Durable Power of Attorney Documents: Why They Are So Important

Protecting Your Loved Ones Independence and Well-Being at HomeHelping a family member remain independent and living at home is a labor of love, but at times it can be overwhelming. There is so much to consider beyond just their overall health and well-being. Depending on the situation, a loved one may need immediate or future help coordinating medical care or managing finances. Having the proper Power of Attorney credentials established can help caregivers navigate the complexities of the system and avoid costly or time-consuming pitfalls during their loved ones aging journey.Here is a basic overview of two of the most common Power of Attorney documents:Financial Power of Attorney (Durable)With a Financial Power of Attorney (POA), a person known as the principal appoints an agent to carry out financial and other activities, as instructed by the principal. Often the person designated is a family member but note that it may be advisable to name a primary agent and an alternate agent. Principals may choose whether the POA becomes effective immediately or only in the event of illness/disability. Ideally, the POA document should have language indicating that it is durable (remains in effect even after the person is legally incapacitated). In Pennsylvania, the Financial POA must be notarized and witnessed. The law also stipulates that a POA must exercise the powers for the benefit of the principal, keep the assets of the principal separate from their own, and exercise reasonable caution and prudence. Financial Power of Attorney ceases after the principal passes away.Medical Power of AttorneyPennsylvania recognizes two types of advanced directives for healthcare decisions: Medical Power of Attorney and Living Wills. The Medical Power of Attorney, also known as a Healthcare POA or healthcare proxy, is broader in scope than a Living Will in that it empowers the caregiver to make all medical decisions if their loved one is unconscious, incapacitated, or mentally incompetent. The appointed person will be able to access medical records, speak to healthcare professionals, and make healthcare judgments and medical decisions based on their loved ones treatment (or non-treatment) preferences. A Medical POA is a crucial component of advance care planning, allowing your loved one to ensure that their healthcare preferences are honored. The document must have two witnesses and be notarized.Information and downloadable Power of Attorney pdf documents are available online. During the application process to Senior LIFE, a Senior LIFE outreach coordinator can also help you get started with the POA process. Contact us today.   

Introduction: I felt strongly compelled to write this blog on heart failure as it is such a pertinent issue in the aging population today. Before I go into details on this, Id like to address the definition of this disease process. Heart failure occurs when the heart doesnt pump well and fails to deliver adequate oxygen to the body. As a result, fluid builds up in the body and vital organs dont get the blood that they need. This can make it harder for individuals to perform everyday tasks and can lead to eventual overall decline. Problem:Heart failure is the number one reason for hospital admissions in older adults, and often leads to multiple readmissions (Agarwal et. al., 2021). As a cardiac nurse for many years, I can attest to the fact that heart failure is the biggest reason for multiple hospitalizations in seniors. Patients come in and out for problematic symptoms, sometimes coming into the hospital as often as every month. The three biggest symptoms I see that result in hospital admissions are shortness of breath (particularly when lying flat), weight gain, and swelling in the legs.One reason for such frequent admissions is the complexity of heart failure itself. It is a complicated clinical syndrome and is notoriously difficult to manage. A lot is put on patients to manage their heart failure at home, and this can be a challenge. In addition, individuals may have some level of cognitive impairment or multiple other comorbidities, making it even more challenging to perform the extensive monitoring needed to prevent heart failure from worsening. The importance of education:Education is also important in the treatment of heart failure. Unfortunately, this often does not get done. When I first started working in acute care back in 2004, every patient received extensive education in managing their heart failure prior to discharge. Nurses would provide lengthy verbal education on the importance of medication adherence, daily weights, low salt diet, and other factors, in addition to providing the patient with a heart failure educational pamphlet prior to discharge. Over the years, however, hospitals have increasingly faced staffing shortages and high nurse turnover. As a result, a lot of important patient education is not getting addressed. A lack of awareness and understanding in patients on how to manage their heart failure is definitely a key reason for worsening heart failure and repeated hospitalizations. Management:From a clinician standpoint, the goal in addressing heart failure is twofold: we want to reduce symptoms and prevent mortality. The best way to do this is through patient/family education and implementation of a treatment plan. A proper treatment plan will include such lifestyle modifications as a low salt diet, quitting smoking, and getting regular physical activity. A low salt diet can be incredibly helpful in preventing further fluid build up in the body. The American Heart Association recommends that all individuals consume no more than 2,300 mg of sodium per day (AHA, 2024). In todays era of processed