When is a health lasting power of attorney useful?

[tonbridgecat]

Hello

Slightly depressing topic but when are lasting powers of attorney for health useful? I think the donor has to have lost capacity for the LPA to come into play, but what does the LPA enable the attorney to do? agree treatment? Agree admission to a care home? Sort out care packages?

thank you.

In my experience the health POA was utterly useless. Medics made it very clear they would ignore my parent's wishes and do what they want. And they did.

I think the time it is useful is if there are various relatives with different ideas about care for the person concerned. The relative with health LPA gets to make the choice.

But aside from that I am not sure it's particularly useful. My mother had dementia and I had finance LPA for her but not H&W. I am an only child, there was no one else interested in her care. When she lost capacity I chose the care she received and did a DNA and Respect forms. All her medics and carers always consulted me, and said that me having H&W LPA would have made no difference. They took my views into account and we were in agreement about how her treatment and care.

I was told you need the H&W one to make decisions about going into a care home, for example, and which care home. But you need the finance one to actually pay for it!

We found it helpful when we wanted to speak to a doctor on a parent's behalf. Some would only interact/answer questions from us ( without the parent being present - eg if you wanted to speak to a GP about a blood test result over the phone as we lived at a distance) once they had seen the power of attorney

It’s been useful for me and my sister - dad has dementia and although mum is next of kin she is struggling with the stress of it and making decisions. The LPA means the medical teams and GP will talk to us about his condition, his care, and ask us for decisions. This means it is less pressure on mum, even though she is still involved in the discussions. Whether it makes any difference in practice I don’t know but it certainly feels less stressful to have it there.

It is useful in stopping the State from murdering your parent in a care setting such as a care home or hospital, to put it bluntly. It means you can act on your parent's behalf and are able to move them to a better care home at the point when your parent is judged to have lost mental capacity - and this is decided by the State and not you. Otherwise, the local authority aka social services will be colluding with the care home to decide what is best for them, not you or your parent. Ker-ching! Esp if you are self-funding, because you are subsidising council-funded care home residents to the tune of several hundred a week.

The elderly are placed on covert end-of-life care aka murder via dehydration and so on - this goes on in Surrey care homes, approved by Surrey County Council and I'm not even sure it's illegal as it's passive euthanasia. Any time you want to hold anyone to account over their wilful neglect, they will be tipped off to use the words 'Do you have LPA in Health and Welfare?' all cocky like. And if you say no, well, they've got you over a barrel.

You will not even be allowed to read your parent's medical notes.

I used it to hold the Home and GP to account for pain relief or rather lack of for my DM.

My MIL has dementia, I asked DH to set up POA finance and health before she lost capacity. So glad he did.
The doctors speak to him, every step of the way. The council spoke to him about care, at home and later in a nursing home. The care home nurses speak to him about daily routines, ongoing medical procedures, what end of life care will look like, what measures will be taken in what circumstances etc. First question any medical professional asks is do you have health POA.

@NewspaperTaxis which Surrey care home are you referring to? Just asking because my FIL has just moved to one 😕

My Dad was diagnosed with cancer and in spite of applying were told that POA wouldn't come through in time so the palliative care nurse did a DNR and RESPECT form with Dad. But unfortunately those weren't enough to stop my sister from meddling in Dad's care and thanks to her efforts, he was moved from a wonderful hospice to a shit nursing home where he died a horrible death. I will never forgive her.

Hence DH and I have them in place for each other (health and finances) because I won't ever be put in that situation again. Trust me, if you've got anyone who can and will make trouble for the sake of it, you need them. And I suspect that DH's sister will be a prime candidate.

I'm not sure it's much use. Without one most doctors will speak to family anyway if the person has no capacity.
My mother never lost capacity and the only time we needed it was to get past gatekeepers. Health professionals were fine.

I was able to access my mum’s medical records at the GP on line to keep up to date with treatments, medications etc.

When she was declining in the care home, the paramedics would call and when I said I didn’t want invasive measures they needed to know I had POA before they would take my wishes into account. This happened 3x.

I think it gives you a voice which is listened to but, they did say, if they felt I was going against her best interests, they had a duty to her so it’s not clear cut. But I’d rather have it than not.

