Being Prepared for Life’s Unexpected Events is One of The Most Caring Gift’s Seniors & Their Family Members Can Give One Another
Conversations With Seniors Aren’t Usually About a Power of Attorney or a Personal Directive?! But Should They Be?
Aging is a sensitive topic that isn’t frequently contemplated or talked about as it is not only inevitable but has the overwhelming power to make us feel vulnerable. We venture into adulthood with the desire to be independent, but the effects of aging will limit our ability to tend to our needs and wants independently. The loss of independence puts seniors at a standstill as their limited mobility makes them lose the motivation that was once there to pursue what they want and when they want. Associated health conditions and illnesses can also limit a senior’s social choices as they might feel intimidated or uncomfortable to regain access to the community around them. And while health concerns may not appear overnight, the potentially overwhelming anxiety the senior experiences can be instantaneous.
Aging is typically seen as a negative part of life and this is precisely the reason why the challenges and fears around aging should be discussed with those who are closest to us. By conquering our fears and examining problems in greater depth, we can begin making proactive choices and taking preventative actions to give our loved ones the strength for tomorrow. At Harmony Caregiving we offer a variety of care options to empower seniors to make informed decisions and plans that best suit their future goals.
In the following article, we have provided a general overview of some of the current care approaches offered through Alberta Health Services (AHS), our Provincial Health Care Provider. We discuss options available to seniors in preparation for their future plans regarding health care, advance directives, financial concerns, and services or supports.
What Is Continuing Care?
Our Provincial Continuing Care system is run by Alberta Health Services (AHS). According to their website Continuing Care is defined as, “an integrated range of services supporting the health and well-being of individuals living in their home, supportive living or long-term care setting. Continuing care clients are not defined by age, diagnosis or the length of time they may require service, but by their need for care.”
You can learn more about their many care and living options online at http://www.albertahealthservices.ca/cc/Page13328.aspx. You can also access needed information by calling HealthLink #811.
There are three main approaches to medical care in Alberta.
Defined by AHS as the following:
- Medical care: Medical tests and interventions are used to cure or manage an illness as well as possible but don’t use resuscitative or life support measures. Medical care is appropriate when resuscitative, and life support measures won’t work or when a person chooses not to receive such treatments. Medical care can be provided in many locations, depending on the person’s wishes and values as well as medical appropriateness.
- Resuscitative Care: The focus is to prolong or preserve life using any medical or surgical means including, if needed, resuscitation and admission to Intensive Care.
- Comfort Care: In this approach to care, the aim of medical tests and interventions are for optimal symptom control and maintenance of function when cure or control of an underlying condition is no longer possible or desired. Transfer to a hospital may occur to better understand or control symptoms.
Why have the Discussion Today Regarding Medical Care Tomorrow?
Individuals receive medical care according to what type of health condition they have, the medical approach they want and the services they need. There are numerous options available. Seniors can discuss with their health-care providers and close others exactly what kind and level of care they want to receive should they develop health conditions.
Speak Now or Forever Hold Your Peace until Death or Disability is Decided FOR You
Difficulties arise when people do not or cannot know the decisions a senior would make when faced with various health-care situations/scenarios. Often the decision is left to the senior’s spouse, children or close others in the family who may not know what type of health care their loved ones would prefer. As such these individuals often default to making decisions based on what they themselves would want for themselves or others under similar circumstances. These decisions may differ greatly from what the seniors themselves would want, further underscoring the need for important discussions now between seniors and their family members.
One way is to start having conversations with their loved ones, close family friends and family doctors. Family members can also initiate conversations with their senior loved ones regarding their needs and preferences for future health care. While it is uncomfortable to talk about these topics it is very helpful to have this information should one’s health begin deteriorating or a sudden health crisis occurs. Family members want what is best for their aged loved ones. However, the decisions can be numerous and extremely stressful when faced without any direction or prior experience with the Continuing Care system. Having these discussions can serve as a roadmap for family members so that they can make decisions for their elderly loved ones that they know they would approve of under the circumstances. Likely, many of the emergent health circumstances that would merit a discussion with your senior loved one, however that type of conversations are the ones that just seem to always get delayed, or postponed…as no-one thinks one of these crisis emergent situations like a stroke or heart attack or brain aneurism will happen to them. That being said, these conversations can provide you both with peace of mind, knowing that you (the family caregiver) is capable, understands your parents wants and is able to articulate those to other family, medical professionals, and is willing and able to represent your loved one’s wishes should such problems arise.
