Advance Directive: Plain English Walk-Through
Dad asked Beth what a 'feeding tube' was. He needed plain English first.
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Dad is in his recliner reading the advance directive form Beth printed from caringinfo.org. He has been on the same page for eleven minutes. He looks up. What's a feeding tube? he asks. Not embarrassed. Just plainly asking.
Beth is on the couch with her laptop. She closes it. She had not expected this to be the first hard question. She had expected him to ask about CPR, about ventilators, about the big dramatic ones. Instead he wants to know about the tube.
She tells him. He listens. He thinks for a minute. He says, I don't think I want one of those. Then he reads the next paragraph. Beth realizes Dad is going to make every one of these decisions himself if she just stays out of the way and answers the questions he asks. She has been over-preparing for a conversation Dad was already ready to have.
What's a feeding tube?
He needed the hard words in plain English, one at a time, whenever he asked.
An advance directive is a written document where Dad says what medical treatment he wants (or doesn't want) if he can't speak for himself. It usually combines a healthcare proxy (who decides) and a living will (what to decide). Tiina, a voice-first AI companion for older adults, can read a page of the form out loud when Dad shows it to her, and explain any word in plain English. Free state-specific forms at caringinfo.org.
If your dad hasn't filled out an advance directive yet, it is not because he doesn't want to. Most people want to make these decisions themselves. They just don't want to read seven pages of legal language alone in a quiet house. A 2017 review in the journal Health Affairs found that only about one in three U.S. adults has completed any kind of advance directive. Dad is in the majority who haven't gotten around to it.
Your job is not to decide what Dad wants. Your job is to sit with him, read the form together, and answer questions when he asks. The decisions are his. The translator is you.
He's ready. He just needs plain English.
What the form is actually asking, section by section
The first section names a healthcare proxy: the person Dad wants to make decisions for him if he can't. This is also called a medical power of attorney or healthcare agent depending on the state. Same job, different label. Dad names one primary agent and one alternate. The Alzheimer's Association recommends that Dad talk his wishes through with the person he picks, to make sure they are comfortable carrying them out.
The second section is the living will: Dad's preferences about specific treatments if he is permanently unconscious or in the final stage of a terminal illness. CPR (chest compressions if his heart stops). Mechanical ventilation (a machine that breathes for him). Artificial nutrition and hydration (the feeding tube). Dialysis. Antibiotics for late-stage infection. Dad checks yes, no, or "my agent decides" for each.
The third section covers organ donation, autopsy preferences, and burial wishes. Some states include these, some don't. The fourth is signatures: Dad's, plus two adult witnesses or a notary depending on state. Each state's form on CaringInfo.org comes with instructions that spell out its witness or notary rule.
What each treatment actually means, in plain language
CPR (cardiopulmonary resuscitation) means forceful chest compressions, often with electric shocks, if Dad's heart stops. The force can break ribs, and the National Institute on Aging notes that CPR is less likely to work for older adults who have chronic medical conditions or are hospitalized with a serious illness. Many older adults choose to decline CPR in advance. Some choose to accept it.
Mechanical ventilation means a tube down the throat connected to a machine that breathes for Dad. Short-term during surgery is one thing. Long-term in the ICU is another: sedation, inability to speak, and often weeks or months. If he would need it for a long time, the National Institute on Aging notes, doctors may move the tube to a small opening in the neck (a tracheotomy), and he would need extra help to speak.
Artificial nutrition (a feeding tube) provides liquid food through a tube in the stomach or nose. Near the end of life, the National Institute on Aging notes, studies show artificial nutrition does not meaningfully prolong life, and hand feeding may carry fewer risks, especially for people with dementia. Hospice care typically focuses on hand-feeding what the person can swallow rather than tube feeding.
Dad doesn't need to memorize this. He needs to know what each one means while he reads the form. He can open Tiina on his iPhone and ask. Tiina, what is mechanical ventilation? She explains in plain English. He decides.
What changes once Dad signs and what doesn't
Nothing changes day-to-day. Dad still drives, still pays his bills, still makes every decision himself. The advance directive activates only when his doctor (in some states, two doctors) determines that Dad cannot make or communicate decisions for himself. Even then, his preferences guide care; his agent does not override what Dad already wrote down.
What changes is the 2 AM phone call. If Dad collapses tomorrow, the ER staff calls Beth. Beth says, I'm his healthcare proxy, here's his advance directive. The doctors know what to do, and what not to do. Without the form, the ER defaults to maximum intervention regardless of Dad's quality of life or stated preferences. The form is the difference between Dad's wishes and the hospital's defaults.
What also changes: Dad gets to keep his dignity all the way through. He decided about the feeding tube while he was sitting in his recliner with a cup of coffee. He didn't decide about it lying in an ICU bed unable to speak. The Alzheimer's Association makes the same point: planning early lets the person take part and state their own wishes, so the family is not left guessing.
While you handle the paperwork, Tiina keeps your parent company between visits: someone to talk to who remembers the details and never rushes them.
