It’s certainly not unheard of for an older employee to return to work after a serious illness or terminally ill employees to return to work to regain a semblance of normalcy. In situations like these, it’s always to the benefit of both employee and employer to be prepared for decisions affecting their wellbeing, treatment and care.  Yet so few people ever talk about or write down how they want those decisions made. 

Although in your role as benefits advisors, the topic of living wills may not frequently come up, considering the growing number of terminally ill employees returning to work, it makes sense for you to be educated on advance directive documents and be able to wisely advise your clients in this area. 

In broad terms, an advance directive is any document that allows a person to state in advance how they wish to be treated if they are unable to make those choices themselves.  The most common advance directive is a living will. Contrary to what many people think, living wills do not have to limit treatment or “pull the plug;” they can also be used to request every medical intervention available. 

Also, if someone is conscious, capable of making decisions, and able to sign permission forms, there is no need to consult the living will. Living wills only take effect when a patient is unconscious, demented, or otherwise incapable of making their own decisions. 

The living will should be the clearest description possible of the person’s desires. People often list their wishes based on various situations, as they may want different treatments if imminently dying of cancer or when in a coma from which recovery is likely.  

The advantages of living wills:

1.   They keep people in greater control of their lives and deaths, even in cases where they are unable to speak for themselves.

2.   They can promote honest conversations within families.

3.   They can help prevent legal battles and courtroom fights.

4.   Survivors of a loved one’s death grieve with fewer regrets and guilt when they do not have to make treatment decisions without clear instructions from the dying person.  

Common problems of living wills:

1.   Only a small percentage of people complete one, and when they do, 62 percent do not give copies to anyone. A living will kept in a safe deposit box or desk drawer is inaccessible when decisions need to be made.

2.   The perspectives of a healthy, active person can change dramatically when they actually become ill, and too few people update their documents as they age or diminish.

3.   Living wills are not legally binding upon health care professionals, and uninformed family members sometimes override them. Family should be informed of the person’s desires, so they can support those desires with medical providers. 

4.   Each state has their own form, so clients who use the standard living will must complete the form from their state of primary domicile. 

But just because there are a number of valid concerns about living wills doesn't mean that financial advisors should discourage their clients from creating the documents.  Instead, they should: 

1.      Strongly encourage clients to write their desires in as clearly and specifically as possible.   

2.      Consider giving clients a living will form that names a healthcare proxy, and has additional directives such as which comfort measures a person desires in their room (music, lighting, blankets, religious items), what messages they would like to leave with loved ones, and their wishes for services.

3.      Schedule a follow-up to ensure clients complete a living will, and that it is properly signed and notarized. 

4.      Guide clients to distribute copies to their family members and to any person or institution involved in their care, including primary doctors, specialists, nursing home, rehab center, and hospitals.  Offer to keep a copy in the client’s files at your office, in case a family member needs one and cannot locate it.

5.      Add the updating of all advance directive documents to the agenda for annual review meetings so the client’s wishes are kept up to date. 

When people are educated about living wills, it eases their fears that someone else will dictate their medical decisions. It keeps them in greater control and takes a burden off their family members.  And, it encourages them to have valuable discussions with those they love.