When is a health lasting power of attorney useful?

My father had mylodysplasia, a blood cancer. He became extremely frail in his terminal phase, requiring carers four times a day. He was never going to recover, but the carers (did their job) and would call an ambulance at every worry. The trip in and out of hospital was more likely to kill him so having LPA (both types) I sought an end to hospital care. It wasn’t easy, but he did die peacefully at home with my mother by his side, just as he wanted.

I will bite. I am very passionate about what my team and I do. We enable people to make choices about how they want to spend time before death and where they die.

I have heard of LCP and Gosport. That doesn’t mean that everyone in health and social care is trying to kill everyone off. For example myself and the majority of my colleagues do not fully support the assisted dying bill.

As I said in my previous post we support the person and their family/friends/carers. This encompasses hundreds of people over my career to date. Again, I have never encountered what you claim but I have encountered people who have expectations that cannot be met with the evidenced based practice, years of experience and a wealth of knowledge that my colleagues and I have.

I wish you peace and hope that what ever you are searching for you find.

You’re putting your attorneys in a different position, here.
Do you have sufficient funds for 24hr care at home long term if it’s needed?

Absolutely agree with @hatgirl! In the case of the elderly relative I used to support, it took weeks of the social worker working calmly with her to develop her trust and reduce her hostility before any attempt to assess her capacity could be made. It simply wasn't possible to assess her capacity in one meeting.

Sorry but this is completely unworkable and most likely will leave your family in an impossible position where they simply can't get a consultant psychiatrist to become involved just to make that decision. You can't just rock up and demand one gets involved it would be months on a waiting list if they even accepted a referral which for something like this they probably wouldn't because it's a want rather than a clinical need.

Capacity assessments where necessary should be completed by whichever professionals are involved at the time, have the fullest knowledge of the person and their circumstances and are who require the decision to be made. Some random consultant psychiatrist is unlikely to be considered the appropriate person.

If you are setting up health and welfare LPOA but tying the hands behind their backs of the people you give it to then it becomes an expensive piece of worthless paper. Just don't give them LPOA if you ultimately want professionals to make the decisions.

If you are going to mix documents you need to be very careful as the most recent document will override the previous one.

So if you set up a LPoA for health and welfare after the advanced directive, the person you assign as your advocate can override anything in you advanced directive. Which comes back to the point that the LPoA is only at good as the person you choose to act on your behalf.

This is completely unworkable, unless you have a consultant psychiatrist on retainer whom you have paid privately to undertake a capacity assessment whenever you need one. An NHS consultant psychiatrist is not going to come running every time you need a capacity assessment just because you put it in your LPA. Nor would it help in your situation

If you are adamantly against care home admission, you can put this in your LPA or as an advanced decision, making clear that you refuse to go into a care home even if it results in serious harm or death. Having a consultant psychiatrist assess your capacity would be pointless as they would not then be involved in the subsequent decision as to whether you go into a care home or not

FIL’s care home call me regarding his care decisions. I sign things on his behalf.

I will répond to your onslaught some other time @tiatempo but @hatgirl is quite correct - I have been going on about these conspiracy theories for years, I usually back it up with newspaper cuttings from the mainstream press. Again, it's hardly wild stuff by any reckoning. And I will point out that Surrey County Council's Safeguarding teams have pointedly denied none of it.

I do have to wonder about you both however - I mean, have you ever heard of the Liverpool Care Pathway? Yes? No? Or Gosport War Memorial Hospital, which made the front pages of all newspapers in the summer of 2018 I think it was. Was all that a conpiracy theory? Did any of it happen? No charges re Gosport it emerged last month, though we know what happened. The police took its time investigating and what a surprise, no charges brought.

Can either of you tell me why my sister and I had to spend years literally taking it in turns to visit my mother in her care home to give her drink, while all our appeals fell on deaf ears? In fairness, it took me a while to figure it out, I thought they were just being obtuse. No, not a bit of it, they knew what they were doing and why.

I just find it incredible that you two make out you don't know what is going on, but I guess that's how institutions work isn't it, the left hand not knowing what the right hand is doing.

Chill out though, there'll be no investigation into it.

Nobody would - that's why you agree to it, it all sounds perfectly reasonable and in some cases it is. However, as far as I am concerned, given my experience, it can also allow the NHS to give up on your parent altogether - they can interpret it however they want.

It was very useful during covid - it allowed my sil to go into hospital with my mil, who had dementia, at a time when she otherwise wouldn’t have been allowed.

We didn’t have one for my father, but were very much included in decisions and discussions with doctors. I have done one for my mother, but again, all medical staff have always seemed happy to discuss everything with me. Even my mum’s bank know I use her card/account and seem ok with that (they have occasionally spoken to my mum to check, and she confirms she knows, but she’s clearly very confused on the phone. I’m always amazed the bank doesn’t spook! But it’s been several years now, and I haven’t emptied her accounts yet).

