Obstructive sleep apnea (OSA) is a sleep disorder that occurs when a blockage of the airway prevents you from breathing during sleep. OSA blockages can be caused by your tongue or relaxed throat muscles. If left untreated, OSA is linked to daytime sleepiness and an increased risk of anxiety, diabetes, hypertension and stroke.

The primary treatment for people with moderate or severe OSA is a continuous positive airway pressure (CPAP) machine. This device keeps your airway open by pumping air through a mask that is worn over the mouth and/or nose when sleeping. Losing weight, giving up smoking and limiting alcohol can all help ease the symptoms of obstructive sleep apnea such as snoring.

However, many individuals have difficulty tolerating CPAP machines and will not use one because they are noisy and uncomfortable. Fortunately, newer CPAP machines have become smaller and quieter, with more comfortable options available. For some people with mild to moderate OSA, less invasive alternatives to CPAPs may be worth considering. Here are several treatments to ask your doctor about.

Dental device: This is designed to move the jaw so that the tongue shifts toward the front of the mouth to help keep the airway open. It is one of the primary alternatives to CPAP machines and can also be used alongside a CPAP device to help make severe obstructive sleep apnea milder.

A dentist who specializes in sleep medicine will be able to customize and fit it to help your breathing without causing harm to your bite or teeth. These custom-made oral appliances can cost between $2,000 and $4,000 but may be covered by insurance.

There are more affordable options available online to treat snoring, but experts say these may not help with OSA and could move teeth out of place or cause jaw issues if they are not properly fitted.

Position therapy: For some, sleeping on the back can make OSA dramatically worse. In these cases, switching to side sleeping – perhaps using pillows or a tennis ball attached to the back of a shirt – can sometimes help.

Tongue trainer: In 2021, the Food and Drug Administration approved a tongue-stimulating device for mild sleep apnea. These devices are worn for 20 minutes a day for six weeks and then 20 minutes twice a week thereafter.

Surgery: Those who cannot tolerate CPAP machines could have upper airway surgery to reduce the size of their soft palate or other tissue in their throat. However, surgery could have serious potential complications and results cannot be guaranteed or reversed. Generally, surgery should not be a first-line treatment.

A newer option is a surgically implanted device referred to as an upper airway stimulator. The implant stimulates a nerve that moves your tongue to keep your airway open and can be removed if it is not tolerated. This option should also be tried only if someone is unable to use a CPAP device.

Drug therapy: A study recently published in the New England Journal of Medicine, found that tirzepatide – the main ingredient found in type 2 diabetes medication Mounjaro and weight loss treatment Zepbound – helps reduce symptom severity by almost two-thirds in adults with obesity and obstructive sleep apnea. Ask your doctor about this option.

For more information on diabetes and prediabetes or to find help, join a lifestyle change program recognized by the CDC (CDC.gov/diabetes-prevention). These programs offer in-person and online classes in more than 2,100 locations throughout the U.S.

1. IRA Charitable Rollover — The IRS refers to the IRA charitable rollover as a qualified charitable distribution (QCD). An individual over age 70½ is permitted to make a transfer directly from his or her IRA custodian to a qualified charity. The transfer is not included in taxable income. If the IRA owner is over age 73, the distribution may fulfill part or all of the IRA owner’s required minimum distribution (RMD).

Because many individuals have invested their IRAs in stocks, bonds or other securities, it may be necessary to exchange the IRA stock or bond accounts for a money market fund prior to the distribution. Most custodians require a QCD to be paid from a money market account or similar fund.

There are some limits for the IRA charitable rollover. The IRA owner must be at least age 70½ and the maximum transfer for 2024 is $105,000. The transfer must be to a qualified exempt charity and may be for a designated purpose or field of interest fund. However, it may not be to a donor advised fund (DAF) or supporting organization (SO). In addition, the donor may not receive a charity dinner or other event ticket that involves a partial benefit to the donor. The entire QCD must be for a qualified charitable purpose.

2. Gifts of Cash — Individuals who itemize deductions may deduct 2024 gifts of cash up to 60% of their contribution base, which is usually your adjusted gross income (AGI). A couple with $100,000 in income may give and deduct up to $60,000 this year. While the 60% of AGI limit is substantial, some generous individuals give more than this and may carry forward and deduct the excess gift amounts during the next five years.

