power of attorney

hannah: planning for the future is even moreimportant after a diagnosis of dementia, having lasting power of attorney for health and welfareallows the attorney to make decisions on your behalf if there comes a time when you areunable to make these decisions for yourself. hello i’m hannah and in this edition ofthe podcast i speak to helpline advisor vicky about lasting power of attorney for healthand welfare. she’ll also be giving her thoughts on the ‘your answers’ section of livingwith dementia magazine from february/march 2016.hannah: what is a lasting power of attorney for health and welfare?vicky: a lasting power of attorney, which is shortened to lpa - is a legal documentthat allows an individual to choose a person

they trust to make decisions for them if therewas a time in the future when they cannot and there are 2 types of lpa, one for healthand welfare decisions and the other for decisions about the person’s property and finances.hannah: who can make an lpa? vicky: to make an lpa you must be over theage of 18, have the capacity to make this decision and so this means that you are decidingfor yourself that you wish to make an lpa, and you understand what it means. when makingan lpa you are referred to as the ‘donor’. hannah: what happens when someone has setup an epa or enduring power of attorney already? vicky: lpas are part of the mental capacityact 2005, and only came into force in october 2007. before this people created epas, theseonly covered managing a person’s finances

and property. all epas made before october2007 are still valid and can still be registered. lpas are only valid in england and wales,there is a different system in northern ireland and these are called the enduring power ofattorney. hannah: what is the difference between anlpa for health and welfare and lpa for personal welfare?vicky: the lpa for health and welfare is also referred to as lpa for personal welfare; thetwo are exactly the same. the reason for this confusion is because the mental capacity act(mca) and the mca code of practice both refer to this type of lpa as personal welfare. whereasthe opg lpa form calls it lpa for health and welfare. it’s important to note that whateverpeople refer to them as they are the same

thing.hannah: what is the role of the attorney? vicky: an attorney is the person appointedby an individual who is making an lpa – (the donor) - to make specific decisions for themregarding their health and welfare. the attorney can make decisions relating to the person’scare and treatment and this covers a wide range of decisions, when making the decisionsthe attorney is acting as though they are the person and so is able to make the decisionsthe donor themselves would have made. hannah: who can be an attorney?vicky: you can choose anyone to be your attorney, as long as they are over 18. this is differentfor lpa property and financial affairs the attorney cannot previously have been declaredbankrupt, that’s the difference for that

one. it is essential to think carefully aboutwho you may appoint. the role of the attorney involves a great deal of responsibility andpower so it’s important to choose a person you can trust. think carefully about who youbelieve would be able to carry out the role and make decisions in your best interestsis reliable and has the skills to carry out the role. most people will choose a relativeor close friend, but you can ask a professional such as an accountant or solicitor. it isworth considering that a professional may charge for their time, and you need to namean individual rather than an organisation or company. the person who agrees to be theattorney must also sign the lpa form. when making decisions, your attorney must followthe mental capacity act. this means that they:

must act in your best interests, must consideryour past and present wishes and cannot take advantage of you to benefit themselves. youcan choose to have more than one attorney whereby you must decide how your attorneyswill act. they can make decisions together, they can act together and separately, or acombination of the two. you can also appoint a replacement attorney. this is the personyou would like to make decisions for you if your first choice attorney is no longer ableor willing to be your attorney. if the attorney fails to comply, the lpa must be cancelled.if an attorney has taken advantage of you, this will be investigated by the opg and theperson could be prosecuted. having an lpa in place can therefore offer you protectionfrom potential future abuse.

hannah: what happens when someone doesn’thave a person who can be their attorney for health and welfare?vicky: if there is no one who is able to speak on your behalf, such as a family member ora friend, an independent mental capacity advocate (imca) must be provided to protect your rights.an imca cannot make decisions on your behalf instead it is their role to represent yourthoughts and feelings when important decisions are made. an imca will be notified from thenhs or local council for example doctors, social workers and care home staff. an imcamust be involved when decisions relate to life sustaining medical treatment or decisionsabout where a person will live and there is no one else such as family or friends thatcan do this. an imca may be consulted about

a care review or adult protection procedures.hannah: what decisions does the lpa for health and welfare cover?vicky: an lpa for health and welfare allows a person, who is the donor, to choose a person,called the attorney, to make decisions relating to their care and treatment if they were everunable to in the future; this can cover a whole range of things. to use a lpa for healthand welfare it must be registered, and an attorney can only use their power if the personlacks capacity to make the specific decision. the mca code of practice states that an attorneymay make decisions about: consenting to, or refusing medical assessments or treatmenton the donor’s behalf, arrangements needed for the donor to be given medical, dentalor optical treatment, assessments for and

