Patient with Dementia, Extended Family Want Power of Attorney

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.

AD04

Full Member
10+ Year Member
Joined
Dec 27, 2011
Messages
610
Reaction score
706
setting: general psychiatry outpatient

This is a potentially hairy case that has been scheduled but not yet seen:

Person married into the family (which I'll refer to as "person" from now on) claimed to be the caretaker of patient with dementia. Person claimed patient has no close family as the spouse and children of patient all passed away. Person is seeking to be power of attorney for patient. Person is seeking to change will of patient as people named in will all deceased.

Psychiatrist cannot verify if person is telling the truth -- if person really wants to help patient or has an ulterior motive ($$$). Psychiatrist want to provide clinical care if warranted but don't want to get involved legally.

How to best proceed? Would geriatric or forensic specialist be best in this case for the patient?

Members don't see this ad.
 
Social work/APS to determine next of kin

Do you know this patient lacks capacity?
 
  • Like
Reactions: 1 user
Social work/APS to determine next of kin

Do you know this patient lacks capacity?

If you have a solo PP there’s no social work to consult
 
Members don't see this ad :)
This is easy if context is institutional/public clinic, insurance based etc--send to the higher ups and they can figure it out, SW support, etc

If you are solo PP, this is generally not part of clinical care. You can either provide forensic services and charge appropriately or provide clinical care. It's typically frowned upon to do both at the same time. In limited scenarios it's possible that you have to do both, in which case I would just bill by the hour.
 
  • Like
Reactions: 3 users
The capacity to change a will is substantially lower than the capacity to sign POA. If the patient lacks the ability to change their own will, they almost undoubtedly lack the ability to sign POA.

Document, report to APS.
 
  • Like
Reactions: 2 users
setting: general psychiatry outpatient

This is a potentially hairy case that has been scheduled but not yet seen
Why is the patient scheduled with you? If there's some clinical complaint that they're expecting you to address, you can do so and make it clear that you aren't doing a forensics eval.

Edit: on the other hand, if during your visit it's clear the patient lacks capacity for medical decisions, you have to do something. A few people above state to report this to APS -- without an in-house SW is that really the best way to go about setting up a POA in such a case?
 
  • Like
Reactions: 1 user
I may not be understanding your question, but you won’t be determining who should be POA or what/how to change the will.

This is basically a capacity consult, but I’d want the attorney being used to determine the specific questions to be answered.
 
I don't understand the context of your question. What is your role in this case? Are you a treating provider for medical care? In that case, unless they are legal guardian/conservator(depending on how the laws are in your state), then they can't override the decision making of a competent patient regardless. If the patient does not have capacity, then you need to figure out who will make medical decisions on their behalf. They don't need to be POA or anything else if they are also next of kin. A POA that is not for healthcare doesn't override next of kin either for medical decisions.

Separately, if you have reasons to suspect that a vulnerable adult is being taken advantage of by this person, you need to call APS to investigate.
 
I agree the OP needs to return and clarify the situation. Some posters seem to be assuming that some aspect of this PoA/will controversy, like a capacity evaluation, is the chief complaint/reason for presentation, but the OP didn't say that. How I read the OP is that he was browsing his schedule in advance, delving into the charts of new patients, and pieced together this story from, say notes from previous encounters with the PCP or others. That doesn't mean that this "person" is bringing the patient in specifically to try to get a psychiatrist on his/her side in this will/PoA contention. That may very well be the case, but if it is, the OP should tell us.
 
Thanks for the responses everyone. They were very helpful. Person was notified that the visit will be for clinical purposes only and anything more should be referred out.
 
Thanks for the responses everyone. They were very helpful. Person was notified that the visit will be for clinical purposes only and anything more should be referred out.

Yeah I was gonna say I recently took guardianship and poa of my mother, and the only input any medical professionals had was to test for capacity & then write a letter recommending my EPOG/EPOA be activated once nil capacity had been determined. I'm in Australia, so things might be different here, but if extended family wanted to challenge for the guardianship etc themselves then they would've had to have arranged a legal hearing with the Public Trustee.
 
I still remember this case. I saw the patient and explained to patient and family-in-law I can only provide clinical treatment and started her on an antidepressant. I gave them information of other psychiatrist specialists to help with POA. And they never followed up with me after that.
 
  • Like
Reactions: 1 users
I still remember this case. I saw the patient and explained to patient and family-in-law I can only provide clinical treatment and started her on an antidepressant. I gave them information of other psychiatrist specialists to help with POA. And they never followed up with me after that.
probably the best outcome for you
 
  • Like
Reactions: 3 users
You're not in a position to determine if specific people are the best caretakers. This is for other professionals and the court to determine. You job is to evaluate and treat.

So e.g. dementia dx, treatment, and recommendations that the person needs a guardian. You don't determine who the guardian or power-of-attorney is. During your evaluation you may get enough information to offer an opinion but this is ultimately not your decision so rest easy on that matter.
 
  • Like
Reactions: 1 user
Top