Five Wishes: America's Most Popular Living Will with Paul Malley
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Welcome to the Stay Wealthy Podcast. I'm your host, Taylor Schulte. And today we're going to be talking about a difficult but really important topic, which is how you are treated if you get seriously ill. Before we go any further, we're going to be referencing a document in today's show called The Five Ways to Stay Wealthy.

Wishes. And Five Wishes is this really easy to complete living will that lets you say exactly what you want to happen if you were to get seriously ill. It's a conversation piece for you and your family, and it's a legal document in over 42 states.

So I've actually purchased a box of these documents for our listeners. And I'm going to be giving away stacks of five copies to the first three listeners that email me after hearing this. So if you'd like a stack of five copies for you and your family, shoot me an email at podcast at youstaywealthy.com with the subject line, five wishes, and we'll get them out to you. Okay. I've got a really special guest on today's show. His name is Paul

Mally, and he's the president of the Five Wishes organization. Paul has over 20 years of experience in the field of aging and advanced care planning. And you're going to walk away from this interview learning these three things today. Number one, what is Five Wishes? Who should use it? And how does it work with all the other estate planning documents you might have?

Number two, how advanced care planning reduces healthcare costs in retirement and improves the quality of a person's life. And then number three, where exactly Five Wishes fits into your financial plan. For all the links and resources mentioned in this episode, visit youstaywealthy.com forward slash 48. Without further ado, here is my conversation with Paul Malley. ♪

Paul, thanks so much for joining me on the Stay Wealthy podcast today. Thanks, Taylor. Good to be with you. I always like to start off these podcasts with just a really good story to help kind of set the foundation for the rest of the conversation. So I know you've got something really interesting to share with us today. So I'm just going to turn it over to you and let you share this story that you brought to the table today.

Sure. And that's one of the really exciting things about being part of the work of Aging with Dignity and Five Wishes is now we're hearing so many stories of families who have used Five Wishes to make plans for care and caregiving during times of serious illness.

One that really stands out to me was a family. And I heard from the mother in this case, and she said that her husband had had a stroke kind of out of the blue. He was healthy. They weren't expecting any health crisis to come around the corner. He had completed five wishes, but

And a couple of things she said to me. Number one, she said, after the first day of staying with him in the intensive care unit, I saw that in his five wishes, he wrote that he wanted to have pictures of his grandchildren to be in the room.

So she said,

And she went on to tell her the rest of the story and was unfortunately that her husband passed away. But she was able to make the decision about life support treatment in the middle of difficult disagreement between her two sons when it came to a question about life support treatment for their father.

And when she gave her sons the copy of Five Wishes that their dad had completed, they looked at it. They saw that he had made these decisions, that he had signed the document. And then everyone in the family was in agreement. The very last thing that happened in this family was

It was that this woman said, my husband checked the box in wish number five that said that if possible, he wanted his family to make peace with each other, if that was possible before he died. And she said, my two sons spoke for the first time on that day as a way of honoring their father's wish.

So this was just an example of what can come from five wishes, not just the legal questions of naming a health care agent or giving instructions on medical care. But when it comes to what's most important to us, what matters to our heart and soul, five wishes hits those things right on the bullseye. And this man, you know, he gave a gift to his family by simply writing some of these wishes down in a way that his family could honor. Wow.

That is a really powerful story. I'm just having chills listening to you. I know over like 20 million people have completed Five Wishes. So I'm sure there's a lot more of those types of stories. It's a really, really important document. Maybe we can just back up really quick and talk about what, maybe in its most simplest form, what is Five Wishes? Sure. So in its most basic form, a lot of people think of Five Wishes as a living will. That's a term that a lot of people are familiar with. Usually,

When you think of a living will, you think of a legal document that you can use to make medical decisions or treatment decisions about the kind of care you want if you're not able to speak for yourself. So Five Wishes does that. We wrote Five Wishes with the help of the leading experts in medicine and in law. We worked with the American Bar Association's Commission on Law and Aging to look at the legal structure in all 50 states.

And today, five wishes meets the legal requirements for a living will or an advance directive in most states. So it's a legal document.

And you can name a healthcare agent, a decision maker for you and give instructions about the medical treatment you'd want if you're near the end of life. But then as that story just showed, what's really important about Five Wishes and what sets it apart is that it lets you focus on the things that are most important to you, to you, to your family, to the people who you love, to your comfort and to your dignity. That's what sets Five Wishes apart.

