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Power of Attorney, Healthcare Proxy, DNR

Power of Attorney

A power of attorney should be considered when planning for long-term care. There are different types of Power of Attorney that fall under either a general power of attorney or limited power of attorney.

A general power of attorney acts on behalf of the principal in any and all matters, as allowed by the state. The agent under a general Power of Attorney agreement may be authorized to take care of issues such as handling bank accounts, signing checks, selling property and assets like stocks, filing taxes, etc.

A limited power of attorney gives the agent the power to act on behalf of the principal in specific matters or events. For example, the limited Power of Attorney may explicitly state that the agent is only allowed to manage the principal’s retirement accounts. A limited Power of Attorney may also be limited to a specific period of time.

Most powers of attorney documents allow an agent to represent the principal in all property and financial matters if the principal’s mental state of mind is good. If a situation occurs where the principal becomes incapable of making decisions for him or herself, the POA agreement would automatically end. However, someone who wants the Power of Attorney to remain in effect after the person’s health deteriorates would need to sign a Durable Power of Attorney (DPOA).

Durable Power of Attorney

The Durable Power of Attorney (DPOA) remains in control of certain legal, property or financial matters specifically spelled out in the agreement, even after the principal becomes mentally incapacitated. While a DPOA can pay medical bills on behalf of the principal, the durable agent cannot make decisions related to the principal’s health.

The principal can sign a durable power of attorney for health care, or Healthcare Power of Attorney (HCPA), if he wants an agent to have the power to make health-related decisions. This document also called a healthcare proxy, outlines the principal’s consent to give the agent Power of Attorney privileges in the event of an unfortunate medical condition. The durable Power of Attorney for healthcare is legally bound to oversee medical care decisions on behalf of the principal.

Another type of DPOA is the durable power of attorney for finances, or simply a Financial Power of Attorney. This document allows an agent to manage the business and financial affairs of the principal, such as signing checks, filing tax returns, mailing and depositing Social Security checks and managing investment accounts, in the event, the latter becomes unable to understand or make decisions. To the extent of what the agreement spells out as the agent’s responsibility, the agent has to carry out the principal’s wishes to the best of his ability.

When the agent acts on behalf of the principal by making investment decisions through the broker or medical decisions through the healthcare professional, both institutions would ask to see the DPOA. Although the DPOA for both medical and financial matters can be one document, it is good to have separate DPOA for healthcare and finances. Since the DPOA for healthcare will have the principal’s personal medical information, it would be inappropriate for the broker to have it, and the medical professionals do not need to know the financial status of the patient either.

The conditions for which a durable POA may become active are set up in a document called the springing power of attorney. The springing POA defines the kind of event or level of incapacitation that should occur before the DPOA springs into effect. A power of attorney can remain dormant until a negative health occurrence activates it to a DPOA.

Healthcare Proxy

The New York Health Care Proxy Law allows you to appoint someone you trust — for example, a family member or close friend – to make health care decisions for you if you lose the ability to make decisions yourself. By appointing a health care agent, you can make sure that health care providers follow your wishes. Your agent can also decide how your wishes apply as your medical condition changes. Hospitals, doctors, and other health care providers must follow your agent’s decisions as if they were your own. You may give the person you select as your health care agent as little or as much authority as you want. You may allow your agent to make all health care decisions or only certain ones. You may also give your agent instructions that he or she must follow. This form can also be used to document your wishes or instructions about organ and / or tissue donation.

Do Not Resuscitate

A Do-Not-Resuscitate order, or DNR order, is a medical order written by a doctor. It instructs health care providers not to do cardiopulmonary resuscitation (CPR) if a patient’s breathing stops or if the patient’s heart stops beating.

Ideally, a DNR order is created, or set up, before an emergency occurs. A DNR order allows a patient to choose whether they want CPR in an emergency. It is specific to CPR. It does not have instructions for other treatments, such as pain medicine, other medicines, or nutrition.

The doctor writes the order only after talking about it with the patient (if possible), the proxy, or the patient’s family.

A DNR order may be a part of a hospice care plan. The focus of this care is not to prolong life, but to treat symptoms of pain or shortness of breath, and to maintain comfort.  If a patient has a DNR order, they always have the right to change their mind and request CPR.  Due to illness or injury, a patient may not be able to state their wishes about CPR. In this case:

  • If a doctor has already written a DNR order at a patient’s request, the patient’s family may not override it
  • A patient may have named someone to speak for them, such as a health care agent. If so, this person or a legal guardian can agree to a DNR order for the patient

If a patient has not named someone to speak for them, under some circumstances, a family member can agree to a DNR order for the patient, but only when they are not able to make your own medical decisions.

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