Alternatives to Five Wishes for Advance Directive Planning

Five Wishes is the most widely used advance directive document in the United States, with over 40 million copies distributed since 1997. It covers personal, spiritual, and medical preferences in accessible language — a significant improvement over the clinical statutory forms most states provide. But it was designed as a simplified directive, not a complete advance care planning system, and families dealing with dementia progression, sibling conflict, multi-state coordination, or complex Medicare decisions will find its scope too narrow.

Here are the alternatives worth considering, depending on what Five Wishes does not cover for your situation.

Where Five Wishes Falls Short

Five Wishes addresses five questions: who makes decisions for you, the medical treatment you want or do not want, how comfortable you want to be, how you want people to treat you, and what you want your loved ones to know. These are important — and they are about 30% of what advance care planning actually requires.

Five Wishes does not cover:

• Healthcare proxy appointment as a standalone process — it names a proxy but does not walk through how to choose the right person or what to do when the proxy's judgment conflicts with the written directive
• POLST/MOLST completion — the medical order that EMS actually follows during a 911 call (Five Wishes is not a POLST and does not replace one)
• Dementia-specific planning — stage-by-stage documentation timelines as capacity narrows
• Family coordination — sibling alignment, task allocation, perception-gap resolution
• Medicare hospice and palliative care rules — eligibility, enrollment, revocation, coverage
• Multi-jurisdictional forms — Five Wishes is valid in 46 states but does not map form names or requirements across all 50 states, Canadian provinces, or international jurisdictions
• Document distribution and tracking — ensuring the right people and institutions have copies

Alternative 1: Comprehensive Advance Care Planning Toolkit

A full toolkit covers the entire planning process — from the initial conversation through document completion, family coordination, and emergency preparedness. The End-of-Life Conversations and Advance Care Planning Toolkit includes values-conversation scripts (the conversation Five Wishes assumes you have already had), advance directive walkthroughs, healthcare proxy designation worksheets, POLST preparation checklists, a dementia planning timeline, sibling task allocation tools, and a 50-state jurisdictional form finder.

Best for: Families who need the complete planning process — not just the directive document — especially those dealing with cognitive decline, sibling dynamics, or multi-state coordination.

Limitation: More comprehensive means more to work through. If your only need is a simple directive for a healthy parent, Five Wishes may be sufficient.

Alternative 2: The Conversation Project

The Conversation Project (theconversationproject.org) offers free conversation starter kits designed specifically to help families begin end-of-life discussions. Its strength is exactly what its name suggests: starting the conversation. The kits provide thoughtful prompts and a non-threatening framework for a topic most families avoid.

Best for: Families whose primary barrier is getting the conversation started. If your parent refuses to discuss end-of-life planning at all, this is a lower-stakes entry point than presenting any document.

Limitation: The Conversation Project does not produce legal documents. It helps you talk — it does not help you plan. After the conversation, you still need to complete an advance directive, designate a proxy, and potentially complete a POLST.

Alternative 3: State Statutory Forms + Self-Guided Process

Every state provides free advance directive forms through its health department. These are the legally authoritative documents — Five Wishes and other commercial alternatives are supplements that feed into (or sometimes replace) these statutory forms. You can download, complete, witness or notarize, and file them without any third-party resource.

Best for: Families with straightforward situations — a cooperative parent, no family conflict, no dementia concerns, and comfort navigating legal and medical terminology independently.

Limitation: The forms themselves provide no guidance on how to have the conversation, how to make the medical decisions the form asks about, or how to coordinate with family. They assume you already know what you want — which is the part most families have not figured out.

Alternative 4: Professional Facilitation

A social worker, palliative care specialist, or certified advance care planning facilitator can guide the conversation and document completion in person. Many hospitals and hospice organizations offer this service, sometimes at no cost for patients already in their system.

Best for: Families with active conflict, a parent with communication challenges, or cultural dynamics that make a structured document feel too impersonal. Professional facilitators are also valuable when the parent has complex medical conditions that require nuanced treatment preference discussions.

Limitation: Cost ($100–$250 per session for geriatric care managers; potentially free through hospice or hospital programs), scheduling, and geographic access. The facilitator covers the conversation and documents but typically does not provide ongoing family coordination tools or follow-up resources.

Comparison Table

Who This Is For

• Families who have used Five Wishes and found it insufficient for their situation
• Adult children coordinating advance care planning across multiple siblings or states
• Caregivers dealing with a parent's cognitive decline who need dementia-specific planning tools
• Anyone comparing advance care planning approaches before committing to one

Who This Is NOT For

• Families who only need a basic advance directive for a healthy, cooperative parent — Five Wishes itself may be adequate
• Situations requiring estate planning, Medicaid asset protection, or guardianship — these need an elder-law attorney regardless of which advance care planning tool you use

Frequently Asked Questions

Is Five Wishes legally valid in all states?

Five Wishes meets the legal requirements in 46 US states. In Alabama, Indiana, Kansas, New Hampshire, Ohio, Oregon, Texas, and Utah, it can be used as a guide but should be accompanied by the state's statutory form to ensure full legal validity. Check your state's specific advance directive laws.

Can I use Five Wishes with a comprehensive toolkit?

Yes. Five Wishes can serve as one component of a larger advance care planning process. Complete the values conversation and family coordination using a comprehensive toolkit, then use Five Wishes as the directive document if it meets your state's requirements — or use your state's statutory form for broader legal coverage.

What is the difference between Five Wishes and a POLST?

Five Wishes is an advance directive — a document that expresses future preferences. A POLST is a medical order — a clinician-signed document that provides immediate, actionable instructions to any healthcare provider, including EMS. A POLST does not replace an advance directive; it translates the directive's preferences into standing medical orders for the patient's current condition.

Do hospitals accept Five Wishes?

Most hospitals accept Five Wishes as a valid advance directive, but practices vary. Some hospitals will ask you to also complete their own intake forms. Having your state's statutory form as a backup ensures there is no question about legal validity. The most important factor is that the document is on file with the hospital — any valid advance directive that the medical team cannot find during a crisis is functionally useless.