powers of attorney and healthcare directives

In short

A friend of mine once spent three weeks at a hospital bedside, unable to pay his father's bills or speak for him to the doctors, because no papers had been signed. You have probably wondered whether you need such papers yourself. Two documents do most of the work. A power of attorney names a person to handle your money and legal matters if you cannot. A healthcare directive names a person to speak on your medical care and records your wishes. Each state writes its own rules and forms, so start with your own state's forms. Sign them while you are well and clear headed. Then tell your agent where the papers are kept.

The whole of it

What it is

I once sat on a porch with a neighbor who had just buried her husband, and she told me the grief was bad but the paperwork was worse. Nobody had been named to act for him when he fell ill. So she spent months asking a court for permission to do what she had always done at home.

These two documents exist to spare people that. A power of attorney is a written paper in which one person, called the principal, gives another person, called the agent, the right to act for them. The agent might pay bills, sell a car, or file taxes. A healthcare directive is a paper about medical care. It usually has two parts. One part is a living will, which states what treatment you would want or refuse near the end of life. The other part names a healthcare agent, sometimes called a healthcare proxy or a healthcare power of attorney, who makes medical choices if you cannot.

Some people mix these up. They are different papers with different jobs. A money agent cannot automatically make medical choices, and a healthcare agent cannot automatically touch your bank account. Many people sign both and name the same trusted person, or two different people, depending on who is best suited to each task.

How it works

If you are holding a blank form and wondering how it all fits together, here is the plain path. The principal chooses an agent and signs the paper. Each state sets its own signing rules. Some call for a notary, some call for witnesses, and some call for both. Your state's own statute or its attorney general or health department website will say which.

A power of attorney comes in a few kinds. A general one covers a wide range of money matters. A limited one covers a single job, like selling one house. A durable one keeps working even after the principal loses the ability to decide. That word durable matters a great deal. An ordinary power of attorney may end the moment the principal becomes incapacitated, which is exactly when the paper is needed. Many states presume a power of attorney is durable unless it says otherwise, while others require specific words. The form itself will tell you.

Some powers of attorney take effect right away. Others are called springing, meaning they spring to life only after a named event, such as a doctor certifying that the principal cannot manage affairs. A springing paper can feel safer, but it can also cause delays, because the bank may want proof before it will honor the agent.

A healthcare directive works only when the principal cannot speak for themselves. While you can still decide, you decide. The paper waits in the drawer. When you cannot, the hospital looks to your agent and to your written wishes. The agent must follow what you wrote and, where you were silent, act in your best interest.

A principal can cancel either document at any time while competent. A new paper usually replaces the old one, and the old agent and any bank or doctor holding a copy may keep relying on the old version until they are told.

The numbers, and where to find yours

These papers have few numbers in them, but a few matter. Notary fees are set by state law, and each state's notary rules say what a notary may charge. Many banks, hospitals, and senior centers notarize for little or nothing for their customers. The cost to have a lawyer draft a package varies by lawyer and by town, so ask for a flat fee before you sign anything.

Age matters too. An adult must usually be at least the current figure, which the official source publishes each year to sign. Your state sets that age, and your state's statute is the place to confirm it.

Where do you find your state's forms? Start with your state attorney general, your state bar association, or your state department of health. Many hospitals also hand out the healthcare form at no charge. The National Hospice and Palliative Care Organization and the American Bar Association both publish plain guides, and the Centers for Medicare and Medicaid Services explains patient rights in hospitals. A form from another state may not be honored where you live, so use your own state's version, and look at it again if you move.

A worked example

Let me tell you about a woman I will call Ruth Ellison. Ruth is 58, a widow, with a house, a checking account, and a daughter named Carla who lives forty minutes away. She also has a son, Daniel, who lives across the country.

Ruth sat down one rainy Saturday and thought it through. Carla is close and good with numbers. Daniel is steady in a crisis and has always asked sensible questions. So Ruth named Carla as her agent for money and Daniel as her agent for medical care. She also named each as the backup for the other.

At a local bank, a notary stamped the power of attorney for no charge, since Ruth was a customer. Her state also required two witnesses for the healthcare form, so two neighbors signed it. Ruth made copies. One went to Carla, one to Daniel, one to her doctor, and one stayed in a folder in her desk labeled for the family.

Two years later, Ruth fell, hit her head, and could not speak for a week. The hospital asked who could make decisions. Daniel showed the directive. Carla used the power of attorney to pay the mortgage that month. Suppose the mortgage is $1,240 and the electric bill is $135 and the insurance premium is $210. Carla paid $1,240 plus $135 plus $210, which is $1,585, from Ruth's own account, with a record of each payment. No court, no delay, no fight.

Ruth recovered. She thanked both of them. Then she kept the papers right where they were.

Where it goes wrong

I have seen good people trip on small things. The most common stumble is signing and then telling no one. A paper in a locked box that nobody can find helps nobody. Give copies to the agents and to the doctor.

Another is picking an agent out of loyalty rather than fitness. The oldest child is not always the best fit for the job. A good agent is calm, honest, and easy to reach.

A third is vague wording. A living will that says only that you want no heroic measures leaves doctors guessing. Say what matters to you in plain words, such as whether you want a breathing machine or tube feeding.

Some people forget about out of state moves, since a form from one state may not fit another. Some forget to update after a divorce, a death, or a falling out. Whether a former spouse named as agent stays in that role after a divorce depends on state law, so the paper should be changed to be safe.

Banks and hospitals can also be slow to accept a paper, especially an old one. It helps to ask your own bank whether it has a preferred form.

Last, agents can misuse their power. A power of attorney is trust in writing. Pick someone worthy of it, and consider naming a second person to see the statements.

Questions to answer before you leave this page

Who is the one person you would trust to pay your bills if you were ill, and would that same person be the right voice for your medical care? Have you asked them, kindly and plainly, whether they are willing to serve? Have you thought about what kind of care you would want near the end of life, and could you put it into a few honest sentences? Do you know what your own state requires for witnesses or a notary, and have you looked up the official form on your state's website? Does anyone besides you know where the signed papers are kept? Have you given copies to your agents and your doctor? And when did you last check whether your choices still fit your life as it is today?