The documents caregivers need to make medical decisions

Nearly one in five adults in the U.S. is caring for another adult with health issues or other needs. If you’re providing care to parents or older relatives, one important part of that support could be making medical decisions on their behalf or helping them make informed medical decisions.

The key to better caregiving is to have a conversation with your parents or relatives before they face a health crisis like a hospitalization or serious diagnosis. This provides you with an opportunity to get a clear understanding of their current health and their wishes in terms of healthcare. It’s also a chance to start gathering the documents you’ll need when making medical decisions.

There are several situations when you may need to take on the role of medical decision maker for parents and older relatives, including:

• If they’re diagnosed with a serious illness or sustain a serious injury
• If they cannot speak for themselves, for example after a stroke or if they have condition that affects their ability to speak
• If they’re being cared for by several specialists and are struggling to manage appointments, prescriptions, and medical records or are having trouble connecting with a specialist with experience treating their condition
• If they’re living with cognitive impairment or a serious mental health condition that may impair their judgment and ability to make decisions
• If they move to a senior living community or need to spend time in a rehabilitation facility after hospitalization and need help completing paperwork
• If they need help understanding and paying medical bills and managing insurance coverage and payments 

What documents do you need?

You’ll need eight documents to access your parents’ or relatives’ medical and financial information:

• HIPAA authorization: This allows healthcare providers to share information with you. HIPAA authorizations can be customized, allowing your parents to decide if there are some types of medical information they prefer not to share with you. There are generic HIPAA forms online or ask your primary care physician for one.
• Advance directive: An advance directive, or living will, details what specific types of medical care you do and do not want if you are dying or not expected to regain consciousness. It also outlines the circumstances when these decisions should be applied. For example, do your parents want to CPR if their heart stops? Do they want mechanical ventilation or a feeding tube? Your parents can get an advance directive template from their physician, have a lawyer create the document for them, or get a form from their state’s health department or department on aging.
• Durable power of attorney for healthcare: This document lists who you would like to be able to make medical decisions on your behalf (your healthcare proxy). Your parents can choose whether they want their proxy to be able to make all types of medical decisions or just specific ones.
• Durable power of attorney: This allows you to make financial decisions on your parents’ behalf, pay bills, and access financial information, including talking with insurance providers and hospital and healthcare provider’s billing departments so you can help with filing claims and checking and paying medical bills.
• Comprehensive medical record: An up-to-date comprehensive medical record is especially important if your parents are receiving care for several health issues from multiple providers or if they take several prescription medications. This medical record can ensure that information is available to everyone who treats them, which can lower the risk of overtreatment, duplicate testing, and drug interactions or overmedication.
• Do not resuscitate and/or do not intubate order, if desired: Even though this information is often included in an advance directive, if your parents do not want to be resuscitated if their heart stops or put on a ventilator, it can be helpful to have a separate order that is shared with physicians, EMTs, hospital and other healthcare facility staff, and staff at their senior living or rehabilitation facility.
• Medicare, supplemental, and long-term care insurance policy information: You’ll want to gather policy numbers and customer service phone numbers so you can review coverage, file, check, and dispute claims, and pay premiums.
• Letter of instruction: This details your family member’s end of life wishes. The information can include their wishes surrounding funeral and memorial service arrangements, burial or cremation plans, and organ and tissue donation. A letter of instruction may also include the location of their will and any safe deposit boxes, bank, investment, and retirement account locations and numbers, PIN numbers and passwords for banking and investment accounts, life insurance information, and a list of financial and legal advisors’ contact information.

A health advisor or health navigator can help you support your parents and older relatives, connect them with experienced specialists, arrange second opinions, and gather and consolidate medical records to help make sure they’re receiving the best care.