An Expert Guide To Advance Care Planning for Seniors In 2025!

If you or someone you love is thinking ahead about future care, advance care planning gives you a way to set out what matters most — before a crisis forces rushed decisions. This guide explains what's involved in England, the legal documents you need to know, and how to start the conversation.

What is advance care planning?

Advance care planning is the process of thinking about, discussing, and recording your wishes for future health and personal care. It covers things like which treatments you would or wouldn't want, where you'd prefer to be cared for, and who should make decisions on your behalf if you lose the ability to do so yourself.

It isn't a single form. It's a conversation, backed up by one or more documents, that you can update as your circumstances change. Done well, it gives your family and care team a clear steer instead of a guess, at exactly the point when guessing is hardest.

Why does this matter for older people specifically?

Health and priorities shift as people age, and conditions like dementia can affect the ability to communicate wishes later on. Planning early — while you have full mental capacity — means your voice is captured before it's needed, not after. For families, a written plan removes the burden of guessing what a parent or partner "would have wanted" during an already difficult time.

The Alzheimer's Society recommends starting these conversations soon after a dementia diagnosis, while the person can still take part fully in decisions about their own future.

What documents make up an advance care plan in England?

Several distinct tools sit under the "advance care planning" umbrella. You don't need all of them, but it helps to understand what each one does.

Lasting power of attorney (health and welfare)

An LPA lets you appoint someone you trust — an "attorney" — to make health and care decisions for you if you lose capacity. This can include decisions about medical treatment, daily care routines, and where you live. You register it with the Office of the Public Guardian while you still have capacity. See GOV.UK's guidance on lasting power of attorney for the full process and forms.

Advance Decision to Refuse Treatment (ADRT)

An ADRT — sometimes still called a "living will" — is a legal document where you state which treatments you do not want in future, such as CPR or artificial ventilation, in specific circumstances. Unlike an LPA, it doesn't appoint anyone; it speaks for itself. To be valid, it must be clear, signed, and (for decisions about life-sustaining treatment) witnessed and explicit that it applies even if your life is at risk.

ReSPECT form

Many NHS trusts and GP practices now use a ReSPECT form (Recommended Summary Plan for Emergency Care and Treatment). It's completed with a clinician and records your priorities and realistic treatment recommendations for a future emergency, including whether CPR would be attempted. It sits alongside, not instead of, an ADRT or LPA.

Statement of wishes and preferences

This isn't legally binding but it's still valuable: a written note of what matters to you day to day — comfort, dignity, faith, family involvement — that helps carers and family make decisions in the spirit you'd want, even on matters an ADRT doesn't cover.

How does the Mental Capacity Act protect your wishes?

The Mental Capacity Act 2005 is the legal backbone of advance care planning in England and Wales. Its core principles are:

• Assume a person has capacity unless it's shown otherwise.
• Support people to make their own decisions before concluding they can't.
• Never treat an unwise decision as proof of incapacity.
• If someone lacks capacity, any decision made for them must be in their best interests.
• Choose the option that interferes least with their rights and freedom.

A valid ADRT or LPA carries direct legal weight under this Act: it removes guesswork by telling decision-makers exactly what you wanted, rather than leaving them to infer your "best interests" from scratch. The NHS social care and support guide has more on how capacity assessments and best-interest decisions work in practice.

How do you start the conversation with family?

Many people put this off simply because it feels awkward to raise. It gets easier once you frame it clearly.

• Pick a calm, unhurried moment — not during a crisis or hospital visit.
• Say plainly why you're raising it: "I want my care to reflect what matters to me, and I need your help with that."
• Be specific where you can — about particular treatments, where you'd want to be cared for, and who you trust to decide for you.
• Expect more than one conversation. Views can shift, and that's fine.
• Ask your GP or a hospital advance care planning nurse to help structure the discussion if it feels too big to tackle alone.

If dementia or another condition is part of the picture, Dementia UK's Admiral Nurses offer specialist support for these conversations, and Carers UK has practical guidance for the family members supporting a plan.

How do you put a plan in place, step by step?

1. Reflect on your priorities. Think about what "quality of life" means to you, and which treatments you would or wouldn't want in various scenarios.
2. Talk to your GP or care team. They can explain medical terms, discuss a ReSPECT form, and confirm you have capacity to make these decisions now.
3. Set up an LPA for health and welfare. Choose an attorney who understands your values and is willing to advocate under pressure. Register it via GOV.UK.
4. Write an ADRT if relevant. Be specific about which treatments and which circumstances it covers. Get it witnessed correctly.
5. Share copies widely. Your GP practice, your attorney, close family, and (if relevant) your care home should all hold a current copy.
6. Review the plan at least yearly, or after any diagnosis, hospital admission, or significant change in your wishes.

When should you review or change your plan?

Review your advance care plan:

• Every year, as a habit, even if nothing has changed.
• After a new diagnosis or a significant change in health.
• If your chosen attorney is no longer able or willing to act.
• After a house move, bereavement, or change in family circumstances.

You can change or cancel an ADRT or LPA at any time while you have capacity. Once changed, tell everyone holding a copy — an outdated plan in a GP file can cause real confusion in an emergency.

Does this work differently outside England?

This guide covers England. Scotland, Wales and Northern Ireland have separate legal frameworks for capacity and attorney powers — for example, Scotland uses the Adults with Incapacity Act rather than the Mental Capacity Act. If you live outside England, check the equivalent rules for your nation before relying on any document described here.