What Is The Difference Between An Advance Healthcare Directive And A Polstdnr?

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What is the difference between an Advance Healthcare Directive and a POLST/DNR?

Both Advance Healthcare Directives and POLST/DNR forms address your healthcare wishes, but they operate very differently. An Advance Healthcare Directive is a broad document outlining your values and preferences for medical care, typically effective when you can no longer communicate. A Physician Orders for Life-Sustaining Treatment (POLST) or Do Not Resuscitate (DNR) order, on the other hand, is a specific set of medical instructions for your current health status, requiring a physician’s signature.

Think of an Advance Healthcare Directive as a comprehensive plan for the future, while a POLST/DNR is a real-time order. The Directive anticipates a wide range of scenarios, while the POLST/DNR focuses on immediate, life-or-death decisions. In California, the Advance Healthcare Directive typically includes a Durable Power of Attorney for Healthcare, naming someone to make decisions on your behalf, and a Healthcare Declaration, detailing your treatment preferences.

I’ve practiced estate planning and as a Certified Public Accountant for over 35 years here in San Diego, and I’ve seen firsthand the peace of mind a well-drafted Advance Healthcare Directive provides. It’s not just about avoiding conflict; it’s about ensuring your wishes are honored, even when you can’t speak for yourself. The CPA advantage comes into play when considering long-term care costs and potential asset protection strategies. Understanding the tax implications of healthcare decisions is crucial for comprehensive planning.

What happens if I don’t have either an Advance Healthcare Directive or a POLST/DNR?

Without these documents, medical professionals will typically turn to your family members to make decisions. This can lead to disagreements, delays, and potentially unwanted medical interventions. California law has a hierarchy for surrogate decision-making, starting with a spouse, then adult children, and so on. However, this process isn’t always smooth, and a court may need to intervene, as in Eliana’s case.

Furthermore, without a clear directive, your healthcare providers are obligated to provide life-sustaining treatment, even if you would have refused it. This can result in prolonged suffering and significant medical expenses. A POLST/DNR, while more limited in scope, provides immediate clarity to emergency medical personnel about your wishes regarding resuscitation, intubation, and other critical interventions.

Having both an Advance Healthcare Directive and a POLST/DNR offers the most comprehensive protection. The Directive provides the overall framework, and the POLST/DNR ensures your immediate wishes are known and respected. As a CPA, I often advise clients to consider the financial implications of potential long-term care needs when completing their Directive, factoring in potential asset depletion and Medi-Cal eligibility.

Can I change my Advance Healthcare Directive or POLST/DNR?

Absolutely. Both documents are revocable, meaning you can change them at any time, as long as you are of sound mind. It’s important to review your Directive periodically, especially after major life events, such as a divorce, relocation, or change in health status. You should also inform your healthcare agent and physician of any changes.

To revoke an Advance Healthcare Directive, you typically need to complete a revocation form and notify your healthcare agent and physician. A POLST/DNR can be revoked by completing a new form or verbally informing your physician. It’s crucial to keep copies of all your documents in a safe and accessible location, and to ensure your healthcare agent knows where to find them.

In San Diego, we often see clients updating their Directives after moving into assisted living facilities or experiencing a significant health change. The key is to maintain open communication with your healthcare team and ensure your wishes are always current. The step-up in basis rules for inherited assets, for example, can influence decisions about long-term care planning and the overall estate strategy.

What is the difference between a POLST and a DNR?

While often used interchangeably, a POLST (Physician Orders for Life-Sustaining Treatment) is a more comprehensive document than a DNR (Do Not Resuscitate) order. A DNR specifically addresses whether or not you want cardiopulmonary resuscitation (CPR) performed if your heart stops or you stop breathing. A POLST, however, covers a broader range of medical treatments, including artificial nutrition, hydration, and mechanical ventilation.

A POLST form is typically completed with the assistance of a physician and is based on your specific medical condition and preferences. It’s designed to be portable and available to emergency medical personnel, ensuring your wishes are honored regardless of where you receive care. A DNR, on the other hand, may be a standalone order or part of a POLST form.

It’s important to discuss both options with your physician to determine which is right for you. A POLST is particularly beneficial for individuals with serious illnesses or chronic conditions, while a DNR may be sufficient for those who simply want to avoid CPR. Understanding the capital gains implications of healthcare-related assets is another area where a CPA’s expertise can be invaluable.

Who should have an Advance Healthcare Directive and a POLST/DNR?