@cannotmakedecisions weirdly, some people do have their LPAs written like this- giving the responsibility for deciding on their capacity to a relative! I couldn't believe it when I heard that, but have since seen examples so I know it is true.

I have experience of various Professionals being asked to assess capacity. Imo, they did not have the necessary training, nor understanding of the person to undertake the assessment in a complex situation. My family know that if my capacity is in question, either by an hospital or themselves, then a Consultant Psychiatrist must be involved. My main issue would be admission to a care home, which I am against.

The decision around capacity would not be made by a relative. That makes no sense.

That poster has been posting about their conspiracy theories for many years - at least 9 or 10 that I can recall. I've learned not to bite.

It's not hard to recognise what the other side of the story is likely to be even when we only have the poster's extremely one-sided and frankly potentially libellous ramblings.

The idea that health and social care would collude with each other so efficiently is the least believable aspect of the story to be honest!

@cannotmakedecisions consultant psychiatrists often get called on for "tricky" capacity decisions.

I went to training on this, and one of the trainers, a senior social worker, said that was in his LPA documentation, along with his GP.

Apparently he'd seen too many LPAs drawn up where the decision about whether capacity was lost was to be made by the patient's relative,who did not always have the person's best interest at heart.
He wanted an objective opinion.

I’m not sure that’s workable in reality. Your POA won’t come into play until you’ve been deemed to not have capacity. The best person to assess capacity depends on what decisions need to be made. It could be a hospital doctor, GP, social worker, nurse, OT.
Why do you think a consultant psychiatrist would be the best person? Do you have a consultant psychiatrist psychiatrist who knows you and will still be involved when the assessment needs to be done?

Care home decisions. I have seen people without capacity for decision making wait in hospital for months as they could not be moved to a care home without either it or guardianship, which took many months and much expense ( in our area, may not be the same elsewhere).

Also when my FIL got sepsis - he'd had dementia for over a decade and moving him to hospital would have been distressing and futile. With welfare LPA, the GP could talk to relatives about what was the kinder option.

I don't want futile treatment if something happens to me and I want my relatives to advocate for me when I can't advocate for myself. LPA allows for this.

Thank you for sharing that and for all you do. It's very reassuring. I worry a lot about what might happen to me in old age, as I don't have any family who could speak up for me.

I had it for my sister who was terminally ill with brain tumours and it was very helpful. I had both health and financial.

What I didn't know was that this wasn't sufficient for DWP where they need to have an "appointed person." By the time I found this out DSis didn't have capacity to appoint me! This led to a whole load of issues with benefits, the care home contributions, reclaiming over payments etc. (Scotland, might be different rules in England). Took ages to sort out after she died.

What a sensationalist and ridiculous thing to say. You clearly have no concept of the care system, what a power of attorney affords someone who has lost mental capacity and what happens to the body when someone approaches end of life.
I am a specialist nurse that works in the community helping patients and their families make decisions about end of life choices and supporting death at their chosen place and have never been part of or seen what you are describing.
There is no colluding with the state. There is no murder via dehydration.
When there is no power of attorney best interests decisions are made by professionals with knowledge and experience that may be at odds with a family’s understanding of physical health and how the body responds at end of life.
Everyone is entitled to non means tested Fast Track funding when they are in the last weeks of life and this can be put towards are in the home/care home/nursing home.
I’ve never encountered ‘murderers’. I am sorry if you had a bad experience. I work in Surrey in private homes and care homes for the NHS and as I said previously have supported hundreds of people die at the place they wish to do so.
Having LPA for health and/or finance (ideally both) is a huge help when you want to actively partake in the decisions for your loved one. But please let me be clear, I have never come across anyone from health or social care that would not put a patients or residents best interests at the heart of what they do.

I ensured in my P.O.A. that a Consultant Psychiatrist should be the one to determine my capacity. Hopefully, this will aid matters where there is conflict.

The key point is that having it doesn't cost that much in the great scheme of things (tho there was that thread about it being expensive) but not having it is extortionate and requires solicitors and court (I think) and it was this argument that finally persuaded my DM to allow me to get one done.

Regarding CPR etc, the hospital needs to explain the options and prognosis more clearly rather than just saying “we refuse to resuscitate”. In my Mum’s case I was fortunate enough to know an A&E doctor who I called and she explained to me that it was entirely reasonable to expect some aspects of ICU care to be offered, but that other things would be futile and painful and therefore it was reasonable of the hospital to withhold those. On the basis of that conversation I could make the case for the former but not fight for the latter. In the end it didn’t help but for some people it might.