March 25, 2026

By Brooke Webber

Advance care planning decides what happens if you can’t speak for yourself; in situations like a stroke, an accident, or a sudden diagnosis.  Most separate it from estate planning. That’s a mistake.  You may have planned your assets, but the hardest decisions happen while alive: families agonize over care, what to continue, stop, or what you’d want.  Without your direction, they have to guess.

Let’s explore why advance care planning is often omitted from estate plans and what changes when it’s integrated.

Understanding advance care planning

An advance directive includes the legal designation of a health care agent, or proxy, and a living will, which outlines your care preferences.  The health care agent makes health care decisions only when you can’t make them yourself.

Documents alone aren’t enough. Without conversations, interpretations lead to crisis conflicts. Talk early, before urgency hits.  If you want a clear starting point for how these documents work together, there is a NIA guide that breaks it down simply.

Conrad Wang, Managing Director at EnableU, has spent years advocating for early conversations about healthcare preferences. “I think advance care planning empowers individuals to maintain control over their medical care, regardless of their current health status. When patients document their preferences clearly, healthcare providers can deliver care that truly aligns with their values and wishes. This planning benefits everyone involved, patients, families, and medical teams alike.”

Evidence backs him up.  A BMJ study found that advance care planning improved end-of-life care and increased family satisfaction, while reducing stress in surviving relatives.

Advance care planning and estate planning

Estate planning covers who gets the assets, who manages them and how they transfer.  Advance care planning covers medical decisions while you’re alive.  They intersect deeply.

That connection shows up in the data. Patients with advance directives had lower out-of-pocket costs – around $1,976.50 vs. $3,500.08 for those who don’t – while also tending to live longer, be better educated and more financially prepared. Care decisions reflect preferences and how resources are used.

Decision-makers matter too. Your financial power of attorney manages assets; your healthcare proxy handles medical choices. Misalignment pits one against the other: costs vs. care. Integration aligns them.

Legal considerations

Even strong plans fail if they’re legally invalid. Legal requirements differ by state: witnesses, notarization, and precise language. One error can void it, so be careful.

Bryan Henry, President of PeterMD, works closely with healthcare providers and patients navigating treatment decisions and the documentation that supports them. “Each state has its own requirements for witnessing and notarizing advance directives, and even small oversights can make a document difficult to enforce.”  You can certainly hire an attorney – and you should for estate planning purposes – but Five Wishes for health care decision-making meets state legal requirements, is written in everyday language, and is easy to understand and use.

To make your plan usable, focus on the basics. Here are the essentials:

• Use state-compliant forms like Five Wishes
• Follow proper signing requirements
• Keep your documents accessible
• Share copies with your proxy and health care providers
• Review after major life changes
• If undiscoverable or outdated, the plan collapses

Steps to get started

Start simply, no need for a full overhaul. Here are practical steps to begin:

• Define what matters most
• Choose your health care agent. It need not be a spouse or relative
• Talk to your family and doctor
• Align health care and financial decision-makers
• Share copies with key people
• Review these changes every 3–5 years or after changes like marriage, divorce, diagnosis, moving, or loss.

Here are some great resources to help get the conversation started:

Five Wishes:  A practical, values-focused document for families.  There are more than 44 million copies of Five Wishes in national circulation.

The Conversation Guide for Individuals and Families:  A guide to getting the conversation going.

POLST: Information for people with serious illness on turning wishes into medical orders.

Aging with Dignity’s resources can help you move from intention to action, with tools that center your values.

National Council on Aging: What Is Estate Planning? Key Steps to Protect Your Family and Finances

An estate plan without advance care planning has a real gap; one that emerges in emotional, time-sensitive moments. Start small: a talk, a note, aligned documents.

(Long Beach, California-based Brooke Webber is a passionate advocate for a people-first strategy in Human Resources.  Her major focus areas are workplace psychology and employee listening, where she has already accumulated five years of writing experience.)