3. Gifts of Land — With substantial increases in value for real property, many donors will find that a gift of appreciated property is attractive. A gift of appreciated land provides two benefits for the donor. First, the donor may receive a charitable deduction for the fair market value of the land. Second, the charity is tax-exempt and therefore the donor is able to bypass tax on the capital gain. If the donor purchased development land ten years ago for $50,000 and it is now worth $250,000, the donor would pay capital gains tax on $200,000 if he or she sold the property. However, by giving the land to charity, the donor may receive a deduction for the $250,000 in value and bypass the tax on the $200,000 of potential gain. Because the donor is receiving both the deduction and capital gain bypass benefits, this type of charitable deduction is permitted for up to 30% of a donor’s adjusted gross income (AGI). If the gift value is more than this limit, it may be carried forward for five years. For example, Mary Smith has adjusted gross income of $100,000 this year and makes a gift of appreciated land with fair market value of $80,000. She can deduct $30,000 this year, carry forward $50,000 and deduct that amount over the following five years.

Editor’s Note: Many donors make their largest gifts in November or December. This is a good time to plan and consider options for end-of-year gifts.

According to the Centers for Disease Control and Prevention, as of 2021, more than 38 million Americans have diabetes, and 97 million are prediabetic. The symptoms of type 2 diabetes are often so subtle that many people overlook them, making regular testing important. Here is what you should know.

Type 2 diabetes is a disease that develops slowly over decades. Most people have prediabetes for a long time before the disease progresses to diabetes and, once at the diabetes stage, it continues to progress gradually.

Diabetes occurs when your blood glucose, also called blood sugar, is too high. Elevated blood sugar levels can damage blood vessels and affect circulation, putting you at risk for a host of ailments, from a heart attack and a stroke to blindness, kidney failure and nerve damage.

Signs and Symptoms

The earliest signs of diabetes are usually subtle, including urinating more frequently (often at night), being more thirsty and hungrier than usual, weight loss without trying, feeling very tired, having dry itchy skin and blurry vision. Symptoms of advanced diabetes and long-term damage may include cuts or sores that heal slowly, having more infections than usual and pain or numbness in your feet or legs.

Who Should Get Tested?

Because prediabetes typically causes no outward symptoms and the signs of early type 2 diabetes can easily be missed, a blood test is needed. Everyone 45 years or older should consider getting tested for diabetes, especially if they are overweight.

If you are younger than 45 but are overweight, have high blood pressure, a family history of diabetes, or belong to an ethnic group with a higher risk (such as Latino, Asian, African or Native American), you should get checked too. To help you determine your risk for diabetes, the American Diabetes Association (ADA) has a quick, online risk test you can take for free at Diabetes.org/risk-test.

Diabetes Tests

There are three different tests utilized to diagnose diabetes. The most common is the “fasting plasma glucose test,” which requires an eight to 12-hour fast before you take it. There is also the “oral glucose tolerance test” that analyzes how your body processes sugar and the “hemoglobin A1C test” that measures your average blood sugar over the past few months.

Most private health insurance plans and Medicare cover diabetes tests. If you cannot visit your doctor to get tested, an alternative is to go to the drug store, buy a blood glucose meter and test yourself at home. The cost for the device is in the range of $15 and $30, with additional costs for the test strips.

If you find that you are prediabetic or diabetic, you should visit your doctor to develop a plan to get it under control. In many cases, lifestyle changes like losing weight, exercising, eating a healthy diet and cutting back on carbohydrates may be all you need to do to get your diabetes under control. For others who need more help, many medications are available.

For more information on diabetes and prediabetes or to find help, join a lifestyle change program recognized by the CDC (CDC.gov/diabetes-prevention). These programs offer in-person and online classes in more than 2,100 locations throughout the U.S.

The majority of traditional IRA owners with larger IRA balances take the RMD during the months of October, November and December. Because many individuals with larger IRAs do not require funds immediately for living expenses, by delaying an RMD until the end of the year, they benefit from additional tax-free growth in the IRA.

Fortunately, the IRA charitable rollover will qualify for the donor's RMD. The IRS term for an IRA charitable rollover is a qualified charitable distribution (QCD). Your IRA custodian may also use this term.

There are five donor profiles for IRA charitable rollover gifts. The first are the convenience donors who appreciate the simplicity and ease of using this method for their end-of-year contributions. The second is the generous donor, who wants to give past the 60% of AGI deduction limit. The third is a major donor. This person may be a generous individual who is looking for a favorable opportunity to make a major gift. Fourth, the Social Security recipient may reduce taxes with an IRA rollover gift. Finally, a standard deduction donor will benefit from a direct IRA to charity gift.

