A Guide to Advance Care Planning - Hospice TorontoA Guide to Advance Care Planning Of all the choices you make in life, among the most important could be the choices you make now about

A Guide to

Advance CarePlanning

THIS PUBLICATION IS FREE OF CHARGE.

C o m m u n i c a t i o n / C h o i c e / R e s p e c t

Helping you know and exercise your rights in

preparing for a time when you may be unable

to make decisions about your care.

A G U I D E T O A D V A N C E C A R E P L A N N I N G

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A Key Initiative of the Ontario Government This Guide to Advance Care Planning has beendeveloped by the government of Ontario as part ofOntario’s Strategy for Alzheimer Disease andRelated Dementias, which was released inSeptember 1999.

Accompanying this guide is a wallet card, found onpage 35, which we encourage you to fill out andkeep in your wallet

Ontario was the first in Canada to develop acomprehensive, multi-faceted Strategy on AlzheimerDisease. The government is investing $68.4 millionover five years – 1999 to 2004 – in this Strategy toimprove the quality of life for those people withAlzheimer Disease and related dementias andprovide support to the families who care for them. Itwill also help train health professionals and expandservices.

Advance Directives On Care Choices is one of ten key initiatives in this Strategy. This specific initiative was created to help seniors andpersons with dementia in Ontario

become more aware of the benefits of advance careplanning and their rights in this area. The governmentis also providing training for advance care planning tohelp service providers respect the choices seniorsmake in the advance care planning process.

The government of Ontario has provided funding tothe Alzheimer Society of Ontario for informationsessions on advance care planning. These sessionsare designed to help family, professional caregiversand persons affected by Alzheimer Disease andrelated dementias across the province. Thisapproach was developed by the Ontario Seniors'Secretariat on the advice of Ontario’s major seniors’organizations, service providers, advocates andother experts in the field of advance care planning.


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For information about an education session in yourcommunity, call your local Alzheimer Society, orcontact its provincial office at (416) 967-5900.

For information about Ontario’s Strategy forAlzheimer Disease and Related Dementias, visit theOntario Seniors’ Secretariat Web site atwww.gov.on.ca/mczcr/seniors, or call the Seniors’InfoLine at 1-888-910-1999 or the Ministry of Healthand Long-Term Care INFOline at 1-800-268-1154.

Support for the AdvanceDirectives on Care ChoicesInitiativeEndorsements from Ontario Advocacyand Service Provider Organizations

The government of Ontario is committed toprotecting seniors' rights and ensuring they livewith dignity and respect. The following organizationshave endorsed the government of Ontario'sAdvance Directives on Care Choices Initiative andthis booklet for seniors on advance care planning,as an important step in both protecting the rights ofseniors and enhancing their quality of life.

• Alzheimer Society of Ontario

• Ontario Long-Term Care Association

• Ontario Association of Non-Profit Homes andServices for Seniors

• Ontario Residential Care Association

• Ontario Association of Community Care AccessCentres

• Ontario Community Support Association

• Regional Geriatric Programs of Ontario

• Advocacy Centre for the Elderly


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Table of Contents

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Why Do Advance Care Planning . . . . . . . . . . . 10

Making Personal Care Choices . . . . . . . . . . . . 12

Communicating Your Choices . . . . . . . . . . . . . 14

When Advance Care Choices Take Effect . . . . 16

Choosing Your Substitute Decision-Maker . . . 19

How to Give Your Substitute Decision-Maker Power to Act for You . . . . . . 22

Carrying Out Your Care Choices . . . . . . . . . . . 28

If You Don’t Appoint a Substitute Decision-Maker . . . . . . . . . . . . . . . . . . . . . . . 29

Steps in Advance Care Planning . . . . . . . . . . 33

Your Substitute Decision-Maker Wallet Card . . . . . . . . . . . . . . . . . . . . . . . . . . 35

Where to Get More Information . . . . . . . . . . . . 35

Summary of Steps in Advance Care Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42

Alphabetical Listing of Contacts . . . . . . . . . . . 43



A Guide to Advance CarePlanning

Of all the choices you make in life, among themost important could be the choices you makenow about your future personal care.

