and medical record.

• Your hospital chart. If you are in the hospital, ask to have a copy of your advance directives put in your chart. (Your health care agent or a family member should do so if you are unable to do it.)

• A safe spot in your home. File the original documents in a secure place in your home — and tell your agent, family, and friends where you put them. Hospitals may request an original, so it's important that someone can find the documents when necessary. The National Hospice and Palliative Care Organization suggests noting on all copies of the documents where the originals are stored.

• Carry it with you. Put a card with your health care agent's name and contact information in your wallet or purse. Also note on the card where you keep the original and additional copies of your directives.

If you have a do not resuscitate order (DNR), remember that you or your health care agent may be required to produce a signed form, or you may have to wear a special bracelet identifying that decision. If a lawyer drew up your advance directives, ask whether he or she will keep a copy, and for how long.

Being a caregiver for an ailing parent, spouse, child, or other loved one can feel like a lonely undertaking. It needn't, even if you don't have family nearby to pitch in. Help for caregivers is available from various organizations. Once you learn what's available, it may be easier to chart a less-demanding course toward meeting the needs of your spouse, relative, or friend.

Here are some types of services and professionals you might want to investigate.

Why you should plan now for care you may need later.

Be skeptical and get the big picture from multiple sources.

When you need to find a hospital or medical center to have non-emergency surgery or a diagnostic procedure, you often have a choice—assuming you clear it with your insurance provider. How do you figure out the best place to go?

Q. My doctor, an internist, just retired, and my health plan is asking me to designate a new primary care physician. I'm 75. Would there be advantages to choosing a geriatrician as my new doctor?

A. First, a disclaimer: I am a geriatrician. So my short answer is, "Yes, of course!" But my reasoned, unbiased answer would be, "It depends." If you are a generally healthy 75-year-old woman, a family physician or internist will be able to take excellent care of you. Geriatricians are trained to care for older adults with complex illnesses and are expert in managing the care of people who are frail. Improving your ability to function, and the quality of your life, are the guiding principles of geriatric medicine. We are expert at managing complexity and uncertainty, working with families, and caring for people with serious illnesses who are approaching the end of life. A geriatrician would be a good choice if you have physical or cognitive impairment, if you take a lot of medications, or if your friends and family are involved in your medical care. For people who have several medical problems, we emphasize the role of patient and family preference in making medical decisions, with the patient's goals as our primary focus.

You need to meet strict criteria, get proper counseling on pros and cons, and be tested at a qualified center.

The term "living will" can be confusing.

Simply put, a living will is a legally binding document that allows you to express your preferences for medical treatment under certain circumstances. For example, you can set out how aggressive you'd like your care to be as the end of life nears. This written record guides your doctors and loved ones in caring for you, should you ever be unable to communicate your wishes directly.

Be aware that in many states, living wills are invalid during pregnancy. If you want your wishes honored whether or not you're pregnant, be sure to put that in your living will. Doing so won't guarantee that your wishes are followed, but it will improve the chances.

Patient-centered medical homes are improving your care by focusing on prevention and teamwork.

If you decide to change something in your living will or health care power of attorney, the best thing to do is create a new one. Once the new document is signed and dated in front of appropriate witnesses — and notarized, if necessary — it supersedes your old directive.

The American Bar Association Commission on Law and Aging suggests that you re-examine your health care wishes whenever any of the following "five d's" occurs:

Here's how to make sense of your new benefits under the ACA.

The major provisions of the Affordable Care Act (ACA) were scheduled to start January 1. By that date, all Americans are required to carry health insurance. Coverage is available to those who don't have it through the Health Insurance Marketplace. (As we went to press, the Marketplace website was experiencing some technical issues, but the government was working to repair them, and said the site should be fixed by the time you read this.) If you're still confused about the ACA and its terms, here's an overview.