Convenience Donor

Many IRA owners delay taking IRA withdrawals until October, November or December each year. As the individual approaches the end of the year, he or she will need to make decisions. If an IRA owner is actively making gifts to charity during the year, then it may occur to him or her that this is a good opportunity to make a gift.

Convenience donors may contact their IRA custodians to arrange for an IRA charitable rollover. There is no charitable income tax deduction, but also no inclusion in federal taxable income. It is simply a very convenient way to help their favorite charity.

Generous Donor

Some very generous individuals are already giving up to the 60% of adjusted gross income level. This is the maximum level under IRS rules to deduct cash gifts each year. Any gifts over this limit may be carried forward and deducted over the following five years. Some generous donors may also have a large IRA. Since they frequently live at a moderate level in proportion to their income and assets, they may not actually need all of their IRA.

If there is a desire to give more, they can give up to 60% of adjusted gross income from their regular assets and then make "over and above" gifts from their IRA. Some generous donors may in effect give nearly 100% of income per year through this method. Since the IRA rollover is not included in taxable income, it will have no impact on their regular income and other charitable gifts.

Major Donor

Board members, trustees and other major donors frequently have large IRAs. As the rules have continually become more favorable for IRAs and required withdrawals have been reduced, large IRAs will continue to grow. Over longer periods of time, there are occasional market dips, but the longer-term trend is positive and large IRAs will continue to increase in value.

For many professionals and business owners, the IRA may even become the vast majority of the estate. They have a need to do some "asset balancing" or there may be major future income tax problems. Therefore, it may be desirable for the major donor to give up to $105,000 in 2024 to charity from his or her IRA. This has the advantage of "balancing" the estate assets.

In addition, there may be income tax benefits. If the donor were to take the IRA distribution into his or her own personal income, there are several types of exemptions that are phased out at higher income levels. Thus, it may actually be preferable to make the gift directly from the IRA rather than making a charitable gift from regular income.

Social Security Donor

Social Security is subject to two levels of taxation. For donors who have income in excess of the first level, 50% of Social Security is taxed. For donors with income in excess of the second level, up to 85% of Social Security income may be subject to tax.

Withdrawing an amount from an IRA will potentially cause your income to increase from the 50% taxable bracket to the 85% Social Security taxable bracket. Even though the withdrawn amount is given to charity and deducted, there still is increased tax on your IRA. Thus, by making the transfer directly to charity, many Social Security recipients will save income taxes.

Standard Deduction Donor

Many seniors do not have a mortgage and their medical deductions are less than 7.5% of adjusted gross income (AGI). Thus, they may not have a sufficient level of deductions to itemize and choose instead to use the standard deduction.

If this donor withdraws $1,000 from his or her IRA and then gives it to charity, there is $1,000 of increased income with no offsetting charitable deduction, since the standard deduction is taken. Therefore, it will be preferable for all donors who are taking a standard deduction to make IRA rollover gifts directly to charity and avoid the additional income tax.

Engaging an attorney can be costly, whether you require assistance in drafting a will or a contract, or if you are confronted with a legal issue or predicament. Most lawyers today charge anywhere between $200 and $400 an hour. Fortunately, many different programs and organizations provide free or low-cost legal advice, as well as assistance in finding an affordable attorney. Here is where to look for help in your area.

Legal Aid: Directed by the Legal Services Corporation, Legal Aid provides free legal assistance to low-income individuals. Each community program will differ slightly in the services they offer and income qualifications. Visit LSC.gov/find-legal-aid to locate a program near you.

LawHelp: Powered by Pro Bono Net, a national nonprofit organization, LawHelp.org is a resource that will help you locate free legal aid near you, find answers to your legal questions or assist in filling out legal documents. These free services are for people with low to moderate incomes.

Free Legal Answers: This is an online program created by the American Bar Association that connects low-income clients with volunteer lawyers who agree to provide free legal advice online. This service does not answer criminal law questions and is not available in every state. See ABAfreelegalanswers.org to look for a program in your state.

Senior Legal Hotlines: There are approximately 30 states that offer legal hotlines for those over age 60 to access free legal advice over the telephone. To find out if this service is available in your state, go to ProSeniors.org and click on “Resources,” followed by “U.S. Senior Legal Hotline Directory.”

Senior Legal Services: Coordinated by the Administration on Aging, this service may offer free or low-cost legal advice, legal assistance or access to legal representation for people over the age of 60. Your Area Agency on Aging can tell you what is available in your community. Call the Eldercare Locator at 800-677-1116 to get your local number.

