After receiving a diagnosis of dementia, families seek expert advice for advanced care planning. Advanced care planning includes legal documents that require understanding various aspects of care and their consequences on healthcare decisions. But one question often pops up – can someone with dementia sign legal documents?
Families and their loved one with dementia need to start advance care planning after receiving a diagnosis of dementia.
Medical experts and attorneys can help your loved one to be involved in their care planning.
Legal assistance may be offered by local non-profit agencies or social service agencies.
Advance care planning in dementia
Depending on their medical condition, persons with dementia are often capable of making their own decisions regarding legal aspects such as advance care planning. It is important to bear in mind that starting discussions earlier contributes to making sure the person with dementia remains involved and understands the planning process. Likewise, regular reviews of plans over time are beneficial for ensuring their wishes are carried out.
Including persons with dementia in their healthcare decisions is usually encouraged. When family members do not know the preferences of their loved one, they experience difficulties and distress in making decisions. Family members report feelings of guilt, self-doubt, and stress while making advanced care decisions.
Physicians and care teams can assist with discussions between the patient and their families to guide them about the patient's ability to make decisions. Healthcare providers should incorporate semi-structured questions to gather the necessary information when engaging with those who have dementia and their families.
Medications may be prescribed temporarily to improve memory or slow down cognitive decline through advance care planning. Medicare typically covers advance care planning discussions during the annual wellness visit, while private health insurance may also cover them.
Mental health counseling may assist individuals living with dementia in coping, as well as their families in learning how to manage more difficult emotions and behaviors before planning. Music or art therapy may play a role in reducing anxiety while increasing general well-being – both important aspects of advanced care planning for those living with dementia.
Laws in each state or country may differ. Working with elder law attorneys can help older adults interpret state laws, plan how wishes will be carried out, and understand financial options. Additionally, geriatric care managers, trained social workers, or nurses can offer support to those living with dementia, as well as their families.
What documents are included in advance care planning?
While advance care planning, families and their loved ones with dementia focus on creating a plan for long-term care and planning for funeral arrangements in advance. Advance care planning documents commonly include a durable power of attorney for healthcare, a living will, and do-not-resuscitate orders. (Depending upon state laws, additional documents may be necessary.)
A durable power of attorney for healthcare appoints another person who can act as a proxy for the person with dementia when the patient may not be able to make healthcare decisions for themselves.
A living will states a person’s wishes for end-of-life treatment. Their views about specific procedures such as dialysis, tubal feeding, or blood transfusion are noted. If the person becomes permanently unconscious (coma), then families can make treatment decisions based on wishes expressed in a living will.
A do-not-resuscitate order is placed in a patient’s chart when the patient does not wish to receive cardiopulmonary resuscitation (CPR) when their heart stops or breathing ceases. A doctor needs to sign these DNR orders before they can be placed in the patient’s charts.
The death of a loved one leads to grief and anxiety for the family. Advance planning for the disposition of remains after death benefits families by providing a sense of peace and reducing any associated anxiety. Persons with dementia can let their families know about their wishes e.g., the type of funeral or memorial service, burial or cremation, and disposal of ashes. If there are any arrangements already in place e.g., a family burial plot, or companion plot, then providing details to family members will make it easier.
Apart from these healthcare-related documents, families may need to have other financial documents in place. It may be a good idea to seek a lawyer for advice on financial management, estate plans, and other documents, which could aid the process of long-term care.
How to select a healthcare proxy
When selecting a healthcare proxy, individuals should consider a range of important factors, such as their wishes and applicable state laws, as well as their individual views on treatments such as dialysis, resuscitation, tube feeding, and organ/tissue donation. People often choose their spouse, adult family members, or a friend to be their proxy, while some prefer their lawyers or spiritual guides to be their proxy.
It is essential to ensure the patient trusts the proxy to understand and make decisions based on the best interests of the patient. Legally valid documents should be prepared before your loved one is incapable of executing them, and changes in the situation may necessitate revision. Other important aspects include the potential proxy’s physical/mental health, trustworthiness, reliability, and communication skills.
Advance care planning can be a sensitive topic for families and persons with dementia. Seeking medical and legal advice early on is useful for planning advance care. Involving the person with dementia in the planning process helps families to ensure that the wishes of the patient are respected.