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.

we found it very useful . Fil in hospital lost mental capacity and we weren’t happy wirh his care and we asked to see what treatment had been administered and they handed over medical records because we had a lpa . The other was were was the property and finance we were able to access their bank account to pay care costs direct . Made life so much easier .

for us it was invaluable

Yes, the hospital goes through the trick of asking if you want your parent resuscitated - in the case of Epsom we thought, right, actually what that seems to mean is 'Can we kill your parent then?' They don't sell it like that, instead they talk about how your parent might have a severe heart attack or stroke and in their condition it would be cruel and futile to bring them back to life and so on, all quite reasonable stuff. However, given what happened the last time we were wise to it and said 'no'. So then the staff in A&E cheerfully informed us that they could overrule us anyway!

It's one of those Tony Blair-style things - we'll consult with you on what you want, and if you agree that's fine, you're not put out - but if you don't agree we'll go ahead and do it anyway!

Oh, don't get me wrong, this can happen too! Never happened in Surrey in my experience. My theory is that the State is just nuts - it is all about control, and the only way they can feel they've got that is to do the blind opposite of what the civilian's family wants!

'Activated' might not be the right word. But you see the problem - if the NHS or whatever can make out that actually your parent still has mental capacity, then the LPA becomes irrelevant. As is your word. So you may need to have a doctor's note or something backing that up, that your parent lacks mental capacity.

Otherwise you may be in the classic situation of having a 'kindly' consultant charming your vulnerable and bewildered parent into agreeing to say on their ward while they finish them off via injection in the night with impunity. Your waving your LPA around won't necessarily prevent that.

The area of mental capacity is quite vague. That almost doesn't matter if your parent is lying on a hospital bed asleep or out of it, or hardly speaks, but if you have a seemingly alert and manipulable chatterbox as a parent, there could be difficulties.

Why would you want your parent to go through a "cruel and futile" resuscitation attempt?

Extremely useful for us with Mil with dementia. Helps with social workers, carehomes but particularly when dealing with the paramedics.

I must sort one for myself.

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.

Thank you all for these comments. I’m going to take some time to read them through and then speak to my parents. Thank you all very much.

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.

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.

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 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.

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.

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.

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?

@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.

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!

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

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.

@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.

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).

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.

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.

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