During the 29 years Bruce Tucker has worked with Veterans and their families as a social worker and now as a VA Medical Center director, he has seen his share of medical crises and the challenges they can present for Veterans and their families.

During a crisis, medical staff may ask family members to help make health care decisions for a loved one. If a conversation about care preferences did not previously occur, it may be difficult for family members or trusted others to know exactly what decisions to make.

“I’ve worked most of my VA career as a social worker in various areas and assisted Veterans in completing hundreds of health care decision forms,” Tucker said. “Some of the most difficult situations were when a Veteran’s preferences had not been expressed in advance and there was confusion about what decisions the Veteran would want made on their behalf.”

Only a third under 65 have advance directives

Almost half of all U.S. Veterans are under the age of 65. According to recent research published in the Journal of Health Affairs, in 2017 only about a third of the U.S. population under the age of 65 had completed an advance directive communicating their wishes about medical and mental health care choices they would want in case they would not be able to make decisions on their own.

Tucker is raising the awareness of advance care planning by recently completing his own advance directive. He encourages others to do the same.

“I would not want any family to go through the stress, uncertainty and conflict of making health care decisions for a loved one without knowing the person’s wishes,” he said.

Advance care planning can help reduce this stress and uncertainty during an unexpected emergency, according to Jennifer Koget, a social worker and VA acting national director of Social Work.

“Advance directive forms allow the health care team to know what the Veteran’s preferences are and to honor those preferences in situations when the Veteran is unable to communicate,” Koget said. “When Veterans appoint a health care power of attorney, it allows the health care team to make sure we engage the person the Veteran trusts to make decisions on their behalf.”

According to National Social Work Program Office officials, there are many reasons to communicate these choices ahead of an unexpected situation, including to:

  • Make sure you receive the treatment you want.
  • Help your loved ones represent your preferences to the healthcare team when making decisions.
  • Reduce the stress your loved ones may experience when asked to make decisions on your behalf.
  • Communicate cultural and religious preferences related to medical care.

Additional information

Additional information about advance care planning is available:


Elisabeth M. (Beth) Skaggs is a technical writer for HSR&D, Central Arkansas Veterans Healthcare System.

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