Health Care Power of Attorney: Part I

Part I: Health Care Power of Attorney

The set of responsibilities that I wanted to focus on here is the power of attorney (POA) role in medical care. This technically requires a completely separate document from the POA. Two commonly used terms are “health care power of attorney” (HCPOA) or “power of attorney for health care.” This is a fairly robust important role with many different facets that often don’t come up until a crisis happens.

And you definitely want to have this document in place BEFORE a medical crisis occurs. A crisis is not a good time emotionally to make large decisions.

Let’s break this HCPOA role down into two parts: Part I is about the practical day-to-day management of medical decisions like appointments and records. Part II is about the longer, larger discussions about health care wishes and end of life.

This blog will focus on the practical as Part I, so stay tuned for Part II.

Here are some common scenarios (yes, these are true stories):

· Scenario 1. You learn from your father he has decided to go to a neurologist because he has problems remembering things. When you ask how it went, he says “everything is fine and I should go back in four months.” It may be true that he has to go back in four months, but you’d want to ask yourself why. How often do you walk away from an appointment without to-do’s? Here is the time to start gently nudging your loved one in a trusting, kind manner to learn what’s going on. That appointment likely resulted in orders for a brain MRI (which likely has a wait time), neuropsychological testing (a much longer wait time), and deciding if he would like to pursue a blood test for abnormal protein associated with Alzheimer’s, a spinal tap or a PET scan (less wait times, but lots of logistics and out-of-pocket costs). Your father returns to the neurologist in four months having no recollection of any of these instructions, and mentions he is still driving. You get a knock on your door from social services that a provider is concerned about your father’s safety.

· Scenario 2. You decide you feel you aren’t getting the full picture from your wife about what the neurologist is saying, so you decide to go to her next appointment with her. You are unfamiliar with her current medications, and to your surprise so is your wife, so the neurology provider is not able to make a safe decision regarding a treatment plan. And did she have that brain MRI that was ordered four months ago? By the way, the neurologist isn’t quite sure who you are and if they should be sharing any information with you at all because your wife’s sister came to the last appointment, and she claimed she was mostly taking care of your wife.

· Scenario 3. You live in a different city or state, you are the designated health care power of attorney, and your mother has been admitted to the hospital. You’re in touch with the providers there, and the plan is to discharge her to a nursing home for rehab and then follow up with neurology in 2 weeks. You are assured your POA documents travel with her and that she will have transport to her appointments. This sounds great because you have to work anyways. She arrives at the neurology office for post-hospital follow up. She is alone other than with a transport person who does not know her. She is scared and agitated in an unfamiliar environment. Ther is no POA documentation or contact info for you provided to the neurologist. And the neurologist has no way to make any medical decisions because they have little to no information about your mother who was admitted to a hospital that they don’t have access to for records. The provider calls the nursing home who acts completely confused about why you would possibly need a POA present for this visit. This is how post hospital discharge care goes. Complete chaos. No communication. And think about how scared your loved one is without a familiar face. Yikes.

When you are HCPOA, you’ll want to consider that this means the following concrete things:

· Consolidating all providers into one health care system so that you can easily communicate with them and they can see each other’s records;

· Enrolling in the medical record as a proxy to communicate with those providers- again, one hospital system, one electronic communication method, one login.

· When providers see “dementia” as the reason for a visit, they often automatically look for who will be coming along or search the record for legal documentation on file legitimizing you. A little proactive communication goes a long way: sending your POA to all medical providers, introducing yourself, and asking that your contact information be listed as primary. “Hello, I’m Melissa, you’ll be seeing my dad tomorrow. I’m HCPOA and I will have my documentation with me.”

· You are in charge of making and attending all medical appointments;

· I repeat: you are in charge of making and attending all medical appointments;

· You are requesting and compiling records to keep in a file folder or binder. Yes, you are the notetaker at appoints and yes, in hard copy: CDs with images like brain MRI’s, progress notes, labs, and a list of medications at the ready for any provider who needs it in order to make safe medical decisions during an appointment. You may think you keep track of things, but wait until things become abnormal, meds change, then your mom is in the hospital a third time, what is the new dose of that blood pressure medication??!!

Lucky for you, you are armed with all the information providers need when you show up at medical appointments or hospital admissions.

Congratulations! You are a rock star HCPOA!