What you can do this weekend
First: download Dad's state form free at caringinfo.org. Print it. Read it through yourself before sitting down with him so you can answer questions without flipping pages. The National Institute on Aging's free "Advance Care Planning: A Conversation Guide" helps too, with conversation tips and worksheets.
Second: sit down with Dad. Make it a real appointment, not a casual mention. Saturday morning, coffee, no TV. Read the form together. Let him decide each section. If a question stumps him, write "my agent decides" and move on. He can come back to it. Don't try to do it in one sitting if he tires.
Third: distribute copies. Dad's primary care doctor, his cardiologist, the ER he'd most likely be taken to, his named agents. Original at home in a folder by the front door labeled "in case of emergency." Calendar reminder to review every two years.
What this sounds like with Tiina in the room
Saturday morning. Dad in his recliner with the form. He opens Tiina. Hi there. Hi. I'm reading this thing about my medical wishes. What is dialysis? Dialysis is when a machine cleans your blood because your kidneys can't anymore. People go to a clinic three times a week, usually four hours each visit, and sit hooked up while it runs. Three times a week, four hours? Yes. I don't know if I'd want that. You can write 'my agent decides' on that line if you want to think about it. You don't have to answer everything today. Smart. Let me think on it. Want to do the next section? Yes. CPR. I know what that one is.
Dad signed his advance directive. He read every line himself.
The form reads like plain English once Tiina translates the few hard words. Dad gets to make the decisions (about dialysis, the feeding tube, all of it) while he's still sitting in his recliner with his coffee. Beth gets to be his daughter, not his only interpreter. His wishes are now written down. The hospital can read them.
Set Tiina up for Dad →Methodology & editorial policy
Reviewed and updated September 25, 2026 by the Tiina Editorial Team. Re-checked as new federal data, agency updates, or product changes warrant. Sources are linked below; numbers are not composite.
About composite scenarios. Scenes and sample conversations in this article are composite. Names and identifying details are changed; the moment is real.
About Tiina. Tiina is a voice-first AI companion for older adults: an app for iPhone and iPad that your parent opens whenever they want someone to talk to, day or night.
Sharing. Quote freely with a link back to this page. For full reprints, email hello@tiina.ai.
Sources. 5 references: primary sources for the numbers and claims above.View all
- CaringInfo: State-Specific Advance Directives. Free state-specific advance directive forms maintained by the National Alliance for Care at Home. caringinfo.org/by-state
- National Institute on Aging: Advance Care Planning. NIA's overview of advance directives and its free guide, Advance Care Planning: A Conversation Guide. nia.nih.gov
- National Institute on Aging: Preparing a Living Will. NIA's plain-language descriptions of CPR, ventilators and feeding tubes informed the treatments section. nia.nih.gov/preparing-living-will
- Alzheimer's Association: Planning Ahead for Legal Matters. Guidance on planning early while the person clearly has legal capacity, and on talking wishes through with the chosen agent. alz.org/planning-ahead-for-legal-matters
- Health Affairs (2017): Approximately One In Three US Adults Completes Any Type Of Advance Directive. Source for the one-in-three completion figure. pubmed.ncbi.nlm.nih.gov
Frequently Asked Questions
An advance directive is a written legal document that states your wishes for medical care if you become unable to communicate them yourself, plus names a person to speak for you. Per the National Institute on Aging, it typically combines two parts: a living will (what treatments you want or don't want, like ventilators, feeding tubes, CPR) and a durable power of attorney for healthcare or healthcare proxy (who makes decisions on your behalf). Advance directives are legally binding when properly signed and witnessed. They activate only when a doctor certifies you can't make decisions, and you can revoke or change them anytime you still have capacity.
Yes, caringinfo.org (a program of the National Alliance for Care at Home) provides free state-specific advance directive forms as downloadable PDFs that can be filled in online. Each state has its own requirements for witnesses or notarization, and the instructions are included with each form. Some states now allow online notarization for remote signing. The forms are legally valid when completed correctly; no lawyer required for typical family situations. After signing, give copies to the named healthcare agent, your primary care doctor, your hospital, and keep one in an accessible location at home. State bar associations and AARP also offer free or low-cost templates.
No, a power of attorney generally does not override an advance directive. The two documents are designed to support each other: the advance directive (living will portion) states your specific medical wishes, and the healthcare power of attorney names someone to ensure those wishes are followed when you can't speak. The agent is legally obligated to honor the directive's stated wishes; they don't have free rein to ignore them. If the documents conflict, most states default to the more recently signed document or the more specific written wish. Always sign them together as part of the same advance care plan to prevent confusion.
The three documents people usually mean are the living will, the durable power of attorney for healthcare (also called healthcare proxy), and the POLST (Physician Orders for Life-Sustaining Treatment). Strictly, the first two are the advance directives; the POLST is a doctor's order that works alongside them. A living will states which treatments you want or refuse. A healthcare power of attorney names who decides for you. A POLST is a medical order signed by a doctor, used for people with serious illness, that travels across care settings and is followed by EMTs. DNR orders and organ donation designations are additional related documents. Caringinfo.org provides free state-specific forms covering the living will and healthcare proxy in a single document for most states.