And who would be the ideal candidate for filling something like this out? Is it somebody who's later on in life, in retirement, or can someone of younger age complete something like this? And should they? Perfect question, because it's one of the most frequently misunderstood concepts. It's for every adult. Every person age 18 or over should have a document like Five Wishes. In fact, most of the cases that come up

play out in the court system where families are torn about disagreements of what to do for a brother or sister or a family member are often regarding younger people. So, this is not something to put off for a time when you're older age or after you get a difficult medical diagnosis. The best way to do this as a family is to fill out five wishes together. So,

You asked about stories. Some of the greatest stories that we hear about are families that pull together, whether it's over a holiday or a family reunion or any time where everyone is together. And they have this multigenerational conversation where you have grandparents and parents and adult grandchildren saying, here's what's important to me. And if you ever have to care for me, if I'm ever sick and I can't speak for myself, here's what's most important for you to know about me.

What are some of the questions inside of that document that prompts these conversations and gets people talking? Maybe what are the five wishes? Sure. So the first wish is simply naming somebody who you would trust to be your healthcare agent, a person who you would trust to be your voice if you're not able to speak for yourself. That could be...

because you're near the end of life. It could be because you're recovering from a surgery or you were just in a car accident. If there's a time where you can't speak for yourself, who would you trust to make decisions on your behalf? That's simply the first wish.

The second wish gets into specific preferences regarding medical treatments and life support treatment and when you'd want it or not want it. So there are a few scenarios there where you can check a box and say, in this case, I'd want life support treatment. In this case, I wouldn't want it.

And what's nice about five wishes is that it also includes some blank lines so that you can put your wishes in your own words. And a lot of people tell us they really like that. It's like putting their own personal stamp or seal on here to say, you know, whether even if they say, I mean it with a big exclamation mark, or they say, you know, I want you to talk with my priest or my rabbi or my minister or my best friend, Joe, to know what I would want to do in this case.

Those kinds of personal instructions are nice to have. So those are the first two wishes in the nutshell. Then wishes three, four, and five really focus on what it means for you to be comfortable and

how you want people to treat you, and what you want your loved ones and your healthcare providers to know. So as practical examples on what it means to you to be comfortable, that means your physical characteristics. What are your thoughts about pain management, about being comfortable and clean and warm? Where would you like to be? Would you prefer to be at home if that's possible? Do you want people with you? Do you want music played or

And as I mentioned in the story of the family, do you want pictures of your loved ones nearby? Those types of little things may sound small when you're thinking about it ahead of time, but I can tell you through the messages that we've received from families who have used Five Wishes, that's where the true gift is in this document, is that it lets people tell their family members, their loved ones, if you want to be a good...

caregiver for me. If you want to honor my human dignity, here's exactly how you can do it. And that's the beauty of five wishes. Yeah. There's some really important and really hard topics inside of this document to answer. I know when I first learned a five wishes, I brought two of the documents home with me and I shared them with my wife and I said, we're going to complete these. And she opened it up and she started reading some of the questions and she closed it. And she's like,

I can't, like, I can't even wrap my head around thinking about and answering these questions. Is that a common response to this sometimes? And if so, like, how do you suggest people handle that? So it is, yes, it is common. And so if you try to start that conversation and the person doesn't jump on board at the first mention of it, that's okay. So try again.

And here's one suggestion. And we've heard that this usually works well. Rather than asking somebody in your family, whether it's a spouse or a parent or a grandparent, to think about filling out five wishes for themselves,

Another idea is to fill it out for yourself first and then go to that person, whether it's a spouse or parent or friend, and say, I filled out my five wishes and I want to tell you about it just in case you ever have to make decisions for me so that you know what I've decided and where this document is and what's inside it. That's sometimes a softer approach and an easier way to bring up a conversation, kind of a backdoor approach, a softer way of saying, here's something that we should talk about.

And sometimes it does take two or three or four or five times and you don't want to push it. Quite frankly, yes, it's a good thing to do. But if a person's not ready to talk about it, it's not something that you want to force or push directly.

put a pin in it and come back to it when it's the time is right. Yeah. I probably could have been a little bit more strategic bringing it, bringing it up with my wife too. Yeah. After a long day of work and, you know, cooking dinner, I'm like, here, let's fill this out. And she's like, I don't think so. Exactly. Yeah. But those are really good suggestions. Actually. I like that. I like filling it out for myself first and then sharing that with my family members and they can really see the power and the benefit of it. So that's actually a really good suggestion. I like that.

So, you know, we're talking about this document. How can somebody actually complete this document? Physical copies online? Are there other forms and ways for people to actually complete this document? So both options are available. You can either fill out a document in a hard copy format. It's a 12-page booklet that includes all the instructions and the information that you need to fill it out. And you fill it out with a pen, you sign it, and it's witnessed by two people. So that's one option to fill out Five Wishes in the hard copy format.