IntroductionMaking personal choices is basic to a person’ssense of identity and well being. This is especiallytrue of decisions about personal care includinghealth care (treatment and services), food, livingarrangements and housing, clothing, hygieneand safety.

Every year, many Canadians become unable tomake their own decisions about their personal careand medical treatments. It can happen slowly, overtime, as with Alzheimer Disease; or it can happensuddenly, without warning, through a stroke oraccident.

If an illness or accident leftyou unable to makedecisions for yourself about


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things that really matter to you, who would makethose decisions for you? How could they know whatyou would or wouldn’t prefer?

It’s important to take steps now, while you arecapable, to ensure your wishes, not someoneelse’s, guide the decisions made for your care andmedical treatment if you ever become unable tomake such decisions yourself. This is what advancecare planning is about: Making clear how you wishto be cared for, and giving someone you trust theauthority to act on those wishes for you, if the needarises.

This booklet encourages people totalk about their care wishes withtheir families and those who willmake decisions for them in thefuture, in the event they are unableto make decisions themselves. Itexplains step-by-step what you needto do to begin your process ofadvance care planning and providesanswers to some frequently askedquestions. Included are optionsavailable to help you take the stepsNOW that are right for you.

A G U I D E T O A D V A N C E C A R E P L A N N I N GA G U I D E T O A D V A N C E C A R E P L A N N I N G


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Personal Stories

At age 75, Henry has developed AlzheimerDisease. He can still make decisions on his ownso he and his wife, Ann, have begun to talkabout his wishes and plan for his future care. Asa result, Henry feels comfortable that Annknows what is important to him, and Ann feelsbetter able to make the right care decisions forHenry when the time comes.

Claudette is in good health in her 60s but shehas firm views on the kind of medical care shewould want if, for example, she had a suddenstroke. Her daughter, Lise, lives far away, soClaudette’s good friend, Johanne, has agreed tomake care decisions for Claudette if herdecision-making ability is ever affected.Claudette has talked over her future carewishes with both Johanne and Lise tomake sure they understand what mattersmost to her, and has given Johanneauthority to act for her through aPower of Attorney for PersonalCare.


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Why Do Advance CarePlanning?What is advance care planning?

Advance care planning is about making choicesnow, while you are capable, about how you wish tobe cared for in the future if you become incapable ofmaking decisions. It is also about giving someoneyou trust the information and authority to act onthose wishes for you. This person is called yoursubstitute decision-maker.

Advance care planning is different from, but just asimportant as making plans for your finances,property, estate, will or funeral arrangements.

What does “capable” mean in thiscontext?

To be capable of making personal care choicesmeans that you can understand information that isrelevant to making a decision about your healthcare, nutrition, shelter, clothing, hygiene or safety,and can grasp the likely results of making thedecision or not making it.

For health care, your doctor or other health careprovider needs to have your informed consent. In

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A G U I D E T O A D V A N C E C A R E P L A N N I N GA G U I D E T O A D V A N C E C A R E P L A N N I N G


order for you to give informed consent, you must becapable, given information about your condition, therecommended treatment, alternatives to theproposed treatment and the likely outcomes of eitheraccepting or refusing the treatment.

Why is advance care planning important?

Advance care planning gives you the opportunity tomake choices about your future personal care. Itcan give you the peace of mind that someone youknow and trust understands your wishes and will acton them on your behalf, should they ever need to.

It can make it easier for everyone concerned: easierfor you, because you’ll have the confidence thatyour wishes are known; easier for those close toyou, because it can reduce their stress in makingtough decisions on your behalf; and easier for yourcare providers, because they’ll be able to act inkeeping with your wishes in an emergency.

Does advance care planning have to bedone?

It is your choice whether to do advance careplanning or not. No one can do it for you or makeyou make those choices. It is your right to express


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your wishes, to appoint a substitute decision-makerand to expect your wishes to be followed. There isno legal requirement to do advance care planning.You are not legally obliged to state your wishes inany form before you can get health care, or moveinto a care facility.

Making Personal CareChoicesWhat kinds of personal care choices canbe made?