From the perspective of a social worker:

If the person has lost capacity around their care and support needs and can't make a capacitated decision about having carers at home or going into a care home then the H&W LPOA can lawfully make that decision on their behalf.

If there is no LPOA for H&W then the responsibility falls to the state to make that decision.

If the person is insisting they don't want carers coming in because they don't recognise they need them then the H&W LPOA can go ahead and make these arrangements anyway if they believe it's in the person's best interests.

If the person goes into hospital and the hospital feel they need to be discharged to a care home then the H&W LPOA can agree to this without having to go through a lengthier best interests process delaying discharge and increasing the risk of hospital acquired infections ans delirium.

Providing the LPOA for H&W also is able to make the financial decisions with their LPOA for finances as well they can choose which care home/ care agency they want and when that starts rather than being at the mercy of Adult Social Care waiting lists for Care Act Assesssments - for example in my local authority there is around an 8 week waiting list for assessments.

You also have the authority to agree to things like covert medications if required. You can consent to things like brain scans and make decisions about whether to pursue treatments where there is a balance of options regarding quantity or quality of life.

Ultimately Adult Social Care will usually be very pleased if you have LPOA for H&W as it significantly reduces the amount of paperwork required and gives the decision making power legally back to the family who know them well rather than the onus being on a frazzled social worker to make decisions based on the few hours they have spent with the person.

id say the finance one is more important, as medical teams shoukd involve relatives in decision making even without one. But, it really does help. It gives you the power to advocate for the person and be heard, as you are speaking for them. And yes some teams will only properly involve you if you have PoA. In cases where someone has lived with dementia for years with an early loss of capacity, it can really make a difference.

They are not as crucial as Finance but there are times they can be a bit of a trump card; where I've seen them come into play has been

• where there is a living spouse but someone else who has knowledge and expertise who is better able to judge the person's wishes and best interests (eg elderly spouse but child who is a medic)
• where there are no living relatives but there are others (eg friends) who could advocate for the person. Without LPA the friends would not get a say, and "best interests" decisions would be made by medics/carers who had no knowledge of the person

I have one, and I also have an Advance Decision.

From a health care professional point of view its really helpful.

1. when descions need to be made in someone's best interests its so much easier to liaise with POA and get the common sense descion made e.g not being admitted for hospital for an infection that can be treated at home or discussed palliative care. Or refusing treatment that the person wouldn't have wanted, such NG tubes.
2. if family are in the unfortunate and regrettable situation were they really disagree with a medical descion then they can over rule that descion ( unless it's clearly wrong in which case it would have to go to court of protection but this would be an extreme case).
3. it's also much eaiser to get information from health care about your loved one of you have POA.

For me this is the most important page. My mum has said I can decide if she is given life sustaining treatment.

My mum said to me many times and also wrote down that she wants to be released from a life of just existing.

Mum is now in her 90s with advanced dementia so doctors would probably agree it wasn’t in her best interests to treat pneumonia etc. But if they did want to give her antibiotics I can tell them not to and speak as if I was her.

When my stepfather was in hospital and clearly needed to go into a home, the discharge team asked me if I was willing to act as him Next of Kin in terms of liaising with them and social services. I was included in all decisions regarding any future medical treatment he needed but as he was subject to a deprivations of liberty order, I wasn’t able to make any decisions contrary to medics.

When my father who had early onset dementia, had moved from a "care" home, into a nursing home, and had lost the capacity to control every muscle except his swallow, (so he couldnt dehydrate to death because the nurses can not let that happen).... and got an infection, that meant he was unable to swallow, his nurses and GP who visited wanted to transfer him from his nursing home, to a hospital for an antiobiotic that he could ONLY have in hospital, I WISHED I'd had his health POA as well as financial. (I'd been his financial legal attorney for at least 5 years)

Thankfully, from 250miles away, over the telephone I managed to convince his GP to agree to him staying in his care home to die naturally ASAP rather than give these ABs to prolong his miserable life.

It was VERY clear that without health POA to choice to admit him was the Drs choice and NOT mine. (I was acting for what I know would have been his wishes). Yes I won this battle..... but an HOUR telling a Dr to let your Dad die was not a very nice converstaion which could have been avoided.