The Need for Personal Directives and Goals of Care Designation Documents for Seniors
Once you have an idea of what approach and type of health-care your senior loved one requires when faced with various health conditions and/or medical situations the next step is to create a Personal Directive. A Personal Directive is “a living will which outlines end of life wishes but is broader. A personal directive can be about all health-care decisions, where you live, the activities you take part in, etc.,).” http://www.humanservices.alberta.ca/guardianship-trusteeship/personal-directives-how-it-works.html
When writing a Personal Directive, it is recommended by AHS that seniors select one or more trusted persons (e.g., family members or friends), to represent and advocate for them in health care situations where they are unable to represent themselves. These individuals will be their “agents” and act on their wishes should circumstances dictate. Seniors in need of someone else to make key decisions are given a capacity assessment. If it is determined that they are unable to make decisions the agents are then able to act on the senior’s behalf. The Government of Alberta continues to write that it’s important you write a personal directive when you can still make your own decisions. Your agent does not step in until you need help, which is confirmed through a capacity assessment. If you get better you can take back the power to make your own decisions. This is also confirmed through a capacity assessment.
It is also advised by AHS that the person selected to act as an agent for the senior be fluent and proficient in the English language to avoid any miscommunication. Seniors may not envision themselves ever needing nursing care, but a sudden accident, fall or mishap can land them in a hospital or a long care facility in a very short time. Such health concerns or crisis can occur overnight, so it becomes particularly important that your senior loved one has a Personal Directive in place. This allows them to have control over who makes key health-care decisions for them when unable to do so themselves.
Besides having a Personal Directive, seniors can opt to have a Goals of Care Designation. According to AHS, this is a medical order used to describe and communicate the general aim or focus of care including the preferred location of that care. The Goals of Care Designation is a specific document outlining and detailing the kind of care they wish to receive in the future.
Another benefit of writing or registering a Personal Directive is that there is no cost involved. More details and step by step guidance on how to construct a Personal Directive can be located by visiting www.humanservices.alberta.ca/guardianship-trusteeship/personal.
Substitute Decision-Makers for Seniors
There are times when seniors become unable to make decisions regarding their health and medical care due to conditions like dementia, stroke and or sudden illness that can impair their mental abilities (mental-capacity). This can present as problematic for the senior and their family caregiver particularly when the senior does not have any documentation such as a Personal Directive or Goals of Care completed. If the senior has not had any prior conversations with the family or any of the above documents then the family is placed in the difficult position of having to make decisions for the senior without knowing what their wishes are. According to the Alzheimer’s Society, when such situations arise a substitute decision-maker can make decisions in regards to health care for the senior.
According to the Alzheimer’s Association, the Substitute Decision-Maker (SDM) is the person chosen to make personal care decisions, including medical decisions, for the person with dementia when they are no longer considered capable of making them alone. The laws regarding substitute decision-makers vary from province to province across Canada. If the person with dementia does not appoint a substitute decision-maker most, provinces and territories have a priority list, usually starting with family members.
Typically the substitute decision-maker makes these decisions by consulting with the seniors medical/healthcare team, getting advice from others and also giving consideration to the seniors values and wishes. For this reason, it is strongly suggested that this substitute decision-maker be someone who is close to the senior and knows them well. Please visit the above link to find more information on the topic of substitute decision-makers and a list of questions that will be helpful for the substitute decision-maker to consider when making decisions.
The Need for Power of Attorney Documents for Seniors
As stated above sometimes seniors encounter periods of time, temporary or permanent, where they are unable to make healthcare decisions due to mental incapacity. At such times, the same holds true for making financial decisions. This can put seniors in a precarious and vulnerable position if unable to make appropriate financial decisions that are in their best interests. Seniors have a number of options to help prepare for such situations in advance, the most important being arranging to have a Power of Attorney legal document in place. Power of Attorney documents can be temporary or permanent and can begin at a time of the seniors choosing.
According to OakNet, a resource for aging seniors, “A Power of Attorney is a written, signed, dated and witnessed a document that gives someone else the right, while you are still alive, to act on your behalf with respect to your financial affairs, including debts. This document can either take effect immediately upon signing and continue if you become incapable of managing your financial affairs, or take effect only upon you becoming incapable of managing your financial affairs, or some other specified event (this is known as a “Springing” Power of Attorney).”
Also, according to OakNet,”There is also an Enduring Power of Attorney document that is similar to the Power of Attorney but may also start immediately and will continue after your mental incapacitation. Alternatively, an Enduring Power of Attorney can either commence at the set date in the future and continue after your mental incapacitation or only commence when declared mentally incapable (this last kind is sometimes called a “Springing” Power of Attorney).”
This type of legal document is advantageous to seniors in that they can choose the person, family member or someone they trust, who will take over their financial decisions for them when the need arises. This individual has the ability to decide whether or not the senior is mentally incapacitated and therefore unable to make financial decisions. So it is of extreme importance that whoever is selected be someone the senior trusts. In the case where a senior does not select someone to represent their financial affairs then the decision as to whether the senior is mentally incapacitated is completed by two medical practitioners.
