No doubt, you explain to your clients the role of the Health Care Power of Attorney when preparing their estate-planning documents with them. But here’s a news flash: most of your clients probably don’t understand the difference between their Emergency Contact and their Health Care Power of Attorney. Such is the finding of a recent study conducted at the Henry Ford Hospital in Detroit:
95% of patients admitted to the ER assumed that their emergency contact is their medical decision-maker, including for end of life care.
Ouch. The responsibility for the confusion may well fall on doctors and emergency room staff. According to Dr. Erin Zimny, an Emergency Medicine and Palliative Care physician at Henry Ford Hospital and co-author of the study, here’s why: hospital staff typically ask only for a patient’s Emergency Contact information; they do not typically ask who the medical decision-maker is. Nor do they explain what “Emergency Contact” means to them. “We’re using an antiquated vocabulary in medicine,” said Dr. Zimny in a hospital news release. “We should be asking and educating patients about the importance of an advance directive instead of defaulting to the emergency contact world.” As a result, the Emergency Contact assumes a falsely heightened level of significance in the mind of the patient, and inadvertently downplays the importance of a Health Care Power of Attorney.
When a hospital asks your clients who their emergency contact is, it’s important for clients to tell hospital staff who their medical decision-maker is and – if it’s a separate person – who their emergency contact is. Just to be clear, here’s the difference: An Emergency Contact is just that – someone who is notified of the emergency. That’s it. Even if that person shows up at the hospital, they have no special powers or authority. A health care power of attorney, as you well know, assumes legal authority for medical decision-making if your client is unable to do so. Even if they are not present at the hospital.
Most advance directives registries and other providers of medical ID cards include the name(s) of an Emergency Contact so that the patient’s loved one can be notified promptly in an emergency. Obviously, the benefit of being enrolled in a registry is that clients’ HCPOA will also be known – in addition to the Emergency Contact – because the hospital obtains the advance directives from the registry. That’s the whole point. The registry with which I am affiliated automatically uses the client’s HCPOA as the Emergency Contact named on the wallet card (if the firm uses one of the estate planning software programs in which the registry enrollment form is embedded). This feature automatically eliminates the potential for confusion identified in the Henry Ford Hospital study. (But the client does have the option to change these names to non-HCPOA individuals if they wish.)
So — don’t have your good work undermined by admitting clerks, nurses and physicians who ask your clients only for their “Emergency Contact.”
If you don’t enroll your clients in an advance directives registry:
- Suggest to clients that on their medical ID card or their paper wallet card they list their HCPOA and their EC separately. Or indicate if the same person is both.
- Be sure to educate them many times that in hospital lingo, their emergency contact is not the same thing as their HCPOA. And that they need to make clear to medical staff who their medical decision-maker (HCPOA) is.
- Consider enrolling your clients in a registry. In this study, only half the patients with advance directives had given the directives to their primary physician before their visit to the ER (not that this would necessarily have made them accessible).
If you do enroll your clients in an advance directives registry:
- Explain that you’ve registered them so that their medical decision-maker will be known – and so that there will be no confusion between their decision-maker and the emergency contact.
- Make sure they keep their registration active and up to date.
P.S. We had a great response from last month’s blog post for the Digital Asset Guide. If you’re still interested in a copy, please email us at email@example.com.
Randi J. Siegel, MBA, is the President of DocuBank (docubank.com), which ensures that the emergency information and healthcare directives of its 200,000+ enrollees are available 24/7/365 through the largest advance directives registry in the U.S., as well as access to an online safe for storage of digital assets and other vital documents. Working with estate planning professionals since 1997, Randi frequently speaks at national estate planning conferences and has appeared on radio and television as an authority on registries. A member of the Philadelphia Estate Planning Council, the International Society of Advance Care Planning and the Coalition to Transform Advanced Care, Randi is active in health education and public engagement related to advance care planning/advance directives. She serves as Pennsylvania liaison to the National Healthcare Decisions Day initiative and as a board member of the Center for Advocacy for the Rights and Interests of the Elderly. Randi is an ongoing contributor to the Academy blog.
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