What happens if there is no power of attorney?

[FaithFrank]

My pil are both in their 90s and still live in their own home. SIL has financial poa and that's all ok, but they never did health ones. They are now talking about doing the health poa. I think it's too late, they don't have capacity and mil especially shows sign of dementia.

What would happen if decisions needed to be made and there was no poa in place? Does anybody have experience of this?

I deal with this all the time. For day to day things a 'best interest' decision would be made by whatever relevant professional, this is normally in conjunction with the family (if the situation allows) who may know their wishes prior to loosing capacity but there is no legal right of the family with regard to devision making if no poa exists. If the matter is very complex or a team of professionals don't agree on the best way forward then an Independent mental capacity advocate (IMCA, usually a social worker but not necessarily) will be consulted. Rest assured that any good professional would always have the best interests of the patient at the heart of any decisions, and would be very happy to answer any questions if asked.

Thanks for your response SIB.

DP and siblings are mostly pretty harmonious when it comes to the care of their parents. Or at least they have been so far. I'm not sure why this came up now, other than general worries about their declining health and what might happen in the future.

No problem. These things normally go smoothly, it's normally only if the family have disagreed prior to decisions being made that things get a little tricky and upsetting.

Who is "talking about doing the health poa"? PILs? If so, there is a far chance they do have capacity for that decision (capacity isn't an all-or-nothing, it's capacity for the decision in question) so might still be worth exploring. I was concerned we'd left it too late with Dad, but his solicitor took him off on his own and had a long chat with him, and was happy to provide a capacity statement. I think she was right - he still had the capacity to decide he wanted us to put his point of view if he was unable to, even though his conversation would veer off into flights of fantasy.

It may not be worth the effort from the point of view of the decision making described above, but it greases the wheels with respect to getting information out of medical staff on a day to day basis.

I agree. Talk to a solicitor. It might not be too late at all. As they are talking about it they still might be ok to make one.

We have just done both POAs for my MIL. She's been in and out of hospital for a few months and is currently in respite waiting for a permanent residential home. Although the POA for health hasn't come through yet, we have been included in all discussions regarding her care. She had an MRI a couple of months ago, and it showed signs of Alzheimer's so her social worker advised us to sort out a POA.

The siblings have been talking about it. I presume SIL has discussed it with PIL themselves, but don't really know.

SIL has now made an appointment with a solicitor, so we'll see how it goes.

The comments on this thread have been reassuring, that even without poa there would be procedures in place.

It's capacity on the day op. Do they ever have moments of reason? My mums gp signed it off happily as he knew her and knew she understood, even though sometimes she didn't really know what was going on. As it happened she died before I got it registered and it didn't make any difference - but I argued strongly about what was in her best interests regularly.

My fil definitely has those moments, sometimes gets confused, but is reasonably 'with it' most of the time. MIL is more lost mentally, and also in worse health physically. It's really mil who I think doesn't have capacity. I would be relieved to be proved wrong.

Also note that you don't need a solicitor involved - you can do it yourself using the government website.

I was worried that we might have left it a bit late for my father but the go was happy to sing him off. As someone said upthread, capacity isn't black and white. Have you talked to her about how she wants her health handled, so that you can draw the poa up accordingly - I did an advanced directive at the same time so all points of end of life tackled. If they can give indications on that, then I would expect that they do have capacity.

If she has dementia, think about what time of day to have these conversations/ appointments / signing efforts. Mornings often much better

There is an Advance directive they could do about refusing certain treatments perhaps?

www.nhs.uk/conditions/end-of-life-care/advance-decision-to-refuse-treatment/

There are links online as well compassion in dying for example.