IOWA — Denise Nicholson, a registered nurse and advance care planning manager at Emplify Health by Gundersen in Iowa, emphasized the importance of advance care directives for adults aged 18 and older on July 7, 2026.

"Having an advance care directive, a power of attorney for health care, is our best defense to not needing to have the court appoint a guardian, someone to make our decisions for us, who may or may not be somebody that we know, and could actually be the very person we -don't- want to make decisions for us," Nicholson said. She noted that people often assume advance care planning is only for those 65 or older. "They talk about it as 65 or older, but at any given time, 18 and above, we could have a medical emergency, accident, or illness, and someone's no longer able to make their own medical decisions," she said.

Nicholson explained that once a person turns 18, if they have not planned ahead, there is no longer a legal medical decision maker for them in an emergency. "When no conversation has taken place, everyone has their own opinion and we can't hear from the patient — who is the most important person in the room — and so it can cause a lot of discord," she said. "It can certainly ease the tension and the emotions surrounding it." Nicholson added, "I have seen a lot of families pulled apart when planning doesn't take place."

She mentioned that her father, who died in July 2025, had been very verbal about his wishes, which allowed the family to gather around him. "I like to refer to it more as how do I want to live, not so much how do I want to die," Nicholson said. Emplify Health by Gundersen operates clinics in Calmar, Decorah, Fayette, Lansing, Postville, and Waukon, and a hospital in West Union.