From the U.S. Government Accountability Office, www.gao.gov

Transcript for: Advance Care Planning

Description: GAO reports on challenges Americans may face when planning 
for medical care late in life. 

Related GAO Work: GAO-19-231: Advance Care Planning: Selected States' 
Efforts to Educate and Address Access Challenges

Released: February 2019


[ Background Music ]

[ Carolyn Yocom: ] It’s really about educating yourself, educating your 
family and your loved ones. And making sure that you know the wishes of 
those around you. 

[ Matt Oldham: ] Welcome to GAO's Watchdog Report, your source for news 
and information from the U.S. Government Accountability Office. I'm 
Matt Oldham. Advance care planning is the collection of legal, 
financial, or medical documents to carry out your intentions in case 
you experience a serious or life-limiting condition, and cannot 
otherwise communicate your wishes. I’m with Carolyn Yocom, a Health 
Care director at GAO, and she led a report looking into what Americans 
face when it comes to this advance care planning. Thank you for joining 
me, Carolyn. 

[ Carolyn Yocom: ] It’s a pleasure to be here. 

[ Matt Oldham: ] So did you find any challenges for people planning for 
these circumstances?

[ Carolyn Yocom: ] We found a lot of challenges. These are difficult 
conversations. You need to have them not just with yourself but with 
your family and your loved ones but also with your physicians. And they 
are difficult conversations for physicians as well. Initiating the 
conversation, being respectful of people’s beliefs and values is 
another piece of this that is very important. 

[ Matt Oldham: ] So what goes into advance care planning?

[ Carolyn Yocom: ] Well it depends. If you have a serious illness, then 
you are really thinking about what is called a physician order for 
life-sustaining treatment. What kind of steps do I want my medical team 
and my doctors to take in the event of the end of my life? More 
broadly, it’s thinking beyond that. If something were to happen, what 
are my choices in terms of how I want to live and how I want to be 
treated? Orders such as do not resuscitate, for example are common 
things that could be in an advance care planning document. 

[ Matt Oldham: ] So does the federal government have an across the 
board guidance or guideline on how to carrying out this advanced care 
planning, or is this left to the states?

[ Carolyn Yocom: ] It really is left more to the states. And that is 
one of the complications. We looked at just a small number of states, 
but you know, what It showed us was how different the states can be and 
how they look at these things. One example is emergency treatment. 
There are states that are working to have an electronic form available 
so that they can look up and see if someone does have an advanced 
directive, or advance care planning documentation. For other states, 
those are not even close to being available. And then if you’re out of 
state, we did identify a complication that could come up where the 
wishes that you express from the state that you lived in are perfectly 
within the law, but may not quite be within the law of another state. 
So then, if you have an accident, or an injury, or a serious event 
outside of your own state, if can be difficult for that neighboring 
state to know for sure how to honor your wishes

[ Background Music ]

[ Matt Oldham: ] So it sounds like Americans can expect some 
differences in advance care planning based on a variety of factors, 
including what state they live in. So Carolyn, what can be done with 
what your report found?

[ Carolyn Yocom: ] I think at the individual level, it’s really about 
educating yourself, educating your family and your loved ones, and 
making sure that you know the wishes of those around you. Having those 
difficult conversations first within your own circle of family, however 
defined, is really important. And secondly, getting those written down, 
and making sure that your loved ones know where they are. On the state 
level, there have been efforts in place to try to encourage the use of 
documents. One of the states we looked at was Oregon. And they have a 
procedure by which physician orders for live sustaining treatment are 
automatically centralized and gathered so that it’s more accessible. 
Others have efforts like that, but were not able to sustain the funding 
to maintain them.

[ Matt Oldham: ] Final question, what do you believe is the bottom line 
of this report?

[ Carolyn Yocom: ] Well, the bottom line is, we are all going to die. 
And it can be easier on yourself, it can easier on your family, if you 
take charge of that and make it clear what’s important to you at the 
end.

[ Matt Oldham: ] Carolyn Yocom is a Health Care director at GAO, and 
she was talking about her report looking into advance care planning for 
Americans. Thank you for your time, Carolyn.

[ Carolyn Yocom: ] Thank you.

[ Background Music ]

[ Matt Oldham: ] And thank you for listening to the Watchdog Report. To 
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[ Background Music ]

[ Matt Oldham: ] For more from the congressional watchdog, the U.S. 
Government Accountability Office, visit us as gao.gov.