Alzheimer's Foundation of America

Foundation of America

Creating a Long-Term Care Team

The concept of a “team” usually connotes a group of individuals working closely together to achieve a common goal. When it comes to health care, the “team” members don’t all necessarily work together, but they ideally coordinate their efforts and share information, even though they may not meet or communicate regularly. Their common goal? Enabling the person living with dementia to exercise their choices, sense of independence, and social and community involvement to the greatest extent possible.

Someone with dementia may feel a formal and detailed “care team” is unnecessary, at least early on; but having a care team—even an informal one—is beneficial in the long run:

  • The person with dementia should be the center of the team, making care and other decisions, and being encouraged to do so, consistent with their capacities.
  • The person’s key family member(s) and/or friend(s), primary health professionals and specialists should be team “members.”
  • Support groups, even if involved only with the person’s family caregiver(s), should be seen as part of the person’s care team as well.

Where does a lawyer fit into the “team”?

A lawyer is unlikely to be considered a member of the care team. However, a lawyer has a critical obligation to the team as a whole: to provide confidential advice and assistance to a client—in this case, the person with dementia. While the lawyer may need to exchange information with team members, they must have the client’s permission to do so. Generally speaking, the lawyer’s role is to: (1) help the person with dementia and their family and friends to be better aware of the person’s legal rights and options; (2) prepare documents that help them carry out the person’s choices and responsibilities; and (3) possibly pursue legal actions on the person’s behalf, if ever needed.

When to seek legal advice?

When a person first learns that they are experiencing symptoms of dementia, they should seek the assistance of an elder care lawyer.

Why? Because if they haven’t already done so, they should start considering how to protect their income and assets to optimize future care and assistance and enable their family or others to help manage their affairs when their own capacity to do so diminishes.

Individuals with substantial financial resources may seek the services of lawyers specializing in trusts and estates. Many others may consult with lawyers about wills and other estate planning options. Many consult lawyers who specialize in “Medicaid planning” to consider lawful ways of preparing for possible nursing home or home-based care.

Some civil legal services will help prepare wills and related documents for persons with limited assets, as well as educate seniors on matters such as simple “life planning” and the often-bewildering offering of government benefits. Those efforts range from information about steps to take—and forms and procedures to use to help manage the person’s affairs—to highlighting areas of misinformation that can cause needless depletion of financial resources or denial of benefits.

Preparing Important Documents: Advance Directives Including POAs

The two most important types of documents upon which a person with Alzheimer’s and their families commonly rely are advance directives and powers of attorney; and, to a lesser extent, government benefits forms.

Advance Directives

  1. Declare things that a person does or does not want to happen to them or their property in the future.
  2. Authorizes one or more other persons to make specified decisions on their behalf in the future. Two
    of the most widely used types of advance directives are both “Power of Attorney” documents.

Powers of Attorney

A Power of Attorney (POA) is a written, legal document, by which one person (“the Principal”) can authorize one or more other persons (“the Agent(s)”) to take actions on their behalf during their lifetime. The two types most
commonly used:

Financial POA

A financial POA enables a person or persons to act on someone else’s behalf regarding “financial interests,” such as issues involving banks and other financial institutions, as well as real estate, government benefits and taxes. The “Principal” has the option of deciding whether they want a POA to go into effect immediately or sometime in the future, when they become unable to manage financial responsibilities on their own (i.e., “incapacitated”).

Health Care POA

Essentially an advanced health-care directive or living will, this POA provides for the appointment of a person or persons to make healthcare decisions on the “Principal’s” behalf when they become unable to do so. It should be signed by the “Principal” when they still have the capacity to do so. Such decisions may involve end-of-life preferences, pain relief and anatomical gift designations.

One major difference between financial and health care POAs are the consequences of not having one. If a person without a financial POA becomes incapacitated, it may be necessary to pursue a guardianship and/or conservatorship proceeding in court to have an agent appointed. When someone without a health care POA becomes incapacitated, state law specifies who is entitled to make health care decisions on their behalf.

Important Reminder: Government Benefits Require Government Forms

Keep in mind, different agencies that administer government benefits have their own forms that must be used to obtain various results. For example, agencies like Social Security, Medicare, and the Veterans Administration have forms that must be used instead of state-recognized POAs. Agencies will have their own forms for applications, appeals, appointment of representatives, appointment of representative payees, and more. Lawyers regularly help clients and members of the community cut through this maze of forms, to help people be more aware of them, and better understand and complete them.

Written by Michael C. Parks, Esq., an attorney with Senior Citizens Law Office, a civil legal services organization that serves persons aged 60 and older in Central New Mexico.

This article originally appeared in Alzheimer’s TODAY, Volume 16, Number 1, published by AFA. View the entire issue here.