Many years ago my parents set up an EPA which covers finance but not health. At the time they thought it covered both. Having dealt with a family friend with no POA, I had a real problem with finance issues but the hospital and care home had no problem dealing with me. After he had a major stroke I made the DNR decision, what home he went to (NHS funded) etc. Would it be such an issue if there was no POA covering health as I think at this stage the PWD would be rather upset at the suggestion?
EPA for finance but not health
- Thread starter Pebblepebble
- Start date
I’ve just read through some of your previous posts and I’m assuming you are talking about one of your parents here. If and when a PWD gets to the point where they no longer have mental capacity, then the next of kin would be the person who would work with services and in this instance I’m assuming this would be your other parent.
I have LPA for health for my mum and I have been consulted on everything since she lost mental capacity, she was also self funding so in some respects that does make a difference. I was able to find and move her to a home , make decisions about vaccines, health issues, medication etc. I suspect I would have had the same if I didn’t have the LPA but I have worked with people who don’t and decision have been taken out of their hands. I think it really comes down to the individual circumstances but the bottom line is the PWD must no longer have the ability to make their own decisions beforehand anyone can speak for them.
I have LPA for health for my mum and I have been consulted on everything since she lost mental capacity, she was also self funding so in some respects that does make a difference. I was able to find and move her to a home , make decisions about vaccines, health issues, medication etc. I suspect I would have had the same if I didn’t have the LPA but I have worked with people who don’t and decision have been taken out of their hands. I think it really comes down to the individual circumstances but the bottom line is the PWD must no longer have the ability to make their own decisions beforehand anyone can speak for them.
The old style POAs used to cover both finance and health, but were converted to finance only a while ago.
As Kevinl says, health decisions tend to be a partnership approach anyway. More often than not, the NHS and Social Services are only too happy to hand over to relatives and step back. That’s not to say there are never disputes - as this forum will show. But with my Granny, it was the lack of a financial POA which really caused us trouble. We never found ourselves disagreeing with decisions which were made about her health and wellbeing, even when they went against her wishes (going into hospital for assessment, discharge into a care home for ‘recovery’, DoLS for permanent residence in the home).
As Kevinl says, health decisions tend to be a partnership approach anyway. More often than not, the NHS and Social Services are only too happy to hand over to relatives and step back. That’s not to say there are never disputes - as this forum will show. But with my Granny, it was the lack of a financial POA which really caused us trouble. We never found ourselves disagreeing with decisions which were made about her health and wellbeing, even when they went against her wishes (going into hospital for assessment, discharge into a care home for ‘recovery’, DoLS for permanent residence in the home).
It is an interesting topic. The reality is that an individual will always be encouraged to express their wishes regardless of being deemed to no longer being deemed to have capacity. The dementia journey of course is not like a light switch that turns off everything but a longer journey. So for instance, a person may no longer be capable of feeding themselves but can make a decision over what meal they would like upon being given a choice.
I think there is a big difference to between a financial LPA and a Health & Welfare one. Ultimately, subject to the legal responsibilities of a financial LPA, the LPA has significant control. A Health & Welfare LPA is far more restrictive, particularly the more advanced stage of dementia an individual is in, given the more active involvement of healthcare professionals.
Given historical and ongoing family dispute issues, when I have been approached regarding DNR, I actually chose to effectively hand over that responsibility to the healthcare professionals with mum's advance wishes and my feelings recorded within it. This has been carried out several times now, once at home, once in hospital and then upon move to a Nursing Home. For the latest one, I advised what my mum's advance wishes had been, my personal feeling that mum's dementia had progressed to sufficient a level that if she were to have CPR with the inevitable breaking of ribs, and likely further deterioration that I didn't feel CPR would be appropriate and if successful likely cause further suffering. The first one carried out, which was several years ago now, I felt that it wasn't yet time for a DNR given mum's issues at the time really were mainly down to short term memory issues.
I also expressed that upon 'end of life', unless a hospital visit was likely to help (eg intravenous antibiotics for infection), I felt mum should remain in the nursing home with any appropriate pain medication. This has been recorded and will be included with medical assessment should that situation arise.