It just so happened that he recovered from this infection and continued "living" for several more months.

A few months later, when he WAS ACTUALLY DIEING on his syringe driver, (< 2 hours before he actually died) a "bank nurse" came into his room to change his nappy. It was VERY VERY clear that he was not going to live much longer and having neither eaten or drunk anything for days, there was not going to be much to change:
I had a full on stand off with her and won. She INSISTED she had to change him there and then, and I lied and said has is attorney I do NOT consent and you will NOT touch him. It was only going to distress him.
It was very clear that she didnt like it, but she could also not overrule me, because my answer was no and I meant it. No one was going to do that to my Dad as he was dieing in bed "because it was policy"

He died < 2 hours after this disagreement.

So yes, I have both financial and health POA, as does my husband (for all possibilities.... if just 1 of us is dead / dieing, or if both of us are dead / incapable (when me mum / sister can act jointly / severaly for me, as can his mum and brother for him)
Yes our wills are sorted too.

IMO POA is even more important than a will because unless you are killed in a freak accident or something, you are likely to become incapable before being dead, and someone will need to act on your behalf.

Your will is for the benefit of your beneficiarys, once you are dead; your POA can benefit you while you are alive

We had this for MIL. It meant they discussed with us whether she should be kept in hospital or sent back to the nursing home and when, whether to do a DNR, whether to allow her to die once she was completely out of it. All awful, horrible decisions for her son to have to make, but we felt it was better than the doctors deciding that. You may not feel the same way though, and that’s fine.

My father became bedridden after being weakened with mylodysplasia (a blood cancer). Aged 88, the in place PoA allowed me to advocate for withdrawal of further hospital treatment/admission to allow him to spend his remaining time at home with my mother.
It was a trying time, no exaggeration. But I couldn’t have achieved his last wishes otherwise. Plus I reckon he lasted longer without being carted back and forth.

Without the health and welfare element of PoA I would not have been able request that my late OH not be taken to hospital for life saving treatment with no hope of improvement. I did not want him dragged back to the miserable existence he was enduring.
The medics all accepted this without question and made the necessary arrangements for end of life care.

Not wishing to intrude @nannyl but from my experience with two late parents looking back it seems clear that they get changed when staff are anticipating a death, possibly because it's not nice to change someone after they've departed their life... But your case does describe what can happen - this was the case with my late father in Epsom General Hospital. The bastards gave him a pressure wound, really nasty, we'd had him at home for years and he never got that. Still, it's the same in maternity wards at the other end of things isn't it, they just hate us.

@BB49 you will have to DM me! I put a few care homes in the local and national press, Social Services never contacted me about it, just plotted ways to get their own back. They are able to operate outside the law it turns out. No point going to your MP, they are beyond that - Epsom's Chris Grayling I suspect was using our meetings to carry out surveillance and feed back to them, and I've emailed current MP Helen Maguire the entire shooting match as to what goes on and what they get up to. Surrey Social Services simply acknowledged the document and didn't deny any of it, including allegations of euthanasia!

Social Services oversee and collude in cover-ups of poor care homes, because the worse the care home, the more money it saves - dead bodies save them a fortune, and care homes that don't follow that policy can be blacklisted. They waged war on me because I 'whistleblew' a bad care home to the press - our not having LPA in Health and Welfare became their trump card at all times. We had it in Finance but it wasn't enough.

The Surrey Safeguarding heads behind it, such as Jean Hills, are still in post and remain untouchable.

OP make sure that you get the Health and Welfare Lasting Power of Attorney and the Property and Financial Affairs Lasting Power of Attorney, not only for your elderly relatives you expect to be responsible for, but also you yourself, DP if you have one, as well as any children that are of adult age. No one is ever promised tomorrow, and no one is immune from tragedy. The other point to remember is keep copies of everything close by, including possibly in your motor car just in case you're not able to return home for it. Care and nursing homes in the US have been notorious for taking LPA away from the family if there's nothing in place, which being a "for profit entity" they are given this option. Just safeguard everyone, including yourselves.

For me it was a waste of time as they kept saying dad had capacity, so I couldn’t use it. The only time I used it was at the very end when he was unconscious and I insisted the paramedics took him to hospital.