Local Law Schools: More than 200 law schools across the country have pro bono programs that offer free legal assistance provided by law students, who are supervised by law professors. See AmericanBar.org/groups/center-pro-bono – scroll down and click on “Directory of Law School Public Interest and Pro Bono Programs” to locate a program near you.

Pension Rights Center: This is a nonprofit consumer organization that provides free legal assistance for problems with a pension, 401(k) or other retirement plan. Visit PensionRights.org/find-help to search for help in your state.

Stateside Legal: For military members, veterans, and their families, StatesideLegal.org provides access to free legal information and legal assistance in your area.

National Disability Rights Network: This is a nonprofit membership organization that provides legal assistance to people with disabilities through their Protection and Advocacy System and Client Assistance Program. If you are disabled, visit NDRN.org to find help in your state.

Other Options: If you cannot get help from one of these programs, or find that you are not eligible, another option is to contact your state or local bar association to ask if there are any volunteer lawyer projects in your area or if they can refer you to an affordable lawyer. To contact your state or local bar association, go to FindLegalHelp.org.

Savvy Living is written by Jim Miller, a regular contributor to the NBC Today Show and author of "The Savvy Living” book. Any links in this article are offered as a service and there is no endorsement of any product. These articles are offered as a helpful and informative service to our friends and may not always reflect this organization’s official position on some topics. Jim invites you to send your senior questions to: Savvy Living, P.O. Box 5443, Norman, OK 73070.

There are several places early retirees can find health insurance coverage before Medicare kicks in, but your options will depend on your income level, your health care needs and the length of time you need coverage.

Affordable Care Act: For most early retirees who are not yet eligible for Medicare, the Affordable Care Act (ACA) health insurance marketplace, also known as Obamacare, is the best option for getting comprehensive health coverage. Coverage will not be denied or cost more for preexisting health conditions.

If your income falls between 400% to 100% of the poverty level (or to 138% in states with expanded Medicaid coverage) after you retire, you will also be eligible for a subsidy that will reduce your monthly premiums. In 2024, 400% of poverty level is $60,240 for one individual or $81,760 for a married couple. Those with incomes below 100% of poverty level (or 138% in Medicaid expansion states), will qualify for Medicaid. For those with household incomes above 400% of poverty level, the ACA also provides subsidies to ensure premiums do not exceed more than 8.5% of their income for a benchmark policy.

To see how much subsidy you are eligible for, use the subsidy calculator at https://www.healthcare.gov/lower-costs/. To shop for ACA plans in your state, visit HealthCare.gov or call 800-318-2596. For extra help, contact a certified agent or broker at HealthCare.gov/find-assistance.

COBRA: Another temporary health insurance option you may be eligible for is the Consolidated Omnibus Budget Reconciliation Act (COBRA). Under this federal law, if you work for a company that has 20 or more employees, you can remain on your employer’s group health plan for at least 18 months – but could last up to 36 months. It is important to note that with COBRA, you will pay the full monthly premium yourself, plus a 2% administrative fee.

For more information, talk to your employer’s benefits administrator or contact the Employee Benefits Security Administration at Askebsa.dol.gov or call them at 866-444-3272.

If the company you work for has fewer than 20 employees, you may still be able to get continued coverage through your company if your state has “mini-COBRA.” Contact your state insurance department to see if this is available where you live.

Short-Term Health Insurance: If you cannot find an affordable ACA plan and COBRA is too expensive, another possible option is short-term health insurance. These plans, which are not available in every state, are more affordable, basic health plans that provide coverage for up to three months with a one-month extension available. Please note that short-term plans do not need to comply with the ACA so they can deny coverage, exclude preexisting conditions and may not cover prescription drugs.

Healthcare sharing ministries: If the previously listed options do not work for you, another temporary solution could be healthcare sharing ministries (HCSM). These are cost-sharing health plans in which members – who typically share a religious belief – make monthly payments to cover expenses of other members, including themselves.

HCSMs are less expensive than paying full out-of-pocket costs for traditional health insurance but be aware that HCSMs are not health insurance. They do not have to comply with the consumer protections of the ACA, and they can also reject or limit coverage for having pre-existing health issues and limit how much you will be reimbursed for your medical costs. Preventive care is also typically not covered either.

Savvy Living is written by Jim Miller, a regular contributor to the NBC Today Show and author of "The Savvy Living” book. Any links in this article are offered as a service and there is no endorsement of any product. These articles are offered as a helpful and informative service to our friends and may not always reflect this organization’s official position on some topics. Jim invites you to send your senior questions to: Savvy Living, P.O. Box 5443, Norman, OK 73070.

