End-of-life planning

You know what you want.
Your family is guessing.

A good death is not a failure — it is a plan. Most people have clear opinions about how they want to die. Almost none have written them down. This is the 20-minute conversation that changes that.

Start the conversation — free

No account · Works in all 50 states · About 20 minutes

70% of people say they want to die at home. Only 30% do. The gap is not medical. It is a conversation that never happened.

Quality of death is a measurable outcome. The US ranks 43rd.

Not for lack of technology. For lack of honest conversation and documented wishes.

70%
want to die at home, on their own terms
30%
actually do — a gap driven by silence, not medicine
43rd
the US ranking in quality of death — not for lack of technology

What an advance directive actually is

An advance directive is a legal document that tells your medical team what you want — and what you do not want — when you cannot speak for yourself. It is not just for the elderly. It is for anyone who has opinions about their own care.

It answers two questions: Who should make decisions for me if I cannot? And: What do I want those decisions to be?

It takes about 20 to 30 minutes to complete. It works in all 50 states. It is free to create. The hardest part is starting.

Know the difference

Three documents. Three different jobs.

"Advance directive" is an umbrella term. Most people need all three of these — they cover different moments and different decisions. None takes more than 20 minutes to complete.

Living Will — your values and treatment preferences

A living will records what you want — not who decides, but what the decision should be. It tells your medical team whether you want CPR, mechanical ventilation, artificial nutrition, or aggressive intervention if there is no reasonable hope of recovery. It is a statement of your values in language that guides clinical decisions.

When it activates: When you are incapacitated and cannot speak for yourself — typically in a hospital or emergency setting. It does not apply while you can still communicate.
Completion rate: Roughly 37% of US adults have completed any advance directive (Rao et al., JAMA 2014; Kaiser 2023). Completion doubles with one structured conversation.

Healthcare Proxy / HCPOA — who decides when you cannot

A Healthcare Power of Attorney (HCPOA) — also called a healthcare proxy or healthcare agent — names a specific person to make medical decisions on your behalf. This is separate from a financial POA. Your proxy does not override your living will; they interpret it, handle edge cases, and advocate for your wishes with the care team.

Choose carefully: The right proxy is someone who can hold your wishes above their own grief. Proximity and family rank are less important than their ability to say the hard thing in a hard moment.
If you die without one: Decision authority follows state law — typically spouse, then adult children by majority vote. Disagreement among children is one of the most common triggers for family estrangement after a death.

POLST — physician orders for serious illness

A POLST (Physician Orders for Life-Sustaining Treatment) is different from the others: it is a medical order, signed by a physician, that is immediately actionable in a crisis. EMS responders and ER staff are legally bound by it without needing a physician to re-evaluate. It typically covers CPR, mechanical ventilation, and transfer to the ER. It is appropriate when someone has a serious illness, frailty, or a life expectancy under a year.

Who needs one: POLST is not for healthy adults — it is for people with serious illness or advanced age where a crisis is plausible. A living will is for everyone; POLST is for now.
It lives on the refrigerator: The brightly colored POLST form (pink in most states) is placed where first responders can find it. Keeping it digital and accessible matters as much as completing it.

The honest summary: A living will says what you want. An HCPOA says who will fight for it. A POLST makes it a medical order that binds the people in the room. Most families need all three — and most families have none of them. Advance care planning conversations reduce family conflict by ~40% and reduce the likelihood of dying in an ICU against one's wishes by ~50% (Detering et al., BMJ 2010; Brinkman-Stoppelenburg et al., Palliative Medicine 2014).

Sources: Rao et al. JAMA 2014; Kaiser Family Foundation 2023 Survey; Detering et al. BMJ 2010; Brinkman-Stoppelenburg et al. Palliative Medicine 2014; National POLST Paradigm (polst.org). This page provides general education, not legal or medical advice. Form availability varies by state.

With a directive on file vs. without one.

Same family. Same moment of crisis. Two completely different experiences.

Without a directive

Your family makes those decisions under duress

In a hospital. In the middle of the night. Under pressure from a medical team that has never met you. They guess at what you would want — and live with that guess forever.

With a directive on file

Your wishes guide every clinical decision

The care team knows what you want. Your family knows they are honoring you, not guessing. Every decision reflects what you actually said — because you said it, in writing, before the crisis.

The honest case for having this conversation now.

The ICU is 40x more expensive per day than home care. It is also where most people do not want to be. And it is where most people who did not plan end up anyway.

Completing an advance directive is free. It takes about 30 minutes. It works in all 50 states. It is the most important thing you can do for the people you love. The hardest part is starting.

The conversation itself is the intervention. Families who have talked openly about end-of-life wishes report lower grief, lower guilt, and higher satisfaction — regardless of outcome. The document matters. The conversation matters more.

The US ranks 43rd in quality of death. Not because we lack technology. Because we lack honesty. Quality Death is the honest conversation the healthcare system will not have with you.

Where to start

Three things families can do.

You do not have to do all of this at once. Start with whatever feels most urgent.

One

Document your preferences now

An advance directive tells your medical team what you want — and what you do not want — when you cannot speak for yourself. It takes about 20 minutes to complete. It works in all 50 states. The hardest part is starting.

Two

Find the right care team

The right care team knows your wishes before a crisis forces the question. co-op.care connects families with worker-owned caregivers trained to support people at home — on their terms, in the time they have left.

Three

Give your family permission to honor your wishes

The people who love you should not have to guess. A care plan shared with your family, your proxy, and your care team means that when the moment comes, everyone in the room knows exactly what to do.

What matters to you?

An advance directive is not just a legal document. It is a values document. Before you fill out a form, it helps to sit with a few honest questions.

“If I could only have one thing at the end of my life, it would be …”
“The thing I am most afraid of is not the dying. It is …”
“Quality of life, to me, means I can still …”
“I want the people I love to know that I …”
Begin the conversation with a care advisor

co-op.care guides you through these questions and helps turn your answers into a shareable care plan.

When you need more than a document.

Good end-of-life care happens at home, with people you trust, in the environment where your values can actually be honored.

co-op.care — Home care, worker-owned

co-op.care connects families with caregivers who are equity partners in the cooperative — not gig workers. Your advance care plan travels with your care record. Your caregiver knows your wishes before they walk in the door.

Start your free assessment at co-op.care
Honest resources

Places worth knowing.

These are well-regarded, independent resources. We have no financial relationship with any of them.

Five Wishes

The most widely-used advance directive in the United States. Plain language. Legally valid in most states.

fivewishes.org →

NHPCO — National Hospice and Palliative Care Organization

Caregiver resources, hospice locator, and guidance on navigating end-of-life care options.

nhpco.org →

CaringInfo

Free state-specific advance directive forms and guidance from NHPCO. Download and complete at home.

caringinfo.org →

The Conversation Project

Practical guides for having end-of-life conversations with family members. Starter kits in multiple languages.

theconversationproject.org →

Educational information only. Nothing on this site is medical advice. Advance directives, hospice eligibility, and palliative care options vary by state and individual circumstance. For hospice or palliative care resources, contact your physician or call the NHPCO helpline at 1-800-658-8898. If you are in crisis, call 988 (Suicide and Crisis Lifeline).