provision of community care services, wherethe donor should live and who they should live with, deciding the donor’s day-to-daycare, including diet and dress and deciding on the person’s leisure activities, thatis say what they do in their spare time, accessing personal information such as medical recordsand care plans. a attorney must be consulted when a care plan is being devised for thedonor, and they should agree to it. when a care plan is drawn up for a person that lackscapacity to consent to their care plan, an attorney for health and welfare must be consulted.hannah: does an lpa for health and welfare cover decisions about life sustaining treatment?vicky: an lpa for health and welfare only covers decisions about life sustaining treatmentif the person chooses this option when they

created it; it is a specific question on theform. hannah: what are the benefits of making anlpa for health and welfare? vicky: it can be reassuring to know that,if you are unable to make a decision for yourself in the future, the person you have chosento be your attorney will be able to make them for you. making an lpa can help you to talkwith others about your future wishes. making an lpa ensures that the person you want tomake decisions for you will be able to do so. this prevents a stranger, or someone youmay not trust, from having this power. it can be more expensive and take more time forfamily and friends to try and gain a similar power in the future.hannah: when a person lacks capacity can someone

make an lpa for health and welfare?vicky: if there comes a time when you can’t make a particular decision, and you haven’tcreated a lpa, the court of protection may need to become involved. although rare, itcan be possible to become a deputy for health and welfare this can give someone similarpowers to that of an attorney. this is because often when there is an issue it is usuallyabout one decision, for example, a decision about where someone will live. the court willdecide to make the one-off decision rather than giving someone the continuing power tomanage the person’s health and well-being. if someone were to apply to become a deputythe applicant must clearly show why a continuing power is needed and why the person who lackscapacity needs a deputy for their health and

welfare. a relative or friend can apply tobe your deputy, or a professional may be appointed. the process of becoming a deputy is a lotmore time-consuming and expensive than an lpa. if someone is considering this they maywish to speak with the court of protection about whether they should apply or not. usuallydecisions about care and treatment can be made without a legal power, and this willbe under the duties of the mental capacity act, in particular that all decisions shouldbe made in the persons best interests. hannah: if someone were to complete the formsnow, does it mean that they will no longer be able to make decisions for themselves?vicky: no, this is because the purpose of the form is so that if you were unable tomake decisions in the future, your attorney

can make these decisions for you. if you makea health and welfare lpa, your attorney cannot make decisions unless there comes a pointwhere you cannot make these decisions yourself. this is different for the property and affairslpa, as for these types of decisions you can decide that you want your attorney to actwhile you still have capacity, you would both have the power to act and make decisions. hannah: what is the difference between anlpa for health and welfare and an advance decision?vicky: if someone has an lpa for health and welfare and an advance decision to refusetreatment there are set rules for which one is valid. someone may have both an advancedecision and a lpa for health and welfare

and so it is important that the right oneis used and takes precedence. an advance decision only covers the refusal of treatment relatedto end of life care, and so this issue of which is valid only comes up where the lpafor health and welfare includes the ability of the attorney to make decisions about lifesustaining treatment. in these cases it will depend upon whether there is any guidanceon the documents and/or which was made last. hannah: what happens when someone is sectionedunder the mental health act and they have an lpa for health and welfare?vicky: if someone is detained in hospital under the mental health act, the mha it’sshortened to, the mha takes precedence. this means that an attorney for health and welfarecannot consent or refuse treatment for a mental

health disorder if the person is detainedunder the mental health act. hannah: how would someone set up an lpa formfor health and welfare? do you need a solicitor? vicky: many people find that they are ableto complete the form without legal help. it is necessary to ensure that the form is checkedthrough thoroughly as it is a legal document; a mistake in the form may mean that the lpawill need to be resubmitted again and will incur another administration fee. the feecurrently for registering lasting powers of attorney for health and welfare is â£110,but there are exceptions for people on certain benefits or a low income. however an lpa isa powerful legal document and you may wish to get advice from a legal adviser with experienceof preparing them; again costs are to be involved.