and packaged food, a majority of the American population consumes much more than that, and it comes in the food itself rather than the saltshaker. Maintaining a low sodium diet has one other priceless benefit that I often do not see emphasized enough in heart failure: it can help reduce blood pressure. Almost half of all heart failure patients have uncontrolled hypertension (Heart Failure, 2022). It is a major risk factor in the development of heart failure and managing it can greatly reduce heart failure symptoms and decrease stress on the heart. Current guidelines recommend maintaining a systolic blood pressure of less than 130. Medication management is another important factor in the management of heart failure. This often includes the use of diuretics, beta blockers, and other medication classes that I will not go into detail on. I wanted to discuss diuretics and beta blockers because these are the two medications in heart failure that I see non-compliance with the most. I witness individuals often not taking one or the other for two main reasons:  they either dont understand the importance of them or they dont like the side effects. Seniors can often have difficulty getting up to go to the restroom. Diuretics cause frequent trips to the restroom because their purpose is to get excess fluid off the body. Many individuals do not comply with their prescribed diuretic because of the hassle of frequent bathroom trips. Unfortunately, ineffective diuresis causes heart failure to worsen and puts further stress on the heart. I often see non-adherence to beta blockers due to their side effects. The two biggest symptoms that get reported to me are fatigue and dizziness. As in the diuretic, a beta blocker can also help reduce the stress on the heart, and heart failure symptoms can worsen if the prescribed dose is not adhered to. Its important to maintain prescribed medication regime and if any negative symptoms are experienced to discuss them with the doctor. One final thing:I wanted to touch on one final monitoring recommendation for heart failure because it so often gets missed: daily weights. Weighing oneself daily is of tantamount importance in heart failure and can identify early on if heart failure is worsening. This can lead to early intervention, thus decreasing potential hospitalization. Adherence to this all too often does not occur. I see patients come into the hospital for large amounts of weight gain often 20 or more lbs. Many patients report that they never stepped on the scale to assess for weight gain and often do not get admitted to the hospital until symptoms are severe such as severe weakness and shortness of breath. In heart failure its recommended to contact the doctor if weight goes up by more than 2 pounds in a day or greater than 4 pounds in a week. The doctor can make modifications in the treatment regime and hence reduce potential hospitalizations and mortality. Conclusion:Heart failure is complex but manageable. Early action can prevent hospital admissions, reduce mortality, and optimize quality of life. Having ongoing guidance from an experienced clinician can be of great benefit if you or your loved one is having difficulty managing heart failure and other disease processes. Please do not hesitate to reach out to me if you have any further questions. I want to help and make the process of aging as stress free as possible while promoting positive health outcomes.  My name is Laura Carson and I have been a Registered Nurse (RN) for over 20 years and have witnessed firsthand the challenges and complications that aging presents. It affects not only the aging themselves but also their families and loved ones. Health care is complex, and in this increasingly fragmented and overburdened system, it can be extremely helpful to have a professional oversee all aspects of care. As your eldercare manager, I will comprehensively assess the needs of your loved one and we will work together in establishing a care plan. I will assist you and your family with difficult decisions and help promote healthy communication on issues that are often difficult to address and navigate. Contact me for a 20 minute free consultation at 714-403-7040.  References:Blood Pressure and Glycemic Control Among Ambulatory US Adults With Heart Failure: National Health and Nutrition Examination Survey 2001 to 2018 (April 28, 2022). Heart Failure. Almost half of heart failure patients have uncontrolled hypertension and diabetesAgarwal, M., Fonarow, G., & Ziaeian, B. (February 10, 2021). National Trends in Heart Failure Hospitalizations and Readmissions From 2010 to 2017. https://pmc.ncbi.nlm.nih.gov/articles/PMC7876620/Weber, C. (May, 2023). Heart Failure Pharmacology.  How much sodium should I eat per day? (2024). American Heart Association. https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/sodium/how-much-sodium-should-i-eat-per-day  

As we age, having all our legal ducks in a row becomes increasingly important before anything happens; for example, having a written will. But what is the best way to ensure others can safeguard your loved ones affairs if they cannot? Two common solutions are guardianship and power of attorney. A guardianship involves court-appointed authority over an incapacitated persons affairs, with broader and ongoing responsibilities and oversight. The power of attorney allows a competent person to give another person broad authority over their senior care options and other affairs without court involvement. When weighing guardianship vs power of attorney, it is essential to understand the differences and similarities between them. This article provides a broad overview; please consult an elder law attorney for your specific scenario.  