Don’t Procrastinate About Picking a Health Care Agent

Disclaimer: Views and opinions expressed in Bob’s Blog are solely those of the author and do not purport to reflect the views and opinions of the Office on Aging or its staff. Posted January 8, 2024.

In a post several years ago, I wrote about the importance of

  • specifying what type of medical care you want in the event you had a serious illness and were incapable of letting doctors and other medical professionals know this on your own, and
  • designating someone (a family member or close friend) to do this for you.

I also indicated this was easier to do before you had a serious condition. You could do it in a relaxed manner at that time. Your family members could be present at this meeting. There would be no pressure on you to do it quickly.

At Aging: A Family Affair in November of 2023, I attended a session on “Making Healthcare Decisions Before the Storm Hits.”  In this session, Dr. Adam Tyson, the Medical Director of the Palliative Care Department at the University of Tennessee Medical Center talked about the importance of Advance Care Planning.

As I listened to him, I realized in my prior post I didn’t do a good job of stressing how important advance planning was. I also glossed over choosing the right person as a health care agent.

I want to correct that now.

The Annual “Wellness” Review

If you’re on Medicare and get an annual physical exam, your doctor may have someone on their staff do a “Wellness” review. During this, one of the things they talk about is Advance Care Planning.

They let you know how important it is to have someone act as your health care agent.  They also ask you if you have completed an Advance Directive for Health Care or a Five Wishes Living Will.

One thing you have to do is both the Advance Directive for Health Care and the Five Wishes Living Will is name a Health Care Agent to make decisions for you.   In the Advance Directive for Health Care, you can also designate an alternate Health Care agent.

If you want to see An Advance Directive for Health Care, please click here . You can check out a Five Wishes Living Will by clicking here. The Advance Directive for Health Care is free.  Many websites charge for the Five Wishes Living Will.  As you will see, It looks like you can complete one online for free at the website I linked to.

I Hate to Admit It – I Am a Procrastinator

Personally, I tend to avoid thinking about my own mortality, I also avoid thinking of what would happen if I had a stroke or developed Alzheimer’s. I tend to procrastinate and have not prepared an Advance Directive for Health Care or a Five Wishes Living Will for myself yet. I think many others may be just like me.

When the physician’s assistant is doing the “Wellness” review with me realizes this, she doesn’t spend much time talking about it. She also doesn’t really talk about picking a Health Care agent.

The Problem That Can Make Many Avoid This

Many articles I have read before writing this post say it’s best to sit down with your family long before any medical problems exist. That way you can have a casual discussion and go through the Advance Directive for Heath Care or the Five Wishes Living Will with them. At that time, you can talk about a health care agent and an alternate.

This assumes there are no problems in the family.  How does one have a casual discussion

when one or both of the parents have remarried and the adult children don’t get along with their step mom or step dad?

where a parent doesn’t get along with one or more of their adult children?

where the adult children don’t get along with each other?

Arguments can arise and feelings can be hurt

if the person chosen as the health care agent or alternate is not liked by the others, or

one person really wanted to be the Health Care agent or the alternate and was not chosen.

These Can be Avoided

Older people need to take these into account and anticipate what will happen at this meeting.  Most of these things can be worked out if they are anticipated ahead of time.

Most of the time, the spouse would be expected to be the agent or alternate unless they have a medical condition which would prevent this or the marriage is strained and there is a fear that the spouse would not follow the wishes of their partner.

If there is no spouse or if the spouse would not be a good choice, then one of the children would be a logical choice.  Here again, all of the children should concur with the choice.

If there are no spouse or adult children, a niece or nephew might be chosen.

If the person has brothers or sisters, they might not be a good choice because they may be at an age where they might have health issues themselves and may not be able to act an agent when the time comes.

It’s possible that an adult grandchild can be chosen as the agent.

If none of these family members or friends exist, a close friend may be chosen.  This person has to know what the person wants and agree to make decisions in line with their wishes.

The person selecting the agent or alternate needs to be aware that the person they would like as their Health Care agent may not want that role and may turn them down. They may be too emotionally attached to the person and don’t feel they would be able to make the decisions which may be required of them.

Annual Reviews of Advance Directives or Five Wishes

This Advance Care Directive should be reviewed on a yearly basis. Changes will need to be made if a person designated as the agent or alternate dies, has a stroke, develops Alzheimer’s or some other condition which would prevent them from acting as an agent.

This Can’t be Done in 2 or 3 Minutes

As you can see, this can be far more complex than it appears. It is not something that can be done in 2 or 3 minutes.

The Advance Care Directive approved for use here in Tennessee has the person name an alternate health care agent.  That is because if the person named as the Health Care agent is unavailable, the doctor or medical staff can contact the alternate.

What Happens If . . .

. . . you don’t have an Advance Care Directive for Health Care or a Five Wishes Living

Will at the time you are incapacitated and can’t make decisions on your own? It can get

really messy.

In Tennessee, there is a hierarchy as to who makes decisions for you. It is

  • your spouse (unless legally separated)
  • Your adult child
  • Your parent
  • Your sibling
  • Another adult relative
  • A friend who has exhibited special care and concern for you, knows your values, and is willing and available to act

As you can see, there can be problems here.

Your current spouse, if you are remarried, would make the decisions.  What if you have an adult child from a prior marriage?  They can start legal proceedings against your current spouse.

What if you wanted that adult child to make decisions rather than your spouse? You spouse would be in charge and your child couldn’t.

What if your only living relative is an adult son whom you haven’t spoken to for years?  Would he make the right decisions?

It’s in your best interest to keep this from happening by completing an Advance Care Directive ahead of time.

Other Forms

When you are thinking about an Advance Directive for Healthcare, there are certain other forms you might want to consider adding.

Do Not Resuscitate order (DNR)

This form simply states you do not want CPR or other life-support measures to be attempted if your heartbeat and breathing stop.

Do Not Intubate order (DNI)

This form tells the medical staff in a hospital or nursing facility that you do not want to be on a ventilator.

Do not Hospitalize order (DNH)

This form lets long-term care providers, such as nursing home staff, know you prefer not to be sent to a hospital for treatment at the end of life.

Out-of-hospital DNR order

This form alerts emergency medical personnel to your wishes regarding measures to restore your heartbeat or breathing if you are not in a hospital.

Physician Order for Scope of Treatment form

This form is signed by the person and their physician.

It is the physician’s active order set for the patient’s current medical condition, which also includes resuscitation and treatment preferences. It helps ensure that the wishes of a patient are followed even if the patient lacks capacity to make decisions.

Seriously ill or frail patients, especially those whose health care givers expect their remaining life span to be less than one year, are encouraged to complete a POST form.

The form takes the patient’s wishes and puts them into a physician’s order set that can be followed at any Tennessee health care facility as well as by first responders.

Organ Donation form

If you have not already done so, you may want to donate some of your organs to others in need of them. You can register on the Tennessee Organ and Tissue Donor Registry by clicking here.

A person does not need a lawyer to help complete Advance Care Directives.

Life Changes on a Regular Basis

It seems that as we get older, these changes occur more and more frequently.  People should review their Advance Care Directive and any of the other forms they may have in place on a yearly basis and update these as necessary.


If you have any comments on what you have read in this post, I would love to know them. Please email them to me. Also – if you have any ideas about subjects you would like to see discussed in future posts, please send me an email and let me know. My email address is