When it comes to choosing a walker, there are several styles and options to consider, but finding the best fit for your parent will depend on their abilities and where they will be using it. Here are some tips that can help you choose.

Types of Walkers

There are three basic types of walkers on the market today. To help your parent choose, consider how much support they will need. You should also visit a medical equipment store or pharmacy that sells walkers to test the different types. To locate a nearby equipment supplier, search Medicare’s directory available at Medicare.gov/medical-equipment-suppliers.

Here are the different types of walkers to choose from:

Standard walker: Considered the most basic style, this walker has four legs with rubber-based feet (no wheels), is very lightweight, about 5 to 6 pounds, and typically costs between $30 and $100. This type of walker must be picked up and moved forward as you walk, so it is best suited for individuals who need significant weight-bearing support or who are walking very short distances.

Two-wheel walker: This type has the same four-leg style as the standard walker except it has wheels on the two front legs that allow you to easily push the walker forward without lifting, while the back legs glide across the floor providing support while you step forward. These are ideal for people with balance issues and are priced between $50 to $250.

Rollator: A rolling walker has wheels on all (three or four) legs. Four-wheel rollators typically come with a built-in seat, basket and hand-breaks. This style is best suited for people who need assistance with balance or endurance inside or outside the home. Some rollators even come with pushdown brakes that engage with downward pressure and lock if you sit on the seat. If your parent needs to navigate tight spaces at home, three-wheel rollators provide good maneuverability, but without a seat. Rollators typically run between $55 and $650.

Other Tips

After deciding on the type of walker, there are additional factors to consider to ensure that the walker meets your parent’s needs. The walker’s height must be adjusted appropriately. To find the correct height, your parent should stand with their arms relaxed at their sides and adjust the walker so that the handgrips line up with the crease on the inside of their wrist.

You should also verify that the walker’s weight capacity will support your parent, and if they choose a four-wheel rollator, that their body fits comfortably between the handgrips when sitting. Heavy duty (bariatric) rollators with higher weight capacities, bigger wheels and wider seats are also an option.

Your parent should also test the handgrips to make sure they are comfortable and that the walker folds up for easier storage and transport. Depending on where your parent plans to use the walker, there are accessories that can be added for convenience such as food tray attachments, tote bags for carrying personal items, oxygen tank holders and tennis ball walker glides that go over the feet of a standard walker to help it slide more easily across the floor.

Lastly, if a walker is medically necessary, consult with your parent’s doctor or a physical therapist. If a walker is prescribed, Medicare will cover 80% of the rental or purchase price.

Senior Medical Planning

There are three important background areas that you should learn about before entering into senior medical care. These are the medical oath and principles of your care providers, the rules created by Congress to ensure your medical information is protected and the decisions by your state on the specific document that you use to convey your wishes.

Doctors will frequently follow a set of principles that were originally called the Hippocratic Oath. The first oath was written by Hippocrates, a Greek doctor who is considered the father of modern medicine.

A modern version of the Hippocratic Oath typically states, "To practice and prescribe to the best of my ability for the good of my patients." Following this principle, your doctor will attempt to restore you to good health.

Because of modern improvements in medicine, it is possible to prolong your life through the use of ventilators, intravenous feeding and other devices. While you certainly want your doctors and nurses to provide very good care, you may also need to offer some guidance on how extensively your family and doctors should use modern technology to prolong your life.

A second major area for you to understand is called HIPAA. The Health Insurance Portability and Accountability Act (HIPAA) was passed by Congress in 1996. It is designed to provide protection for you and to keep your health information private.

Under the HIPAA rules, you have the right to see your health records, but you must give written permission before your records are released to other individuals. The information provided by doctors or nurses about your care, medications or other personal information is protected. However, you will want to be certain that your designated healthcare proxy (the person who will assist in making healthcare decisions) has the right to review these records. You should sign a HIPAA release form in order to enable your advisors to give proper recommendations to your doctors and nurses.

Finally, you must understand the specific documents of your state. Some states use an advance directive in which you choose a combination of a durable power of attorney for healthcare and a living will. Other states have separate documents. It is very important that you use the appropriate document tailored for the laws of your state.

The Advance Directive

Your first key advisor is the person who will make your medical decisions if you are incapacitated. This individual is frequently called the healthcare proxy. He or she is your agent and holds your durable power of attorney for healthcare. Normally, you will select primary and secondary persons as your healthcare proxy agent.