Everyone over the age of 18 should have an Advance Healthcare Directive. While it’s often associated with end-of-life planning, it’s important to have these documents in place regardless of your age or health status. Unexpected accidents or illnesses can happen to anyone, and having a Directive ensures your wishes are known and respected.

A POLST/DNR is particularly important for individuals with serious illnesses, chronic conditions, or those nearing the end of life. It provides clear instructions to medical personnel about your wishes regarding life-sustaining treatment, reducing the burden on your family and ensuring your preferences are honored. As a CPA, I often advise clients to consider the potential estate tax implications of long-term care costs when making these decisions.

Ultimately, having both an Advance Healthcare Directive and a POLST/DNR provides the most comprehensive protection for your healthcare wishes. It’s a proactive step that can bring peace of mind to you and your loved ones. I’ve been assisting families in San Diego with these matters for over 35 years, and I can attest to the value of thoughtful planning.

What is the role of a healthcare agent?

Your healthcare agent is the person you designate in your Advance Healthcare Directive to make medical decisions on your behalf if you are unable to do so yourself. It’s crucial to choose someone you trust implicitly and who understands your values and preferences. Your agent will have the authority to access your medical records, communicate with your healthcare providers, and make decisions about your treatment.

It’s important to have an open and honest conversation with your healthcare agent about your wishes, and to ensure they are comfortable carrying out your instructions. You should also provide them with a copy of your Advance Healthcare Directive and inform them of its location. In California, your agent is legally obligated to act in your best interests and to follow your wishes as outlined in your Directive.

Selecting a successor agent is also important, in case your primary agent is unable or unwilling to serve. The valuation of healthcare-related assets, such as long-term care insurance policies, can be a complex process, and a CPA can provide valuable assistance in this area.

How does a pour-over will work with an Advance Healthcare Directive?

A pour-over will is a type of will that directs any assets not already held in a trust to be “poured over” into the trust upon your death. While primarily focused on asset distribution, it can also reference your Advance Healthcare Directive, ensuring your wishes are known and respected during the probate process. It acts as a safety net, capturing any overlooked assets and ensuring they are distributed according to your trust’s terms.

The Advance Healthcare Directive focuses on your medical care while you are alive, while the pour-over will addresses the distribution of your assets after your death. Both are important components of a comprehensive estate plan, working together to protect your interests and ensure your wishes are honored. In California, the probate process can be complex and time-consuming, and a well-drafted pour-over will can help streamline the process.

Understanding the spendthrift provisions within your trust can also protect your assets from creditors and potential lawsuits, providing an additional layer of security for your beneficiaries. The April 1, 2025 implementation date for AB 2016 and the Small Estate limits is a critical factor to consider when reviewing existing estate plans.

What are exclusionary clauses and disinheritance protocols?

Exclusionary clauses are provisions within a will or trust that specifically exclude certain individuals from inheriting assets. Disinheritance protocols outline the steps you must take to legally disinherit someone, ensuring your wishes are upheld in court. While you have the right to disinherit anyone, it’s important to do so carefully and with legal guidance.

Disinheritance can be a sensitive issue and can lead to legal challenges. It’s crucial to clearly state your reasons for disinheritance in your will or trust, and to ensure the document is properly executed. In California, a judge may scrutinize disinheritance clauses, particularly if there is evidence of undue influence or fraud.

A well-drafted will or trust can minimize the risk of legal challenges and ensure your wishes are honored. The power of attorney durability, whether immediate or springing, is another important consideration when planning for incapacity. As a CPA, I often advise clients to consider the potential tax implications of disinheritance, such as gift tax liability.

What is the difference between a healthcare directive and a POLST/DNR in terms of legal validity?

Both Advance Healthcare Directives and POLST/DNR forms are legally valid documents in California, but they have different requirements for execution. An Advance Healthcare Directive typically requires two witnesses and must be signed by the principal. A POLST/DNR, however, requires the signature of a physician and may also require the signature of a healthcare agent.

It’s important to ensure both documents are properly executed to avoid legal challenges. California law has specific requirements for witness signatures and notarization. A POLST/DNR is typically portable and available to emergency medical personnel, while an Advance Healthcare Directive may need to be provided to healthcare providers. The Small Estate Threshold is currently $208,850 (effective April 1, 2025), and assets exceeding this limit are subject to formal probate.

Reviewing your plans before April 1, 2025 is crucial, as the new AB 2016 and Small Estate limits do not apply retroactively to deaths occurring before the effective date. The FinCEN 2025 Exemption for domestic U.S. LLCs is another important consideration for business owners.