In a perfect world, seniors would always be able to speak for themselves. But aging doesn’t follow the script. A diagnosis, a fall, or a sudden decline can make it hard, or impossible, for your loved one to speak for themselves. And when that happens, someone else needs to step in. The question is: who’s legally allowed to do it?
Medical decisions in senior living don’t run on assumptions. They run on paperwork. Whether your loved one is still fully independent or already in memory care, the right forms, and the right person need to be in place before anything goes wrong.
Authority Must Be in Place When Capacity Changes
In independent living, most residents handle their own doctor visits, prescriptions, and care decisions. But once someone moves into assisted living or memory care, new challenges often show up: confusion, memory loss, or just trouble keeping track of instructions. What used to be simple, like reviewing treatment options or managing symptoms, can start to feel overwhelming.
If your loved one loses the ability to make medical decisions, whether slowly or suddenly, someone else must take over. But unless that person is legally authorized, care teams and hospitals can’t take direction from them.
Why Medical Power of Attorney Is So Important
A medical power of attorney, also called a healthcare POA or healthcare proxy, is a legal document that names someone to make medical decisions on another person’s behalf if they become incapacitated. That person can talk with doctors, access medical records, approve or decline treatment, and make end-of-life care decisions. They can’t act outside the bounds of the document. And they can’t override what’s already written in an advance directive or living will.
Quick side note: Don’t confuse this with a financial POA. That’s a different role entirely. Medical POA handles care. Financial POA handles money. You’ll need both.
How to Determine Decision-Making Capacity
It’s not about age; it’s about understanding. If your loved one can weigh options, ask questions, and communicate a decision, they still have the capacity to make their own medical choices.
But if there’s any doubt, a physician (usually a primary care provider or neurologist) makes that call. In memory care, where cognitive decline is expected, capacity is reassessed regularly. In an emergency, staff need to know, right away, who legally speaks for the resident. Different states use different terms: healthcare proxy, surrogate, POA. The title varies. The role is the same.
What Happens When There’s No POA or Advance Directive?
If your loved one hasn’t appointed anyone, the law often falls back on a default list of potential decision makers: a spouse, then adult children, parents, siblings, and so on. This might sound simple, but it rarely is. In blended families, or when relatives live far away or disagree, the lack of clear documentation can lead to delay, conflict, and legal intervention. In some cases, the only option is to seek guardianship through the courts, but this process is expensive, time-consuming, and emotionally draining.
Even when a power of attorney is in place, it does not override an advance directive. These documents, such as a living will, spell out specific care preferences, particularly around end-of-life treatment. If your loved one has recorded their wishes in an advance directive, the POA is legally obligated to honor them.
What Medical POAs are Actually Called upon to Do
A medical POA is often involved in real-time decisions about hospital transfers, medication changes, pain management, and whether to begin or stop certain treatments. In assisted living and memory care settings, this could mean deciding whether a resident is treated on-site or sent to the ER. It may involve conversations about comfort care or initiating hospice. Legally, the role may be defined as a healthcare proxy or surrogate. But in most families, it sounds more like, “I’m the one making the decisions now.” What matters is clarity for doctors, staff, and loved ones.
Choosing the Right Person and Having the Right Documents
The right person is, first and foremost, someone you can trust. However, they should also be someone who can stay grounded under pressure, communicate with care teams, and follow your loved one’s wishes even when it’s hard. Families with multiple adult children should have these conversations early and decide on roles before a crisis forces the issue.
Every adult should have both a medical power of attorney and an advance directive. These forms are available through hospitals, elder law attorneys, or state health departments. Don’t wait for a diagnosis or a move to assisted living. Get them in place while your loved one can clearly express their preferences.
Start Early, Make a Plan, and Avoid Guesswork
These conversations are hard. Waiting makes them harder.
Without a plan, families end up guessing. Staff are left scrambling. And decisions that could have been clear become complicated, emotional, and messy. Getting it sorted now honors your loved one’s voice and gives you the legal footing to support them when they need you most.
How Cura Living Can Support You Through Medical Decision Making
Medical decisions carry weight, emotional, legal, and deeply personal. At Cura, we don’t leave families to figure that out alone. From the moment someone moves in, we review legal documents, clarify who’s allowed to decide, and stay in close conversation as needs shift.
Our teams are trained to act with compassion and clarity. Whether it’s a routine doctor visit or a moment of real crisis, we make sure the right person is involved, and that every decision reflects your loved one’s values. If you have questions about POAs or care planning, reach out. We’ll walk you through it, step by step.
Disclaimer: This article is intended for informational purposes only and should not be considered medical, legal, or financial advice. Please consult with the appropriate professionals regarding your situation.