Medical Power of Attorney: What Family Caregivers Don’t Know

Agreeing to accept the responsibility of medical power of attorney for an aging parent, family member or friend is a serious legal responsibility. Adult children and family caregivers accept the responsibility of a legal agent with little or no knowledge of what happens when a loved one needs care or how to make end-of-life care decisions.

Managing the care of eldelry parents, when to get power of attorney, how to appoint a power of attorney, understanding how care needs increase, creating a care plan, and advocating with the healthcare system aspects of estate planning. If you are unsure whether being a medical power of attorney is for you this article may help you decide. 

Medical Power of Attorney: When It’s Okay to Disagree With Medical Professionals

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Managing the Care of Elderly Parents

Adult children are most often appointed as medical power of attorney to manage the care of an elderly parent.  What adult children fail to understand is that the responsibility of managing care involves negotiation—a give and take relationship—with an elderly parent.

The role of a medical power of attorney is to support the “principal” or the elderly parent who executed the legal document. The adult child is considered the “agent.” Most elderly parents have the goal of remaining independent and living in their own homes for as long as possible.

Adult children may have a different desire or opinion of the situation. Being appointed medical power of attorney does not give adult children the legal right to take over making medical and lifestyle decisions for an elderly parent. Being appointed as medical power of attorney is similar to serving in the role of an assistant or advisor.

The medical power of attorney’s role is to know the health conditions and the desires of the elderly parent and to be able to communicate this information to others if or when an elderly parent is unable to communicate on his or her own. This knowledge requires time devoted to understanding health conditions, medications, desires for extensive care.

If your parent has dementia or Alzheimer’s, the online course How to Get Guardianship of A Parent may be helpful in understanding the difference between medical power of attorney and guardianship. 

Creating a Medical Power of Attorney Care Plan

This process of learning about health conditions, medical and healthcare needs, and the care wishes of an elderly parent can be completed by when creating a power of attorney care plan. A care plan is a written or typed document with historical and current information and personal preferences.

The goal of creating a medical power of attorney care plan is so that the information can be reviewed and confirmed by the elderly parent to be accurate. When emergency care needs arise, family members can become emotional and disagree about what an elderly parent would have wanted for care.

Written documents avoid confusion and provide a plan for the medical power of attorney to follow despite potential disagreement by brothers and sisters or other family members. Written documents describing the wishes of an elderly parent eliminate guesswork and assumptions.

Medical Decision Making

An elderly parent will, at some point, need support evaluating information and making medical decisions. It is the role of the medical power of attorney to provide support in these situations.

Support by the medical power of attorney specific to medical decision making may include:

• Obtaining medical or treatment recommendations from a healthcare provider and evaluating the information to decide about the next steps
• Reviewing medical information and the consequences of decisions with an elderly parent
• Developing a list of questions for healthcare providers
• Making a pro and a con list so that the potential advantages and risks are identified
• Discussing the short- and long-term prognosis of chronic disease and associated care
• Asking an elderly parent about his or her desires for “improving, maintaining, or comfort care” which may be different from the opinion of the medical power of attorney agent or family members
• Reviewing treatment costs and other expenses that might be incurred
• Preparing for alternate options if medical treatments or decisions do not work out as expected
• Discussing all information with an elderly parent to arrive at the best possible decision

Making medical decisions is a process that supports daily quality of life. Caregivers acting as medical power of attorney agent should be aware that the health of aging parents can change quickly. This means that having a plan with additional options is important to avoid crisis decision-making.

Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs)

Depending on the health situation of an elderly parent, daily decisions about various types of assistance may be required. Elderly parents struggle over time with completing activities of daily living or ADLs.  ADL is the abbreviation for activities of daily living that include: bathing, managing continence, eating, dressing, toileting, mobility, and transfers. This type of assistance is needed as the health and physical abilities of an elderly parent decline.

Other tasks like grocery shopping, meal preparation, arranging and attending medical appointments, picking up prescriptions are less “hands-on” and more social or activity-focused projects. Still, someone, if not the power of attorney or the healthy spouse, is needed to coordinate, assist, and oversee these activities.

The Costs of Caring for Elderly Parents

The costs of caring for elderly parents include personal costs related to the time of the caregiver or medical power of attorney and hard costs for expenses for which checks are written. As daily needs advance, consideration must be given to who will provide care. If the caregiver is not a healthy spouse, the medical power of attorney, or another family member, the cost of paid assistance in the home or community care should be considered.

The Caring Generation® podcast, called The Costs of Caring for Elderly Parents, offers a guide for the costs of a variety of types of care including community care. Discussed during the program is the benefit of Aid and Attendance for wartime veterans including how to know if a loved one qualifies.

Adult children who act as medical power of attorney must discuss the costs of care with elderly parents and with the financial power of attorney to avoid surprises. Part of creating a care plan is creating a financial plan that supports the costs of care described in the power of attorney care plan. Planning for Medicaid may be part of this plan.

Supporting Elderly Parents to Stay at Home

Most elderly parents want to stay at home. The support of a healthy spouse and adult children are the main components that make the desire to stay at home a reality. In situations where family support is not sufficient due to care needs and the time involved, outside care agencies may be hired.

Agents under medical power of attorney or financial power of attorney may be shocked at the hourly rates for in-home care averaging between $20 to more than $30 an hour depending on where an elderly parent lives. Calculating the costs of caring for elderly parents into a care plan is important for long-term care planning.

Retirement savings and income may only last for a few years. The medical power of attorney must ask the practical question of what happens when elderly parents spend all of their savings and need care that exceeds the cost of monthly income.

At this point, options, if a parent was a wartime veteran may be the Aid and Attendance program or the Medicaid. Both of these programs have financial and physical qualifications and can have long lead times for approval. If you are the medical power of attorney concerned about money to pay for care investigate and learn about these options as early as possible.

Planning Ahead Relieves Worry and Stress

Waiting to make a care plan and a financial plan can be hazardous to the health of an elderly parent and to the caregiver who becomes filled with worry and stress. A medical power of attorney is changed with monitoring health and ensuring a parent has care when needed.

This involves investigating options and planning ahead when an elderly parent is in relatively good health. At the time of a change in circumstances when a health emergency occurs, the medical power of attorney can present and discuss options for care.

The idea of no surprises is best in pre-planning care. Having a plan A and a plan B helps avoid responding in crisis mode to an emergency situation. Making decisions in haste can result in making decisions that may be regretted later.

Medical Power of Attorney Conversations

The idea of having early and frequent conversations about health status, all aspects of medical and daily care needs, and costs provides the best opportunity to avoid unexpected situations. The stress of aging, experiencing health issues, and feelings of losing control can be significant for an elderly adult.

Adult children who become the medical power of attorney or who are caregivers for elderly parents experience similar stresses. Working caregivers struggle to find a work-life balance with the role of being a medical power of attorney or a caregiver added in. Adult children with young children may be stretched to work, care for their families and care for aging parents.

In caregiving situations, there is an abundance of stress and worry that goes around. By becoming more educated and learning what family caregivers don’t know about being a medical power of attorney, family caregiving relationships can be more positive. Elderly parents will feel more confident that their wishes and desires will be met and that there is a financial plan and a backup plan for care.

Looking for More Help With Caregiving Responsibilities? You’ll Find What You’re Looking For in The Caring Generation Library Section Difficult Discussions

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