What is Guardianship? A guardianship is a legal arrangement in which a court appoints someone to make decisions for another person. This occurs only when a person becomes incapacitated due to disability, age, or another form of incapacity.   The purpose of guardianship is to protect the best interests of the person, who then is considered a ward. Guardianship proceedings are held in court, and the guardian is appointed to serve the wards needs.  Not all guardianships are the same. Like powers of attorney, there are several types, including: Guardian of the person: This person makes all decisions on behalf of the ward, including living arrangements, health decisions, and financial decisions. Guardian of the estate: Also known as a conservator, this person handles all financial decisions on behalf of the ward, including property, income, and expenses. Plenary guardian: The appointee handles daily and financial business for the ward. Limited guardianship: This person handles a specific area of responsibility for the ward. Guardianship is often a last resort when other less restrictive options are insufficient to protect an individuals interests. It is a significant legal responsibility, with the guardian expected to act with the highest level of integrity and care.What is a Power of Attorney? A power of attorney, or POA, allows a person to act in another persons stead. Depending on the scope of a power of attorney, the person named may be able to make health, financial, and any other decisions as per the termsThere are several types of powers of attorney, includingGeneral power of attorney: Allows the appointee numerous powers depending on the terms of the POA. Special or limited power of attorney: Has a specific purpose and is often used for property transfers or sales. Durable power of attorney: Designed to extend automatically should the maker become incapacitated. The terms of these POAs are generally broad. Nondurable power of attorney: Expires immediately if the maker becomes incapacitated. Springing power of attorney: Takes effect upon a specific event, such as when the maker of the POA becomes incapacitated. It is important to remember that the maker may revoke any power of attorney at any time, although some may have a time limit. Additionally, all POAs expire when the maker of the agreement dies.  What is Incapacity for Guardianship Purposes? A guardian may be appointed when a person cannot manage their activities of daily living, such as personal care, property, or finances.   A guardianship may occur when the subject of the guardianship petition is a minor or is suffering from a mental illness, physical incapacitation, or a senior with declining cognitive abilitiesSomeone who wants to seek guardianship must file a petition with the court. If approved, the guardian must agree to court oversight throughout the guardianship. The guardian must also demonstrate that the allegedly incapacitated person cannot manage his or her own financial matters, legal affairs, or personal careDoes a Durable Power of Attorney Help Prevent Guardianship? A durable power of attorney is a legal document you can use as a proactive measure. It can prevent the need for guardianship, assuming the person could execute the power of attorney before becoming incapacitated.  In some cases, a power of attorney may only cover the principals financial affairs, while in other cases, it can help avoid guardianship proceedingsKeep in mind that the person executing a durable power of attorney can designate a trusted individual to make decisions on his or her behalf should the person become incapacitated. Powers of attorney may allow the person appointed to make health, legal, and financial decisions on behalf of the principal.Advantages and Disadvantages of Guardianship One of the most significant disadvantages of guardianship is a loss of autonomy. Wards may lose the right to make many personal decisions, including where to live. You must weigh the advantages and disadvantages of guardianship carefully to ensure the ward retains dignityAnother disadvantage is loss of privacy since guardianship proceedings are often a matter of public record. While there can be potential for abuse of authority, guardianships are complicated. There are reporting requirements and numerous legal steps that one must completeSome of the advantages of guardianship include ensuring the well-being and safety of the ward. Additionally, this step can help prevent financial exploitation because a trusted person manages finances on behalf of the ward rather than another entity or the state assuming control.Guardians also serve as advocates for their wards, ensuring they receive proper medical care, educational opportunities, and other essential services. The guardian is also regularly present in the wards life, providing stability and more predictable outcomes.Deciding Between Guardianship and Power of Attorney A guardianship proceeding can be complex and difficult under the best of circumstances and should only be implemented when there is no better alternative. You can often avoid seeking guardianship through the courts by creating a power of attorney as a piece of an overall estate plan. Every family is different but ensuring your family members physical and emotional well-being is essential to us all.  How CarePatrol Can Help If your loved one needs senior care solutions, whether assisted living, nursing home, or another type of senior living environment, CarePatrol is here to help. Our local senior care advisors will meet with you to help you navigate the best senior care options for your loved one and even take you on personalized tours of the top three communities.  The best part is that our service is provided at no cost to you. Contact a local senior living care near you to get started.