Your Advance Directive Is Only Useful If Someone Can Find It

When I complete an estate plan for a client, I provide the original documents in an estate planning notebook. I generally recommend keeping that notebook somewhere secure, ideally in a fire-resistant box, and making sure the important people in your plan know where it is.

Your successor trustee should know. Your personal representative should know. If you have minor children, your nominated guardian should know. But there is one estate planning document that I think deserves different treatment:

Your Advance Directive for Health Care.

This may be a perfectly good place for the original. But it shouldn't be the only place your Advance Directive can be found.

A document nobody can find isn't much help in an emergency

An Advance Directive is designed for precisely the situation in which you may not be able to speak for yourself. It identifies the person you want making health care decisions for you and allows you to provide guidance about the care you would (or would not) want.

Oregon's Advance Directive form is specifically designed to let you identify a health care representative and communicate your values, beliefs, goals and wishes if you cannot express them yourself. That makes accessibility particularly important.

If you're unconscious in an emergency room, it isn't terribly helpful that a beautifully organized original Advance Directive is sitting in an estate planning notebook at your house. The medical team needs to know that the directive exists, who your health care representative is, and what it says.

Put it in your medical record

One of the best things you can do after signing your Advance Directive is simple:

Give a copy to your health care provider and ask that it be added to your electronic medical record.

Many health systems allow patients to do this electronically through their patient portal. For health systems using Epic, for example, MyChart can include an Advance Care Planning area where patients can upload documents such as advance directives and living wills. Some systems instead ask patients to send the document to their physician or medical-records department. The important thing isn't the particular software. The goal is to get the signed document into the medical record where your health care providers can find it.

I recently did this myself. I sent my signed Advance Directive and HIPAA authorization through my health system's patient portal and asked that they be added to my medical record.

In my case, it took about two minutes. I attached PDFs of my signed Advance Directive and HIPAA authorization and sent a short message:

“Hi, can you please have someone on your staff add my Advance Healthcare Directive and HIPAA release (both attached) to my records?”

That's it.

If your patient portal has a specific Advance Care Planning or Advance Directive upload feature, that's even better. If it doesn't, send a message to your physician's office or ask at your next appointment how to have the document added to your record.

Don't stop with your doctor

Your medical record isn't the only place a copy should exist. I generally recommend that clients also give a copy to the person they've named as their health care representative, and make sure that person actually knows what the client wants.

That conversation may be just as important as the document itself. Oregon's Advance Directive expressly encourages people to discuss the directive and their wishes with their health care representative so that the representative can make decisions reflecting those wishes. 

If you receive care through multiple health systems, it may also make sense to provide the directive to each of them. Some electronic health-record systems can exchange records between participating providers, but I wouldn't rely exclusively on that happening automatically. 

Where should everything go?

My basic recommendation after signing an estate plan is:

• Original estate planning documents: Keep them together in a secure, accessible location, preferably protected from fire or other damage. Make sure your successor trustee and other important fiduciaries know where they are.

• Advance Directive: Keep the original with your estate planning documents, but also get a copy into your electronic medical record and give a copy to your health care representative.

• HIPAA authorization: Consider providing this along with the Advance Directive so the people you've authorized can obtain medical information when necessary.

• After any update: Replace the old copies. An obsolete Advance Directive floating around can create exactly the kind of confusion good planning is supposed to prevent.

Estate planning isn't finished when the documents are signed

This is a good example of something I emphasize with clients: an estate plan isn't just a collection of documents. It has to work.

A trust that was never funded can create problems. A successor trustee who doesn't know where the documents are can create problems. And an Advance Directive that no one at the hospital can locate when it's needed can create problems. Signing the documents is important. Making sure the right people can find them is also part of the plan.