End-of-life planning and its practical costs

Advance planning is the area of personal finance and healthcare with the widest gap between how cheap it is and how expensive its absence becomes.

The documents that matter

With names varying by jurisdiction.

A will, which determines what happens to your estate and, importantly, who becomes guardian of any children.

Dying without one means the law decides, which frequently produces outcomes nobody wanted and considerable expense.

Power of attorney, allowing named people to make decisions about finances and about health and welfare if you lose capacity.

This must be set up while you still have capacity — after that point, the alternative is a court process that is slow, expensive and stressful.

Separate documents frequently cover property and financial affairs and health and welfare, and both are worth having.

Advance decisions or directives, which record refusals of specific treatments and which are legally binding in many jurisdictions when properly made.

Advance statements, recording preferences and values, which are not binding and which guide decision-making.

And nominating people to be consulted, which prevents disputes.

Why it is left too late

The predictable reasons.

Discomfort with the subject.

The assumption that it applies to older people, when capacity can be lost suddenly at any age.

Believing that a spouse automatically has authority, which in many jurisdictions is not true for financial or medical decisions.

And believing it is expensive, when the documents cost modestly and the alternative costs a great deal.

The cost of not having them

Concrete.

Without power of attorney, accessing a person's money to pay for their care requires a court application, which takes months and costs substantially more than the attorney documents would have.

Meanwhile bills go unpaid and care cannot be arranged.

Without a will, intestacy rules apply, which may leave unmarried partners with nothing, may not reflect blended family arrangements, and generally produces higher administration costs.

Without recorded wishes, families are left making decisions under pressure without knowing what the person wanted, which is a documented source of lasting distress.

The conversations

Which are free and are the part most often skipped.

What matters most to you if you become seriously unwell — what you would want and what you would not.

Where you would want to be cared for, and where you would want to die, which is a question most people have a clear answer to and never state.

Who you would want making decisions.

What you want to happen with organ donation, where opt-out systems in some countries still make a stated wish important for families.

Funeral preferences.

And where the documents and information are kept.

Structured conversation guides exist free from several organisations and make this considerably easier to start.

Palliative care

Frequently misunderstood.

Palliative care is not only for the last days — it is specialist symptom management and support that can run alongside active treatment, sometimes for years.

Trials of early palliative care in serious illness have found improved quality of life, less aggressive treatment at the end, and in some studies longer survival.

Which makes early referral a positive intervention rather than an admission of defeat, and it is one of the most commonly delayed referrals in medicine.

Hospice services in many countries are free and provide home support as well as inpatient care.

Care costs

Where the financial planning matters most.

Long-term care funding varies enormously by country, from largely state-funded to largely private, with means testing common.

Rules about which assets are counted, whether property is included and what thresholds apply are complex and change.

Specialist advice is worthwhile before making decisions such as transferring property, which can have serious consequences including being treated as deliberate deprivation of assets.

Continuing healthcare funding, where the state funds care for people with primarily health needs, exists in some systems and is under-claimed and frequently refused on first application.

And carers' entitlements apply to whoever is providing unpaid care.

The practical file

What to assemble and tell someone about.

Will, and where the original is held.

Power of attorney documents.

Advance decisions.

Insurance policies.

Pension details.

Bank, mortgage and utility accounts.

Digital accounts and how to access them, which is an increasingly significant gap.

Medical information: conditions, medications, allergies and clinicians.

Funeral wishes and any prepaid arrangements.

And a list of who to contact.

Where to get help

Practically.

Solicitors for wills and powers of attorney, with fixed-fee services widely available.

Some charities offer free will-writing schemes.

Public guardian or equivalent bodies publish free forms and guidance in several countries, which allow the documents to be made without a solicitor for straightforward situations.

Hospices and palliative care services provide advance care planning support.

And free advice services help with care funding, benefits and entitlements.

General information only, not legal, financial or medical advice. Rules vary enormously by country — consult a qualified solicitor and a free advice service.