Lasting Power of Attorney - why so expensive and why isn't everyone nudged to do one?

[housemonkey]

My parents have been filling in their LPAs, which are inherently useful and mean that it's clearly set out what they want done in case of serious illness. In their case, they don't want anything at all.
https://www.gov.uk/power-of-attorney/make-lasting-power
But why on earth is it such a ball ache and why on earth does it cost £92??
If my grandmother had filled one of these out, it would have saved the NHS literally hundreds of thousands of pounds for an utterly joyless extra month in her nineties that she didn't want.
But these forms are complicated (they're on it and organised, but have struggled) and not everyone has £92 lying around! Why aren't they readily available (and you could just be referred by eg your GP if it was something you were interested in?). It's crazy! I totally understand that not everyone would want one (and that's obviously fine), but if you are, it should be straightforward and free.

I think it’s important when you get on in years and especially important if you are elderly and single. If you get a dementia diagnosis it won’t be as straightforward to just do one then because capacity has to be proved . Then it becomes difficult for your family to support you easily ( paying bills, sorting out and paying for care, maybe helping you downsize or move to a carehome etc) Obviously if you don’t actually trust anyone close to do it rhen it would be social services making the choices for you and managing everything when you could no longer do it yourself. I’d rather my kids decide for me personally if DH is no longer around or capable.

For the majority of people, the are straight forward to complete. The forms and guidance have been designed for self usage rather than having to pay out for a professional to complete the forms for you.

Some people may find the forms challenging, but plenty will manage perfectly ok, with or without help from a friend or family member (its always sensible for someone else to check the forms). My husband did his when he was in his 70s, I am a lot younger and did my own, although we both checked each others. I helped my neighbour who is in their 70s with theirs. The hardest part was making sure that the right people signed in the right places and the right order (but there is very clear guidance about how to sign).

Others will prefer for the likes of a solicitor to complete the forms.

Absolutely agree.

The site is incredibly easy to use.

The cost is because they are reviewed by people, notifications sent out, and everything checked before they are registered. The OPG is then responsible for a huge amount of work in terms of monitoring LPAs and deputyships.

"As I have now said repeatedly, can you genuinely not see that if people could do it for free, it would save the NHS and social care vast sums?"

No, I genuinely can't.

The only concrete point is the assumption that removal of the £92 Registration Fee would result in more people setting up LPAs than do at the moment. But then what?

My Health LPA gives my Attorneys power over health-related decisions regarding my health and welfare in the event that I am determined to have lost Capacity to manage my own health-related affairs. Can someone explain in an objective manner, perhaps even with a relevant case-study, exactly how this saves either the NHS or the Social Care system any money at all.

You are making this out to be far more complicated than it is!!!
I can believe they wasted 2 GP visits for this....its ridiculous.

When we did our then-Enduring PAs, a couple of decades ago, they were about £50. At a talk recently the cost of LPAs was raised; the lawyer said EPAs covered 95%+ of cases, LPAs cover just about everything. So massive cost increase for no benefit fir the vast majority of people.

Just to say £92 is much, much cheaper than we were quoted, which is why my earlier post may not have made much sense. Round here, looking at £300+ per person for absolutely straightforward affairs. £92 would be a bargain.

A £42 increase in 20 years isn’t that bad.

im confused what you mean re EPA & LPA. LPAs replaced EPAs nearly 20 years ago. The OPG needs funding from somewhere because there isn’t an ongoing fee for LPAs, but should they be needed to investigate the money has to come from somewhere.

its £92 per document to register. Making them yourself is obviously cheaper than paying a solicitor for their time.

I did both the health and the financial ones for my parents. There's a lot of paperwork to fill in but you just work your way through.
They are absolutely necessary though and much easier to do earlier rather than once needed.
My late dad was admitted to hospital with a serious condition and my mum was too disabled to go in with him. Fortunately my dad was briefly conscious long enough to tell the surgeon he could talk to me and I could give permissions etc. After that we got the lpa sorted.
I put me and my mum on dad's and me and dad on mum's so they never gave up having a say. It was a just a safety net.
My dad was in and out of hospital until he died and not always able to discuss things for himself but mum and I knew what he would want. It made life a lot easier for everyone.