it can be helpful to look at the forms firstand read the guidance notes to decide whether you need legal advice.hannah: where can you access the lpa forms? vicky: it is possible to access them onlineon the gov.uk website and this includes guidance and prompts as you complete the form. if youwould prefer you can download paper copies from gov.uk website or have them posted toyou from the office of the public guardian who can also send free guidance booklets.on average it takes up to 12 weeks to register an lpa with the office of the public guardian.hannah: what happens once you have completed the form?vicky: once you have completed the form, you will need to get someone to sign it to statethat you have the mental capacity to make

an lpa. this means you have the ability tomake this decision; you understand what an lpa is and you made the decision yourself.the signed form is a 'certificate of capacity' and the person is called the certificate provider.they can be: a professional, such as your doctor, social worker or a solicitor or theycan be someone who has known you for two years, but is independent that isn't a family memberor an attorney and they will not benefit from the lpa, there is more information about thisin the guidance notes. you also need to sign the form in front of a witness, and each attorneymust sign the form to say that they agree to act as your attorney if needed in the future.they will also sign to show that they understand the duties this involves. in addition, youare given the option to list one or more 'people

to notify'. this is someone who you want tobe alerted if there is an application to register the lpa. this could be almost anyone, forexample a friend or relative. the purpose of this is to provide you with an additionalsafeguard. it is only an option, so you can choose not to name someone, but many peoplelike the protection it can offer, and the reassurance of knowing that people will bekept informed of what is happening. hannah: how would someone know if there isan lpa in place? vicky: in some situations someone may wishto check that someone is an attorney if they claim they are so. so it is possible to searchthe government registers to see whether someone has got an attorney acting for them. you wouldneed to apply to search the public guardian

register, complete a form and send and sendthis to the opg. the information required to carry out the search would be the personmaking the application name and address. they would also need to provide the ‘donor’sdetails’ that is again the person with dementia, their full name, date of birth and address.an alternative address can also be provided, and this can be helpful if the person movedsince they have made an lpa. hannah: what organisations are useful whenmaking an lpa for health and welfare? vicky: you can go to the citizens advice bureau;they are often the best starting place for advice, also through the office of the publicguardian, the court of protection, solicitors for the elderly, age uk or you could ringthe national dementia helpline or contact

us on the email or the live online adviceservice. hannah: in the february/march 2016 editionof ‘living with dementia magazine’ the magazine of alzheimer’s society, the youranswers section asked the question ‘what to do if a person with dementia walks outof shops without paying for goods’. in this section talking point members share theiradvice on what to do if a person with dementia walks out of shops without paying for goods.aisha rebecca said 'one suggestion could be to let the shop staff have a contact numberfor yourself or someone close by, who could be the first port of call. if they make anote of what the person is taking then you can go up to the shop later and pay for thegoods. if they are unaware then you'd have

to take things back or pay for all the thingsyou later find at home. or have a week's "tab" set up that they can take it off of when theywalk out without paying. basically it is all about awareness. make them aware of the person'scondition and i have found that people are often understanding.vicky: this is a good suggestion as it helps the person with dementia keep to a familiarroutine. if they were to be stopped from going to the shops it may lead to the loss of self-esteem;confidence and independence. talking with the staff about the person’s dementia willhelp them have a better understanding on how someone with dementia may behave. giving themanager a photo and or a contact number can help with this continuity of understanding.the person with dementia could carry around

a ‘help card which we have at the alzheimer’ssociety on which you can put down personal information and contact details of someonewho can help them they could also carry round an identity bracelet as well. arranging atab for the person with dementia can work well with a local shop that you have establisheda good relationship with. some supermarkets may have a pre-paid card /store card to useworth seeing. absolutely awareness is the key. encouraging others can help a communitybecome more dementia friendly. hannah: fellow traveller said, ‘when myhusband, who has early-onset alzheimer's, was still able to do the family weekly shopat morrisons by himself, he started to come home with things without paying for them.he'd load up the conveyor belt and chat away

happily to the cashier. then take goods backoff and put them in the bags in his trolley before they had gone through the till. mymain worry was the stress it would cause him if the security guards accused him of shoplifting,so we decided to try talking to morrisons about it. i made an appointment with the manager.we went along together and met him. he was brilliant. he introduced my husband to histeam of supervisors and explained that he had memory problems and may need a bit ofhelp. it made us feel quite secure about my husband continuing to shop there – in factit was the last place he still went shopping independently.'vicky: this sounds like a very supportive experience for the pwd and those close tothem. it’s important to help maintain a

sense of normality for as long as possiblehannah: jeanie 73 said ‘i have found myself heading for the exit of a shop without paying!thankfully i was with my daughter who called me back. it was not as if i was hiding things,as they were in my disability buggy basket and festooned on the handlebars. none theless, i would have been mortified if i had actually left without paying. these days irarely go out without my daughter to the shops.' vicky: what can be so upsetting and distressingfor the person with dementia is the fact that they are doing things very unusual to them;having someone there to support them can feel reassuring as well as keeping that independence.hannah: see the full discussion thread on this topic on talking point. thank you forlistening to the alzheimer’s society podcast.