You can express your wishes about anything relatedto your personal care - where you want to live, whatyou want to eat and wear, what kind of health careyou want, how you prefer to be groomed and howyou want your safety ensured. If, for any reason, youare not mentally capable of making a personal carechoice that needs to be made, your health care

providers are required to take directionfrom your substitute decision-maker.Your substitute decision-maker mustfollow your expressed wisheswherever possible. If it is impossibleto follow your wishes, your substitutedecision-maker must act in your bestinterests.


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How can these choices best be made?There is no one-size-fits-all formula for advancecare planning. The process calls for careful thoughtand communication.

You may find it useful to think about your ownvalues, wishes and resources. For example, is itimportant to you to live in your own home as long aspossible? Do you have the financial means to dothis? If you are unlikely to recover from an illness,do you wish to receive medical care that will prolongyour life?

You should talk these things over with people whoare close to you – it will help you now and them inthe future.

You do not have to specify decisions for all possiblesituations; in fact, this would be impossible to do! Itis more important that your substitute decision-maker knows you, your values and beliefs and feelsconfident in acting on your behalf.


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Communicating Your ChoicesWho needs to know that advance carechoices have been made?

Advance care planning is about communicating whatpersonal care you do or do not want to receive in thefuture to whoever will be making those decisions foryou if you are not capable. That would be, first andforemost, your substitute decision-maker, but couldalso include your family, close friends, doctor, lawyer,or other care providers, as you see fit.

Your family and friends may need encouragementand time to accept the idea of advance careplanning before they are ready to hear about yourwishes for the future. Many people do not like to talkabout illness, mental incapacity or death. Tell themhow important it is to you to talk about this now. Talkthrough potential disagreements on care options, asthis may prevent problems later on.

How can you ensure that your carechoices are understood?

Your values and beliefs will influence your wishes.Talk about them with your substitute decision-makerand those close to you, to help them understandyour wishes clearly.


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You may change your mind at any time. Review yourwishes on a regular basis with your substitutedecision-maker and make sure your family, friendsand care providers are aware of any changes. Themore they know about your care wishes, the betterthey will be able to act on them. The personal carewishes you express while capable are legallybinding.

Talk to your substitute decision-maker aboutwhether it is helpful if your care wishes areexpressed in writing.

Do care choices need to be in writing?

No. You can express your care wishes to yoursubstitute decision-maker any way you like. It can bedone face to face or with a recording device such asan audiotape or videotape, or in any written form,including Braille or Bliss Board.

However, in order to name someone as yoursubstitute decision-maker, you must appoint them inwriting through a Power of Attorney for PersonalCare. How to do this is explained later in this guide,beginning on page 22.


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What happens if changes are made toadvance care choices?

You can always change your mind about your carewishes. But be sure to tell your substitute decision-maker that your wishes have changed. You can dothis face-to-face or any other way you choose.

Your decision-maker is obligated to follow your lastknown capable wishes no matter how youexpressed them. However, if you have given anyprevious instructions about your personal care inwriting or on audiotape or videotape, you may wantto revise them and add the new date.

When Advance Care Choices Take EffectAny wishes that you express concerning your futurepersonal care will take effect only if you becomeincapable of making the relevant personal caredecision for yourself.

Your substitute decision-maker only makesdecisions for you that you are not capable ofmaking yourself. If you remain capable of makingsome or any personal care decisions, then youcontinue to do so.


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Who decides if a person is no longercapable of making decisions?

• The health care provider offering the treatment toyou decides whether you are capable or not ofmaking decisions about your medical treatment,admission to a long-term care facility or personalassistance services in a long-term care facility.

This kind of assessment is ongoing, rather than aone-time event, because your ability to makedecisions can vary greatly with your condition,from month to month, week to week, or even dayto day. It can also vary with the type of decisionto be made.

• For other personal care decisions you have twooptions. Your substitute decision-maker candecide whether you are capable of making thedecision or not.

OR

You may prefer to have anindependent confirmationof your mental incapacitywith regard to personalcare decisions.


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You can state that wish in a document called aPower of Attorney for Personal Care. If you dothis, the person you name as your attorney forpersonal care cannot start making decisions foryou until the independent confirmation is made.

In the Power of Attorney for Personal Care youcan name a person close to you to provide theindependent confirmation of your incapacity tomake personal care decisions—for example, yourfamily doctor or a good friend. Or you can specifya certain kind of professional, such as apsychologist or social worker. If you ask for anindependent confirmation of incapacity withoutspecifying who you would like to provide it, aprofessional capacity assessor will provide thatindependent confirmation.

