I was very pleased to be updated today about a friend with late stage dementia who had never made any mention of a care home when signing up for a full POA, has now had the care package extended to allow her to remain in her own home after being offered a 24 7 care home alternative due to increasing balance issues.
This distressing episode has made me wonder if a POA can actually impose a 24 7 care home when it was never included in the original POA agreement and has been strongly rejected by the dementia person who is able to pay for her own 24 7 care in her own home.
Being as this dementia person can still make there own care decisions it appears the POA in this case had not done there homework about
the late stage changes and as such had taken on more responsibility than they could cope with or was prepared to give full consideration to the depth of empathy that has been found by the Dr Snow nun study project that began about 1986 to be essential for the dementia person to socially function.
"Countrymouse is asking for clarification about what my actual question is.. which has given me pause for thought, firstly given that I am not directly involved with the care but rather not for the first time in a community support role for a dementia person, I will ASAP be inquiring further about what the clearly stated wishes of this person, who is now at what may be a tipping point for late stage dementia rather than the actual late stage as in point of no return, actually were when the POA was signed."
There's no option here to emphasize, underline or highlight phrases, so I'm addressing them here as well as in the quote:
"I am not directly involved with the care but rather not for the first time in a community support role for a dementia person, I will ASAP be inquiring further about what the clearly stated wishes of this person..."
On what legal authority are you relying for assuming this position and involving yourself? I can't under any circumstances imagine someone involving himself with affairs under the circumstances stated.
If anyone tried this with a friend or family of mine, I'd head to the courthouse and get a TRO, ASAP.
This causes me to wonder and query, as Glad has, who you really are, what your interests are and equally important, what role you want to play with this person, and what authority a "community support" person has.
Previously stated wishes are helpful when a person is unable to communicate or unable to make a decision, but they needn't stop a person changing her mind. Suppose a lady had set everything up to be cared for at home right to the end of life - and then got frightened, and begged to be taken to a skilled nursing facility. Or suppose a new form of treatment which is more effective and less onerous is now available which the person couldn't have known about when creating her healthcare directive.
This is why the person's best interests take priority. It is assumed that the person herself does know best about herself when she sets up her POA, but none of us is omniscient when it comes to the future. Wiggle room is essential in avoiding horrible outcomes.
I gather that:
the person has late stage dementia; but you also state that this person is (? -currently, now?) able to make her own decisions about where she wants to live.
the person gave no directions or instructions about where she wanted to live at the time the POA was drawn up
the person has at this time expressed a strong preference for care at home and rejected an offer of residential care
there is no difficulty in funding either adequate home care or appropriate residential care
- please correct anything I've misunderstood?
We have a slightly different system here: "full" POA as you term it would be the equivalent of a legal Lasting Power of Attorney, of which there are two recognised types: Finance, and Health & Welfare. As you state that the issue of where the person was to live was never discussed when the POA was drawn up, I'll assume that the POA governs only financial management and decisions.
But even if it were different, and the full POA did allow for health and welfare decisions such as where to live and what sort of support for quality of life the person would want to receive - e.g. opportunities for socializing to be prioritized - the POA could not legitimately overrule preferences arrived at by the person and clearly expressed. If the little old lady is glaring from her bed and saying "you're not putting me in a Home!!!" then you don't put her in a home. Not even a really nice one where she'd get to chat to lots of other little old ladies and take pottery classes.
It is the duty of the person with POA to act #1 in the subject's best interests, #2 in line with the subject's known preferences (either currently expressed or previously stated), #3 as far as practicable.
So. To overrule what the lady is *now* saying about where she wants to live, you would have to have very strong best interests arguments for it. You may feel (I would tend to agree) that there is excellent evidence that intellectual function is better preserved in a community that offers daily stimulation and opportunities to socialize; but for the lady herself this does not outweigh her desire to remain in her familiar surroundings - and there is a strong counter-argument that the change of environment and the indignation she might feel at being overruled and having her wishes ignored would not be in her best interests at all.
Don't give the person who is trying to manage this situation a hard time. The decisions are rarely simple and back seat drivers are never popular.
Countrymouse is asking for clarification about what my actual question is.. which has given me pause for thought, firstly given that I am not directly involved with the care but rather not for the first time in a community support role for a dementia person, I will ASAP be inquiring further about what the clearly stated wishes of this person, who is now at what may be a tipping point for late stage dementia rather than the actual late stage as in point of no return, actually were when the POA was signed.
