When should caregivers take control?

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Wednesday’s #eldercarechat centered on the topic of Power of Attorney (POA).  Who has used one? Why? When has it been useful ? What are the pitfalls? It was a terrific discussion—perhaps precisely because there are few clear cut absolutes and lots of gray areas.

There is no question that everyone should issue a Durable Power of Attorney along with Advanced Health Directives and a will, and that it is far preferable to have these things in place long before they are needed than to either face that tricky conversation in tandem with a traumatic incident—or worse, not have the requisite documents during a crisis and have no sway over the treatment of a loved one.

But, of course, there are always issues. Family dynamics and human dynamics both come into play.

First, there is the question of who holds the POA. The elderly spouse? The oldest child? The closest child geographically? The child who is a doctor? The family lawyer?  There is not always an obvious choice—people’s assessment of the critical criteria will always differ—which can lead to resentment and power struggles among those who aren’t chosen.

More poignant is the question of when a POA is used. A POA becomes active when a person can no longer make decisions for themselves. Yet, who determines when that point is reached? Obviously, if the person is unconscious—whether from a heart attack or an accident—the need for someone else to make decisions on their behalf is clear. But what if they simply aren’t exhibiting as good judgment as they once did?

If a 40-year-old has a bad habit of ordering indiscriminately from the Home Shopping Network, friends laugh about how they are a shop-a-holic; when an 80-year-old exhibits the same behavior the family wants to step in to take over their finances. If a 40-year-old sells their house for less than its value, people recognize that they aren’t good negotiators; when an 80-year-old does the same, it is a sign of decline.  Take it a step further. What if someone starts giving their belongings away away? Or refuses medical treatment? Or moves to Vegas? They are over 18; isn’t that their choice?

Well, maybe. But as a family member looking on in dismay, here’s your choice: Let a grown-up you love make decisions you believe are at best poor and at worst fatal. Or intervene in a way that ensures they end their life robbed of their independence and their dignity.

Armed with a POA you can take your loved one to court to be declared incompetent. But such action will cause friction at best and a final rift at worst—when all you want is to be loving and protecting.

Some people think that is a clear decision. For many it’s a tough call.