How important is POA for Health and Welfare?

[Lightbeam]

My aunt is 86 and getting increasingly frail and forgetful. Years ago (2007) she made an Enduring POA which covers Finance, my sister and I are listed as her attorneys on this. It is not registered yet, (enduring POA is only registered once they start to lose capacity).
But we don't have Health and Welfare POA. How important is it we get one? Or can we just rely on NOK status? It'll be quite a bit of an effort to get one for her as she is house-bound, reclusive and seemingly no able bodied friends to witness etc.

My sister and I are her only relatives.

MIL had LPoA for health and welfare and a DNR, and no capacity, but the hospital ignored both and completely ignored the family, to the extent that staff would not meet our eyes and actually ran away when we tried to speak with them.

Up until then we thought we had all bases covered.

Yes definitely put health and welfare in place. Had for my late mother. You can then maintain some control over your aunts future welfare/treatment

Adults in old age Social worker here

Definitely get LPA finances and property in place as early as you can as deputyship for finances after person loses capacity takes 6-9 months sometimes longer and there are delays post covid due to backlog at courts.

Do you absolutely need LPA health and welfare - no. If the person has lost capacity on the specific decision, the best placed professional will assess capacity and make best interests decision if they cannot decide themselves. And include most involved relative in that. But that relatives views may hold weight but aren't definitive. There's lots of guidance around that and challenges that can be taken up legally if you disagree as their closest relative.

But I strongly advise if you can then do please get LPa health and welfare as your Aunt may trust you or your DH and want you to do what you feel is in her best interests. It isn't expensive to arrange if she still has capacity to understand and agree to POA

Here is how you set it up

www.gov.uk/power-of-attorney

It'll just cost her the court fees which aren't high (& if she is on low income you can apply for help towards court costs from the court)

I hold LPA health and welfare and finance and property for both my parents and have done so for years. Because it has huge value of ease, autonomy and they trust me to decide what they would want when they are no longer able to decide. I know what risks they would take but also what risks would be unacceptable to both of my parents, that can't be predicted as each dementia progresses slightly differently & each individual has their own behaviours that can impact on their lives.

It you hold LPA health and welfare and they lack capacity it becomes your decision - not any other professionals - between the available options.

LPA h&w is the individual that the person themselves trusts most & is legally same as if the person themselves consented or decided.

That's why all the health and social care professionals love having an LPA h&W available - to decide what is in the persons best interests. You know them best, we don't, and we can then advise, recommend and support you.

Having the EPA is most use. The attorneys have a duty to manage finances in the donor's best interests which invariably involves having regard to health and welfare. As a self funder you won't get any meaningful input from social services (if en England) unless she is so ill that she qualifies for NHS continuing healthcare so it'll be your call re choice of care agency or care home etc. Really not worth bothering about given the logistics of it for you and aunt. LPA(HW) have very limited roles in hospital situations as ultimately Drs have to do what they consider best for the patient except in limited situations covered by advance decisions. Hope all goes well if you need to step in to formally support your aunt

Agree with ikeptgoing, I've worked in a hospital for many years with elderly patients and lately on a frailty unit with a lot of the patients having dementia. I'd say finance one more important than health, the doctors always consult the next of kin if the patient lacks capacity and DNARs are discussed very quickly. They do not want to actively treat people if not in their best interests and keep the relatives up to date with any medical information or involve them in any medical decisions that need to be made.

If things go wrong and/or difficult decisions need to be made around complex medical situations then you may regret not having one. Your NOK status will carry absolutely no weight at all.

I thought I would update. It all came to a bit of a head this week as my Aunt had a fall in her flat and couldn’t get up. The fire-brigade came to break in and paramedics to pick her up and check her. She was physically fine but worryingly had no recollection of being on the floor for 3-4 hours. I obviously need to contact her GP re her memory and it will be easier in long run if I have Health LPOA for these conversations.
Her lovely neighbours were able to witness/certificate provide this weekend, so with the 20 week turnaround we’ll get it in place for December..😫

I'm so sorry to read that your Aunt had a fall.
It's good you've got things in motion for the POA and I hope it comes back sooner than 20 weeks.

Sorry to hear about your aunt. Glad you’ve started the process on getting the other LPOA in place.

I found it useful for updates on medical appointments, speaking to mental health teams and even the dentists for my mum.

I'd say massively , my mum had a stroke 4 weeks ago and we have had to make some massive decisions about her health .. very grateful we have everything organised and in place with PoA ! I imagine it would be awful without !

Sorry to hear about your mum @gunnersgold .

My mum also had a stroke several years ago, I remember how stressful the immediate aftermath was as she went from full health to really very much not fine. But then she developed Parkinson’s and associated dementia, & died last yr. We never did have a Health POA for her, I think because my father was her carer and they were fully self funded until end of life kicked in, it never really came up. More useful for us was a DNR that her Doc put on her file once she became really ill and frail.

@Lightbeam thank you , my dad died 9 years ago so she lives alone and has a lot of money and assets but can't manage her money anymore .

It's very sad but I'm so glad we had the PoA organised ! You just don't know what is round thr corner .. I've been asked a few times about dnr so will sort that out too.. I personally don't feel there is much point living when you don't know what's going on around you but I know everyone has a different attitude to it all.