October 28, 2013

The "unbefriended elderly" need this

This actually makes sense for those who find themselves without family and without someone they can trust to act as their health care proxy.  I strongly believe that having a health care proxy in effect that appoints someone you trust to make medical decisions for you can make the difference between a good death and an unnecessarily painful one.

Hiring an End-of-Life Enforcer

The chilling dilemma of “the unbefriended elderly,” who don’t have family or close friends to make medical decisions on their behalf if they can’t speak for themselves, generated a bunch of ideas the last time we discussed it.  One reader, Elizabeth from Los Angeles, commented that as an only child who had no children, she wished she could hire someone to take on this daunting but crucial responsibility.  “I would much rather pay a professional, whom I get to know and who knows me, to make the decisions,” she wrote. “That way it is an objective decision-maker based on the priorities I have discussed with him/her before my incapacitation.” 

Elizabeth, it turns out other people have been thinking the same way.
Last year, Dr. Berman and her co-authors published an article in The Journal of the American Geriatrics Society proposing a new type of professional: the health fiduciary.

“These people would largely be drawn from retired social workers or nurses, people in the helping professions,” Dr. Berman said. They might also be clergy, or perhaps paralegals. “They would need to navigate the health care system,” she added. “They could work comfortably and easily within that world.”

The co-authors envisioned health fiduciaries undergoing up to a year’s training (those already knowledgeable about medical matters and end-of-life decisions would probably need far less), followed by certification in individual states.
Fiduciaries would probably work out of elder law firms or geriatric care management practices, Dr. Berman figures, because clients might retain them so many years in advance that they’d want that kind of continuity.

How much would a health fiduciary cost? In ballpark figures, the authors assumed they’d charge $100 an hour, much less than an attorney or even most geriatric care managers. They might spend 20 hours initially to understand and document a client’s wishes and to later consult with health care providers, the authors theorized — plus additional discussions every few years to see if the client’s thinking or health status has changed.
Posted by Jill Fallon at October 28, 2013 3:32 PM | Permalink