Although you may not like to think about it, your loved one may become unable to act on his or her own behalf. This can happen when one is nearing death or as the result of a physical or cognitive condition that may be either permanent or temporary. Many people assume their spouses or children will automatically be allowed to make financial and/or medical decisions for them, but this is not necessarily so. There are important legal and end-of-life decisions that need to be made while your loved one has the capacity to make these decisions.

Powers of Attorney
A power of attorney is a legal document that allows one person (called the principal) to appoint someone else—called the agent or attorney-in-fact—to act on his or her behalf. The powers that can be exercised by the agent can be broad or narrow; the principal stipulates them, in advance. Your loved one (the principal) might, for example, authorize you (the agent) to do a specific thing (e.g., sell the house). The principal can give the agent the authority to perform any legal act he or she would do. If an older person becomes incapacitated without having a power of attorney, the family may have to go through lengthy and expensive legal action so that someone can act on the individual’s behalf.

The two main types of powers of attorney are:

• A conventional power of attorney gives the agent whatever powers the principal chooses for a specific period of time (e.g., 30 days) beginning when it is signed.
• A durable power of attorney stays in effect for the principal’s lifetime—beginning when it is signed. This power of attorney must contain specific language stating the agent’s power is to stay in effect even if the principal becomes incapacitated.

Signing a power of attorney does not mean a person gives up the right to act on his or her own behalf. The power of attorney assures the principal that the agent will be able to act when and how the principal directed, if it becomes necessary. Also, it’s important to note that a person can revoke or cancel their power of attorney at any time.

Planning Medical Care and Treatment — Advance Directives
Advance directives are written documents that tell doctors what kind of treatment is desired if a person becomes unable to make medical decisions (e.g., falls into a coma). They can take many forms, and it’s a good idea to understand state laws before writing an advance directive. Federal law requires hospitals, nursing homes, and other institutions that receive Medicare or Medicaid funds to provide written information regarding advanced care directives to all patients upon admission.

Living wills are a kind of advance directive that come into effect when a person is terminally ill. A living will does not give one the opportunity to select someone to make decisions, but it allows the person to specify the kind of treatment wanted in specific situations. For example, your loved one might specify that she or he doesn’t want to be treated with antibiotics if death is imminent.

A Do Not Resuscitate order (DNR) is a type of advance directive specifying that if a person’s heart stops or if he or she stops breathing, cardiopulmonary resuscitation (CPR) is not to be given. Unless they are directed otherwise, hospital staff will try to help all patients who have stopped breathing or whose heart has stopped. A person can tell the doctor not to resuscitate and a DNR order will be entered on the medical chart.

A durable power of attorney for health care (sometimes called a durable medical power of attorney) names the person who is to make medical decisions for another person. It is activated any time the person is unconscious or unable to make medical decisions. State laws vary, but most states disqualify anyone under the age of 18, the person’s health care provider, or employees of the health care provider. The individual named as the agent must:

• Be willing to speak and advocate on the older person’s behalf.
• Be willing to deal with conflict among friends and family members should it arise.
• Know the person well and understand his or her wishes.
• Be someone the individual trusts with his life.

Spiritual or religious beliefs may have bearing on the types of advance directives one chooses to prepare. Although death is often a difficult subject to raise, it is a good idea for you, your family members and your loved one to discuss these issues to ensure everyone understands the older person’s values and beliefs. The more communication there is, the easier it will be for the family to respect your loved one’s wishes.
 
Advance directives don’t have to be complicated legal documents; they can be relatively short statements about what one wants done when one can’t speak on his/her own behalf.

Any advance directive must, however, comply with state laws. It’s also a good idea to have written advance directives reviewed by the older adult’s doctor and lawyer to make sure that all instructions are understood as intended. Once advance directives are finalized, copies are distributed to the family, medical power of attorney agent, and the doctor.