Creating a legally binding plan for shared decision-making in dementia care

### Creating a Legally Binding Plan for Shared Decision-Making in Dementia Care

When someone is diagnosed with dementia, it’s crucial to plan for their future care. This includes making sure that their wishes are respected and that someone can make decisions on their behalf if they become unable to do so. One of the most important tools for this is a Power of Attorney (POA).

#### What is a Power of Attorney?

A Power of Attorney is a legal document that gives someone the right to act on behalf of another person. This person, known as the agent or attorney-in-fact, can make decisions about the grantor’s (the person creating the POA) finances and healthcare. The POA is especially important for people with dementia because it ensures that their care is managed by someone they trust.

#### Types of Power of Attorney

There are different types of POAs, but the most common one for families considering Medicaid is a Durable Power of Attorney (DPOA). A DPOA is effective immediately and gives the agent decision-making power after the principal (the person creating the POA) becomes mentally or physically incapacitated.

#### Why Create a POA?

Creating a POA while a person is still healthy is critical. If the applicant’s health fails rapidly and they are not capable of completing the Medicaid application on their own, having a POA will allow the agent to collect the necessary financial and medical documents and complete the application. This ensures that the person’s care is not managed by the state, which could lead to decisions that might not align with their wishes.

#### How to Create a POA

While it is possible to create a POA without an attorney, it is highly recommended to consult with a Certified Medicaid Planner (CMP) or an attorney. They can help ensure that the document is legally binding and covers all necessary aspects of care planning. The agent should be someone the grantor trusts, often a family member or loved one.

#### Understanding Dementia and POAs

If someone with dementia is still able to understand what the POA documents mean and what powers they transfer, they can still create a POA. However, if the state decides the senior was not mentally competent, the POA could be ruled invalid, and the senior would become a ward of the state. This could lead to a lengthy and expensive court process to gain guardianship.

#### Additional Tools for Care Planning

While a POA is essential, it is not the only tool for care planning. An Advance Directive or Living Will can also be used to state an individual’s wishes for medical treatment. These documents can be combined with a POA, but the rules governing them vary by state.

#### Guardianships and Conservatorships

In extreme cases where a POA is not sufficient, guardianships and conservatorships can be considered. These are legal arrangements where a family law judge appoints a third party to make decisions for an individual who is deemed unable to manage their own affairs. However, this is an extreme step and should only be considered after all other options have been explored.

### Conclusion

Creating a legally binding plan for shared decision-making in dementia care is crucial for ensuring that the person’s wishes are respected. A Power of Attorney is a vital tool that allows someone to act on behalf of the individual, making decisions about their finances and healthcare. By understanding the importance of a POA and how to create one, families can better prepare for the future and ensure that their loved ones receive the care they deserve.