You will want to list the persons, their addresses and phone numbers so they can be easily contacted. Your secondary healthcare proxy will assume the primary role if the first person is unable or unwilling to serve.

Part of your advance directive will also explain the level of authority that you have given. Your healthcare proxy usually does not have the authority to make decisions unless, in the view of your doctor, you are no longer able to make decisions yourself. However, many forms allow you to sign and empower that person immediately. The authority of your healthcare proxy may also extend after you pass away so that he or she can make appropriate decisions at that time.

Your healthcare proxy may be called upon to make significant decisions for your care. For example, it may be necessary to decide whether or not to use morphine or other types of pain medication. If the decision is to make use of morphine, then a second decision will be made on the use of a low dose or a high dose. With a lower dose of morphine or other types of pain medication, you may have greater clarity of mind but may be less comfortable. If you receive higher doses of medication, you may not be as clear-headed, even though you are at a higher comfort level. These decisions can only be made based on your condition at a given time, but they do directly impact the quality of your life in that circumstance.

A healthcare proxy may also be called upon to make very significant decisions about the hospital, nursing home or other care facility and the level of treatment. For example, some seniors have suffered broken hips or limbs at a time when their demise was near. A healthcare proxy will need to make decisions about the appropriate level of care or treatment under those circumstances.

A second section of an advance directive allows you to give counsel on the level of measures and technology that will be used to prolong your life. If you have an incurable or irreversible condition that will result in your death within a relatively short time, there are medical devices that can significantly prolong your life.

These are sometimes referred to as "heroic measures." If you desire all reasonable measures to be taken, you can generally request that care. If you do so, your life may be extended to the greatest extent possible under "generally accepted healthcare standards."

Your healthcare guidelines expressed in your advance directive will discuss your preferred level of nutrition and hydration. If you prefer to receive nutrition and hydration through intravenous methods, you may specifically request those options.

It is helpful for medical providers to have some level of direction for your pain management. If you prefer a higher level of pain management even though that gives you less clarity of thought, you may so indicate.

A third, fairly typical section of the advance directive covers donation of organs and designation of your primary doctor. If you would like to donate specific organs or designate specific purposes for the use of your body, you may identify the particular organs or discuss purposes. Common purposes include transplantation, therapy, research and education.

Advance directives and living wills may, under state law, be witnessed in a manner similar to the witnessing of your will. Some states require two witnesses or a notary to witness your advance directive. Check with your state law to make certain that you have complied with those requirements. A helpful website with state law requirements is www.caringinfo.org. It is maintained by the National Hospice and Palliative Care Organization and seeks to improve care at the end of life.

Physician Orders for Life-Sustaining Treatment (POLST)

A Physician Order for Life-Sustaining Treatment (POLST) is a medical order signed by your doctor or a medical staff person as authorized under your state law. While the name and provisions may be different in some states, the POLST option is generally available nationwide. If you have a serious illness or may pass away within one year, you may want to ask your doctor to sign this medical order.

The POLST typically covers cardiopulmonary resuscitation (CPR), medical interventions and nutrition. You may choose to have CPR or select “Do Not Resuscitate (DNR).” Your medical interventions may include full treatment to prolong your life, selective treatment that avoids burdensome procedures or comfort-focused treatment. Nutrition can be maintained long-term with feeding tubes, for a trial period or you may select no artificial means of nutrition.

All of these decisions should be made in consultation with your doctor. Both your doctor and you or your healthcare proxy must sign the POLST. Your POLST may reflect your values, religious beliefs and goals for care.

Even if you have a POLST signed by your healthcare provider, you still need an advance directive. The advance directive appoints your healthcare proxy (primary and secondary) and covers many medical circumstances not covered by the POLST. Everyone should sign an advance directive, while those who are seriously ill may benefit from a POLST.

Action Steps

After completing your living will or advance directive, you will sign and typically have witnesses for your original document. Prepare several copies of your advance directive. You will want to give a copy to your healthcare agent, your family, clergy, your doctors and other advisors who may be involved in assisting with your medical decisions.

At any time you may revoke the living will or advance directive. It generally is best to revoke the entire document and complete a new document. If you attempt to amend different parts of the advance directive, there is a risk that you may sign provisions that conflict or are inconsistent. If you are in need of urgent care or treatment, you do not want any conflicting provisions in your living will or advance directive.

Your living will or advance directive is a very important part of your personal planning. It is designed to help you receive the best possible care at the end of your life and still comply to the greatest extent with your personal healthcare preferences.