There are many challenges to caregiving. One of those challenges can be educating yourself and organizing the many legal documents needed when caring for a loved one with physical and/or mental disabilities. This part of our caregiver series is going to focus on these different types of legal documents.

As a caregiver, the first legal documents to organize are those that appoint someone to handle the care receiver’s medical and financial affairs when they are no longer able to do so on their own. These documents are called Durable Power of Attorneys (DPOA). If the care receiver does not have these documents, it is important to get these in place even if he or she is still able to make these decisions. These documents will be important if for whatever reason, in the future, the care receiver is no longer able to make decisions. The care receiver must be cognitively aware to appoint this person. If these documents are already in place, check to see if any updates or changes are needed. Often times, care receivers may have appointed someone who is no longer available to act on their behalf. If they have an alternative on the document, this person would be next to act on their behalf. If not, a new document should be created. Some types of DPOA’s take effect immediately, while others can be written to take effect only when the person lacks capacity to make decisions. 

Even if you are married, it is important to appoint someone as your power of attorney for financial and health care decisions. Being someone’s spouse does not give you the legal authority to make these legal decisions. The care receiver can appoint his or her spouse or any individual he or she trusts to make these decisions on his or her behalf. In the event that the DPOA is not the spouse, the DPOA can override the wishes of the spouse since the DPOA has the legal authority to make these decisions. Often times, a care receiver may appoint the person whom he or she think will make the best decisions on their behalf.

Different Types of Durable Power of Attorneys (DPOA)

Financial Power of Attorney allows a person to appoint someone to handle his or her financial and legal affairs. There are two types of financial powers of attorney, a General Power of Attorney and a Durable Power of Attorney.

General Power of Attorney allows the appointed person the authority to sign legal documents, pay bills, and make necessary financial decisions.

Financial Durable Power of Attorney allows the appointed person’s power to extend to when you become incapacitated and are unable to make your own decisions.

Health Care Power of Attorney, also known as a health care proxy, is a legal document that is put into effect once the care receiver is unable to make medical care decisions. The DPOA will be able to provide your medical team with consent and authorization to perform medical treatments, such as surgery or life-support decisions.

If a DPOA isn’t in effect, it will be important to have something in writing that allows you to talk with medical providers about your care receiver’s health care needs. For this, you will need a HIPAA Release. The Health Insurance Portability and Accountability Act (HIPAA) requires medical information to be kept confidential. A HIPAA release form is a legal document that lets medical providers share and discuss your medical situation with whomever you specify on the form. By signing a HIPAA release form, your family can have access to your health information, which wouldn’t be authorized under normal legal authority. This is important for terminally ill patients so that their power of attorney or other family members can openly discuss health care plans when the end of life nears.

As I am finding out personally, it isn’t easy to make decisions on someone’s behalf. It’s even more difficult if you are unaware of what the person would want. There are also documents that can help guide you in making decisions on someone’s behalf by having wishes in writing. It can be helpful to review these documents when making decisions. These documents, however, do not cover every type of decision. It is important to talk with the care receiver to discuss what types of medical treatments he or she would want or wouldn’t want that are not discussed in the following documents.

A Living Will is a type of health care directive that provides information about one’s wishes regarding end-of-life care if no longer able to communicate these wishes. It is a legal document that shares one’s preferences about prolonging life. These preferences can pertain to medical treatments, such as tube feeding, pain management, medication, resuscitation, and dialysis.

Five Wishes is another type of living will that is written in everyday language and easy to understand and complete. It helps one to consider and document how he or she wants to be cared for at the end of his or her life. It covers personal, spiritual, medical, and legal wishes all in one document. It allows your family or caregiver to know exactly what you want. It is also helps guide discussions with your family and physician. These forms can be ordered on the following website: https://www.fivewishes.org/for-myself/. Although this document is legal in most states, it isn’t in Kansas as of now. Some additional forms or mandatory notices may also be needed. However, this document can still help guide the conversation and put your wishes in writing. The additional forms required by Kansas can be added to the Five Wishes. These forms can be found and printed from the following website: https://www.fivewishes.org/kansas/.

Letter of Intent is a personal way of sharing one’s end of life wishes with your family or other beneficiaries. This is not a legal document, but it can act as a guide through the estate process to prevent confusion. It can help explain one’s wishes as well as provide information regarding funeral arrangements, list of beneficiaries, care instructions for pets, usernames and passwords for online accounts, outstanding debt information, and the location of any legal documents.

Do Not Resuscitate (DNR) Order is a document that will notify medical personnel in a hospital or nursing home that the care receiver does not wish to have CPR or other life-support measures in the event the person’s heart or breathing stopped. This would allow natural death to occur. The DNR should be on file with the hospital or nursing home where medical care is being provided. If a care receiver wants to receive CPR, a DNR isn’t needed.

Out of Hospital DNR Order is a document that notifies other medical personnel of care receiver’s wishes to not have CPR performed. These documents should be provided to care receiver’s medical providers as well as posted in the home where medical providers can see it in event of an emergency. DNR bracelets also can be ordered to help notify medical personnel of care receiver’s wishes.

Do Not Intubate (DNI) Order means the care receiver does not want a breathing tube inserted into their trachea, via the nose or mouth, to restore breathing.  A DNI does not prevent one from using oxygen or other non-invasive ventilation, such as a BIPAP.

Organ Donor Card can typically be found on one’s driver’s license. This allows certain body parts to be donated after death to potentially save the life of another.

Personal Health Record (PHR) refers to the collection of an individual’s medical documentation maintained by the individual or caregiver. This information may include: diagnosis, historical and ongoing medications, alternative treatments, past medical and surgical interventions, immunizations, allergies, blood type, emergency contact, and health providers’ contact information.

Many of the documents listed may not need an attorney. Some either need to be witnessed or be signed with a notary public. However, some documents may require an attorney, or an individual may prefer to have these documents drawn up by an attorney. If so, you can seek out the services of an elder law or estate attorney. There are many private firms in Manhattan and surrounding areas that provide these services. Below is a list of attorneys found online that can assist in these legal matters.