Support for Caregivers of Older Adults
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Advance Directives

 
 Overview    ↓ next top ↑
  • A personal directive states a person's wishes about medical care decisions if they are unable to make these decisions themselves.
  • A personal directive includes the name of a "proxy", someone who has the authority to make these decisions.
  • Your family member needs to share their feelings on life, illness, and death as well as their wishes about end-of-life care with the proxy and, if appropriate, with other family members.
  • A lawyer can be involved in creating advance directives, or forms for advance directives are available free of charge from various organizations and on the Internet.
  • An Enduring Power of Attorney may also be needed to assist with financial decisions.
 
 Introduction    ↓ next top ↑
  • When adults are healthy and able to think clearly, they should consider setting up a personal directive and enduring power of attorney for future planning and to express their wishes for their care.
  • These types of advance directives are legal documents that allow people to state what they would want done medically in the case of terminal illness, dementia, coma, or stroke.
  • These documents make it easier for family and friends to make medical decisions when the person can no longer do so.
  • They also help the health care team recommend treatments that match the person's wishes.
  • Many caregivers have said that advance directives helped them a great deal when treatment decisions needed to be made. These documents represented their family member's interests when discussing health care decisions with the health care team, and helped reduce the stress associated with emotionally difficult decisions.
  • Advance directives also help older people feel confident that future medical decisions will be based on their wishes.
 
 What You Should Know    ↓ next top ↑
 
 Personal Directives 
  • A personal directive states a person's wishes about medical care. It is used if, at some time in the future, they are close to death or too ill to make decisions for themselves. The personal directive includes the name of someone (a "proxy") who has the authority to make these decisions.
  • A copy of the personal directive should go to the proxy. The personal directive should also be included in the medical record if the older person is admitted to a hospital or a long-term care facility. This way, health care staff will know what the patient's wishes are if he or she cannot speak.
  • A lawyer can answer questions about how advance directives should work and how they will be interpreted by the laws in your province. Lawyers can give you forms for advance directives, or they can create documents that suit your family member's unique needs.
  • However, you do not need a lawyer to make an advance directive. Free advance directive forms are available from various organizations and on the Internet. It can be as simple as filling in the blanks.
 
 Selecting a Proxy or Agent    ↓ next top ↑
  • When your older family member is in a good state of mind, you should discuss advance directives and encourage them to choose someone to make medical decisions if, in the future, they were unable to do so. This person is called a "proxy" or "agent," which means someone who has the authority to act for another person.
  • The older person can identify their proxy by completing a Personal Directive for Health Care.
  • Older people usually select a family member or a close friend as a proxy or agent. The proxy should be someone the older person trusts to make the right decision or choices for him or her. Be sure that the person selected feels comfortable serving as an agent.
 
 Issues to Discuss    ↓ next top ↑

Your older family member needs to share their feelings on life, illness, and death as well as their wishes about end-of-life care with the proxy and, if appropriate, with other family members. They should discuss questions such as the following:
  • Would the person want to receive artificial nutrition at the end of life? Would they want to be on a respirator (breathing machine) if they were unlikely to recover or in a permanent coma?
  • What illness or permanent disability would be unacceptable to the older person? If they had a terminal illness, would they want medical treatments to prolong life or only medicines to remain comfortable?
  • What medical treatments would not be wanted under any circumstances, even if the treatment were used temporarily?
  • What medical treatments are acceptable on a temporary basis to help recover from an illness, but would not be acceptable permanently?
 
 Power of Attorney    ↓ next top ↑
  • Similar arrangements should be made for financial affairs via an Enduring Power of Attorney. A trusted caregiver (family or friend) could be chosen to assist with financial decisions.
  • If there is a significant estate or if there is family discord, this should be done with the assistance of a lawyer. However, in clearer situations, standardized templates can be used.
 
 Guardianship and Trusteeship    ↓ next top ↑
  • Guardianship and trusteeship come into play when someone is no longer capable of making decisions and no advance directives are in place. When this situation occurs, guardianship and/or trusteeship must be obtained through the courts.
  • Assistance is available from social work agencies for families who need to make these types of arrangements.
 
 Capacity and Dementia    ↓ next top ↑
  • The concept of "capacity" – whether or not a person is capable of making decisions – is domain-specific and question specific. For example, a diagnosis of dementia does not automatically mean lack of capacity. A person with dementia may retain the ability to make personal decisions until well into their illness, but lose their financial reasoning quite early, or vice versa.
  • Generally speaking, people with dementia retain their ability to name a proxy or agent well into the illness. However, this is not always the case, so advance planning is always the better option. A physician or psychologist trained in capacity assessment will be able to give you an opinion on whether your family member is still capable.
 
 See Also    ↓ next top ↑

While the content of each Caregiver College Topic may be linked to a variety of other Topic areas, the following has been identified as a Key Linkage which you may be interested in also reviewing:
 
 Resources  top ↑

Government of Alberta
  • What is a Personal Directive in Alberta?: The Provincial Health Ethics Network provides links to information about Personal Directives, including legislation, FAQs and two publications that can be accessed online or sent to you for free.
Alberta Justice
  • Public Trustee and Dependent Adults: Information about the Public Trustee, Informal and Formal Trusteeship and other topics are provided.
  • Enduring Power of Attorney: Information about Power of Attorney is provided.
  • Informal Trusteeship: Informal Trusteeship is where the caregiver acts on behalf of the older adult who requires financial decision assistance.
  • Programs and Services: This is the gateway to Government of Alberta services and information.
Law Society of Alberta
  • Lawyer Referral Service, which assists people in finding a lawyer in Alberta.
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