Courtesy of Joyce O. Beckett

by Joyce O. Beckett PhD, LCSW

One of the most prominent reasons for family caregiving is that the care partner has some physical or emotional challenge such as comes with aging. One of the most important relationships a family caregiver member can have is with the elders medical personnel. Medical staff members are invaluable resources for resolving health concerns. This article presents two prerequisites that are necessary for caregivers to develop a good, supportive, working relationship with medical professionals.

Medical Power of Attorney. In this age of "HIPAA" (the Health Insurance Portability and Accountability Act of 1996), it is essential to have a medical power of attorney provision. The medical power of attorney (POA) is a written, legal document that allows the caregiver to make health care decisions if the care partner is incapable and to have access to verbal or written medical information concerning the care partner, including medical and hospital records. The exact title of this document varies from state to state. In some states, it is entitled a Durable Power of Attorney for Health Care and must be notarized in most states.

Should the caregiver not have power of attorney, medical providers are restricted to sharing limited information about the care partner. The caregiver and care partner should get this document executed as soon as a caregiving relationship is begun. It is essential that all parties realize that the care partner can name more than one Health Care Agent and can, at any point, revoke the medical power of attorney document. The document and procedures for preparing them are available from several sources such as a local hospital, physician offices, and the internet. The form must be valid for the particular state.

In my own personal experience, when my sister was hospitalized for surgery, a social worker suggested to us that my sister sign a power of attorney, in case I needed to make medical decisions for her. The social worker had a person execute the document in the hospital room. This was one of the most important and helpful suggestions I have ever gotten in my role as a caregiver.

Finding a Medical Practitioner. A care partner is likely to have a medical provider, and the caregiver will want to determine the relationship between the patient and physician. The care partner may like the provider and have developed a comfortable relationship over the years. On the other hand, there may be some concerns about the practitioner and indications that a new provider may be preferred. Whatever the care partner’s preference, it is important to spend some time discussing the patient/practitioner relationship. This may be time-consuming and require several different discussion periods before making a final decision. However, this will likely save valuable time in the future. For example, the care partner may want to change providers because the provider has suggested assisted living or wanted to prescribe a medication that the care partner did not want. This could indicate that the care partner lacks comfort or trust in the relationship with the medical provider.

If a new provider is needed, the caregiver might ask for guidance from friends, family members, or other physicians. Geriatricians, physicians specifically trained to work with seniors, are often a good start. These physicians usually perform very thorough evaluations and work with a team of other health care professionals, including nutritionists, social workers, physical therapists, psychologists, neurologist, psychiatrists and others. A team approach may be particularly effective for care partners who are showing signs of severe forgetfulness, getting loss, and other symptoms of dementia. Geriatricians are frequently connected with medical schools and have access to the most current treatment and research knowledge.

Years ago, when my family suspected that my father had dementia, we were able to convince him to get an evaluation at the nearest Geriatric Medical Center, which was in another state. My father cooperated partly because he saw the benefit of getting a second opinion and had high regard for the medical facility. The team of care providers completed a thorough three-day assessment. Following the examinations, the team first met with the family, including my father, and gave us their impressions - early stage dementia. They discussed the likely course of the illness and ways to manage it. They encouraged us to ask questions and to discuss our concerns. Afterwards, half the team met separately with my father and the other half met with the family. This procedure gave both the family and my father an opportunity to bring up our private concerns. We all found this process quite beneficial. The team sent a report to my father’s physicians and gave the family a copy of the medical records.

These two tasks - executing a medical power of attorney and finding a medical practitioner - are necessary steps in planning for good medical care for your care partner. As the examples suggest, there is no particular blue print for completing these tasks. Be creative and develop the methods with which you and your care partner are most comfortable.

Joyce O. Beckett, PhD, LCSW is a clinical social worker, gerontologist and family caregiving expert. She is author of LIFTING OUR VOICES: The Journeys into Family Caregiving of Professional Social Workers (Columbia University Press, 2008) and presents workshop on family caregiving throughout the U.S. She has been a caregiver for various family members and loved ones since she was a child.