The other option is that you can fill it out online and you can get either one, either the hard copy or the digital format at fivewishes.org. We're also grateful to work with thousands of partner organizations all over the country. They're healthcare providers or places of worship or employers or financial planners or attorneys who provide Five Wishes to their clients or out into the community at large.

So what I hope every person does is take a look at Five Wishes for yourself, share it with your family, and then also think about what other people are you in touch with, whether it's through your workplace or through your community that you can share Five Wishes with, whether it's in the hard copy or the digital format. We're grateful for your help and to work with you to help the people around you.

Great. And I know you don't know this, but I'm going to be giving out five copies to three different families, three different listeners from this podcast episode. So at least three families will get their whole family taken care of, which will be great. But for others, we'll be able to share all the links and resources and everything if you want to go purchase copies for yourself or take it online. Wonderful. So Five Wishes, as you mentioned, is a legal document. It's a living will. Right.

What do you do if somebody already has a living will in place, if they already have an estate plan that's completed, if they have an attorney? What if they already have that all taken care of? Where does Five Wishes fit in? Sure. And if you have a living will that you completed years ago, my first suggestion would be to make sure you go back and look at it.

and make sure that it still matches your preferences today. Sometimes that can be one of those things that some people fill out as part of their estate planning process, and it's almost like a side piece of paper. It's one extra piece of paper that was part of the estate planning process, and it's included in a file, and people often think, okay, I've done that, and I don't have to worry about it again.

But if you have that and it's part of your file, go back and look at it and make sure it's still accurate. And if you've named a healthcare agent, a decision maker, make sure that that person knows that you've named them and that that's still the right person for you. And again,

Oftentimes, it's always a good idea to update your document. So if you've completed a different document, and even if it still matches your preferences, if it was five or 10 years old, it's a good idea to update it so that it has a more current date, whether it's five wishes or any other document.

Now, if you've just done your estate planning, you've completed an advanced directive with your attorney, you can still use Five Wishes because it goes into a lot more detail and gives your family a lot more to work with than the traditional boilerplate legal documents. And if you do that, if you use Five Wishes, just make sure you talk with your attorney and make sure that Five Wishes is added to any existing documents that you already have. They can coexist.

They can live together. But if you haven't crossed that bridge yet, if you haven't filled out any type of advance directive, or if you haven't done an estate plan or worked with an attorney for a last will and testament, you don't have to have the guidance of an attorney to complete five wishes and still make it a legally valid document.

So it works in all of those cases. And it's important to update documents so that they reflect your current wishes today. And it's not a one and done scenario. Yeah. And I was just going to ask, you know, if somebody is using five wishes, how often do you suggest that they review that with themselves and their family and consider updating it? You know, I'd say at least every few years, glance back at it.

Make sure that especially the person that you named as your healthcare agent and your guidance on life support treatment is still accurate. So every couple of years, go back and look at that. There's not an expiration date attached to it. So it continues to be valid until you void it or fill out a new document. But it's good to make sure, especially because it continues to be valid, it's good to make sure you go back and look at it and make sure it's still accurate.

Beyond that, if there's any change in your health condition, if you have a new diagnosis, if there are new health issues that you're dealing with, that you're talking with your doctor about, that's a time to redo your document. If you've had any change in your family relationships, if you have been married or divorced or separated,

If you have had other family members who have died, especially if they're people that you named as your healthcare agent or your alternate, then it's time to update the document. Those are the big milestones to make sure that you update the document and go back and look at it.

But then regardless, every couple of years, go back and make sure it still matches what you want today. So you mentioned that Five Wishes is a legal document, it's a living will, but it's only a legal document in 42 states. And do you know off the top of your head what states it's not a legal valid document in? Sure. There are just a few states that still require you to use their state form. So the standouts in my mind are Texas, Ohio, Alabama, Vermont.

Utah, Oregon, Kansas. Those are the ones that come to the top of my mind. Have some state-specific requirements about using their state-required form. And what we let people know is that

you can use Five Wishes in all 50 states. If you live in one of those few states that requires a separate form, you can get that information on our website at fivewishes.org and get your state form that you can combine with Five Wishes to make sure your legal bases are covered. But in most other states, thanks to the guidance that we received from the American Bar Association's Commission on Law and Aging,

we know that five wishes meets the state requirements for an advanced directive. So if you fill it out and you follow all the instructions, you sign it, you date it, and you follow the instructions for witnessing in five wishes, then you know you can have the peace of mind that you've met those legal requirements.

