By Laura Herman, Dementia and Eldercare Professional
What if your health declined, or there was a sudden accident, and you were unable to speak for yourself? Advance care planning is the process of considering the types of decisions you may need to make in such a situation, discussing them with those who would need to know your wishes, and then documenting them in a way they’ll be honored.
The healthcare power of attorney authorizes certain individuals to make medical decisions on your behalf, if you can’t do so yourself. Many consider this to be the single most important document in advance care planning.
What is a Healthcare Power of Attorney?
A healthcare power of attorney (HC POA) is a legal document that authorizes another person to make medical decisions on your behalf if you’re physically or mentally unable to do so yourself. A HC POA is sometimes called a “durable medical power of attorney” or a “durable power of attorney for healthcare.”
Note that a durable general power of attorney (or any POA that doesn’t specify “medical” or “healthcare”) will not grant authority over health related decisions, so most older adults need both a general POA and a healthcare POA.
The healthcare power of attorney is often combined with a living will into a single document.
Want more information about living wills? Learn more about these important advance care planning documents here.
What is a Healthcare Proxy?
The person named in the healthcare power of attorney is known by different names in different states, including health care agent, representative, surrogate, attorney-in-fact, or patient advocate.
Your proxy can make decisions on all kinds of medical matters. Just a few examples include:
- Life-sustaining treatment
- End-of-life care
- Long-term care
- Medical providers
There are limits to what a healthcare proxy can do. Among other things, your proxy cannot:
- Choose someone else to be your proxy
- Override your decision if you can speak for yourself, even if you have dementia and are making unsafe choices
How to Choose and Designate a Healthcare Proxy
While some people choose to designate their closest relative to be their healthcare proxy this isn’t always the best choice.
A good healthcare proxy should:
- Meet legal criteria for the position (criteria may vary by state, but generally the person must be over the age of 18 and can not be your healthcare provider)
- Be able and willing to advocate for your wishes – regardless of their own – in potentially stressful or difficult situations, including cases where information or opinions may differ between healthcare providers or family members
- Be able to travel to be with you in person if needed
- Likely be available long into the future
You can also assign an alternate proxy to act in the event that your primary is unavailable.
You legally designate your healthcare proxy by completing and signing a health care power of attorney. An important part of the process is to discuss your decisions and wishes with your healthcare proxy as well as other key family members and healthcare providers.
Consider giving your healthcare proxy the American Bar Association’s guide for Making Medical Decisions for Someone Else.
Are you healthcare proxy for your dying loved one? Grief can make hard decisions even harder. Learn about Handling your Grief as You Care for Your Loved One
How to Set Up a Healthcare Power of Attorney
Once you’ve decided on your agents and discussed your philosophies and wishes regarding potential future care, the process of creating a healthcare power of attorney can be very easy. However, if there are complex circumstances, difficult family dynamics, or you have questions, you should consult an elder law attorney. It’s worth taking the time to set it up correctly and truly in line with your wishes to avoid complications from arising once it’s too late to correct.
You can find HC POA forms online. Be sure to choose one that is specific to your state.
- The American Bar Association Multi-State Form is valid in most states and comes with an easy-to-use guide book.
- PREPARE for Your Care offers a simple advance directive document combining a living will and HC POA with simple guidance in multiple languages.
When your HC POA is signed and notarized, provide a copy to everyone named in the document. Your healthcare teams may require copies as well. Keep the original in a safe, yet accessible spot, such as a fireproof safe.
How are Healthcare Power of Attorneys Different from Other Advance Directives?
The healthcare power of attorney is a type of advance directive, an important legal document for advance care planning. A HCPOA names a person who can make medical decisions on your behalf.
Other types of advance directives include:
- Living will - A legal document which describes your wishes regarding the type of healthcare you’d like to receive if you were permanently unconscious, dying, or unable to speak for yourself. It’s not a medical order, but it provides direction for your loved ones and future medical decision-makers.
- DNR (Do Not Resuscitate) orders and POLSTs - Medical orders which direct emergency responders and other healthcare personnel regarding whether (or how aggressively) they should try to resuscitate you or keep you alive versus just keeping you comfortable. These are medical orders and must be signed by a doctor.
Curious whether a POLST is right for you? Read about them here.
Healthcare Power of Attorneys are Possibly the Most Important Advance Care Planning Document
Advance care planning can make a huge difference in the quality of life you experience in your final chapter. It can give priceless peace of mind to loved ones who may otherwise have to struggle to make difficult decisions when you can’t speak for yourself. There are different types of advance directive documents involved in advance care planning, and a healthcare power of attorney is an extremely important part – perhaps the single most important part.
Because it’s impossible to predict every possible future scenario, it’s essential to name a capable healthcare proxy to make decisions in line with your values and wishes in real time.
Are you interested in exploring how hospice can support you to die peacefully in your home? Read about In-Home Hospice here.
- “Advance Care Planning: Health Care Directives.” National Institute on Aging, 15 January 2018, www.nia.nih.gov/health/advance-care-planning-health-care-directives.
- “Tool Kit for Health Care Advance Planning.” American Bar Association Commission on Law and Aging, 3rd Edition 2020, www.americanbar.org/content/dam/aba/administrative/law_aging/2020-tool-kit-hcap.pdf.