What if you disagree with a healthpractitioner’s finding of your mentalincapacity?

You can appeal a finding of mental incapacity to theConsent and Capacity Board, which is anindependent body created by the Ontariogovernment. Its members can be psychiatrists,lawyers, or members of the public.


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Among other things, the board can hold a hearing toreview your capacity to make decisions about healthtreatment, personal assistance services, oradmission to a long-term care facility. There is nocharge to go to the Consent and Capacity Board.

For more information, contact the Consent andCapacity Board.

Telephone: 416-327-4142 Web site: www.ccboard.on.ca

Choosing Your SubstituteDecision-MakerWhat is a substitute decision-maker?

A substitute decision-maker is someone who makesdecisions on your behalf if you become incapable ofmaking them yourself.

Who can be a substitute decision-maker?

You can choose to appoint anyone who is willingand able to act on your behalf to be your substitutedecision-maker except:


• someone who is paid to provide you withpersonal care e.g., your nurse, unless thisperson is your spouse, partner or relative,

• someone who is mentally incapable,

• someone who is under 16 years of age.

It is likely you will want to choose someone close toyou, whom you trust and who knows you well. It isimportant that you discuss your intent to name theperson ahead of time to make sure they are willingto act for you if it becomes necessary.

What is the role of a substitute decision-maker?

If you become unable to make decisions, yourdoctor or other health care providers must contactyour substitute decision-maker to seek their consentbefore your doctor or other health care provider cangive you treatment.

An exception would be an emergency situationwhere a health care provider may not know your

wishes and may have to act quickly.However, health care providershave to follow your wishes, if theyknow what they are, in any andall emergency situations.


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Your substitute decision-maker must try to make thesame personal care choices that you would havemade in that situation, and follow your instructions ifyou gave any. He or she acts for you only when youare unable to make decisions yourself. That situationcould be temporary, or it could last for the rest ofyour life.

Your substitute decision-maker must:

• maintain contact with you, involving you as muchas possible in any decision about your care,

• get all the relevant information from health careproviders about your medical care and treatment,

• follow your known care wishes as much aspossible in making any decisions that come upabout your personal care.

For some decisions, you may not have given anyinstructions or your substitute decision-maker maynot know of any wishes you have that might apply.In that case, your substitute decision-maker mustconsider your values and beliefs, weigh theprobable benefits and risks of any course of action,and make decisions based on what he or shebelieves to be in your best interests.


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How to Give Your SubstituteDecision-Maker Power to Act for YouHow and why do you appoint a substitutedecision-maker?

To give someone power to act on your behalf, youmust appoint them to be your substitute decision-maker in writing, through a document called aPower of Attorney for Personal Care.

The person you appoint is called your attorney forpersonal care – this is a specific type of substitutedecision-maker. You can appoint more than onesubstitute decision-maker, and you can direct themto make decisions together or separately.

If you do not appoint an attorney for personal care,your health care providers must get consent orrefusal of consent for treatment from the first personavailable to act for you from a hierarchy of substitutedecision-makers set out by law. See page 30 in thisbooklet for more information on the order that healthcare providers must follow to identify that individual.Not only may this person not be your first choice ofperson to act on your behalf, this person only has


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the authority to make decisions related to yourhealth care, admission to a long-term care facility,and the personal assistance services you receive ina long-term care facility.

• Therefore, it is important to designate asubstitute decision-maker through a Power ofAttorney for Personal Care to ensure you have aperson of your choice making decisions aboutboth your health care and other aspects of yourpersonal care.

What is a Power of Attorney for Personal Care?

A Power of Attorney for Personal Care is adocument through which you appoint your substitutedecision-maker and give them the power to makedecisions about all aspects of your personal care,unless you specify otherwise. This includes yourhealth care, shelter, clothing, nutrition, hygiene, andpersonal safety.

A Power of Attorney for Personal Care may only beused if you become incapable of making a particulardecision. You continue to make your own decisionsuntil found incapable.


