The Thankful V/S The Burdened: A View On Medical Power Of Attorney

If you have ever needed someone to step up and serve as the medical power of attorney for a mentally ill patient, you know how difficult it can be to get that commitment. And how that person responds emotionally to your request can make you feel proud to be a member of the human race or ashamed that you’re included in the group.

I do clinical assessments of patients being admitting to an inpatient geriatric psychiatric program. My job is to ensure that my patients, who are often suffering from dementia and are actively psychotic, will have someone to act in their best interests while they are receiving treatment.

Here’s why I’m writing this: We clinicians need to remind ourselves constantly that relationships in the greatest family histories and the deepest personal friendships can be ruined for an endless number of reasons. Even though we might be in dire need of assistance from a family member or a patient’s friend, it is irrational to expect that all of them will be willing to serve in that role.

We can never fully know the interpersonal conflicts and histories that might have led family members to choose not to care for one another any longer. We can only do our best to convey how badly their help is needed and explain thoroughly why their assistance is so crucial to the patient’s treatment. And when clinicians have made every effort and nobody will step up, we can still be vigilant on behalf of patients who cannot help themselves, and not give up.

I see people every day who not only embrace this responsibility, but are deeply thankful to have been chosen or nominated. On the other hand, I also see people who are so burdened by the mere request that they refuse it. The humanity that I witness in my job is often beautiful–seeing people care so deeply for older men and women. But often the humanity is equally ugly, when caring is actually nonexistent among family members and “friends.”

There are choices available to clinicians. You can choose not to allow others to diminish your level of caring. You can choose to advocate for your patients even when it seems that nobody cares about the patient but you. You can be the difference in your patients’ lives when they cannot do so for themselves.

–  This article also published at Great Places Inc. The following are comments that were made in reference to this article:

“Jason, this post evokes strong emotions in me.  The elderly are so vulnerable and defenseless.  Each human life is so precious.  Thank you for being there (and advocating for that in other clinicians) when the patient’s family is not.  I just read a review of a book written by a brain scientist who had a stroke.  She writes about the different levels of care and respect she was shown by medical professionals, and how it impacted her and her recovery.  What a wake-up call! This book ought to be required reading.   http://drjilltaylor.com/book.html” – Comment made by Dale Carter of Transition Aging Parents

“Jason, you have articulated very well the sentiments of many professionals that deal with these situations.  I recently had a meeting with a daughter who said to me “I just want you to take over.  I want nothing more to do with Dad and I am moving out of state.”  When I heard her story I was surprised that she had stepped up in the first place to care for Dad for the last 5 years.  The other side of this is the depression of the person receiving care and the sadness when they realize that they have been abandoned by family and friends and often due to their own behavior. Sometimes in the case of memory impaired clients we never find out the story behind the story.  We as clinicians can make a difference by valuing every individual regardless of frailties or past mistakes.  Our ability to advocate, protect and care for others is the gift we have been given.  My philosophy: God’s love is realized in our daily dealings with our fellowman.  Remember in all you do that you may be the answer to someones prayer. Every interaction holds opportunity. An encouraging word or smile or the smallest act of kindness may be the thing that rekindles the flame in another to keep on for another day.” – Comment made by Anne Sadler of Smart Senior Services.

“I’m going to come at this from a different angle: the caretaker who just happens to be a registered nurse.  Nobody asked me to become guardian for my father – it just became evident that I needed to do so because of some decisions he was making in his life (i.e. selling his home for 100 k less than it was worth, buying a truck (he can’t drive) while I was away at work.  But the thought of having control over my father’s life was terrifying.  I had dreams that Eldercare Protective Services came out to see how much food I had in my refrigerator.  Social workers DO visit and I wondered: is my house clean enough, is my father’s room appropriate?  I’ve had bankers question my use of my father’s bank funds, as if I were sneaking off with it for some luxury cruise.  As a caregiver, I don’t get a lot of thanks for what I do, but I have always been treated kindly by my father. In the case of many family members, they have been treated unkindly themselves, often dealing with angry, irrational “patients” and extended family and have just “HAD IT!”  I can understand why family members and friends would shy away from the responsibility, especially in the litigious, disconnected society in which we live.  You’re right, Jason; all we can do as clinicians and caregivers is advocate in the best interests of our clients, or in my case, loved one.” – Comment made by Shelley Webb at Taking Care Of The Folks

“The end of life brings out the very worst in families. It also reveals some of the worst aspects of our healthcare silos — we have no “system” in the U.S.   This will always be a time for dysfunction for some families but providers should not let the patient down. Those who work in this area of care should remember that you get once chance to do it right, to bring comfort and calm to the sick or dying.” – Comment made by John G. Self of HealthCare Voice

“These stories show the variety of skill levels that people who are asked to be caregivers bring to the table.  Many of us haven’t done much work on our emotional lives and now all our beliefs are being tested from minute to minute.  I learned so much about myself from taking care of my husband for 8 years that I can almost say it was the strongest reason I am who I have became today.  Challenges can bring out the best or the worst in us and sometimes some outside help is needed to turn caregiving into a loving, intimate experience.” – Comment made by Christine Sotmary

“You are so right.  We do make a choice how we are going to serve or not serve others.  I also, agree that people looking outside in do not always have a grasp of the family relationships.  It is crucial not to walk into a situation assuming things are as they seem.  I like the idea of engaging thefamily members and doing what you can to help them see ways to be involved with the care of their ager.  The family dynamics are always so deeply rooted that it is wise to keep in mind in regard to filters when dealing with families that are known.  If you are in the family, you will already know the history and particular strengths and weaknesses of the people involved… you have an advantage and can find the best ways to approach those who will be helping. Good blog Jason.  I like the discussion this brings up.” – Comment made by Robyn Blaikie Collins of CaringSource

“Good post, Jason, you said it all.  We regularly provide home care for elderly who have no relatives alive or willing to help them.  Some have a public fiduciary and guardian provided by the county.  I have found the county case managers and our caregivers to care greatly about these vulnerable people.” – Comment made by Sarah Chancellor

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