From the Guidelines
The next best step for a patient in long-term care with no Power of Attorney (POA) or representative agreement is to have the healthcare team identify and contact family members according to the hierarchy established by state law, and if necessary, consult with the facility's interprofessional, multidisciplinary committee or ethics committee to ensure timely decision-making. This approach is supported by the American Thoracic Society/American Geriatrics Society policy statement 1, which emphasizes the importance of early identification of incapacitated and potentially unrepresented patients and comprehensive efforts to find a surrogate.
When a patient lacks decision-making capacity and has no designated representative, the facility should make efforts to locate family members who can serve as surrogate decision-makers. In situations where no family is available, the facility's ethics committee or a court-appointed guardian may be necessary to ensure the patient's care continues. The healthcare team should document all efforts to locate decision-makers and any emergency decisions made, as recommended by 1.
Additionally, providing patients and their families with information and counseling on appointing an Alternate Decision Maker, developing advance directives for care, and palliative care options is crucial, as suggested by the Canadian Stroke Best Practice Recommendations 1. However, the most recent and highest quality study, 1, takes precedence in guiding the next best step for patients in long-term care with no POA or representative agreement.
Key considerations include:
- Early identification of incapacitated and potentially unrepresented patients
- Comprehensive efforts to find a surrogate
- Consulting with the facility's interprofessional, multidisciplinary committee or ethics committee when necessary
- Documenting all efforts to locate decision-makers and any emergency decisions made
- Providing patients and families with information and counseling on advance care planning.
From the Research
Next Best Steps for Patients in Long-Term Care Without POA or Representative Agreement
- If a patient in long-term care has no Power of Attorney (POA) or representative agreement, the next best step would be to discuss options with a social worker, as they can facilitate collaboration and advocate for the patient's needs 2.
- Social workers can help identify the patient's wishes and preferences, and involve family members in the decision-making process, which is crucial in advance care planning 3, 4.
- The patient's family should be encouraged to participate in discussions about the patient's care, as their input is valuable in ensuring that the patient's needs are met 3, 5.
- It is essential to respect the patient's autonomy and involve them in decision-making whenever possible, taking into account their cognitive capacity and ability to make informed decisions 6, 4.
- Healthcare professionals, including social workers, can play a vital role in facilitating advance care planning discussions, addressing the patient's and family members' concerns, and promoting communication among all parties involved 3, 4.