Wednesday, August 28, 2013

Creating a circle of care

There is much to say for creating a circle of care.

For my parent's generation, they had close friends and family in case of caregiving issues. I lived far away from my parents, and my mother was making decisions about my father's care, while facing her own health issues.

Many families face conflict when adult children disagree either with one another, or with one parent they feel is making bad decisions, or not making decisions at all for a spouse.

In this day and age, with families moving for work opportunities, and both parents working, the sandwich generation has wisely determined that the circle of care must include family, friends, neighbours, Primary Care teams (doctor; specialist, i.e., surgeon; nursing staff) are supported by Community Care Access Centres, who deliver home care.

Barriers occur when a spouse is unable to make arrangements, due to ill-health, for the other. Our hospice volunteers face this situation all the time. Romantic notions of dying at home must be made with the full support of the entire family, for the entire family is involved.

The barriers occur should a person be hospitalized, and be unable to make decisions for either themselves or the other spouse.

 If the parameters are not set out in a Power of Attorney for Physical Care, a Substitute Decision Maker, then PHIPA comes into play. It precludes FIPPA, the privacy laws, when someone is not acting in a safe or rational manner.

Capacity to consent
Determination of incapacity
Persons who may consent
Factors to consider for consent
Authority of substitute decision-maker
Incapable individual: persons who may consent
Appointment of representative
Transition, representative appointed by Board

First, someone must decide if the patient is unable to make the decision on behalf of the patient.
Once this is established, then Power of Attorney (POA), is one has been signed, is enforced. A big issue I have seen is if the patient refuses to allow this to be enacted. For example, the husband with dementia continues to go to the bank and make financial decisions. The wife, with POA, refuses to argue with him. 

The act specifies:

Incapable individual: persons who may consent
26.  (1)  If an individual is determined to be incapable of consenting to the collection, use or disclosure of personal health information by a health information custodian, a person described in one of the following paragraphs may, on the individual’s behalf and in the place of the individual, give, withhold or withdraw the consent:
1. The individual’s guardian of the person or guardian of property, if the consent relates to the guardian’s authority to make a decision on behalf of the individual.
2. The individual’s attorney for personal care or attorney for property, if the consent relates to the attorney’s authority to make a decision on behalf of the individual.
3. The individual’s representative appointed by the Board under section 27, if the representative has authority to give the consent.
4. The individual’s spouse or partner.
5. A child or parent of the individual, or a children’s aid society or other person who is lawfully entitled to give or refuse consent in the place of the parent. This paragraph does not include a parent who has only a right of access to the individual. If a children’s aid society or other person is lawfully entitled to consent in the place of the parent, this paragraph does not include the parent.
6. A parent of the individual with only a right of access to the individual.
7. A brother or sister of the individual.
8. Any other relative of the individual. 2004, c. 3, Sched. A, s. 26 (1).

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