Most adults still don't have a directive, and an old one in a drawer doesn't count

What happened

In late September 2026, Bay Pines VA Healthcare System put a familiar problem back in the open: people who already signed advance directives years ago are finding those papers outdated, and their families are still left deciding without clear guidance when a crisis hits.

That story sits next to a quieter national fact. Most U.S. adults still do not have an advance directive at all. And for those who do, a signed form that no one can open in the ER is not much better than having none.

A signed wish only works if someone can open it when you can't speak.

Kiplinger's guide to advance directives puts the completion gap in plain language: all adults should have one, "yet only about a third of U.S. adults have one, according to a study published in the journal Health Affairs."

That Health Affairs figure comes from a 2017 systematic review of 150 studies covering nearly 800,000 people. Researchers estimated that about 36.7% of U.S. adults had completed any type of advance directive, including living wills and health care powers of attorney. Living-will completion alone was lower, at about 29.3%. Rates looked similar for people with chronic illness and for healthier adults, and they had not clearly climbed across the years reviewed.

Roughly two out of three adults, then, still have no written plan on file when they cannot speak for themselves.

The Bay Pines VA piece, published September 26, 2026, shows what happens on the other side of that gap, including among people who did plan once. The system runs Advance Care Planning workshops so enrolled Veterans and their loved ones can learn about advance directives, talk through values, and complete or refresh paperwork before a medical crisis.

Denyse Wilkins, a Bay Pines VA social work supervisor, framed it without drama: planning aligns decisions with your values so family, clinicians, and VA know what to do in a crisis. "It's not just a legal document," she said. "It's about making sure your loved ones understand your wishes and don't have to make difficult decisions during a crisis without guidance."

Army Veteran Marvin Dalzell and his wife, Cathy, used the workshop to revisit documents they had completed years earlier. "We had prepared our own advance care directives before, but they were out of date," Marvin said. His parents' deaths left questions because "things were not discussed beforehand." Cathy remembered her mother's final days: "You're caught up in the emotions of what is happening, and then you have to make this horrible decision. You didn't know what she wanted. I don't want that to happen to my family."

After updating their paperwork and naming trusted decision-makers, Marvin described the result as peace of mind that what he wants done will be done by people he trusts.

Those are two failure modes. One is never signing. The other is signing once, filing the papers, and discovering later that the document is stale or unreachable when it matters.

Why it matters

Kiplinger is explicit about storage and currency. Do not lock the original in a bank safe deposit box you cannot open quickly. Share copies with family and clinicians. Update the plan every five years, or after a major life change or diagnosis. The guide also flags vague instructions that leave clinicians guessing, and the default when no directive is on file: providers look to next of kin under state rules, or make their best call until a surrogate is identified.

Bay Pines puts the human cost next to the paperwork. Families who love each other still end up deciding blind when wishes were never written down, or when old directives no longer match the person's current values, relationships, or medical reality.

Neither source claims that signing a form is enough by itself. Completion rates around one in three already show how many adults stop before the first step. The VA story shows that even people who took that step can leave a gap if the document ages in a drawer, a filing cabinet, or a portal nobody opens under pressure.

In an emergency, the practical question is narrow. Can the people at the bedside see what you signed, in seconds, without hunting your house, guessing passwords, or waiting for someone to remember where the papers live?

If the answer is no, the signature did not finish the job.

What you can do about it

1. If you are among the roughly two-thirds of adults without an advance directive, start there. Sign something clear. Name who can decide. Tell the people who love you what it says.
2. If you already signed years ago, pull the documents. Check the dates, the agent names, and whether the instructions still match your life.
3. Ask the same practical question the ER will ask without saying it out loud: can someone open this in seconds?
4. Keep copies where family and clinicians can reach them. Do not rely on a locked box you cannot open quickly.
5. Revisit every few years, or after a major life change or diagnosis.

WearableDocs exists for the same reason these stories keep repeating: documentation should travel with the person. A signed order is a start. A findable order is how loved ones and clinicians meet you with the care you asked for.

This article is for general public education only. It is not legal, medical, or emergency advice. Laws and forms can change; consult a qualified clinician and, for personal legal questions, a licensed attorney. In an emergency, call 911.