Seniors should note when preparing a Power of Attorney that the person they select to make financial decisions will have considerable power when the time comes to implement the document. This person can do nearly everything the senior can with the financial resources including, but not limited to, selling assets, making investments and deciding how to spend the money on senior care. They, however, are not allowed legally to change/update the seniors will, prepare a new will for the senior or “give a new Power of Attorney on [the senior’s] behalf” www.oaknet.ca To prevent possible misuse of the Power of Attorney, seniors can limit the powers of the person selected to be their Power of Attorney by writing restrictions on the document. For more information regarding Power of Attorney, please visit www.oaknet.ca/content/power-attorney
Having a Power of Attorney is particularly important in that it can give both the senior and their family caregivers peace of mind as to who will control the finances and/or how they will be allocated should be the senior become incapacitated. Having access to a senior’s finances can help trusted family caregivers in that it gives them the ability to provide for the senior’s personal and health costs not covered by public programs or funding. This way they can provide the appropriate and needed services for their senior loved one without having to worry about depleting their own financial resources, which can be a huge strain on family members. The senior’s finances can also be used towards additional/optional services or home modifications that can vastly improve their overall quality of life.
Unfortunately, there are times when a senior may become incapacitated before preparing a Power of Attorney document. In such cases, the court system has the ability to select a trustee to handle the seniors financial affairs. To read more concerning how trustees are appointed and their overall role, please visit the following link: www.oaknet.ca/content/power-attorney.
The benefits of Alberta’s new Green Sleeve Program for Seniors
Wearing Your Heart’s Wishes on Your Green Sleeve
Your living will, Personal Directive and/or Goals of Care designation can now be communicated more efficiently and directly to health care personnel through the Green Sleeve program. This is a new and innovative initiative that has been recently introduced in Alberta. Using this program, anyone, including seniors can keep all information regarding health-care and medical decisions in a Green Sleeve that is kept on or near the household fridge. This program allows health care personnel, particularly those responding to an emergent situation, to have quick access to your health care needs and preferences. Having a Green Sleeve is a convenient option for seniors in that they are able to take all relevant medical information with them wherever they go (e.g., medical appointments, clinic visits, hospital visits, etc.,) as well all the important information is placed in one location at home in case of an emergency. Perhaps the most important function of the Green Sleeve program is that it prevents any miscommunication with regards to whether your senior loved one wants resuscitative care under certain circumstances. The Goals of Care Designation documents can be prepared and written by a doctor or a nurse practitioner after detailed discussions with your senior loved one. The Personal Directive and Goals of Care designation documents are implemented only if the senior is unable to make health care decisions themselves as a result of a health condition. It can be changed or up-dated at any time. As well, seniors can be provided with a wallet card that contains information regarding their emergency contact(s) in case they are unable to communicate for themselves. For more information concerning the Green Sleeve Program, please visit www.conversationsmatter.ca.
In order to design advance directives including but not limited to, a Personal Directive, Goals of Care Designation document and Power of Attorney document reflective of one’s true preferences seniors and family members alike should become well informed about the Continuing Health Care system in Alberta. Seniors should ask themselves what they want if faced with various health conditions or situations and explore what the costs may be for future accommodation and other expenses incurred. It is also advisable that seniors and their family members consider the needs of the primary family caregiver(s) so that these individuals have an easier time carrying out the seniors’ wishes and attending to their everyday needs. As well, seniors can benefit by exploring alternative options, such as additional government/private funding, other living arrangements available to seniors in need and private care services offered within the community. Such options or additional services may be a better fit to suit the senior’s personality, values or needs and may be more affordable.
Can’t we Just use Personal Directive Forms or Online Wills and Power of Attorney Forms?
We strongly encourage you to speak with a specialist when dealing with sensitive legal matters. This page is designed to be informative only and we encourage you to seek the advice of a professional before making a decision.
Harmony Caregiving can assist you in the following ways:
- Can help you find ways of initiating the conversation with your loved ones concerning Advance Directives and care.
- Assist you and your senior loved ones with the planning process when creating Advance Directives like a Personal Directive, Goals of Care Designation document and Power of Attorney documents.
- Provide you with information about the Continuing Care system within Alberta including the public, non-profit and private services available.
- Offer you and your senior loved one emotional support and an objective ear to explore your plans or ideas when creating your Advance Directive documents.
Need a Power of Attorney or Personal Directive? Don’t worry we can help! To learn more about the Continuing Care system in Alberta, including Home Care for Seniors, Supportive Living, and Long Term care, please stay tuned for next article What is Home Care and is it a Good Option for your Senior Loved One?