Personally I think the main benefit of having the H&W LPA is the legal benefit of the access to all records, eg medical and nursing home. Without complete insight I think it can be much harder, if not impossible to make decisions.
My understanding is that unlike financial matters, where you can apply to the Court of Protection to get a deputyship awarded rather than LPA, that it is very rare for the Court of Protection to do so on Health & Welfare LPA's. And even with a health & welfare LPA, other family members will always be included where possible in such as best interest decisions unless ultimately Court of Protection deem an individual's involvement is not in the best interests of the individual.
I think there is a big difference to between a financial LPA and a Health & Welfare one. Ultimately, subject to the legal responsibilities of a financial LPA, the LPA has significant control. A Health & Welfare LPA is far more restrictive, particularly the more advanced stage of dementia an individual is in, given the more active involvement of healthcare professionals.
Given historical and ongoing family dispute issues, when I have been approached regarding DNR, I actually chose to effectively hand over that responsibility to the healthcare professionals with mum's advance wishes and my feelings recorded within it. This has been carried out several times now, once at home, once in hospital and then upon move to a Nursing Home. For the latest one, I advised what my mum's advance wishes had been, my personal feeling that mum's dementia had progressed to sufficient a level that if she were to have CPR with the inevitable breaking of ribs, and likely further deterioration that I didn't feel CPR would be appropriate and if successful likely cause further suffering. The first one carried out, which was several years ago now, I felt that it wasn't yet time for a DNR given mum's issues at the time really were mainly down to short term memory issues.
I also expressed that upon 'end of life', unless a hospital visit was likely to help (eg intravenous antibiotics for infection), I felt mum should remain in the nursing home with any appropriate pain medication. This has been recorded and will be included with medical assessment should that situation arise.
Personally I think the main benefit of having the H&W LPA is the legal benefit of the access to all records, eg medical and nursing home. Without complete insight I think it can be much harder, if not impossible to make decisions.
My understanding is that unlike financial matters, where you can apply to the Court of Protection to get a deputyship awarded rather than LPA, that it is very rare for the Court of Protection to do so on Health & Welfare LPA's. And even with a health & welfare LPA, other family members will always be included where possible in such as best interest decisions unless ultimately Court of Protection deem an individual's involvement is not in the best interests of the individual.
Thank you for your replies. The reality is had she made her wishes known all those years ago I know she would have wanted a DNR and no futher intervention. She always said if she couldn't get up and boogie (she still does) and drive (still does but i can't see that happening much longer) then she wouldn't want to be around. Some years later with her situation as it is I'm not sure she would be comfortable with that decision. If I can get onto the topic at some point I will, but she will probably forget we had the conversation!
@Pebblepebble
What happens if you are unable to make or discuss a DNACPR decision in advance of your heart stopping?
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If you do not have an ADRT (which says that you do not want CPR) or an LPA (with life-sustaining treatment decision-making powers) then a best interest's decision is made by the senior doctor.
This doctor must ask the people who are important to you about your wishes and preferences. This includes anyone with the legal power to represent you, such as a personal welfare deputy, special guardian or – for children and young people under 16 – a parent.
If you do not have family or friends appropriate to ask, then the doctor should ask an independent mental capacity advocate (IMCA) to represent you in the decision-making process. The doctor should also ask members of your healthcare (multidisciplinary) team for their views.
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...
https://www.nhs.uk/conditions/do-not-attempt-cardiopulmonary-resuscitation-dnacpr-decisions/ .
What happens if you are unable to make or discuss a DNACPR decision in advance of your heart stopping?
...
...
If you do not have an ADRT (which says that you do not want CPR) or an LPA (with life-sustaining treatment decision-making powers) then a best interest's decision is made by the senior doctor.
This doctor must ask the people who are important to you about your wishes and preferences. This includes anyone with the legal power to represent you, such as a personal welfare deputy, special guardian or – for children and young people under 16 – a parent.
If you do not have family or friends appropriate to ask, then the doctor should ask an independent mental capacity advocate (IMCA) to represent you in the decision-making process. The doctor should also ask members of your healthcare (multidisciplinary) team for their views.
...
...
https://www.nhs.uk/conditions/do-not-attempt-cardiopulmonary-resuscitation-dnacpr-decisions/ .
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