Choosing a person to make healthcare decisions for you when you are physically and/or mentally unable to make them for yourself is difficult, but it’s a choice that should be made with great care and diligence. This person may be required to make decisions not only about the type of treatment you receive but also about which hospital you go to, where and what type of custodial care you receive, and when it may be time for hospice care. You may be inclined to simply name a spouse or a child, but as my friend Joe found out, this might put them in a very difficult position. Here is Joe’s story (and just for the record, all names have been changed to protect the privacy of those involved):
Joe’s father is one of four brothers who grew up in a traditional Italian family. Like many Italian men (and perhaps men in general), each one is staunchly independent, not wishing to ever rely on someone else to make a decision for them. A few years ago, Joe’s uncle Mario began to show signs of physical and mental impairment, and so Mario decided, under the compulsion of his physician, to put together an estate plan that included a will, a trust, a financial power of attorney, and a healthcare directive (i.e. a living will). Although Mario was married, he and his wife never had children, and so together they named their favorite nephew as their power of attorney for healthcare should either of them become incapacitated. At the time that seemed like the right decision. After all, no one knew his uncle’s wishes better than Joe, so he seemed the best choice for the role.
Eventually, Uncle Mario’s health began to worsen, and soon he was no longer able to take care of himself nor his aging wife. Both had fallen down several times, and it was clear that they were a danger to themselves and needed constant supervision. The problem was that Joe’s aunt and uncle lived an hour away, and the suggestion that they leave their home of 40 years to live closer to him was met with hostile objection.
This put Joe in a difficult spot. As power of attorney, Joe was in charge of deciding what was in the best interest of his aunt and uncle. Clearly, leaving his aunt and uncle in their home was an accident waiting to happen, yet they could not afford in-home care. Moving his aunt and uncle nearby would provide the supervision they needed, but he knew how much mental anguish it would cause, not to mention that his aunt and uncle would have to be forcefully moved, as neither was willing to go.
Joe knew what he had to do. In order to exercise his duties, he had to have his aunt and uncle certified incompetent by their physician. In the end, Joe had his aunt and uncle moved to a nearby senior living facility.
Unfortunately, this sort of thing happens every day. A husband names his wife, a father names his son, a brother names his sister—the list goes on. Naming a close relative to make important decisions about our healthcare seems logical, but before you do, consider the following:
1. Have you made your wishes clear?
Joe thought he knew his uncle’s wishes, but his uncle never considered the possibility of being forced out of his home. Consider every possible scenario, and explicitly provide instructions for your power of attorney not only on what “type” of care you are willing to receive, but also on “where” you are willing to receive it.
2. Does your healthcare power of attorney have the willingness to make tough decisions under difficult circumstances?
It’s one thing to provide instructions that spell out your wishes, but it’s entirely something else to have a person willing to carry them out. It is a lot easier to say “yes” to being named a power of attorney for healthcare than it is to give a physician orders to remove a breathing tube, a dialysis machine, or other form of life support. Imagine how difficult this would be for spouses, children, and close family members, especially those that have been together for many years. Thankfully, Joe has not found himself in this position yet, but if and when his aunt or uncle gets to that point, it could be one of the toughest decisions he’ll ever make in his life.
3. Have you shared your decisions with relevant family members?
Uncle Mario’s wife is from another country, and for the most part, her extended family is unaware of the situation. If they were to discover that she was “forced” out of her home against her wishes, without knowing the facts and circumstances, they might become irate. This could add to the already high level of stress and anxiety surrounding the current state of affairs. Be sure to let key family members know who is in charge of making your healthcare decisions and why you named them. Only provide them with information that you feel is necessary to make your healthcare power of attorney’s life easier.
4. Have you considered purchasing long-term care insurance?
Remember, it was Uncle Mario’s wish to remain in his home, but he and his wife could not afford in-home care. According to Genworth Financial, the average cost of a home health aide in California (where Joe’s uncle lives) is a little over $50,000 a year, but that’s based on about forty-four hours a week. Full-time care could cost two to three times as much. A long-term care insurance policy may have helped to offset the cost, possibly keeping this option available. Since the average person will require care for about 2 ½ years, a three-year policy may be sufficient, but individual needs may vary, so consult a licensed insurance professional.
Uncle Mario’s estate planning was done as an afterthought. He named Joe as a healthcare power of attorney out of convenience rather than giving it much consideration. In the end, it worked out okay, but a little more planning could have made things less stressful. Sadly, Joe’s story does not end here. Next week I’ll share with you why naming a corporate trustee may be a better option to naming a family member.