FREQUENTLY ASKED QUESTIONS

As a caregiver, I can see the changes in my loved one that indicate it maybe time for help with medical and financial decisions, but I am not sure where to begin.

Where and how does the caregiver start when concerned about the person's ability to adequately handle their finances and medical decisions? Begin with the understanding that all persons are competent and have the right to refuse treatment or assistance. Open a discussion with the person to determine if they are willing to accept assistance from you. If not willing, ask the person if documents have been prepared that designate someone who has agreed to assist them with medical and financial decisions.

What if they have not prepared any documents, do not remember, or can no longer communicate? Obtain permission from the person to contact family members, friends, physicians, and their personal attorney to verify if anyone can confirm the existence of these documents.

As the caregiver, do I need some formal documents to be able to make decisions (both financial and medical) or can I just take charge? You cannot just take charge without the person's permission. If the person is willing and accepts your help, a caregiver can assist in a number of ways…..but only up to a point. Depending on the type of assistance required the appropriate legal authority might be needed to make decisions. Also, there may be regulatory issues that might make it difficult to accomplish many tasks without the appropriate documents. The caregiver (other than a spouse) is not obligated to assume this responsibility. It is important the caregiver understand the nature and consequences associated with undertaking this responsibility.

Why do we need any of these documents? At any age, one can have an emergency that might temporarily or permanently limit their ability to verbally communicate or indicate their treatment choices. Also, each of us has varied cultural, personal and religious beliefs that might influence our decisions. It is important to communicate our beliefs to someone who knows us well and will speak on our behalf if we are no longer able to make medical, financial and other important decisions. It is very important that this person will advocate our beliefs even if their beliefs are different. Documents that provide an opportunity to state how and what type of treatment a person wants prior to the need for those decisions are known as "Advance Directives." Every adult should be encouraged to prepare Advance Directives including the following documents:

• Living Will
• Durable Health Care Power of Attorney
• Pre-hospital Medical Care Directive
• Durable Mental Health Care Power of Attorney
• Financial Power of Attorney

PATHFINDER: A Guide for Family Caregiving Pima Council on Aging

There are other kinds of documents referred to as "Power of Attorney", "General Power of Attorney", "Financial Power of Attorney" and others. These may include forms about organ donation or autopsy. Samples and copies of these documents are available from a variety of sources often designed as fill-in-theblank forms. They are legal documents and have a number of rules that may vary from state-to-state. Be sure the documents are current with changes or variations recommended for the state where the person lives as well as address special circumstances and needs.

That's a lot of "Powers;" but what does it mean; who needs one; and, where does a Guardianship or Conservatorship fit into all this?

Advance Directives are documents that describe the health and/or financial preferences of the person, and identify an "agent" (an individual authorized by the person to make decisions on their behalf under certain guidelines with or without limitations). The documents go into effect and the "agent" usually assumes responsibility when the person becomes incapable of communicating their needs or if suffering from an illness that affects their competency. If the person recovers and is able to communicate and make competent judgements, they regain control of their health care decisions. Preparing the above documents can prevent difficult legal court proceedings (called Guardianship and/or Conservatorship) that may become necessary if the person requires an "agent" but has become incapacitated prior to completing the required documents.

If a person has Power of Attorney documents, why would they need to go through the Courts to obtain a Guardianship?

Power of Attorney documents are very helpful, but ONLY as long as the person agrees to cooperate. If the person has prepared these directives but chooses not to comply with the plan or decisions being made by the "agent", then it may become necessary to Petition for Guardianship to protect the person. A Guardianship is a formal court proceeding. The person must be notified of the hearing and an attorney is appointed to present their point of view to the court. If the court finds the person unable to make or communicate responsible decisions, a Guardian or Conservator is appointed to manage the person's affairs even if they object to the decisions.

What if the individual does not have a Health Care Power of Attorney?

If the person does not have the necessary documents and still has the capacity to understand and execute the documents, an attorney can draft them to their specifications. If the person no longer has the capacity to understand the nature of the documents then a Guardianship proceeding might be required or the Surrogate List may apply. The following individuals, if willing, can serve as Surrogate Decision Makers regarding treatment decisions for the patient (in order of priority): spouse (unless legally separated), adult child, parent, domestic partner, sibling, a close friend or the attending physician.

What if the person wants to change their Power of Attorney or Living Will?

The maker of the document can modify their Advance Directives at any time.
Also, the designated "agent" cannot delegate their responsibility to another
"agent." Therefore, it is advisable to have the documents name a second party
as an alternate in the event the designated “agent” is unable or unavailable to
serve when needed. When changing their documents, the person should
notify the selected "agent" in writing, destroy the document, notify their
physician as well as any other health care providers verbally and in writing.

Advance Directives

Advance Directives