Choosing a Healthcare Proxy and Long-Term Care Planning

Planning for long-term care and choosing a healthcare proxy (HCP) must both be done as far in advance as possible, with as much honesty as humanly possible.

Be very sure that the people you choose as your HCP will carry out your wishes.

Both are done because people wish to have the highest possible caliber of care, dignity and options, even if they have limited, or no capacity to make decisions.

Choosing the right HCP also ties in to long-term care insurance (LTCi) purchase because both are done out of the utmost consideration and love of others.

Both actions are done to ensure the least amount of stress and discord for surviving family and friends.

The following is a true story, shared by a very close friend:

“Because my father did not want my sister to feel left out, he named her as his second health care proxy (HCP). That was a bad decision and the wrong reason to grant a HCP.

My Dad lived a long and very productive life, retiring at 87. As he approached 90, some medical issues that he had since his late 20’s became much worse.  But each was survivable.

With Dad’s consent, my siblings and I decided that there would be no surgeries or heroic measures taken to keep him alive.

Despite his failing health, Dad was astute and very capable of managing and understanding his business affairs. He ably directed his wishes. He appointed our brother Power of Attorney. As Dad was filling out the HCP form with his attorney, he said to me, ‘You are number 1. You will make my medical decisions with and for me, as you have been doing for years. I have to give your sister something, or she will feel totally left out, so I am making her #2. I do not want her husband  involved in the decisions.’ Dad also had a Do Not Resuscitate (DNR) order, much to my sister’s surprise.

For years, I took care of all of Dad’s medical care.  My sister only visited from time to time, when Dad was hospitalized, or to spell me for a day or two. She had a family, lived out of town and was busy with her life. The key thing Dad didn’t want was to die in a hospital with tubes sticking out of him, strangers around him, alone. He was very clear about this.

My sister chose to ignore our father’s DNR, along with his wishes.

My sister was visiting.  Sitting in Dad’s living room, She heard Dad’s agonizing gasps but chose to overlook them. She did not call me. When I got there, she said to me cheerily, ‘What’s up?’

I dropped my things on the floor and immediately went to Dad; I knew this was it. That sound, that sound, that unmistakable sound was horrifying. I believe my father was in pain. Unnecessary pain. I do not understand how anyone could sit in a room obliviously over-hearing painful gasps. She did look in on him from time to time, but she was out of touch with reality. She continued texting, making calls, laughing, etc.

Once I got there and she acknowledged the severity of the situation, she said, ‘I am #2 HCP and my husband says Dad should be in the hospital with an IV drip for his dehydration and someone should work on a small bedsore that had appeared in the last few days and he should be intubated.’

My father’s lungs had ceased to function. Her behavior was nuts. I replied, ‘Your husband is not the one with the HCP and you cannot delegate. You can refuse your responsibilities or do what Dad wants. This is the end. The RN has given you the facts. I can have the MD call you directly to tell you the same thing.’  My sister insisted on calling her husband. Our brother had to assertively remove our sister from Dad’s apartment.”

A very difficult situation was made much harder just by the bad choice of a HCP.

Make sure your wishes are known. My attorney has a copy of my last wishes to back up my HCP, just in case some stranger butts in to change your decisions.

My advice is make sure that those you select as HCP are chosen for the right reasons. They should be reliable, in the loop on medical status, doctors, meds. They must be capable of making decisions without consulting a spouse or someone else for every move, and they must be able to defend your wishes and act in your best interests, first and foremost.