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To be valid, a Power of Attorney for Personal Caremust be signed and dated by you. Two witnessesmust watch you do this, then they must co-sign thedocument in your presence, and in the presence ofeach other. At the time that you sign it, you must beable to understand what the document means andthat the person you name as your substitutedecision-maker will make decisions for you whenyou are not capable for a particular personal caredecision. The person you appoint as substitutedecision-maker cannot act as a witness, neither canhis or her spouse or partner. As well, witnessescannot be under 18 years old and cannot be yourspouse, partner or child.

If you wish, you can appoint more than one attorneyfor personal care. For example, you may want yourbrother and your daughter to make decisionstogether on your behalf. In that case, all yourattorneys for personal care must agree before adecision can be made on your behalf, unless youstate in the document that they can make decisionsseparately.

You may also appoint different attorneys to makedifferent kinds of personal care decisions—forexample, one attorney for personal care could make


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decisions about shelter, another about health care,and so on.

Consider also naming another person to act as analternate or back-up substitute decision-maker toensure you have a back-up substitute decision-maker of your choosing should the first person younamed as your attorney for personal care be unableto act for you. For example, an alternate acting asyour substitute decision-maker may relieve your firstchoice, perhaps a spouse or partner, of thepressure of making necessary care decisions in atime of emotional stress.

As long as you remain capable, you can execute anew Power of Attorney for Personal Care, revokingor changing who you have named as your attorneyfor personal care in a previous document.

What is an “advance care directive” or“living will” and how does it differ from aPower of Attorney for Personal Care?

An “advance care directive” or “living will” is used todocument your care wishes so your substitutedecision-maker can refer to it when makingcare decisions for you in the future, if and


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when you can’t make those decisions for yourself. Itmay also help your substitute decision-maker inher/his future dealings with your care providers.

A Power of Attorney for Personal Care may be usedfor the same purpose as an “advance care directive”or “living will” but it also appoints your substitutedecision-maker. If you do a living will and use it toname someone as your substitute decision-maker,then it may be a Power of Attorney for PersonalCare if it meets the legal requirements – that is, thatit be in writing, signed and dated by you, andwitnessed by two people.

Does a lawyer need to prepare anyadvance care planning documents?

You do not need a lawyer to prepare any documentsrelated to advance care planning, whether in theform of a Power of Attorney for Personal Care or an“advance care directive”. However, a lawyer may behelpful in explaining your options and can help youprepare such documents if you wish. Some of theimportant people to involve in advance careplanning are your loved ones, your physicians andother key care providers.


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Do advance care planning documentsrequire a special form?

No special form is necessary to do advance careplanning, although Power of Attorney for PersonalCare forms are available free of charge from theOffice of the Public Guardian and Trustee. You mayprefer to use one of the forms or kits available foradvance care planning (see Tip on page 35).

Does an Attorney for Personal Care alsohave authority over finances and personalproperty?

Your Attorney for Personal Care can deal only withyour personal care decisions. Of course, thosedecisions may have to take your financial meansinto account.

If you wish to give someone the authority to makedecisions about your finances, home andpossessions, you must use a different legaldocument called a Continuing Power of Attorney forProperty (also available free of charge from theOffice of the Public Guardian and Trustee).


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Carrying Out Your CareChoicesWill your expressed care choices alwaysbe followed?

Your substitute decision-maker must follow yourexpressed care wishes unless it is impossible todo so. If it is impossible to follow your wishes, yoursubstitute decision-maker must act in your bestinterests.

For example, you may have said that you wouldnever want to live in a long-term care facility, yet youneed more care than is available for you in thecommunity and do not have money to pay forprivate care. Another example of an impossiblesituation would be a wish for assisted suicide oreuthanasia, as this is illegal in Ontario.

In emergency situations, ambulance attendants maynot be able to follow your wishes. However, health

care providers have to followyour wishes, if they know

what they are, in anyand all emergencysituations.


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What happens to advance carearrangements if a person is outside ofOntario? Will other jurisdictions recognizeadvance care arrangements?

Different jurisdictions have different legislationregarding advance care planning.

If you spend time outside Ontario, it is a good ideato consult a lawyer about whether your wishes willbe followed and your substitute decision-makerrecognized in the province or country you intend tovisit.

