When the senior has cognitive impairment or some type of dementia, they may not be able to make safe and prudent decisions about their own safety and care. When does the family step in to help make those decisions? What decisions need to be made? Do you know the choices that the seniors want made on their behalf?
Most seniors have been in control of their own decision making for their entire adult lives. It is not easy to give up that responsibility. It is not any easier to take on that decision making role for a family caregiver or friend. We often defer the decision making to the senior long after it is safe . There are some basics to understand this process.
There are two types of advance directives available to support decision making. Do not wait to create with documents. Start the conversation with your family member sooner rather than later. When the senior is no longer able to articulate their wishes, it is too late.
Advance directives are unique to each State. The following is a generic description. You will need to check with an attorney or on line to get specific information on these for your local area. If you type advance directives and the name of your State in your internet browser you should be able to find information unique to your jurisdiction.
Advance directives are a tool for designating an individual to make decisions when on behalf of the person when they are no longer able to make decisions for themselves. The person who is making decisions on behalf of the individual is called an agent. The agent is only called to make decisions when the individual is no longer able to make safe decisions either short term or long term.
The agent should be someone that is trusted. It need not be a spouse or child. It may be a friend or in some cases it may be a community resource. The agent should have a similar belief system that the individual has. This is of special importance if the agent is a family member. Other family members may not agree with the individual’s decision choices and may challenge the agent causing additional strife and family dysfunction.
The individual may change their agent any time they wish. The prior agent needs to be told that their authority has been rescinded so there is no confusion about who has the authority. In those cases where the individual has dementia or is not a prudent decision maker, they may be persuaded to change their advance directives to benefit the agent. In that case, the courts will likely need to be involved for the wellbeing of the senior.
If the senior does not have an advance directive and has lost their ability to make decisions, the process becomes very cloudy. In that case, no one is the agent and no one has the authority to make decisions on behalf of the individual. Family and friends may get embroiled in conflict due to the lack of clear direction. In that case, the courts will be called upon to designate a Guardian. This is an expensive and time consuming processes. The court appointed Guardian is responsible to the Courts taking the family and caregivers out of the picture.
Do not keep advance directive documents in a safe deposit box or hidden away. These documents need to be readily accessible to the agent and to others who are involved in the care and oversight of the senior. Make sure that the agent is aware that they are the agent. They should not be surprised when they get a call from an attorney or the emergency department asking them for direction. Being an agent is a honor, but also has legal authority for prudent decision making for the individual. The agent cannot fulfill that roll if they are not aware of their responsibly and the wishes of the individual.
Advance directive documents need to be review periodically to make sure that they are still consistent with the wants and desires of the individual. Conditions and situations change and wishes may change with those clinical conditions. Perhaps the senior wanted everything done, but now has a terminal diagnosis of cancer and does not want extensive care and treatment.
Only the individual may designate the agent and prepare their own power of attorney documents. If someone has end stage dementia, is comatose or has another condition that renders them incapable of decision making, no one else can prepare advanced directive documents on their behalf. Even if the individual has told the friend, caregiver or family member their wishes, if the advance directive documents was not prepared it is too late to prepare one at this late date.
One resource that is very beneficial in the process of defining the amount of cognitive or memory loss is a professional called a neuropsychologist. These professionals use standardized, clinical testing to assess the level of dysfunction and help the clinical team define the decision making capacity. It also helps the medical team to make a more definitive diagnosis since diagnostic testing typically does not provide a definitive diagnosis. Most insurance will pay for this testing if a physician orders the testing.