Five Wishes Document – Helping Seniors Age with Dignity

Five Wishes Document – Helping Seniors Age with Dignity

It’s never easy to think about or plan for the late stages, or even the end of one’s life. While this may be a difficult situation, your loved-ones need to have a clear understanding of your wishes so they can help carry them out. Fortunately, there is a document that is easy to use and written in plain English. It states your emotional, spiritual and personal needs as well as your medical wishes. It’s a short, easy to use, document consisting of check boxes, circle choices, or short sentences.

It is the most popular living will in the U.S. with nearly 20 million in use. That said, it is NOT a substitute for documents that are hospital specific including HIPPA releases, Living Wills, Advanced Directives, etc.

In the process of completing the Five Wishes you can talk with family, friends, doctors about:
• What you would like to happen if you become seriously ill or have a
catastrophic accident
• Your wishes so they won’t have to make the difficult decisions without
you to guide them
• Ensure your needs and wishes are met

The Five Wishes are:
1) The Person I Want to Make Health Care Decisions for Me When I Can’t
2) The Kind of Medical Treatment I Want or Don’t Want
3) How Comfortable I Want to Be
4) How I Want People to Treat Me
5) What I Want My Loved Ones to Know

Steps to Complete the Five Wishes:
1) Obtain the form; you can download it or call and order at:
2) Complete the form with the help of family, friends and physicians.
3) Sign the form in the presence of TWO witnesses – of whom one is NOT a
spouse or a blood relative – the form does NOT have to be notarized
in the state of Florida (if you are outside of Florida, check with your state)

Once you complete the form:

  • Talk to your medical surrogate or health care agent, physician, family members and others who care about you. Give them copies of your completed form.
  • Keep the original copy in a special place in your home. Tell your family and/or friends the location.  Do NOT put it in a safe deposit box.
  • Make sure your physician puts the fact that you have a Five Wishes document into your medical record.
  • Keep a copy of the Five Wishes in your automobile; also bring a copy if you go to a hospital, nursing home or assisted living facility. Ask that it be put into your medical record.
  • Create a list of the people and places that have copies.

Finally, keep in mind that laws and procedures change.  If you have a specific question or issue, talk to a licensed medical or legal professional for advice and guidance.