It doesn't save the NHS or social care any money. The care still needs to be provided but your LPA gets more say in where that care is provided and how. The only way it would save money is if the OP is intending on bumping off their relatives 😳.

At the end of the day the LPA has to be managed in the persons best interests and if the clinicians think they are not then they can ask for the Court of Protection to intervene.

I’ve done several LPAs for elderly family members in recent years. The form really isn’t difficult… it takes you through step by step with guidance notes and advice. There’s absolutely no need for a GP to be involved.

I can’t understand your repeated assertion that a H&W LPA saves the NHS money. The attorney has authority to make medical decisions once the donor loses capacity, but those decisions should be in the best interest of the donor and based on what they think the donor would have wanted. In other words, the treatment will be the same whether it is the donor or the attorney making the decisions.

Your family member being giving life saving treatment despite having a DNR is an entirely separate issue.

I was told that having a LPA is like having an insurance policy , you might not need to use it , but it invaluable when you do .

we had them for my MIL , we needed to use both types as the care she received was awful at the hospital and we were asking questions about care etc , and then they asked do you have a LPA. Which was swiftly handed over .
the finance one was absolute life saver , we were able to pay care costs directly from her bank account , as none of could afford the £10k deposit the care home needed . Having LPAs just made life easier when things were incredibly tough with my MIL in hospital .

i don’t think you are understanding this correctly @housemonkey . You seem to think that if you’d had LPA for your father, he would have been allowed to die earlier and not end up ‘stewing away’ in a care home? Being an attorney doesn’t give you that power! It’s always going to be a medical decision, and doctors generally aim to keep people - even old, sick demented people - alive. You as an attorneycan’t overrule that.

A DNR is a separate thing, and yes there is a problem that medical staff often aren’t aware of or decide to ignore a DNR. That’s why a pp above was advised to put out on the fridge- so that any emergency services would hopefully see it and act accordingly (which I agree is a really stupid way to manage this - there should be a national register of people who have signed these).

MIL gave LPA to FIL and her two children - it didn’t prevent her stewing in a nursing home for four years at enormous cost to the tax payer. Her family didn’t want her to die, the medical staff took good care of her and yes, her miserable existence was extended artificially by it. That’s a whole separate thread and a national conversation that’s long overdue.

This post totally shows that people don't appreciate things which are free. Because it's free to go to the Doctor's then you think they should take on even more work under their umbrella? Why on earth? Getting married brings you legal benefits and that's not free. Being buried or cremated saves the NHS and Public Health Services money (by not having infections spread by having cadavers dumped in piles in the street or being ineffectively buried in home ceromonies) and that's not free. Sewage transportation away from our homes isn't free. It's not just going to save the NHS money, it'll save your parents worrying their wishes won't be adhered to, and it'll save you time and heartache and battles and conversations in hospital in upsetting situations (ESPECIALLY the case with the Financial one). Why can't you see it from point of view if the benefits to yourself and your family rather than "This isn't fair. We shouldn't have to pay" sense of entitlement?

POAs are £92 for a lifetime protection and you don't have to pay the charges if you're on certain benefits. If your income is less than £12k it's only £46. They used to be £110 but in 2017 the price was reduced to £82 to make them more accessible. It's been cheaper for the last 8 years and only went up to £92 a couple of weeks ago. Stop whinging and being entitled.

Or perhaps as you think it's saving the NHS money you'd like them to pay you to get one drawn up?

Effectively it doesn't. OP has such a bee in her bonnet over needing to pay for something she seems to think that as Dad is being wheeled into an Ambulance by paramedics she can block the door and say "No, I have LPA and he doesn't want to go to hospital.". Or "No, I have LPA and I'm overruling that Doctors decision". Wrong end of stick but outraged and entitled regardless.

Maybe she's hoping to get her inheritance sooner!

The forms aren’t complicated, only you do need to read the instructions very carefully, particularly as regards signing and dating. Any mistake, and it will be rejected and you’ll have to start - and pay - again. Dh and I had no trouble doing ours.

