Health and Welfare Power of Attorney - why?

Abbey1991

MSE wrote:

In a nutshell, the health and welfare document sees a nominated individual make decisions over day-to-day healthcare and medical treatments, as well as deal with any health and social care staff.

I don't understand the point of this. Surely you would leave it to the healthcare professionals rather than waving a "power of attorney" document at them and telling them what to do?

What am I missing?

Thanks

Fosterdog

If there are a number of possible courses of treatment that normally the patient would choose the one they want (with advice and guidance from a medical professional) you would make that decision for them.

When it may be time to go into a care home.

Which care home is chosen.

When to turn off life support.

Having access to otherwise confidential medical details as you will need the information to help provide care.

Probably many many more I can't think of off the top of my head.

Pushing for a referral that may not be forthcoming.

Seeking private medical care if NHS may take to long or doesn't offer a certain course of treatment only available privately.

Abbey1991

Thanks. Nevertheless on the Internet I can find examples of people regretting not having a LPA financial, but the health one seems to be less essential, based on the number of anecdotes I have found.

sazdes

as above.

Some people have very strong feelings on how much treatment they'd want to receive eg blood transfusion in jehovah's witnesses (and should they not have an advanced directive which relates to that specific decision), then an LPA helps if there is disagreements between relatives, regarding what the patient would want (as it provides a nominated spokes person for the patient).

They're useful for unmarried couples as the partner technically has less say over the patients care wishes than a blood relative without the possession of an LPA

To be honest they're more used for arranging further welfare needs such as care homes/nursing homes rather than medical decisions as traditionally relatives are always involved in best interests decisions. - see https://www.gov.uk/lasting-power-attorney-duties/health-welfare

Just to note the decision to "turn off life support" never lies with the family. It is a medical decision, during which we discuss it with relatives, but at the end of the day, it is down to the drs (partly due to knowledge, partly because we don't want relatives to feel even remotely responsible for their relatives death.

You can specify if you'd want them to make decisions regarding life sustaining treatments - for example if you were unable to swallow whether you'd want to be kept alive by a feeding tube into the nose or through the abdominal wall - as for some people they would rather not survive in such circumstances (eg previously very fit active people sometimes feel advanced poor neurological states (eg a stroke leaving them unable to walk/talk) would be a worse outcome for them than being allowed to pass away naturally). In this situation medics may naturally suggest artificial feeding (but typically they still wouldn't overrule what relatives thought the patients wishes were - regardless of whether or not they had an LPA)

Abbey1991

Thank you for your detailed response.

sazdes wrote: »

they're more used for arranging further welfare needs such as care homes/nursing homes

In the absence of the LPA does it mean that the family members have to apply to the Office of the Public Guardian before they can select a home?

troubleinparadise

I needed to show the H&W document to my mother's GP who wouldn't speak to me about her medical treatment without it.

It was not required to admit my mother to a nursing home - her very poor physical condition and inability to look after herself was enough (best interests meeting in hospital was the deciding moment)

I did need the Financial LPA to pay her fees from her bank account.

sazdes

I don't think so as I've never heard it being mentioned as a requirement when arranging care during my 2 elderly care attachments (but don't quote me on it, sorry I'm a dr so don't actually get that involved with the social care side of discharge planning).

However, from overhearing discharge planning conversations between the discharge coordinators/care home assessors it seems significantly more straight forward a process for those with LPAs, although that maybe due to them also having financial POA, I'm not sure).

Probably about 70% of senior doctors I've spoken with (particularly those dealing with severe/life threatening illnesses as a day job) have health POAs from experience, I definitely will do in the future, as there are some treatments we "can" offer patients, that I wouldn't personally want to have.

Abbey1991

Thank you for taking your valuable time to post here.

sazdes wrote: »

Probably about 70% of senior doctors I've spoken with (particularly those dealing with severe/life threatening illnesses as a day job) have health POAs from experience, I definitely will do in the future, as there are some treatments we "can" offer patients, that I wouldn't personally want to have.

How will this work, will you specify on the form all the treatments that you would not want to have, will you document them separately in a letter to your attorneys, or will you trust your attorneys to know what you would have wanted?

sazdes

an advanced directive is for specifying exactly what you don't want done to you should you not be able to decide for yourself (you can say what you would want done to you also but that would only get action-ed if medically appropriate) - this is basically a list of treatments (or refusals of such treatments that is witnessed) - what jehovah's witnesses will do so that drs do not give them blood transfusions even if it is a threat to life

I would create one of these (because I can write clearly in medical jargon my wishes, and my family aren't medics so may not know the technical terms for things), but also a LPA to support this - my relatives/friends are pretty clear on my wishes and would express these if required.

As an aside - please please please discuss these things with your friends and family if you have wishes on the levels of treatment you wish to receive (ie how far to push active treatment vs the situations you'd rather be kept comfortable in, whether you wish to be resuscitated etc).

It is really difficult admitting frail elderly patients who are acutely confused (or chronic dementia) trying to ascertain their wishes when the accompanying family member doesn't know what they would have wanted. I know its a bit "doom and gloom" to do so but its an inevitable for all of us, and its really important so that medics can do the best by you/your relatives

elsien

Abbey1991 wrote: »

Thank you for your detailed response.

In the absence of the LPA does it mean that the family members have to apply to the Office of the Public Guardian before they can select a home?

In the absence of power of attorney then the choice of home (or even whether to go into a home rather than other lesser restrictive alternatives) would be a best interests decision by the relevant professional in consultation with family for someone who lacked capacity. Or an advocate if there are no family/friends to consult.

If someone doesn't have a finance POA, then an application can be made to the OPG for a deputyship. With health/welfare decisions deputships are rarely awarded as it is considered that the Mental Capacity Act provides enough protection through the best interests process.

surreysaver

For me personally, I wouldn't want healthcare staff to have an overriding say in decisions if I can't make my own decision. As it is, healthcare staff have a way of persuading you to do what they want, and making you believe it was your decision. I would want someone on my side to have the same power as me in the event that I cannot make my views known.