There are different types of legal documents and they are useful for different situations. First step is to understanding what they are , the second step is to understand how they best meet your unique circumstances, third is to have a family discussion about mutually acceptable decisions and the fourth is to draft them.
Types of Legal Documents
Healthcare Power of Attorney (POA)
Useful when: Your Seenager is unable to make healthcare decisions on their own.
Purpose: This document gives authority to you as the care giver to have conversations on behalf of your seenager with the healthcare providers and make required healthcare decisions. This document can be as detailed as you and your seenager like. Putting the document together gives you the opportunity to make tough decisions early, when you are not in crisis. It is not necessary for you to be the one that has the Healthcare POA for the seenager, especially if you and your seenager do not see eye to eye on things such as when to change the treatment to Palliative care (Hospice). Although for most people the primary care giver ends up with the healthcare POA, there are many that choose someone that is not in the legal chain of command, such as the spouse, child or guardian.
Multiple people can have the POA, and that will work as long as those people get along and can stand behind each other’s decisions. In either case there should be a primary person that has the POA and others as backup or alternates.
Some sample tough situations that may be good to discuss with your seenager and spell out in the POA:
1. Seenager is unconscious, and the doctor wants to remove a limb to save their life.
2. Seenager is not breathing on their own, and doctor wants to know if they should be put on a ventilator.
3. Seenager has dementia and needs to have the dosage of medication adjusted as symptoms get worse.
If you are the primary care giver and/or have the primary POA, it is important that you and your seenager notify other family members about this document and your role as the person that has POA. If the document is revised (possibly because the POA themselves becomes incapacitated), be sure to provide new copies to all applicable parties: doctors, hospital or nursing facility.
The person that has the POA will need to have thick skin to bear with challenges from friends and family that may not agree with the decisions that you are making on the seenager’s behalf.
Financial Power of Attorney (POA)
Useful when: Your seenager is unable to make financial decisions on their own. Whether it is during a short acute crisis or a longer term chronic condition.
Purpose: This document gives you the authority and guide rails to make financial decisions and have financial discussions on your Seenager’s behalf. Note that it must be written to cover all situations for which it is intended to apply: bank account access and changes, safe deposit box access, real estate dealings, etc.
Useful when: When your seenager is ready to make future healthcare decisions. The advance directive provides you with many more options, including the naming of a health care agent.
Purpose: The advance directive is a great document for you and your Seenager to get on the same page about their wishes for health care treatment. They can name you a health care agent. With the advance directive, your Seenager can make decision about life¬sustaining procedures in the event of terminal condition, persistent vegetative state AND end¬stage condition. If life¬sustaining procedures are documented in advance directive, you do not need a Living Will.
Useful when: Your seenager is in terminal condition or a permanently unconscious state in a hospital or skilled nursing facility in a non-emergency situation. This trumps the healthcare POA when your seenager is in that state.
Purpose: Documents the desires of your seenager for any life-sustaining treatment. When decisions need to be made about future treatments, a living will guides your older adult’s health care agent to choose treatments that honor their wishes. Topics that could be covered include:
• Artificially or technologically supplied nutrition
• Comfort care measures
• The use of ventilators
• Pre-existing conditions and how they are to be handled
POLST (Physician Orders for Life-Sustaining Treatment)
Useful when: Your seenager is in terminal condition, they may be unconscious and are not able to breathe. This trumps the healthcare POA when your seenager is in that state.
Purpose: The POLST form is a medical order (signed by a physician) indicating a patient’s wishes regarding treatments that are commonly used in a medical crisis. A POLST form should accompany an Advance Directive when appropriate. It tells emergency medical technicians (EMTs) and hospitals what to do in an emergency situation. Without a POLST, standard emergency protocols must be honored.
Dignity Statutes Document (Death with Dignity)
Useful when: Your seenager is ready to end life. This would be when either pain is unbearable or they are in a state of comma.
Purpose: Death with Dignity (DWD) is about deliberately ending life whereas POLST is about how people want to live and be cared for with their serious illness or frailty.
Useful when: Your Seenager maybe having an acute non-life threatening situation, you may be helping your Seenager get test results for a second opinion. To pickup any medical records on behalf of your Seenager you will need a HIPAA authorization form. HIPPA stands for Health Insurance Portability and Accountability Act, which ensures equal access to certain health and human services and protects the privacy and security of health information.
Purpose: The general POA is not enough to get his medical records. HIPAA release in addition to the general POA. The clinic will probably have a HIPAA release form that you can get him/her to sign.
Useful when: Your Seenager needs to have their Social Security or Railroad Retirement or other similar pension benefits managed.
Purpose: The Social Security Administration does not recognize POA documents to manage SSA benefits or make changes. In order to be a payee, you must apply for and be appointed by Social Security
American Bar Association All fifty states permit you to express your wishes as to medical treatment in terminal illness or injury situations, and to appoint someone to communicate for you in the event you cannot communicate for yourself. Depending on the state, these documents are known as “living wills,” “medical directives,” “health care proxies,” or “advance health care directives.
CaringInfo.com describe advance directives, choosing and being a healthcare agent and preparing your advance directives.
HealthinAging.org created by the American Geriatrics Society’s Health in Aging Foundation has information about advanced directives.
California Polst form http://capolst.org/
Polst.org has good details about Physician Orders for Life-Sustaining Treatment Paradigm POLST the form for a medical order indicating a patient’s wishes regarding treatments that are commonly used in a medical crisis. A POLST form should accompany an Advance Directive when appropriate.
Power of Attorney
Aging in Place has an idea series talks about a variety of important topics like power of attorney, living wills, advance health care directives, and DNR’s.
LegalZoom has information about how to sign a power of attorney document for someone.
NOLO has details about durable power of attorney: health care and finances.
Senior Care Corner has information about DNR codes and levels of care.
American Bar Association “Everyone knows you should have a will, but apparently more than half of us haven’t gotten around to it yet. Here is some information that might convince you to get it done.”
Free Advice “For more information about drafting a will, types of wills, wills and probate and estate planning attorneys, refer to the articles in this section.”
State Bar of California California law provides a will form. “The will form is designed for single, married or divorced people with relatively small estates. If there is anything you do not understand or you are making any provisions which are complicated or unusual, you should ask a qualified lawyer to advise you. ”
Superior Court of California: County of San Diego has Frequently Asked Questions Wills & Estates.
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