Individuals today are living longer lives because of advances in medicine. As a result of these advances, many people spend time at the end of their lives in a nursing home or in a family member's home. During these months or years, a power of attorney (POA) will make financial and medical decisions for elder relatives when they are not able. If they have appointed a trustee, this person also will make the financial decisions. Frequently the trustee is also the power of attorney. The individual may also have named multiple people to serve in these positions. The transition for the appointed trustee/power of attorney can be a difficult time, especially if they have not heard other people's experiences or had counseling with an elder care attorney. In this article, I will try to pass on some of what I have learned in the last year being the sole power of attorney and trustee for my Grandmother.

An individual can choose to appoint one or more power of attorneys to make decisions for them financially or medically. If you are appointed POA, it is important to keep in mind that all decisions are to be made as that person would wish and not as you would choose. If the person you are making decisions for is incapacitated mentally, you will be making these decisions alone or with the assistance of other appointed power of attorneys. A financial power of attorney has the authority to make financial and legal decisions. This includes a wide range of powers that are designated within the power of attorney document but can include everything from the right to write checks, pay bills, buy and sell property and even sue in the individual's name. The document is lengthy to include all possible scenarios but typically will end with a broad statement that gives the power to do anything the individual would do on their own. Recently (2009), banking regulations have changed and while the document may include something like "open accounts in my name", this may not be possible. It is recommended that all powers be discussed with the attorney who created the documents or if this is not possible, an elder law attorney.

Initially, the power of attorney documents will be needed at each place the individual has an account. The bank, cable company, telephone company, utility companies, will all want to see the document before allowing access to an account. Typically you will fax a copy to their legal department, they will review the document and once approved, will give you access to the account. Keep in mind that this process can take up to 14 days, with a minimum of three working days. If possible, you can take a copy to the company and show it to speed the approval process. Making copies of the original is highly recommended because you will use them a lot when you first take over as the POA. Some places will be easier to deal with than others. Don't be afraid to ask for a manager if a representative of a company is difficult. Once the POA document is effective, you are legally seen the same as if the person you are serving were there. They should treat you the same as if you were the actual customer. Most companies are very easy to work with once the legal department accepts the documents but others can require more time. They should add your name to "users" on the account and may require you sign a card so that they have your signature on file. Initially, you may spend quite a bit of time gaining access to all of these accounts, but once accepted as a user, it is the same as accessing your own accounts and paying your own bills each month.

Some individuals create trusts before they can no longer control their finances. Initially the trust appoints them as the trustee and possibly other individuals. If their assets are listed in a trust and you are appointed trustee prior to their incapacitation, they should have provided copies of the trust to each place that has an asset to the trust. This might include financial institutions that hold money market accounts, stocks and bonds and even the deed to their home. As a trustee, you have the same powers on the accounts as the power of attorney but you are able to sign your own name instead of signing as the person on whose behalf you are acting. Keep in mind, trusts can be designed in different ways so getting counsel from the attorney will be extremely beneficial to you in the future if you are not familiar with your rights as a trustee. There may also be a special co-trustee designated to review the trust and ensure ethical decisions are being made. This is a security measure for the owner of the trust. Multiple people may also be designated as trustees and each person can access the trust in a similar fashion. If revisions have been made to the original trust, all financial institutions holding accounts within the trust will need a copy of the most recent version. Similar to implementing the financial power of attorney, some institutions may be more difficult to work with than others. It is necessary to be persistent and make sure that each institution documents when they have accepted the trust so that future dealings with them go smoothly.

Another way that individuals may be asked to serve; besides financial power of attorney and trustee, is health care power of attorney (also called durable power of attorney for health care). This is a separate document that allows the appointed person(s) to make all medical decisions for them. They may also have an advanced directive, which lays out their wishes with regards to lifesaving techniques. These wishes should be followed as the medical power of attorney even if they are not what you would choose for yourself. If you are the appointed medical POA you are the person the doctor will call if anything needs approval. For example, if the person is in the hospital and a procedure of any sort needs to be done, approval will be sought from the medical power of attorney. This can include such things as the placement of a semi-permanent IV line (picc line) to the changing of medications. If the approval is given over the phone, most hospitals will require you to give verbal orders to two different people. A nurse may call and ask for your approval and then hand the phone to another nurse so you can give approval to a second person. If you are onsite, you can give approval by speaking face to face with just one person. It is important that you understand that for a sick individual you will be asked to approve or deny treatments frequently. This can be overwhelming and having a good support system around you will be very helpful. If you have multiple family members serving as medical power of attorney, the entire group will have to discuss treatment options and come to a decision. Ethically, it is best to follow the orders of the advanced directive. If the individual does not want a tube placed, CPR or antibiotic treatments, you should follow those orders because as stated above, you are to make decisions based on their desires. Doctors, nurses and social workers at the hospital or nursing home can be a great resource if you need counseling on what to do in various situations.

Emotionally, for many people (including myself), serving as the medical power of attorney can be significantly more difficult than trustee or financial power of attorney because medical teams will rely solely on your decision. While there may be an advanced directive in place, the medical POA can choose a treatment different than directed and they must follow the orders by the POA. Don't be afraid to ask for help from the staff at a nursing home or hospital. Because they work solely in this environment, they can be a great resource.