A New Twist on Advance Directives

by Joanna Smith on Aug 25, 2011

I heard a story the other day from a colleague about a situation that is occurring more frequently as the population ages, and some people are trying to manage living alone and staying in their own homes.

In this particular case, an elderly woman, who lived alone and had no living family members caring for her, was being admitted to the hospital for surgery.  At the admitting office, the hospital employee asked, as is required by federal law, if the woman had an Advance Directive (which names an agent to make healthcare decisions on her behalf if she is unable to).  The woman said she did not.  What is supposed to happen next is the hospital employee is directed to ask if the woman would like to speak to someone about filling one out.

What happened instead was the hospital employee offered to become the agent for the woman and complete the directive right then.  The woman gratefully accepted. She was in a vulnerable position, and someone offered to help her:  why would she refuse the help?

Because it is a clear violation of federal law, and is a version of elder abuse—both legal, emotional and physical.  After the woman had her surgery, her agent—the employee of the hospital– approved placement in a nursing home.  The woman stated that she wanted to return home, but the agent would not authorize it.  She visited regularly, and the woman became quite attached to her.  When a distant nephew questioned the relationship, his aunt became extremely upset and told him to “stay out of it”.


Why is this wrong?  Hospital employees may not be agents on someone’s advance directive (unless they are already related) because it is a conflict of interest, and federal law prohibits it. In addition, this is victimization of an elder who is vulnerable. In this situation, a single, elderly woman with no known support system agreed to have an unknown person assume the responsibilities of making the most fundamental healthcare decisions for her.  It also appears that this  hospital employee may have obtained control of the woman’s checkbook and financial affairs.



What can you do if you see or hear of this kind of situation?  There are several approaches.  Some people are mandated reporters—physicians and social workers, for example.  If they SUSPECT elder abuse, they need to report:  they do not need to have proof, they only need to suspect in order to report.  But other people can still report, even if they are not required to and they, also, do not need to have proof, they only need to suspect.  In your county or city, you can report, depending on local regulations, to the Adult Protective Services agency or the local police.

There is another way to address this, however, and that would be to call the Risk Management Department at the hospital.  That department is charged with reducing the hospital’s exposure to law suit, but they also can address the issue directly with an employee who is violating the law.  While Risk Management will not tell you the outcome, you can be assured that they are interested in protecting themselves from suit and will address the issue.  It’s best to report to both:  Adult Protective Services and the Hospital.


Listening Carefully

by Joanna Smith on Sep 13, 2010

At Healthcare Liaison we work with people of all ages, so some of our clients are very young (infants) and some are elderly.  I had a call from an older client the other day.  She was concerned because she lived far from two of her children, and close to one of them—but that adult child traveled a lot for work and also had a family of her own.  My client wanted to know what she could put in place to help relieve all three of her children from worry about her.

As I listened to her talk, I realized again what a big part fear plays in the minds of people as they age.  It does not seem to matter whether they are actually ill at this moment:  the conversation is filled with “what if” thoughts and concerns.  “What if my son is traveling when I’m sick?  How will anyone know how to reach him?  What if I need help at home and my daughter is too busy to do it herself?  I live alone:  what happens if I fall and end up in the hospital? “The initial concern about not being a burden was clear, but listening carefully I heard a strong subtext:  “I’m scared and don’t know how I’ll manage.”

Too often I find that adult children take the overt questions quite literally, and try to problem solve, rather than listen to the underlying fears.  The questions listed above are beautiful “openers” to a discussion about the kind of care the aging relative would like to have, where they would like to be cared for and how they envision their death.  These are difficult discussion to have at any time, so adult children can welcome these subtle invitations to talk.  IN ADDITION TO problem solving (by perhaps getting a “medic Alert” button or hiring help at home or someone to check in on a regular basis) consider this an invitation to discuss other topics:

Fears about their care

Setting up notification systems when they become ill

Giving up independence

Advance Directives

Different living options

If you need assistance in having this discussion, we can help!  Contact us to arrange a time to discuss your particular situation:  joanna@healthcareliaison.com or 510-704-8476.

Advance Directives—and Physicians Order on Life-Sustaining Treatment

by Joanna Smith on May 7, 2009

For years there have been “Advance Directives” that you could fill out to state what your wishes were about care for yourself should there be a time when you could no longer state your wishes.  Advance Directives allowed people to appoint agents to make healthcare decisions on their behalf, and to state the kinds of care they would wish to have.

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