seniorhelpEvery day the news seems to bring a new story about how the nation’s healthcare system is under stress—a shortage of doctors, overworked medical personnel burdened by insurance paperwork, emergency rooms turning away ambulances—and everyone, it seems, has a complaint or horror story about their own medical treatment. The inescapable conclusion is that you have to play an active role in your own healthcare. When you’re helping someone else, the problems get even more complicated.

Helping another person with their healthcare and the maintenance of their finances involves issues that are both practical (making sure they take their medications) and legal (signing checks). If the person you are helping can handle the basics, then your role as a caregiver will fall on the practical side. You may need to accompany someone to a doctor’s appointment and take notes, make sure they get their meds on schedule, and keep a set of medical records for reference—medications, surgeries, allergies.

If, however, you foresee a day when the person you are helping won’t be able to handle either their medical needs or practical affairs, it is important that you encourage him or her to create two distinct documents, a durable power of attorney for health care and a power of attorney for finances.

The power of attorney for finances can go into effect when the person is too incapacitated to make their own decisions or it can be effective immediately. If, for instance, you are caring for your mother in her own home and she has signed a power of attorney, you can write checks from her account to pay her bills. The durable power of attorney for health care only goes into effect only when she is unable to understand her medical condition and make decisions on her own.

End of Life Issues
Some of the biggest changes that have taken place in the patient-physician relationship in recent years concern end of life care. In some ways these changes have evolved as a natural response to the growing abilities of medical science. When a hospital can prolong a patient’s life even when there is no hope of a cure, vital questions necessarily arise. Who chooses what is to be done? How long should a person be kept alive with a feeding tube? What about the emotional and monetary costs?

In California, you can specify what kind of life-prolonging medical care you want or don’t want through a legal document called an Advance Health Care Directive. Such directives allow you provide general or detailed information regarding different kinds of procedures, and to name a person who can make your medical decisions for you if you are incapacitated and unable to express your own wishes. An additional document that can insure your wishes is a do not resuscitate order (DNR) that instructs hospital staff or emergency personnel not to attempt cardiopulmonary resuscitation (CPR) if your heart stops or if you stop breathing. Anyone concerned about the kind of care they might or might not receive should at least have a signed and witnessed (or notarized) directive. They should give copies to doctors, family members or whoever might be called upon in a medical emergency.

If you are in the position of caring for someone else and your name appears on their medical directive, then it’s important to have a frank conversation in addition to the paperwork so that you are clear about their desires. You should have a copy of the medical directive in an easily available location, as well as a do not resuscitate (DNR) order if they have one. At the time of a loved one’s imminent death, it can be very hard to think clearly. If medical or emergency personnel are on hand at, or near the time of death, their mandate and your first impulse may be to attempt CPR. Having the DNR in hand or by the bedside can help you follow the person’s wishes and relieves emergency personnel of their responsibility.

A great deal of information on this subject is readily available on the Internet. Two good sources are the California Medical Association and Caring Connections, a program of the National  Hospice and Palliative Care Organization . You may download a copy of Caring Connections California Advance Care Directive from the ProtectPlus website.  In addition, most hospitals and doctors have these or similar forms available.

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