by Emily Carton, LISW

When I began working with older people nearly twenty years ago, the idea that one day I would be old seemed distant and remote. Just as a child thinks of reaching the age of twenty one or thirty or forty as abstract and unimaginable, the idea of aging was something that I saw in others, but not in myself. Gradually I began to understand that the issues my clients and their families were facing were issues that I needed to think about now.

In my work I am often called to a home of someone who is suffering from a dementia or another incapacitating illness. Sometimes a person can no longer pay his own bills. Sometimes they are not receiving proper medical care or don't remember to eat. Family members don't know what to do. Who should be the person to make the decisions about the proper care or the proper use of resources? What should be done if family members or friends don't agree? How can you prevent these disputes from escalating to a legal battle? How do you help ease a family's burden? The harsh reality is that anyone can suddenly be struck by fate and lose the ability to act independently. Yet, even in incapacity, we can control our lives if we have planned for the future by instructing others of our wishes by preparing "advanced directives."

What are advanced directives?

Power of Attorney

This document allows you to name someone to act on your behalf in financial matters if you should, for example, become hospitalized and are unable to take care of your affairs. The person you designate is called your attorney in fact or surrogate decision maker. You may give the person who you name the power to pay your bills, deal with real estate transactions, and any other functions that you specify. This power can be revoked by you at any time and the document becomes invalid if you should become mentally incapacitated.

Durable Power of Attorney

This document takes effect at the time when you can no longer make decisions. This document must be written and signed when the you are competent and fully aware of what you are signing. Naming someone to look after your affairs when you are no longer mentally capable avoids the possibility of having the state appoint a guardian to make decisions for you. The Durable Power of Attorney for Health Care is the health counterpart to the Durable Power of Attorney. This document specifies who can make medical decisions for you in the event of incapacity. In most states this is known power of attorney for health care or health care proxy. This document deals with all aspects of medical treatment including nursing home placement. This document, as with all others, may be as general or as specific as you choose.

Living Will

This document pertains specifically to terminal illness and life support issues. By executing this document you specify how you feel about ventilators, tube feeding, dialysis, and other heroic measures during a terminal illness. The exact terminology and forms may vary from state to state. Although it is legal to create a document on your own, it is always advisable to check with your attorney about your specific needs.

How to begin?

Spend some time thinking about your values and how you wish to live your life. What does quality of life mean to you? What would happen if you were to become temporarily incapacitated and unable to take care of your affairs? Who do you want to act on your behalf? Do you want a friend, a family member, a lawyer? What kind of medical treatment do you want if you should be come incapacitated? How far do you want your physicians to go to keep you alive in the event of a terminal illness? Follow this by:

talking with your family and friends about your wishes

talking to your physician

consulting your lawyer or a legal organization in your community to receive information and assistance in preparing your documents.

It is a gift to those who care about you to let them know what you want. Then they can act on your behalf with the knowledge that they are carrying out your wishes.


"Planning for Incapacity: A self help guide,"
Legal Council for the Elderly.
Each guide is for a specific state and offers a step by step guide to advanced directives.
Cost is five dollars.
Write to LCE P.O. Box 96474 Washington, D.C . 20090. Telephone: 202-4342152


Emily Carton MA, LISW, is a licensed social worker who works with Elder Options, a private care social service firm in the DC Metropolitan Area. She is also an is an intern in Bibliotherapy at St. Elizabeth's Hospital in Washington D.C.


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