July 24, 2017  
Filed under Aging Parents

The next step in the planning process is an advanced care directive. 

“All Vermonters over the age of 18, and especially seniors, should do advance care planning so their wishes with regard to medical decision-making are known,” said Kellie Parks, communications manager at the VNA of Chittenden and Grand Isle Counties.

“Who will speak for them if they’re unable to speak for themselves due to a health crisis? What kind of treatments and interventions are in line with their wishes and values? It’s so important for families to have a conversation about their wishes and execute the necessary paperwork so their health care providers know what they want.”

The VNAs of Vermont have started an online toolkit called Start the Conversation at

The resource is intended to help Vermonters reflect on their end-of-life wishes, share those wishes with their loved ones, and lay them out legally in an advanced directive.

 “‘Advance directives’ are legal documents that allow you to plan and make your own end-of- life wishes known in the event that you are unable to communicate,” according to the Start the Conversation website. “Advance directives describe your wishes regarding the medical care and treatments you would like to receive if you are faced with a life-limiting illness.”

Vermont’s advanced directive forms also let you spell out your treatment goals and wishes, limitations on desired treatment, whether you want to donate tissue or organs and your funeral and remains preferences.

“It allows people not just to appoint a health care agent, but also give a little more specific information about what is important to them,” Bruzzese said. “Are there situations that would be unacceptable? Are there things you definitely would want to have done?”

Vermonters can access the forms through They can also access the forms through their hospital, home health agency or many local agencies on aging.

Bruzzese said advanced directives can be very personalized and individualized. You can fill out as much or as little of the form as you feel ready for, and some people even choose to dispense with the form and write their wishes freestyle.

“This is a one-size-fits-all form, but these decisions are anything but that,” Bruzzese said. “People can feel free to customize the form as they see fit to reflect their priorities and what matters most to them,” she said.

Jarrett said there are several schools of thought in the matter, but he does not recommend getting too detailed in an advanced directive.

“People’s wishes change over time, and you can never predict what a medical situation will be,” he said.

Bruzzese said she encourages people to look at an advanced directive as an evolving document they can update as their situation in life changes. Early on, they can cover basic wishes and goals.

Further down the road as people age or receive a terminal diagnosis, however, Bruzzese said they can work with their doctors to hash out medical orders—specific treatments they may or may not want to receive.

Jarrett also said it’s important to note that a do not resuscitate order is a separate document that must be signed by both a patient and their physician.

For any advanced directive to be legal, you must sign it in the presence of two adult witnesses. Any advanced directive form—like those from other states—is legal in Vermont as long as it is signed and witnessed, according to the Vermont Ethics Network website. You should give copies to your family, agent and physician. Doctors are required to follow your advanced directive wishes.

Jarrett said the state has a free advanced directive registry. Vermonters can send their forms in to the state, meaning doctors can immediately pull up their directive if needed.

“It’s a really good idea, and it’s free,” he said. “We do that for all our clients who are doing that kind that planning.”

Bruzzese said that because the registry is voluntary, it’s hard to have an idea of how many Vermonters have filled out advanced directives, but she said approximately 36,000 Vermonters have registered one. That number is steadily growing, she said, as the group broadens its reach and makes documents more accessible.


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