How to Protect a Loved One When You’re Not the PoA

Power of Attorney (PoA) documents are powerful tools for protecting a person’s wishes when they can’t choose for themselves. Yet, the documents can also lead to considerable family drama, including fights between siblings and even legal interventions.

The resulting fights can be awful and directly impact the care a senior receives.

Why does this happen? The situation is often driven by a combination of factors, including mistrust, differences in values, and varying ideas about the best course of action. You might even get such conflict when everyone legitimately wants the best for the patient.

Today, we’re looking at the issue from the perspective of a family member who isn’t named in the PoA. Perhaps you’re completely on the sidelines and worried about the decisions that are being made. Or, you might be a hands-on caregiver who is frustrated by your lack of authority. So, what can you do?

This discussion focuses mostly on a healthcare PoA, but many of the principles apply to a financial PoA or general PoA as well. The big difference between these is the areas of authority that the proxy has.

How Power of Attorney Works

A Power of Attorney document provides one person (or occasionally two) with authority over specific aspects of the signer’s life. Some people will have multiple PoAs, such as a healthcare PoA and a financial PoA. These documents might have the same agent or different agents.

Basic definitions:

• Power of Attorney (PoA): The document that provides authority for decision making.
• Agent/Proxy/Attorney-in-Fact: The decision-maker named in the PoA document.
• Principal: The person that the PoA document belongs to, perhaps an aging parent or a spouse.
• Durable PoA: A PoA that remains in effect even when the principal has lost decision-making capacity.
• Non-Durable PoA: A PoA that stops being effective when the principal has lost capacity. This is relevant for some financial or property tasks, but generally isn’t useful for healthcare.
• Springing PoA: Comes into effect at a specific point in time, often when someone has lost decision-making capacity.
• Living Will: A key piece of advance planning documentation. This provides details about the principal’s end-of-life wishes and is used to guide the healthcare proxy’s decisions. If there isn’t a Living Will, the proxy will need to use other indications of what the family member would have wanted.

For more details about Power of Attorney, check out our comprehensive post here.

The healthcare proxy has a considerable amount of authority. They’re responsible for major and minor health decisions, including which treatments to pursue. They don’t need to consult family members about these decisions or even inform family members about every step.

This amount of authority can be frustrating for people on the outside. You might feel left out of the loop or worried about some of the decisions the proxy is making. It’s tough to know what to do, as you don’t have decision making authority.

Of course, the proxy isn’t acting in a vacuum. They need to follow the senior’s Living Will and will be regularly engaging with doctors and other medical staff.

How You Can Help

Before we dig into potential issues and problem solving, let’s look at things from the proxy’s perspective. Notably, their role can be intense. They’re trying to navigate a complex world of healthcare decisions based on the senior’s wishes, while trying to deal with everyone else’s opinions, and their own emotions.

It’s not surprising that many proxies end up stressed and overwhelmed, which can make them less communicative with family members. Some may even shut their critics out entirely, largely because constant criticism just makes everything more difficult.

The person in the proxy role is often doing the best they can.

Remember too that the senior’s wishes might be quite different from your own (or the proxy’s!). For example, some seniors want many types of interventions withheld, while their adult children may want to try as many treatments as possible to extend the senior’s life.

Provide Support

Most of the time, the best thing you can do is support the healthcare proxy and your loved one. Constantly arguing for a different approach or fighting the proxy just makes things more difficult for everyone.

One of the best approaches is to simply be there for the senior. The healthcare proxy is doing most of the hard decisions and perhaps some practical tasks which leaves them much less time to be present for the loved one.

So, if your aging parent is dying, try simply being there as a son or daughter. Leave your disagreements at the door and provide support as best you can.

You might end up doing this even if you think the proxy is wrong, simply because it’s time-consuming and difficult to remove their authority. If the senior doesn’t have long to live, it may be best to spend quality time with them instead of trying to battle the healthcare proxy.

Is Something Wrong?

Things don’t always go as they should. There are certainly cases where proxies abuse their position or where they’re making really bad decisions. So, how do you know there’s a problem?

Things That Look Like an Issue but Mightn’t Be

• Not Sharing Health Information. While the proxy may share some health details with family members, they’re not obliged to. They may even need to keep some information private.
• Not Sharing Financial Details. Similarly, someone with a financial PoA isn’t obliged to share financial information with family members as well.
• The Proxy isn’t Consulting Family Members. Proxies aren’t obliged to consult family members at all. Doing so could be counterproductive in some cases, as family members won’t know all the health details. 
• The Senior is Declining Faster Than Expected. There are multiple reasons why this might be the case:
  • You may not fully understand the senior’s diagnosis or current health, so natural declines may seem sudden. This is especially common if you live in another state and rarely see the senior in person.
  • Some comfort measures may decrease the senior’s function while improving comfort (such as considerable increases in pain medication).  
  • Health can be unpredictable, where a person may improve or decline suddenly, despite expectations.
• The Proxy is Going Against Doctor’s Orders. Physician advice generally focuses on extending life, but this won’t always match the senior’s wishes. The proxy is ultimately responsible to the senior’s wishes, not what the doctor recommends.
• The Proxy is Making Wrong Decisions. There are few right and wrong decisions for healthcare. Most things come down to personal values and what matters most. For example, some seniors may want to stay at home as long as possible, regardless of risk, while others may prioritize safety.

