Obtaining a durable power of attorney for health care from nursing home residents.
BACKGROUND
A durable power of attorney for health care (DPA) allows a person to appoint a surrogate decision-maker for any future period of mental incapacity. The absence of advance directives can lead to confusion and the expenditure of resources while trying to exert a substituted judgment.


METHODS
The Wisconsin DPA was presented with an organized pilot program to 150 residents who had been judged by their social workers to have the capacity to make informed decisions regarding medical care. The reasons residents gave for accepting or rejecting a DPA were analyzed.


RESULTS
Seventy-nine percent prepared a DPA. Reasons for signing included allowing the resident to decide who would make medical decisions and assuring that specific wishes would be carried out. Twenty-one percent did not execute a DPA. Reasons were categorized as confusion and misunderstanding regarding the legal system, mistrust, or social isolation.


CONCLUSIONS
The high rate (79%) of DPA completion is probably related to individually counseling residents. However, competent residents who despite counseling do not choose to execute a DPA can have detailed advance directives ("living wills") prepared without appointing a decision-maker.
Spears
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Wisconsin Veterans Home, King 54946.
Drinka
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PJ
Voeks
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D000328:Adult; D000368:Aged; D003376:Counseling; D003657:Decision Making; D005260:Female; D006801:Humans; D007258:Informed Consent; D007872:Legal Guardians; D016224:Living Wills; D008297:Male; D016743:Mental Competency; D008875:Middle Aged; D009735:Nursing Homes; D010361:Patients / Q000523:psychology; D010865:Pilot Projects; D012947:Social Work; D014922:Wisconsin