A 1997 study found fewer than one in five nursing home residents taking advantage of the opportunity. No Blame patients who don't want to contemplate their own demise. Add doctors who are pressed for time and sometimes as reluctant as patients to introduce the subject. Take note of hospitals, nursing homes and other institutions at which advance directives are sometimes just another question to be asked on the admission checklist. Complicating human reluctance to plan for the end is the fact that states sometimes limit the legal power of patients with a terminal illness, filtering out those battling progressive dementia or other chronic problems.
Rules vary from state to state.
Even when completed, experts say, advance directives are often either too vague or too specific. From 1991 through 1993, New York researchers reviewed hospital care of 114 elderly patients. All had advance directives, but only 26 percent of the documents were consulted or recognized during the hospital stay. What's needed, advocates argue, are honest discussions about the medical dilemmas a particular person will likely face.