What if the Proxy Refuses to Let Some Family Members Visit?

This is an interesting situation.

Generally, family members should be able to visit the senior and will often be encouraged to do so. This is especially true towards the end-of-life, as people are looking for the chance to say goodbye and find closure.

Seniors also have the right to see the people they wish to. This is often true even if they lack capacity for healthcare decisions. The right is even written into the law for some states (like Arizona).

Despite this, there are specific situations where the proxy may be justified in restricting family members, particularly if the family member is interfering with care or if there is considerable family drama.

For example, I saw a forum thread where an adult child insisted on feeding her aging mother and transferring her independently, against the instructions of the PoA and assisted living staff. In doing so, the woman interfered with some treatments and even contributed to a broken bone. Because the woman refused to listen to requests she was eventually denied access.

Can The Proxy Place the Senior in a Facility?

The short answer here is yes, a healthcare proxy can certainly make this decision.

Notably, being a proxy does not make someone responsible for providing hands-on care. While some proxies do also act as caregivers for their loved ones, plenty of others don’t. The choice is theirs.

An interesting situation arises when the senior wishes to remain at home for as long as possible, but the proxy still chooses to put them in a facility. This may happen because there just isn’t a way to keep the senior safe at home within the available resources. This is especially true if the proxy can’t provide hands-on care or if the care requirements are too much to handle.

This situation highlights the importance of asking questions instead of assuming that the proxy is doing something wrong. You’ll often find that what the proxy needs to do simply doesn’t look like you expect it to.

Things to Watch Out For

• Excessive Control or Privacy. While proxies do need to respect privacy, there should still be things they can inform family members about, like the senior’s overall health and their prognosis. Proxies that don’t tell anyone anything are a major cause for concern.
• Unusual Spending Patterns. Unusual spending on the part of the senior or the proxy could be a sign that the proxy is abusing their position (especially if they’re named on the financial PoA).
• Decisions That Don’t Match the Senior’s Values. The proxy should be making similar decisions that the senior would make themselves. Large discrepancies could be a cause for concern.
• The Senior Being Isolated. Completely isolating a senior is a major red flag and a common indication of abuse.

It’s important to be cautious here, as there are often good explanations, even for red flags like these. For example, an aging parent may not have told you their true end-of-life wishes because they didn’t want to alarm you, but these wishes are recorded in their living will.

How You Can Change Things

While proxies are generally trying their best, they’re not perfect. Sometimes action may be needed, especially if you’re concerned about potential abuse. Here are some approaches to consider:

Have Gentle Conversations

The first step is to talk to the healthcare proxy about their decisions and the senior’s health.

It’s best to be gentle and curious here, instead of coming at them with criticism.

For example, you might ask why the healthcare proxy is making a particular decision – like why they want the senior to be in a facility instead of being at home. You could also suggest ideas for them to think about.

If the proxy isn’t too stressed or overwhelmed, they’ll likely answer your questions and perhaps take your suggestions on board. They don’t want family drama any more than you do.

Still… they may be under too much pressure to be able to deal with these conversations. There may also be confidentiality issues that influence what they’re able to tell you.

Consider a Mediator

Sometimes you might need a third person, like another family member, a neutral party, or even a professional mediator.

Getting an extra person involved can help to balance difficult conversations, making it easier for the healthcare proxy and you to understand each other’s perspectives – hopefully with less drama.

Doing this can also help you get extra perspectives. Perhaps a family member understands the proxy’s decisions better than you do or has extra insights into the senior’s wishes.

Take Legal Approaches

If you’re convinced that the proxy is making poor decisions or taking advantage of your loved one, you could take the legal route.

This will often be a guardianship procedure, which could give you control over financial and healthcare decisions for the individual.

You’ll need a decent amount of evidence for success here. Crucially, you need to prove the proxy is going against the senior’s wishes or that they’re taking advantage of them. Even if you have the evidence, the legal process is long and expensive, and there are no guarantees.

Talking to a lawyer is a good starting point. They can give you insights about what to expect, plus an idea of whether you’re likely to be successful.

In the case of a financial PoA, you may be able to petition for an assessment, which can involve an examination of the proxy’s paperwork and decisions. However, you’re not the one who gets to access the financial information as part of this process.

Final Thoughts

Assigning a healthcare proxy often creates family challenges, including many we haven’t covered here. Such challenges are tough enough in a family that communicates well. They can quickly get insane in families that are prone to conflict and misunderstandings.

Yet, there really isn’t any other way. If you’re not the PoA, you may simply need to step back and accept that most of what’s happening isn’t in your control. You could take the legal route and fight for guardianship, but this is really only worth it if there is something seriously wrong. Most of the time, it’s a matter of gritting your teeth and being there for your loved one as best as you can.