Are you guys actively pursuing those states and trying to get them to change this? Do you see it changing in the foreseeable future? Or is it just kind of it is what it is, and we're just going to direct people towards these additional documents that they have to complete? So thankfully, we have seen a positive trend in states making their laws more flexible for people to put their wishes in their own words.

So when we first introduced the national version of Five Wishes, it met the legal requirements in only 32 states. Now it's up into the 40s, at least 42 and might be 44 or so by the end of this year, depending on a few legislative changes that might happen this year. So yes, we are actively encouraging states to update their laws. In most cases, in

In these six or eight remaining states that still have mandatory form requirements, these are laws that have been on the books for a few decades and probably were not intended to require mandatory use of state-specific or state-approved forms. So the trend is positive. Our position is that people should be able to put

to put their end-of-life wishes, these personal wishes, in their own words. And it should be honored by the healthcare system, and it should be respected as legally valid.

And we believe that that would be true. It's just jumping over some of these hurdles of some states that have requirements that seem to require state-specific forms. So we're happy to work with any organization. And we have between bar associations and medical associations and hospices and consumer rights groups in some of these states to make it easier for people to put their wishes in their own words and have their wishes respected.

If you do any sort of research on Five Wishes, if you look at your website or just Google around, you'll see this term advanced care planning being thrown around. Can you talk to us about advanced care planning? Maybe let's just start with what is advanced care planning and then we can kind of dissect that a little bit. Sure. So to tease that out, it's making plans for a serious illness.

before it happens, right? That's the concept behind advanced care planning. It's thinking ahead for a situation, say for myself or my family, that might come up if I'm very sick, and especially if I can't speak for myself, then what would I want? What do I want my doctors to know? What do I want my family to know? That can include the conversation that you're having together and the documentation that

that you're filling out and any medical orders that are written to support your wishes. So that's kind of the big umbrella term, advanced care planning. Then underneath that, if we're talking specifically about advanced directives, then that's more of the legal term for the legal documents that meet legal requirements where every adult, every person has the legal right to designate a

decision maker, a durable power of attorney for healthcare or a healthcare agent, and give instructions on medical treatment in a written document that would be followed even if they lose capacity. And that's the key factor there. So even if they lose the capacity, the mental capacity to make their own medical decisions based on what they've written in this document, like five wishes, and communicated to their family and their doctor, then those wishes should be honored and should be respected.

That's the concept of an advanced directive. Okay. And you guys have shared some data that says that advanced care planning helps to reduce healthcare costs and improve the quality of a person's life. Can you talk a little bit more about that? Maybe where the data came from and how this all works? Sure. And that data is research that's done by

other organizations, not looking, say, specifically at Five Wishes, but advanced care planning in general of what happens if people make decisions in advance about their medical treatment. And first, it's important to look at what happens if we don't make any decisions, if we don't leave a written record of what we would want, and if we haven't talked about it with our family, the default is for the healthcare system to provide the full course of treatment all the time.

And what we found anecdotally and what's backed up in all of the national research is that when people are asked about their preferences, they oftentimes would not want the full course of all aggressive treatment all the way until the end of their life.

Oftentimes, people will say, I do want to focus on the quality of my life. I want to focus on being present with my family. I want to focus on my comfort and managing my pain. And it's not the most important thing to me to have the full court press of the most aggressive treatment if that means that my quality of life will suffer.

Well, when people give that instruction, that's very different from the default of providing everything in the kitchen sink. So it's natural to assume, and the data backs up, that when people talk about advanced care planning with their family and they indicate what their choices are for treatment and what treatment they would not want and what treatment that they would want, that the cost of unwanted care comes down. And we will always support the

the rights of every individual and every family to receive all of the treatment that they want. Nobody should be, should feel like they're in a position where they're encouraged to say no to care because it's costly or more expensive. Uh,

But everybody should be given the option to say, here's what's most important to me. Here are my thoughts about medical treatments and life support treatment. And we know that oftentimes when that conversation happens, the preference of people is for the less aggressive, less costly care.

Very interesting. I know you guys shared some links to some articles with all this data and research. So I'll be sure to link to these in the show notes, which can be found at youstaywealthy.com forward slash 48. So we'll link to all those if you guys want to go and dig deeper on this.

You mentioned earlier that five wishes. Maybe I'll back up and say a good chunk of our listeners manage their own investments and financial plans on their own. They don't always work with professional financial planners.