If You Don’t Appoint aSubstitute Decision-MakerWhat happens if a Power of Attorney forPersonal Care is not completed?

Ontario law does not ensure there will be asubstitute decision-maker to make all your personalcare decisions for you unless you appoint asubstitute decision-maker through a Power ofAttorney for Personal Care.

However, the law does make sure that there willalways be a substitute decision-maker to make


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some health decisions for you, but this includesdecisions only about:

• your health care, (e.g. treatments)

• your admission to a long-term care facility, and

• the personal assistance services you will receivein a long-term care facility.

If you have not designated a substitute decision-maker through a Power of Attorney for PersonalCare, a health care provider must turn to thehierarchy of substitutes named in the law to makethe above types of health decisions. The highest-ranking person on this list who is available, capableand willing to make these decisions will becomeyour substitute decision-maker for treatment.

• Your spouse, common-law spouse or partner

• Your child (if they are 16 years of age or older)or parent

• Your parent with right of access only

Custodial parents rank ahead of non-custodialparents

• Your brother or sister

• Any other relative by blood, marriage oradoption


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• The Office of the Public Guardian andTrustee.

The provincial Public Guardian and Trustee is thesubstitute decision-maker of last resort if there isno other appropriate person to act for you.

If there are two or more persons (for example twosisters and one brother) described in the samesubsection of the above hierarchy, who meet therequirements to give or refuse consent on anincapable person’s behalf, they may share thedecision-making responsibility or may choose todesignate a spokesperson. If there is a disagreementamong equally ranked decision-makers that cannotbe resolved, the Office of the Public Guardian andTrustee may be asked to make the decision.

If you have not appointed a substitute decision-maker anyone, including your family or friends, canapply to the Consent and Capacity Board tobecome your substitute decision-maker formedical treatment, admission to long-term carefacility, and personal assistance services in a long-term care facility. They do not have to pay anythingto do this. This is known as your board-appointedrepresentative. A board-appointed representativeranks above your spouse, partner and other family


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members in the hierarchy of substitute decision-makers named in the law.

If you have not appointed a substitute decision-maker, almost anyone, including family membersand friends, can apply to the Superior Court ofOntario to be appointed as your “Guardian of thePerson” with authority for treatment. Like anattorney for personal care, a Guardian of the Personmay be authorized to make the full range ofpersonal care decisions for you, in keeping with yourknown wishes. A “Guardian of the Person” withauthority for treatment ranks highest on the hierarchyof substitute decision-makers named in the law.

Note: The above hierarchy of substitutes named bythe Ontario law does not take effect if you havedesignated a substitute decision-maker withdecision-making authority for health carethrough a Power of Attorney for Personal Care(see page 22 for more information on how todesignate a substitute decision-maker). It isimportant to designate a substitute decision-maker through a Power of Attorney for PersonalCare to ensure you have a person of yourchoice making decisions about both your healthcare and other aspects of your personal care.


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Steps in Advance CarePlanningThink about your values, and what’s importantto you.

What kind of personal care would you want—or notwant—to receive if you were not capable of decidingfor yourself? Personal care does not deal withfinancial matters, but rather with the medicaltreatment you receive, your nutrition and hygiene,where you live and with whom, and your personalsafety.

Consult people you trust who can provide guidance.

What are the legal aspects of advance careplanning? How does your faith influence yourdecision? What decisions are most likely to beneeded given your health? Your doctor, lawyerand/or faith leader may be able to give yousome information to help you make youradvance care plans.

Decide on and appoint a substitutedecision-maker.

Who would you want to makedecisions for you if you were not


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capable? You can choose one or more people to actfor you, but make sure that they understand their joband are willing to accept responsibility for carryingout your wishes.

Make your choices clear to others.

How can your substitute decision-maker make thesame choices that you would make for yourself inwhatever situations arise? You need to communicateyour care wishes clearly, while you are capable, toyour substitute decision-maker as well as to yourfamily, friends and health care providers, as you seefit. You and your substitute decision-maker may findit helpful if you write down your wishes, but you donot have to do this.

Give your substitute decision-maker the powerto act on your behalf.

