When to start planning ahead (and why waiting costs you)
6 min read · Written by an HCPC-registered Occupational Therapist
The honest answer is: earlier than feels necessary. The value of a personal record is set by whether it exists before the moment it is needed, and that moment is rarely scheduled.
The evidence in brief
- Capacity for a specific decision can be lost suddenly — stroke, delirium, injury — not only gradually
- Delirium is common in hospitalised older adults and temporarily removes the ability to explain oneself
- NICE NG108 recommends offering planning conversations early and revisiting them, not waiting for deterioration
- Records made early are more clearly the person's own voice, which matters if they are later contested
Good moments to start
There is no single trigger, but some points are natural and practically useful.
- While well — alongside making or updating a will or Lasting Power of Attorney
- After a diagnosis of a progressive condition, while communication is still comfortable
- Before planned surgery or a period of treatment
- When a move into supported living or a care home is being considered
- When family members are starting to disagree about what someone would want
What waiting actually costs
In a crisis, decisions are made quickly by whoever is present, using whatever information is to hand. Without a record, the default is generic care: unfamiliar routines, avoidable distress, and family members carrying the weight of guessing. The BMJ trial evidence on facilitated planning showed measurable psychological harm to bereaved relatives in the group without it.
There is also a credibility dimension. A profile compiled while someone was clearly able to express themselves is far stronger evidence of their wishes than one assembled late, when capacity is already in question.
Planning is not a single event
Wishes change. Guidance is explicit that advance care planning should be revisited as circumstances change, which is why the Life Profile is written to be reviewed and reissued rather than filed once and forgotten.
Sources
Do it before you need it.
The Future You® Life Profile is an Occupational Therapist-led picture of the person behind the paperwork — who you are, what matters to you and what you would want others to know. It complements, and does not replace, an LPA, advance decision, care plan or medical record.
General information for England and Wales. Not legal advice, and not a substitute for an individual clinical assessment.