Maybe you can talk to us about how you see five wishes being used inside of the financial planning process or maybe how you see other financial planners using five wishes so that they can maybe replicate that process on their own. Sure. So I think from the perspective of both financial planners and individuals who are thinking about managing their investments and managing their financial plan today and 10 years from now, 20 years from now, or after they've died,

It's a natural thing to also think about what else is important for my family to know. If I'm giving thought and giving strategy to my financial investments and managing my retirement planning, then doesn't it also make sense that I give some thought to what will happen to me and to the people around me if I become very sick?

So it's a natural connection if you're thinking about one to think about the other. So that's why we know that a lot of financial planners include five wishes in the package that they offer to their clients because they would say to their clients, we know just like you're thinking about the long-term success for yourself and for your family, it's important for us to think about and important for you as a family to think about what's most important to you when you think about

caring for your loved ones, whether it's your parents or your grandparents or your spouse. So that's why these things go hand in hand together and one can really launch the other.

So for that family that's managing their own assets and giving thought to prudent planning, I would say that as you sit down together, or if you sit down with your friends or others who are involved in your life, people who are important to you, think about what would be most important if you or they became really sick.

and couldn't speak for yourself. What would you want them to know? What would be important for you to know about their preferences so that when you're called on to help each other out to care for one another, you can do it well and also leave a lasting legacy

not just on the financial side, but on the personal side of knowing that you did this well. I think about my own experience with my grandparents. And even as a young child, I knew when they were sick that I wanted to be a good grandson and to do the right things for them. But I had no idea what that actually meant. And part of what that meant was being present by when my grandfather was dying and sitting at the edge of his bed and holding his hand and being present there for him.

And Five Wishes winds up helping to be the guidebook for families on how to be present, how to do what your loved ones want when the time is most important. Really good stuff. Thank you for sharing all of that. Is there anything else about Five Wishes that we haven't touched on that you just think people should know about? Well, one of the things that we hear often is that when people are asked the question about what matters most to you, the top answers are things like, I want to be with my family. I want to be at home.

I want my spiritual needs to be addressed. I want to be prayed for or prayed with. And I want to have some say in what medical treatments are given to me or decided for me. But also a big one is that people say, I want my family to know that I love them.

And I want to be forgiven for times that I might have hurt them. A lot of times when people are approaching the end of life, these are some of the things that they're either most grateful for or some of the biggest burdens of some loose ends or existing knots that still exist in their life that stand out to them as needing attention. And, you know, five wishes is, I'm not going to say it's going to solve all

All of those challenges in life. But what it does provide for families is a launching pad as a way to start some of these conversations to say, you know, when it comes down to it, the most important thing to me is for you to know that I love you.

And if I need to say this, that I forgive you or to please forgive me. Those are the things that stand out to most people that we know from the research and anecdotally from the 30 or more million people who have used Five Wishes.

Those are the things that stand out that really seem to matter most to people that Five Wishes addresses. If someone wants to learn more about Five Wishes or even kind of just follow along with everything you guys are doing and the resources you're putting out there, where do you suggest people connect with you? They can start by visiting our website. It's fivewishes.org.

And if you have a Five Wishes, you can also go to that page and activate your benefits so that we can keep you up to date with any changes and laws in your state or any new resources that are available to you. So that's definitely the place to start. And we also have a national toll-free hotline that you can call with any questions about how to use Five Wishes or if you're filling it out or need more copies. And that's 1-888-5WISH.

Five wishes, 5947437. Great. Well, Paul, I really appreciate you joining us today and talking to us about this really, really important topic that probably gets neglected quite a bit. You've shared some really valuable information. Again, I'll be giving out five copies to three different families. So that's my way of just giving back and getting people started. But we'll be sure to link to everything in the show notes again, which can be found at youstaywealthy.com forward slash 48. All the resources will be there. They can sign up. They can take it online. They can order copies.

Again, I really appreciate you joining us today. Absolutely. Thanks, Taylor. And thanks for what you're doing to put five wishes into the hands of people who can benefit from it. That's fantastic. You got it.

Hey, it's me again. I just wanted to say thank you one more time for listening and remind you to please, please, please leave a quick review. If you're on an iPhone, leave a quick review on iTunes. If you're enjoying the show, I'm getting great feedback from listeners just like you. And I really want to keep the momentum going. So if you have a chance on your iPhone, leave a quick review on the Apple podcast app. And thank you so much in advance for all of your help and support.

This podcast is for informational and entertainment purposes only and should not be relied upon as a basis for investment decisions. This podcast is not engaged in rendering legal, financial, or other professional services. ♪