Not enough Americans have estate plans—or healthcare directives—and the situation is not improving, according to Andrew Crowell, financial advisor and vice chairman of wealth management at D.A. Davidson & Co., an employee-owned financial services firm based in Great Falls, Mont.

Advisors wanting to correct the problem have their work cut out for them, Crowell said in an interview.

“It is incumbent upon the advisor to include these plans in the clients’ annual review and not limit the review to the investment portfolio,” Crowell said. “Most people probably know these are things they need, but they have just not taken action yet.”

According to a survey sponsored by D.A. Davidson, only one in three adult Americans has an estate plan. Even among those who do have one, 20% have not updated it in at least the last five years. Women are worse off than men: 72% of women do not have an estate plan while 59% of men do.

It’s equally disturbing to Crowell that only about 33% of Americans have a healthcare power of attorney—the document that gives another person the power to make healthcare decisions for them. Sixty-eight percent of Americans said they don’t even accurately understand what it is. However, 50% of those in the D.A. Davidson survey were likely to have the document if they worked with a financial professional, while only 20% had the document among those without a financial professional’s help. The numbers were slightly better for Gen Z: 30% said they had a healthcare power of attorney, while only 25% of millennials and 27% of Gen Xers said they did.

“Americans are vastly underprepared to pass on their assets according to their wishes and to care for loved ones in the event of a medical emergency,” Crowell said in a statement about the study. “If the Covid-19 pandemic has taught us anything, it’s the importance of being prepared for life’s uncertainties, and creating a focused and detailed estate plan can do just that.”

According to the survey, which was based on 2,094 responses, 37% of those without an estate plan said they did not think they had enough money to warrant one. An even larger percentage, 44%, said they were just procrastinating.

Twenty-five percent said they did not know what needed to be done or where to start; 16% said they thought they didn’t need an estate plan because they have no dependents; 13% said they thought estate plans were too expensive; and 11% said they were uncomfortable discussing death or money.

“Working with a financial professional has a positive impact when it comes to creating an estate plan,” D.A. Davidson said in a statement about the survey results. “The number of those having a plan increased significantly—from 34% to 56%—for those who worked with a financial professional at some point.”

The survey also showed that those who worked with a financial professional feel more confident and better prepared discussing their estate plan and end-of-life wishes than those who have never worked with one.

Crowell said the survey shows the importance of working with an advisor. In the statement announcing the results, he said, “Estate planning can be a sensitive topic, and an advisor can really help bridge this knowledge—and coverage—gap.” An advisor could bring up the sensitive subject by using a personal example, he added.

If clients are “having a hard time getting started or do not know what to do,” he added, “they might want to get recommendations about an advisor from friends or family. Advisors are in a unique position to know if a client’s wishes will be carried out, or if they will be decided in court.”