How can your substitute decision-maker makepersonal care decisions on your behalf? You need todo two things: tell them your care wishes, andappoint them to act as your substitute decision-maker through a Power of Attorney for PersonalCare. A Power of Attorney for Personal Care must bein writing, signed and dated by you, and witnessed bytwo people.


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Carry your substitutedecision-maker wallet card.How will anyone know you have a substitutedecision-maker, and how to contact him or her, ifyou become incapable? Fill out, tear off and carrywith you the wallet card provided in this booklet (seebelow). It identifies your substitute decision-makerand tells others how to reach them if needed.

Where to Get More Information


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Tip: The most important part of advance careplanning is thinking through and communicatingyour wishes to your substitute decision-maker.There are, however, some good, Ontario-basedproducts available that you may choose to useto assist you in your advance care planning. Agood start would be the Public Guardian andTrustee Powers of Attorney Kit through whichyou can appoint a substitute decision-maker andexpress your care wishes. If you wantinformation on where to find these additionalresources, contact your local Alzheimer SocietyPublic Education Coordinator or one of the otherorganizations listed on the following pages.

A list of community resources to assistwith advance care planning

This booklet, A Guide to Advance Care Planning, isavailable online at the Ontario Senior’s SecretariatWeb site at www.gov.on.ca/mczcr/seniors or bycalling the Seniors’ INFOline at 1-888-910-1999.

Ontario Seniors’ Secretariat (OSS)

Ontario is home to about 1.5 million seniors – 40 per cent of Canada’s seniors. By 2041, it isestimated that almost a quarter of Ontario’spopulation will be over 65. The Ontario Seniors’Secretariat has two primary tasks: to develop andsupport government initiatives which improve thequality of life of Ontario’s seniors and to undertakeand support public education efforts for and aboutOntario’s seniors.

Ontario Seniors’ SecretariatMinistry of Citizenship77 Wellesley Street West6th Floor Ferguson BlockToronto ON M7A 1R3

Web site: www.gov.on.ca/mczcr/seniors


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Seniors’ INFOlineToll-free: 1-888-910-1999 (Ontario only)Local calls: 416-314-7511TTY: 1-888-387-5559 (Ontario only)

Alzheimer Society of Ontario (ASO)

The Alzheimer Society of Ontario is a province-wide,not-for-profit organization with a membership of 39local Chapters located throughout Ontario. The ASOsupports the local Chapters to provide education andsupport services to improve the quality of life ofpersons with Alzheimer Disease and relateddementias and their caregivers. For the telephonenumber of an Alzheimer Society Chapter in yourcommunity, contact:

Telephone: 416-967-5900 Web site: www.alzheimer.ca

Office of the Public Guardian and Trustee

The Office of the Public Guardian and Trustee ispart of the Ontario Ministry of the Attorney General.Contact them for information about Powers ofAttorney for Personal Care; Continuing Powers ofAttorney for Property; the Substitute Decisions Act;and guardianship.


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Telephone: 416-314-2800 (Toronto)1-800-366-0335 (toll-free)

Web site: www.attorneygeneral.jus.gov.on.ca (click on “Office of the Public Guardian and Trustee”.)

Community Care Access Centres (CCACs)

CCACs provide access for people who need in-homehealth services and support or accommodation inlong-term care centres. There are Community CareAccess Centres throughout Ontario, funded by theMinistry of Health and Long-Term Care. Contactyour local CCAC for information about personal careservices, respite care, homemaking and otherservices available in your community. For thetelephone number for your local Community CareAccess Centre, contact:

Ministry of Health and Long-Term Care INFOline: 1-800-268-1154 Web site: www.gov.on.ca/health

Regional Geriatric Programs (RGPs) of Ontario

RGPs offer a range of specialized geriatric servicesthat assess and treat functional, medical andpsychosocial aspects of illness and disability inolder adults who have multiple and complex needs.