You can add your own wishes on the Health and Welfare P of A, as regards any ‘striving to keep alive’. Particularly after far too much experience of dementia, dh and I have both added a fairly explicit paragraph.
On that topic, a DNR only covers resuscitation after the heart has stopped, so won’t cover any ‘striving’.

I don’t think the cost is unreasonable. I’m trying to get my parents to do theirs. But they want to give it to each other, rather than my sister and I. Which would be more useful in the long run.

I live on my own and my niece and cousin have POA. That applies to health and finance and they can act jointly and severally. We paid more to register my mum's POA in 2010 than it costs now. I think people who don't put one in place are irresponsible.

They can put each other down, but also put you and your sister as replacement attorneys which will allow the POA to continue if one of them dies, otherwise wherever lives the longest will no longer have an attorney. I future proofed mine as much as possible. My DC and DH are joint for health and my DH alone for finance with DC as a replacement.

Another confused as to why you think the health and welfare LPA will save the NHS money. Many people would want the NHS to take all measures to save them, or their family want that, so no 'savings' there.

IME, HCPs will consult next of kin where needed anyway, without necessarily requiring sight of the LPA, as no LPA will cover every possible scenario, even if the patient has put down something about care wishes.

OP I don't understand how if everyone had an LPA in place, it would save a vast amount for the NHS and social care. Can you explain. They usually don't go much beyond allowing the next of kin to make decisions on that person's behalf if they loose capacity which is the norm anyway. An advance directive isn't usually much more than a DNR is it? Although maybe it can include treatment too - such as antibiotics being given to a person in hospital via IV which may only prolong their suffering and may not be in their best interests.

My late mum didn't have an LPA. She went into hospital and was moved to a care home when she required nursing care and sometimes 1:1 care over a 2 year period. She lacked capacity and was on a DOLS for a time due to her confusion and demanding to go home. She had progressive vascular dementia and it is the most cruel and debilitating disease.

As next of kin I was consulted every step of the way. At some point after she deteriorated in the care home, I agreed to a DNR, and when it came to her last 24 hours I was asked if I wanted them to send her to hospital or keep her at home. I chose her staying at home and stayed with her until she died peacefully (she had pneumonia). There would have been no point them trying to rally her with antibiotics for a few days or weeks removing a very confused lady from her usual surroundings. Her quality of life was abysmal by that point. I agreed because I thought it was what she would have wanted but also on her GPs advice - who said that is what she would want/choose if it were her mum.

Not having a LPA made no difference to the care she received or the cost to the NHS - which was very high as she was fully funded. She was never at deaths door until the very last day or two and never hospitalised during the 2 years she was in the care home. How would an LPA have helped here?

I already had third party access to her bank accounts which she granted mainly due to her becoming less mobile and unable to go to the bank. She could not cope with online banking as she never had a computer or did telephone banking (she struggled with new things long before she was diagnosed with dementia and was also quite deaf). She trusted me to look after her affairs.

Surely in most cases, the next of kin just speaks for their relative when they are unable to do so? A LPA would be more relevant if you had multiple people involved (or none) and you wanted to nominate someone as your representative. I was an only child and my mum was a widow so ultimately it was up to me and her doctors to decide what was in her best interests. I think most people would want to be treated/resuscitated anyway until their situation becomes truly intolerable.

My mum was asked if she wanted to be on a DNR some time earlier (while she still had capacity) and at that time she said no. While her enjoyment of life was hindered by her having a stroke/mobility issues and her deafness, she still enjoyed visits with friends and family and being a grandma. Progressive vascular dementia strips all that away.

I am not even sure in an emergency situation, the information in the LPA or AD/DNR would be easy to access. A different matter if you are in hospital already or in a care home and they have the records.

I imagine this is most people's experience and why lots of people don't bother with an LPR. They don't think they need one. Your post made me wonder if I should get one but my son is an only child and I am happy for him to make any decisions on my behalf when the time comes.

Yes, I certainly think that the £92 isn't the reason why most people don't have a PoA - it's that most people are bad at planning for their own decline and e.g. don't move to a bungalow/put in a downstairs bedroom/bathroom before a crisis, even if they have the money.