Caregivers must consider a wide range of important legal documents that can impact the preparedness of all parties involved in the support and care planning of a loved one at various stages in their life.
The following sets out a series of documents that might be considered when getting the documents of those that you care for in order:
Medical Orders and Emergency Treatment Instructions
A MOLST, or a Medical Orders for Life-Sustaining Treatment, and a POLST, or Physicians Orders for Scope of Treatment, are the same forms that have been given different names in different states across the United States. These forms can be collectively referred to as Medical Orders. These Medical Orders forms are commonly completed by an individual in either a hospital or nursing home with an imminently life-threatening condition.
- Medical Orders specify what treatments the individual chooses to either undergo or withhold.
- A Medical Order form instructs a medical providers and health care providers whether to utilize ventilation devices, artificially administered food/nutrition and hydration, dialysis machines, certain medicines, CPR, intubation, feeding tubes or other life support devices.
- How to get a Medical Order: A Medical Order such as a MOLST or POLST can be obtained by contacting a physician at a Hospital or Nursing Home.
A DNR or DNI, which stands for Do Not Resuscitate and Do Not Intubate, are documents that instruct emergency care medical professionals, such as doctors and paramedics, to withhold certain potentially life-saving treatments.
- Do Not Resuscitate orders relate specifically to the administration of cardiopulmonary resuscitation, or CPR. CPR is a blanket term that includes chest compressions, cardiac drugs or intubation tubes.
- Do Not Intubate order means that CPR may be utilized, however expressly prohibits the use of a breathing tube.
- How to get a DNR/DNI: A Primary Care Physician can be contacted in order to get certain forms required to have the DNR or DNI added to a persons medical record. The physician may be able to direct the person where to get DNR or DNI bracelets or other methods of displaying the person’s wishes.
Designation of a HIPAA representative
The HIPAA laws are stringent federal regulations that protect a person's protected healthcare information from unauthorized uses. A person can designate another person as their personal representative by completing and signing a HIPAA Representative form. This authorization allows a person to access protected healthcare information on behalf of another person.
- Health Care Decisions: The HIPAA Representative form does not give the authorized representative the power to make healthcare decisions on behalf of another, but instead only allows the representative the ability to access the patient’s protected health information.
- Where to find a HIPAA Representative Form: Each state’s Department of Health will be able to provide a HIPAA Representative Form for use in that state.
Creating Advanced Directives and Appointing A Medical Power of Attorney (PoA)
- Medical Power of Attorney: A Medical Power of Attorney or Health Care Power of Attorney is a document that a person may use to give another trusted individual, such as a family member, the power to make routine medical decisions on their behalf.
- A Medical Power of Attorney document should include a HIPAA waiver provision, which would allow an Agent under a medical Power of Attorney to access protected health information, such as a HIPAA Representative is authorized to do.
- NOTE: A Medical Power of Attorney will allow a health care proxy to make decisions on behalf of a person while they are unable to make their own decisions, but are not necessarily in an end-stage medical condition with no chance of recovery.
- Living Will: Also referred to as an advanced directive, a living will document allows an individual to dictate which medical care and procedures to either administer or withhold when a doctor determines that the person is in end-stage medical condition with no change of recovery. These procedures might include whether to administer life-sustaining treatments, dialysis, hydration, sustenance or pain medication.
- Often, a Medical Power of Attorney document will contain a living will in the same document.
- Where to find a Medical Power of Attorney and Living Will document: An attorney licensed in your state will be able to craft both of these documents upon your request.
Creating a Trust that Provides for Support and Care
A living trust is a legal instrument where one party gives property or assets to a trustee to hold for the benefit of the person who is to receive the gift – a person known as the beneficiary. A trust document will specify the manner in which the property or assets can be released to the beneficiary and for what purpose. Often, a trust will specifically allow for the trustee to distribute the assets to the beneficiary for the care and maintenance of the beneficiary for their lifetime.
- Controlled Distributions: A trust is a useful way that a person can provide for the long-term support and maintenance of another, while limiting the amount of money that the beneficiary can receive at one time.
- Specificity: A trust can specify particular uses of the funds, such as for rent or mortgage payments, healthcare expenses or for personal care services.
- How to Create a Trust: An Estate Planning or Elder Law Attorney should be sought to help create a trust that is tailored to the specific needs of the creator of the trust.
- An Elder Law Attorney can also give legal advice on other senior financial affairs, help with Medicare, Medicaid and other Social Security applications, assist with legal documents, such as Durable Power of Attorney, Advance Health Care Directives, and Financial Power of Attorney, as well as other legal issues pertaining to Elder care.
- Funeral Arrangements: A person can indicate their preferences concerning whether or not to have funeral arrangements, and if they choose to do so, how they should be carried in advance of death in a number of ways. A person can memorialize their preferences in a Last Will and Testament. Also, they may do so by creating a separate Declaration of Disposition of Last Remains Form. An Attorney will be able to assist in creating a Will or a Disposition of Last Remains form.
- Financially Planning for a Funeral: Funeral expenses can be paid for in advance by contacting a funeral home and setting up and funding an account.
TIP: A Disposition of Last Remains should be kept in a safe place and attached to any Last Will and Testament Documents, if any.
A person’s preferences for organ donation and funeral arrangements can be accomplished by one of a number of different means.
- Organ Donation: A person wishing to designate whether they would like to donate their organs after they are deceased might do so by either registering with the organ donation register, indicating their intention to be an organ donor on their driver’s license, depending on the state, or may do so through indicating the same in a Medical Power of Attorney Document.
- Organ Donation Register: Many states keep their own registry of Organ Donors, which can be found online.
What Rights Do Caregivers Have?
Certain legal documents award caregivers rights:
- HIPAA Representative form gives a caregiver the ability to access their loved one’s protected health information.
- Medical PoA gives a caregiver the power to make routine medical decisions on their loved one’s behalf.
- Financial PoA gives a caregiver the power to make routine financial decisions on their loved one’s behalf.