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The RGP services five regional areas of Toronto,Kingston, Hamilton, Ottawa and London. Forinformation about cognitive assessments, careplanning, services for seniors or contact informationfor a regional office, contact:

Telephone:Toronto 416-480-6026

Kingston 613-544-7767

Ottawa 613-761-4568

Hamilton 905-521-2100, ext. 74007

London 519-685-4046

Web site: www.rgps.on.ca

Advocacy Centre for the Elderly (ACE)

ACE is a legal clinic for low-income seniors aged 60or older in the greater Toronto area. It provides legaladvice and representation, legal education andadvocacy services and has expertise in advancecare planning. To reach ACE, contact:

Telephone: 416-598-2656Web site: www.advocacycentreelderly.org


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Law Society of Upper Canada

As a service to the public and members, the LawSociety of Upper Canada provides links to lawyersthat have been submitted by law firms and individuallawyers. No endorsement is implied. To find alawyer, contact:

Web site: www.lsuc.on.caOnline Yellow Pages: www.yellowpages.ca

Lawyer Referral Service (LRS)

Telephone: 1-900-565-4577

(Please note that you must be 18 years of age toaccess this service, and that, at the time of printingthis guide, there is an automatic $6 toll charge forcalling this number).

Legal Aid

Telephone: 1-800-668-8258 (toll-free)Web site: www.legalaid.on.ca

Consent and Capacity Board

The Consent and Capacity Board is an independentbody created by the provincial government thatconducts hearings under the Mental Health Act, theHealth Care Consent Act and the Substitute


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Decisions Act. For further information regardinghearings related to capacity, wishes and substitutedecision-making as well as application forms anddetailed contact information for the regional andhead offices of the Board, contact:

Telephone: 416-327-4142 Web site: www.ccboard.on.ca

Publications Ontario

This booklet provides information about somefeatures of Ontario’s Health Care Consent Act andthe Substitute Decisions Act. Copies of these Actsand other legislation are available from PublicationsOntario.


Web site: www.gov.on.ca (follow the link for “laws”)


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Summary of Steps inAdvance Care Planning

• Think about your own values and wishes.

• Consult people who can provide advice andguidance, such as your doctor, lawyer, or faithleader.

• Think about the people that you trust to makepersonal care decisions on your behalf, inaccordance with your wishes.

• Decide who your substitute decision-makershould be.

• Appoint your substitute decision-maker to act foryou, if necessary.

• Make your care wishes clear to your substitutedecision-maker and others close to you.

• If your care wishes change, let your substitutedecision-maker know. Revise any written ortaped instructions.

• Fill out and carry with you the wallet cardprovided in this booklet to identify your substitutedecision-maker and tell others how to reach themif needed.


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Alphabetical Listing ofContacts

Advocacy Centre for the Elderly (ACE)

Telephone: 416-598-2656Web site: www.advocacycentreelderly.org

Alzheimer Society of Ontario (ASO)

Telephone: 416-967-5900Web site: www.alzheimer.ca

Community Care Access Centres (CCACs)

Ministry of Health and Long-Term Care INFOline:1-800-268-1154

Web site: www.gov.on.ca/health

Consent and Capacity Board

Telephone: 416-327-4142Web site: www.ccboard.on.ca

Law Society of Upper Canada

Telephone: 1-900-565-4577 (there is a $6 charge for each call)

Web site: www.lsuc.on.ca


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Legal Aid Ontario

Telephone: 1-800-668-8258Web site: www.legalaid.on.ca

Office of the Public Guardian and Trustee

Telephone: 416-314-2800 (Toronto)1-800-366 0335 (toll-free)

Web site: www.attorneygeneral.jus.gov.on.ca

Ontario Seniors’ Secretariat (OSS)

Seniors’ INFO Line:Toll-free: 1-888-910-1999 (Ontario only)Toronto calls: 416-314-7511 TTY: 1-888-387-5559 (Ontario only)Web site: www.gov.on.ca/mczcr/seniors

Publications Ontario


Web site: www.gov.on.ca

Regional Geriatric Programs (RGPs) of Ontario

Telephone: Toronto 416-480-6026Kingston 613-544-7767Ottawa 613-761-4568Hamilton 905-521-2100, ext. 74007London 519-685-4046

Web site: www.rgps.on.ca


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A Guide to Advance Care Planning is available atwww.gov.on.ca/mczcr/seniors or by calling 1-888-910-1999.

© Queen's Printer for OntarioISBN 0-7794-2927-3

D3600 03/02 20M

Disponible en français.

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A Guide to Advance Care Planning - Hospice TorontoA Guide to Advance Care Planning Of all the choices you make in life, among the most important could be the choices you make now about