Many individuals may choose to complete Advance Directives so that they can write down their wishes for end-of-life care.  Advance Directives can also be helpful in preparing for other health care needs that people might face, including dementia.



ADs and dementia

For many families, having a loved one suffering from dementia can provide challenging situations.  It can be very difficult to get the individual the care that they need. Consider this example about Helen and her family:


Family members report that Aunt Helen, who has been diagnosed with dementia, has become increasingly disoriented, delusional, and combative. She needs care that they cannot provide for her at home (or in the assisted living facility or nursing home where she is living).


Helen meets the criteria for placement in a psychiatric hospital and could truly benefit from treatment there, but she clearly lacks the capacity to make an informed decision about hospital admission and mental health treatment. The family members are correctly advised that the only way to get Helen the hospital-level psychiatric care that she needs is to seek involuntary commitment for her.


​The family members go to the court to get Aunt Helen to the hospital through the involuntary commitment process.  To their horror, they see Aunt Helen handcuffed and taken into custody by law enforcement officers, as is required by safety protocols.  As Aunt Helen and her family go through the procedures and proceedings to help her get the help that she needs, they feel like they are taking away her dignity.  Her family feels guilty, angry, and confused.


Up until a couple of years ago, there was no way to avoid the legal steps that Aunt Helen had to go through.  However, after changes were made to the Health Care Decisions Act (HCDA) in 2009, Advance Directives became a way that a family could skip this difficult step and still get their loved one the care that they need.  The HCDA now allows a person to give his/her agent the power to admit him/her to a psychiatric facility for treatment. 



ADs, dementia, and non-mental health care

Even in cases where dementia symptoms do not call for psychiatric treatment, the progression of dementia means that all individuals with such symptoms will reach a point when they can no longer make informed decisions about their care.  In other words, they will be considered incapacitated, which is exactly the type of situation for which ADs are designed.  Someone, such as a family member, will have to take on decision making for the person with dementia.  Completing an AD is a way to pick the best person to be that surrogate decision maker, and to give that person important information about preferences and instructions.

Advance Directives and Planning for Dementia