Answers to questions your surrogate decision maker might be asked
December 5, 2021 5:50 AM Subscribe
A beloved relative recently asked if I would act as their primary medical power of attorney, and as a split financial power of attorney. What sort of information should I know about them?
Said relative and I have always enjoyed a close relationship and I’m honored that they trusts me to be in that position. One of my requests is that we should have a regular conversation about their health and other things related to the role of a POA. I live several hundred miles away, so there will be an in-state alternate for health care decisions if I were unable to be present.
Relative is in their 60s with no major health issues that I am aware of. What sort of things would you want your MPOA to know about you that I may not be thinking of? Additionally, from the financial side, how much information should I ask for and what, without seeming invasive?
Said relative and I have always enjoyed a close relationship and I’m honored that they trusts me to be in that position. One of my requests is that we should have a regular conversation about their health and other things related to the role of a POA. I live several hundred miles away, so there will be an in-state alternate for health care decisions if I were unable to be present.
Relative is in their 60s with no major health issues that I am aware of. What sort of things would you want your MPOA to know about you that I may not be thinking of? Additionally, from the financial side, how much information should I ask for and what, without seeming invasive?
Sit down with them and go through the Five Wishes. This is a legal document that can be filed in most US states for a nominal fee, but even more important is the actual conversation: what matters most to this person, what are their values, what do they care about? If medical POA kicks in, you'll be the one who has to convey that to the healthcare team who barely knows your relative. Ideally the alternate would be present for this conversation as well.
posted by basalganglia at 6:29 AM on December 5, 2021 [6 favorites]
posted by basalganglia at 6:29 AM on December 5, 2021 [6 favorites]
Do you have specific wishes if you're in a medical state where you can't answer for yourself.
Do you have specific wishes for what happens to your body if you should die.
Do you have specific wishes for a memorial or other type of service.
Do you have a list of important account numbers, policy numbers, investment information.
Where is the deed to the house, will, etc.
Do you have a list of people, both personal and professional, who will need to be informed about a medical event or death.
Make sure you get listed as the emergency contact everywhere. My work had a remote coworker die earlier this year. He was estranged from his family and living out of a hotel. I was the first one to find out he had passed and I had zero information on him so that anyone in his life could be informed. Plenty of people don't have good or safe relationships with their immediate family members, and that's ok. So make sure you are not just legally set up as the POA, but also socially set up as an emergency contact everywhere possible.
posted by phunniemee at 6:31 AM on December 5, 2021 [2 favorites]
Do you have specific wishes for what happens to your body if you should die.
Do you have specific wishes for a memorial or other type of service.
Do you have a list of important account numbers, policy numbers, investment information.
Where is the deed to the house, will, etc.
Do you have a list of people, both personal and professional, who will need to be informed about a medical event or death.
Make sure you get listed as the emergency contact everywhere. My work had a remote coworker die earlier this year. He was estranged from his family and living out of a hotel. I was the first one to find out he had passed and I had zero information on him so that anyone in his life could be informed. Plenty of people don't have good or safe relationships with their immediate family members, and that's ok. So make sure you are not just legally set up as the POA, but also socially set up as an emergency contact everywhere possible.
posted by phunniemee at 6:31 AM on December 5, 2021 [2 favorites]
I have been an MPOA in the past. Couple additional things to think about -
- You should get to know the in-state alternate since, when the time comes, you will likely have a number of phone conversations about care with so having a relationship prior to that will be helpful.
- Find out who is the person the relative definitely did NOT want to ask. This is someone who is likely to try to step in and make things difficult when the time comes. This is a good thing to know in case you need to manage them as the relative declines.
posted by eleslie at 6:33 AM on December 5, 2021 [3 favorites]
- You should get to know the in-state alternate since, when the time comes, you will likely have a number of phone conversations about care with so having a relationship prior to that will be helpful.
- Find out who is the person the relative definitely did NOT want to ask. This is someone who is likely to try to step in and make things difficult when the time comes. This is a good thing to know in case you need to manage them as the relative declines.
posted by eleslie at 6:33 AM on December 5, 2021 [3 favorites]
Bless your relative for trying to organize this before she actually anticipates needing it! I took care of a beloved aunt who was in her late 80s and procrastinated terribly, though she thought she was a great planner - she was, but in the way that even after her oncologist told her she would best enroll in hospice, as her cancer was no longer treatable she prepaid a full year of long-term care insurance (>$8,000) because "I always do this because of the prepay discount". Denial is a powerful emotion; she lived only 4 months.
