When to Start Advance Care Planning

It’s never too early to start advance care planning. Everyone 18 years of age and older should have advance care planning conversations and document wishes in an advance directive because medical crises can happen at any age. When an adolescent turns 18 years old, the parent is no longer the decision maker and the law prevents healthcare providers from discussing issues with anyone other than the “patient” unless the patient gives permission or there is an appropriate advance care plan. Without the proper documentation, your family may have to go to court to be included in treatment decisions.

Review your advance care plan regularly if your health or situation changes which may include:

Serious Medical Diagnosis

While you can implement an advance care plan at any point in life, it is important to make updates upon receiving a serious medical diagnosis. Certain diagnoses may change how you would approach medical treatment and live your life. It would be beneficial to revise your advance care plan to reflect how you want to be treated with a new prognosis.

‘Serious illness’ is a condition that carries a high risk of mortality, negatively impacts quality of life and daily function, and/or is burdensome in symptoms, treatments, or caregiver stress. There is no single definition of what constitutes a “serious illness,” but there is no doubt that it raises serious challenges for the individual, their loved ones, and caregivers. The illnesses that the Centers for Disease Control and Prevention (CDC) attribute to the leading causes of death and disability include: heart disease, cancer, chronic lung disease, stroke, Alzheimer’s disease, diabetes and chronic kidney disease.

Serious illness affects every person differently. Some chronic diseases are disabling or require major lifestyle changes. Other diseases are managed over time. Most people diagnosed with a serious illness will live for several years with their condition.

In most cases, serious illness affects every aspect of a person’s life. This can include physical and mental health, family, social life, finances, and employment. Serious illness can also shorten a person’s life span. This is especially true if the disease is not diagnosed and treated properly.

The main goal – and challenge – is to ensure that you maintain a high quality of life. In some cases, providing more medical care can sometimes harm quality of life, and it can be difficult to determine what is appropriate. Any care decisions that are made should respect your wishes and allow you to have the best quality of life for the longest time available. Individuals with serious illness should have the opportunity to make their wishes known in a way that clearly informs doctors and family before interventions are made that may do little to help, and could even diminish quality of life. At least 12 million adults and half a million children in the United States are living with a serious illness. By 2035, the number of people over age sixty-five, 81% of whom live with multiple chronic conditions, will approach 78 million.

For more information on serious illness, visit:


Decline in Functionality

Your values may change if your functional abilities start to decline. Review your advance care plan and make any changes to reflect your current preferences and goals of care.

Death of a Loved One

The death of a loved one can result in personal reflection on what matters most in life. This may cause changes in decisions for future medical care. Update your advance care plan to mirror what is currently most important to you.


Most people assign their spouse as their health care representative. Individuals who go through a divorce should consider revisiting who has this responsibility to avoid possible conflicts.

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