There are various ways to begin the conversation to choose an Agent or Fiduciary. 

Ellen Goodman’s website provides helpful information with what you need: 

http://theconversationproject.org/wp-content/uploads/2016/10/SK_distributor.pdf

Alternatives are contacting your attorney, accountant, or wealth advisor to create your essential documents and keep them in a folder, along with storing helpful information in digital service for your fiduciary or other trusted advisors to access your essential documents.

Passwords are also essential to access financial accounts or pay for services online. 

A health care agent or fiduciary are trusted friends or advisors to make financial and health decisions when you cannot make these decisions because of frailty, illness, accident, or end of life.

You may separate the tasks where you have a trusted friend or family to be your health agent and professional advisors or a trusted friend responsible for your finances.

Your role as a health care agent begins when a friend or family member is incapacitated and no longer able to make medical and financial decisions independently. 

A doctor or perhaps filing with the court to obtain permission to be a fiduciary.

Having this in advance will let a health care agent know when they need to begin serving in that capacity.

  • You trust a person to decide how your health care wishes are accomplished if you cannot make those decisions yourself.
  • It may be a short period with an emergency medical situation or a long term if a friend or family member cannot make financial or medical decisions.
  • Having a power of attorney, medical, financial, and password authorizations in advance will be of value to your fiduciary.
  • The fiduciary may have broad powers or specific powers.

The Role of a Health Care Agent or Fiduciary is a commitment, so be knowledgeable, ask questions, and know where the documents are located.

There may be specific instructions to follow in some medical situations, such as end-of-life care, but you will often also be given broad discretion to make decisions for your loved one regarding emergency medical decisions and other types of unpredictable situations related to health care. These are some of the decisions you may need to make and some of the assistance you may need to provide, based on your loved one’s wishes:

  • Choices about medical care, including medical treatment, tests, or surgery.
  • Does your the person want to receive medical treatment and rehabilitation, such as a hospital, nursing home, assisted living facility, or home.
  • Your friend or family person will receive long-term care services, such as a nursing home, assisted living facility, or home.
  • If and when your loved one will receive hospice and palliative care, and whether that care will be provided at home, in a long-term care facility such as a nursing home, assisted living facility, or possibly a hospice facility;
  • Choices about life support and end-of-life care in the event of a terminal illness.
  • Carrying out your loved one’s after-death decisions, such as organ donation, burial or cremation, setting up funeral arrangements.

Sometimes, a loved one’s wishes may not be practical with what they wanted. When a health care agent or fiduciary has to decide, they should ask themselves, “if they were able to speak right now, what would they want?”

This may occur because you cannot do what they want because there may be physical, medical, financial, or safety reasons. 

For example, the family member desires to die at home, but that may not be possible, and they may need to be transitioned to a hospital or care facility.

Having conversations and appropriate documents clarifies your family or friend’s wishes. 

How to Say “No”

Not everyone is comfortable performing the role of a fiduciary or Care Agent. You may not agree with their needs, or you may not be satisfied with making decisions involving carrying out someone’s end-of-life wishes. 

Being a fiduciary or care agent, or caregiver isn’t for everyone. You may want to hire a professional care advisor or licensed fiduciary to take responsibility for these decisions. 

When you cannot make your own decisions, have a plan so your family and fiduciary may follow your wishes.

Incapacity Planning includes

a. an Advance Medical Directive, 

b. a General Financial Power of Attorney, and a HIPAA Authorization for anyone 18 years or older.

  • Choose a person or group you trust to decide how health care wishes will be applied. 
  • Your fiduciary or health agent must access your medical and financial information and passwords if you know your computer or a digital records vendor. 
  • Choices about your medical care include medical treatment, tests, or surgery.
  • Does your family or friend want to receive long-term care services at home, acute care, or a care center? 
  • End of life, do you want to receive hospice or palliative care? Do you want to remain at home in a hospice or care facility?
  • Life support and end-of-life care in the event of a terminal illness.
  • Suppose your state allows assisted death. There is a process to qualify which requires doctors to certify that you are actively dying. 
  • Death decisions, such as organ donations, burial, cremation, setting up funeral arrangements, who will host the after-funeral party. 

As a health care agent or fiduciary, you should have full access under HIPAA to your loved one’s medical information and will only be involved in medical decisions. 

A Health Care Agent is about making decisions for What Your Loved One Wants for Themselves.

Sometimes, a loved one’s wishes may go against what you would have wanted for them. So, when a health care agent has to decide, they should ask themselves, “if they were able to speak right now, what would my loved one say?” 

There may be a time when following a loved one’s wishes isn’t possible. There may be physical, medical, financial, or safety reasons you can’t do exactly what your loved one would have wanted. 

They may say they want to die in their home, but it may not be possible to move them from their hospital bed or nursing home bed when the time comes. 

It isn’t easy to go against your loved one’s wishes, especially when they can’t speak up for themselves. When this happens, the health care agent should do the best to act in their best interest.

If someone can’t die at home, the agent can bring things from their homes, such as blankets, photos, or a pet, to make the environment close to what their loved one would have wanted.

How to Say “No”

What if you’re not comfortable taking on the role of health care agent? If you feel like you won’t be up to the task when the time comes, it’s okay to say “no.”

Not everyone is comfortable performing this role. You may not agree with your loved one’s wishes, or you may not be satisfied with making decisions involving carrying out someone’s end-of-life wishes. That is why your loved one is asking you in the first place. 

It’s okay, to be honest. You can say, “Thank you for asking me. I’m honored, but I don’t think I can do a good job as your health care agent.” This way, your loved one can think about who else they would like to have as their health care agent.

If you are unsure about being named as a health care agent and perhaps afraid that you might not be able to take on the role in the future, if and when that time comes, you should ask your loved one to name one or more alternate agents to you, so that if you are unable or unwilling to act in that role when the time comes, the alternate will be called on instead. 

Understanding Incapacity Planning

Incapacity Planning, including an Advance Medical Directive, a General Financial Power of Attorney, and a HIPAA Authorization, is essential for everyone over the age of 18, as it communicates a patients’ choices when they can no longer speak for themselves, which can, of course, happen at any age.

If you are the person who is going to be signing your incapacity planning documents, please understand that your advance medical directive keeps you in charge when it comes to decisions about your medical care. So long as the doctors deem you competent to make your own medical decisions, the doctors will not look to anyone else to make those decisions for you. 

And even when you’re no longer capable of making those decisions, your advanced medical directive puts you in control to the greatest extent possible because your agent must follow your wishes to the greatest extent possible. Incapacity planning also shows compassion for family and friends. 

When loved ones are left guessing, guilty, uncertain, and arguments too often, making your wishes known in advance, you are helping your chosen agent(s), and other family members and loved ones feel more comfortable with your chosen course of care. 

 Advance medical directives will improve end-of-life care for hospital and nursing home residents while often decreasing health care costs. 

Making your wishes known in advance, you are helping your friends or advisors and other family members and loved ones feel more comfortable with your chosen course of care and end-of-life wishes.