Given the reality of late stage dementia that is accepted to be the point of no return I also inquired further about the meaning of being intellectually disabled and was interested to read it is also an important consideration in respect to a kidney transplant because the patient will require a cooperative understanding of the after care responsibility and that this can be resolved with suitable care support, which, given the latest very welcome update that the POA has now agreed to expand the care package as a trial for the dementia person staying in there own home with more essential support, which, given its success in the transplant field will support the patient need for more independent control and I will share more should this prove to be as effective as it is with transplant patients.
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Intellectual disability (ID) is a term used to describe a person with certain limitations in cognitive functioning and other skills, including communication and self-care. Psychosocial evaluation in kidney transplantation
Kristy L. Engel, Kristin K. Kuntz, in Psychosocial Aspects of Chronic Kidney Disease, 2021
the POA will do so in the best interest of the person who has appointed them
http://www.caregiverslibrary.org › GRP-Legal-Matters › P...
You get power of attorney by having someone willingly and knowingly grant it to you in a signed legal document. He or she must be able to sufficiently comprehend what a POA document represents, understand the effects of signing it, and clearly communicate his or her intentions.
Kristy L. Engel, Kristin K. Kuntz, in Psychosocial Aspects of Chronic Kidney Disease, 2021
If the patient does have cognitive impairment, additional provisions may be needed to support the patient’s success.54 The patient may be required to have a support person present for every appointment to ensure that accurate information is obtained from the patient and that there is adequate understanding of the information provided to the patient.
Patients with greater cognitive impairment may require a higher level of support or oversight to be successful, such as in-home nursing services or a structured living environment. Arrangements for these can be made during the evaluation process.
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Power Of Attorney: The Pros And Cons - National Caregivers Library
http://www.caregiverslibrary.org › GRP-Legal-Matters › P...
You get power of attorney by having someone willingly and knowingly grant it to you in a signed legal document. He or she must be able to sufficiently comprehend what a POA document represents, understand the effects of signing it, and clearly communicate his or her intentions.
intellectually disabled.
Intellectual disability (ID) is a term used to describe a person with certain limitations in cognitive functioning and other skills, including communication and self-care. Psychosocial evaluation in kidney transplantation
Kristy L. Engel, Kristin K. Kuntz, in Psychosocial Aspects of Chronic Kidney Disease, 2021
Intellectual disability (ID) is a term used to describe a person with certain limitations in cognitive functioning and other skills, including communication and self-care. Psychosocial evaluation in kidney transplantation
Kristy L. Engel, Kristin K. Kuntz, in Psychosocial Aspects of Chronic Kidney Disease, 2021
If the patient does have cognitive impairment, additional provisions may be needed to sup
General POAs for financials usually say once a diagnosis that a person can no longer make informed decisions the POA is allowed to do certain things. Of course pay bills. (With my Moms I could buy and sell) It could say that if needed the POA can hire aides for their care. But if it didn't say it, the POA would have that option. Anything the principle needs, within their income, a POA can provide. POA can place them in an AL or NH. A POA can hire someone to do the persons taxes. They can hire a CPA to handle their assets. A POA does not have to do the physical caring.
When my Mom was in the late stages, she had no idea who she was. She could not hold on a conversation. She had forgotten Dad and her children. Late stage means people are coming to the end of their Dementia journey. Most of the brain has died. There is no way they can make a decision about their care. They can't even go to the bathroom by themselves.
In the case of someone with a diagnosis of dementia there is much more to be taken into the equation than their wishes to remain in their own home. MOST of us wish to do that. It is not always affordable in the long run nor feasible and it is up to the POA who was given this duty BY THE ELDER when the elder was competent, knowing the elder, and their wishes.
Moreover, the POA is not accountable to other family members or friends, nor to their opinions and is not free to share any knowledge of assets they may have, nor are they obligated to discuss this with anyone else. They are accountable to the LAW. This is a legal fiduciary duty and the POA does it according to the documents, and to the best of their duty, having been ENTRUSTED to do this duty.
If there is someone in the family who believes that the POA is acting incorrectly they do have access to APS and they do have access to an elder law attorney to apply for guardianship of the elder themselves. A guardianship or conservatorship would override a POA and make it irrelevant, but any fight in court, if lost, would be paid for by the person who is filing against an established POA, and would be highly unlikely to win.
Powers of attorney don't contain things like desires about care homes -- at least I've never seen such a thing -- so I'm not sure where you got that information.