Advance Directive for a Parent with Dementia in Washington State

A durable power of attorney handles finances and legal decisions. An advance directive handles the other half: what medical treatment your parent wants — and does not want — when they can no longer speak for themselves. For a parent with dementia, that moment is coming. The question is whether the document exists before it arrives.

What an Advance Directive Covers in Washington

Washington's advance directive — formally a Health Care Directive under Chapter 70.122 RCW — lets your parent do two things:

1. Name a health care agent (sometimes called a health care proxy) who has legal authority to make medical decisions when your parent cannot.
2. Document treatment preferences for end-of-life scenarios: whether they want CPR, mechanical ventilation, tube feeding, dialysis, or comfort-focused care only.

This is separate from a durable POA. The POA covers financial and legal authority. The advance directive covers medical authority. You need both. A durable POA does not give you the right to refuse a ventilator on your parent's behalf. An advance directive does not give you the right to access their bank accounts.

Execution Requirements

For the advance directive to be legally valid in Washington:

• Your parent must have decisional capacity at the time of signing. This does not mean they need to be cognitively perfect — it means they understand what an advance directive is, what choices they are making, and the consequences of those choices. A person with early-to-moderate dementia can have lucid intervals with sufficient capacity.
• The document must be signed by your parent (or by someone at their direction if they are physically unable to sign).
• It must be witnessed by two competent adults or notarized. Witnesses cannot be the health care agent named in the document.

Timing matters enormously. If your parent's dementia has progressed to the point where they cannot understand what they are signing, the advance directive is invalid. Unlike a durable POA that survives later incapacity, the advance directive requires capacity at execution. Get this done early.

The POLST Form: A Different Tool for a Different Purpose

Washington also uses the POLST (Portable Orders for Life-Sustaining Treatment) form — a bright green medical order that travels with your parent between care settings. The POLST is not the same as an advance directive:

• An advance directive expresses your parent's wishes. A POLST is a physician order that emergency responders and facility staff must follow.
• A POLST is signed by the treating physician or ARNP, in conversation with your parent or their legal decision-maker.
• The POLST covers specific immediate scenarios: full resuscitation vs. DNR, whether to transport to a hospital, whether to use IV fluids or antibiotics.

For a parent with advancing dementia, the sequence is: execute the advance directive (while capacity exists) → later, when clinical decline warrants it, work with the physician to complete a POLST that translates those wishes into actionable medical orders.

When Capacity Is Already Gone

If your parent has lost the ability to execute a valid advance directive, Washington law provides a statutory surrogate decision-making hierarchy under RCW 7.70.065. In order of priority:

1. Court-appointed guardian (if one exists)
2. Person with durable POA that includes health care authority
3. Spouse or state-registered domestic partner
4. Adult children
5. Parents
6. Adult siblings

If you hold a valid durable POA with health care decision-making authority, you can make medical decisions without an advance directive — but you are making your best judgment about what your parent would want, not following their documented preferences. That distinction matters when siblings disagree or when the decision involves discontinuing life-sustaining treatment.

If no POA exists and no guardian has been appointed, the surrogate hierarchy applies — but hospitals and facilities are often reluctant to follow informal surrogacy for high-stakes decisions (withdrawing ventilation, transitioning to hospice). In contested situations, they may require a court-appointed guardian, which means months of delay and thousands of dollars in legal fees.

Combining the Advance Directive with Your Dementia Care Plan

The advance directive is one document in a broader legal authority framework:

• Durable Power of Attorney — financial and legal decisions
• Health Care Directive (Advance Directive) — medical treatment preferences and health care agent appointment
• POLST — immediate medical orders for emergency responders
• HIPAA Authorization — allows named family members to access medical records

Get all four in place while your parent has capacity. An elder law attorney can draft the complete package, but the Washington Dementia & Memory Care Guide includes preparation worksheets for each document — the legal questions to discuss with your parent, the financial inventory your attorney will need, and a capacity-window checklist so you can identify and act during your parent's best cognitive periods.

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