She waited until she fell at her home (because she would not take up throw rugs) and had to go by ambulance to an emergency room, where she was admitted to ICU because of dehydration and critical electrolyte imbalances. (Her home had one bathroom up a flight of stairs; she fluid restricted. Naturally, she refused all entreaties to move.) She called her lawyer to the ICU to draw up a MPOA appointing me. If she had, for example, had a severe head injury from the fall, it might have been too late for power of attorney.
I needed that MPOA as she got weaker and sicker. It was good leverage when the administrator of her nursing home needed to figure out how to get morphine on a holiday when the pharmacy had no stock. In any case, my final recommendation is to have an original "copy" of this document to show the hospital or nursing home because their administrators will insist on an original signed and executed document before they will allow you the authority your relative wants you to have. Mine was stapled to a blue cover sheet, which I understand is customary for these documents.
posted by citygirl at 11:06 AM on December 5, 2021
She waited until she fell at her home (because she would not take up throw rugs) and had to go by ambulance to an emergency room, where she was admitted to ICU because of dehydration and critical electrolyte imbalances. (Her home had one bathroom up a flight of stairs; she fluid restricted. Naturally, she refused all entreaties to move.) She called her lawyer to the ICU to draw up a MPOA appointing me. If she had, for example, had a severe head injury from the fall, it might have been too late for power of attorney.
I needed that MPOA as she got weaker and sicker. It was good leverage when the administrator of her nursing home needed to figure out how to get morphine on a holiday when the pharmacy had no stock. In any case, my final recommendation is to have an original "copy" of this document to show the hospital or nursing home because their administrators will insist on an original signed and executed document before they will allow you the authority your relative wants you to have. Mine was stapled to a blue cover sheet, which I understand is customary for these documents.
posted by citygirl at 11:06 AM on December 5, 2021
Three things:
- IANAL but it is my understanding that MPOA is a legal document in the sense that it is formal and official but may not be binding in the particular state or hospital system. Somewhat the same for DNR, especially with regard to first responder decisions before you are even contacted. I do not believe this changes any of the very good information above, but it does suggest you may also want to look into the fine points I raised with a lawyer (though you may already have).
- I was MPOA for my mother who went into a coma and I was called to the ER and had a discussion with the doctor. He wanted to know what should be done. I asked if he had read the document which he said he had. I said that asking whether brain surgery should be performed on an 84 year old woman found to be in coma (due to an aneurysm) when unable to rouse in the morning was clearly against the stated intentions of my mother, and I would not agree to it. In my judgment it would be extraordinary measures with very uncertain results. I mention this only as a real world example of what you may be called upon to decide. You probably want to discuss such scenarios with your relative.
- Sadly my mother was not totally of sound mind in her last few years, and she had very inaccurate understandings of her pension income, level of savings, expenses in assisted living and later in nursing home, etc. No matter how many documents or speaker phone calls to the bank were made, she never grasped her situation which caused her much anxiety. You may want to discuss this scenario with your relative also, though (of course) should their mental capacity diminish there may not be a way to make them see that in the future.
posted by forthright at 3:04 PM on December 5, 2021
- IANAL but it is my understanding that MPOA is a legal document in the sense that it is formal and official but may not be binding in the particular state or hospital system. Somewhat the same for DNR, especially with regard to first responder decisions before you are even contacted. I do not believe this changes any of the very good information above, but it does suggest you may also want to look into the fine points I raised with a lawyer (though you may already have).
- I was MPOA for my mother who went into a coma and I was called to the ER and had a discussion with the doctor. He wanted to know what should be done. I asked if he had read the document which he said he had. I said that asking whether brain surgery should be performed on an 84 year old woman found to be in coma (due to an aneurysm) when unable to rouse in the morning was clearly against the stated intentions of my mother, and I would not agree to it. In my judgment it would be extraordinary measures with very uncertain results. I mention this only as a real world example of what you may be called upon to decide. You probably want to discuss such scenarios with your relative.
- Sadly my mother was not totally of sound mind in her last few years, and she had very inaccurate understandings of her pension income, level of savings, expenses in assisted living and later in nursing home, etc. No matter how many documents or speaker phone calls to the bank were made, she never grasped her situation which caused her much anxiety. You may want to discuss this scenario with your relative also, though (of course) should their mental capacity diminish there may not be a way to make them see that in the future.
posted by forthright at 3:04 PM on December 5, 2021
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posted by Thorzdad at 6:27 AM on December 5, 2021