My father began to show signs of dementia in his early 60s. Within a few years, he was missing dialysis appointments and not taking good care of himself. When my sisters and I started accompanying him to his doctor’s appointments we were struck with the painful reality that he was no longer capable of managing his healthcare on his own. He could not reliably provide his medical history nor could he make rational decisions related to the treatment of his various chronic illnesses.
I am a physician “insider”, yet at times even I find the healthcare system incredibly confusing. Imagine how confusing it is for individuals with dementia or other illnesses that affect their ability to make rational decisions. Imagine your aging loved one is taken to the hospital via ambulance and is unable to communicate his/her wishes regarding care. These are examples that illustrate why completing a healthcare power of attorney document is essential.
A healthcare power of attorney (also known as a medical power of attorney) is a document that designates a person to make medical decisions on behalf of an individual when they are not able to do so for themselves. The designated person is known as the “representative” or “agent.”
The agent needs to be chosen very carefully. This individual will be responsible for making decisions that are both in the best interest of the patient and are aligned with the patient’s values and wishes. These decisions may range from choosing health care providers and scheduling appointments to withholding or withdrawing life-prolonging therapy. An alternative or “back-up” agent can also be identified. This probably sounds overwhelming, but the alternative is chaos. According to a 2014 study by the American Journal of Preventive Medicine, only 26 percent of Americans have an advance directive. Without this important document, it will be difficult to advocate for your loved one and you may have no authority to make decisions.
Websites like Legal Zoom and Rocket Lawyer have state-specific forms that can be printed or downloaded at no cost. You can also work with an elder law attorney. It is important to have a discussion with your loved one about their wishes and to complete this document before he/she becomes incapacitated. The individual must be of sound mind and able to understand the document, otherwise, it is invalid. Ideally, your loved one should also complete a living will. (See my blog post on Living Wills for more information).
The document must be signed and dated by the patient in the presence of two witnesses. I recommend that the patient and the agent carry a copy of the document at all times. Many experts recommend taping a copy to the refrigerator so paramedics have access to it and can transport the document with your family member, in case of an emergency. Copies should be provided to all medical providers, including hospitals and nursing homes, if applicable. The patient has the right to cancel or modify the document, as long as they are of sound mind. If the agent becomes incapacitated or a judge has reason to believe the agent is not acting in the patient’s best interest, their authority can be revoked. A spouse loses authority to be the agent in the case of divorce. Lastly, the document becomes invalid at the time of the patient’s death.
If you are helping to care for a family member and are feeling confused or overwhelmed, I’d love to help! You can schedule a complimentary consult call with me by going to my scheduling site.
Hi, Dr. Rochester. My father is in early stage dementia, but can still function well within his routines. Any divergence from them overwhelms him and we’ve had some quite alarming incidents regarding his forgetfulness and overwhelm. Whenever I suggest that he grant us power of attorney for his health care or complete a living will, he becomes belligerent and absolutely refuses. He’s definitely the “head in the sand” type concerning this subject. Since he still has his faculties, is there any known way around this?
Hi, Celeste. Thanks for your comment and I’m sorry you’re going through this. Unfortunately, you cannot force your father to complete a power or attorney or living will. This is complicated by the fact that he must be of sound mind to complete these documents, so waiting could be detrimental. Perhaps help him to understand that these are ways to PRESERVE his power and control, not to take them away. These documents empower others to carry out HIS wishes. He can be as specific as he likes regarding the care he wants to receive. Don’t give up! Keep having the conversation.