How to Advocate If You’re a Long-Distance Health Care Proxy

Attorney, distinguished law professor

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In an ideal world, everyone’s health care proxy is a person that lives in close proximity to the patient undergoing medical care. Generally, this is true. When emergency health care events arise, particularly if they arise often, it makes it easier if you are close by and can be “on the scene” at the doctor’s office or at the hospital when decisions have to be made. 

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Let’s say you are your mother’s health care proxy and she has decided to move to California and your roots are firmly planted elsewhere. This does not mean that you cannot serve as her health care proxy just because you live a good distance away.

With the decision to be someone’s health care proxy, you should always be prepared to plan ahead and take advantage of all the resources that are available to you to stay informed and involved. No matter the distance, if you can do this, you can be a very effective health care proxy from just about anywhere.

If you don’t know where to start, here are 10 steps to consider when becoming a long-distance health care proxy.

Step 1: Talk to Your Loved One

According to a study published in the Archives of Internal Medicine, one of the greatest barriers to appointing a health care proxy is believing that because family members are involved, there is no reason to have a health care proxy. However, people are more likely to complete a health care proxy when:

  • They understand what a health care proxy does 
  • A family member or friend will be available to serve as their health care proxy
  • They have been exposed to ventilator support (for themselves or a family member)
  • They perceive their health as fair or poor

It is important, then, to discuss with your loved one what you will be able to do for them as their health care proxy, even from far away. You should discuss with them what needs they may have and as their health care proxy, how you will be able to help meet these needs.

It may be important to reiterate that your loved one should feel that choosing a health care proxy is empowering. It not only allows them to make decisions about their own needs but also, by preparing ahead of time, your being far away does not detract from that.

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Step 2: Execute Other Legal Documents

Of course, as a health care proxy, you may have to make all kinds of decisions, both big and small. However, to the extent possible, you want your loved one, the patient, to make as many decisions for themselves as they can, especially the big ones, like whether to remain on a ventilator, when to stop life-sustaining treatment, and whether to resuscitate.

When the patient executes their health care proxy form, they should also be able to execute their living will or health care directive. With these in place, you as their health care proxy, will have to make decisions on behalf of the patient.

They may not state their preferences for all the decisions they may need to make when incapacitated and in need of medical care, but if you are not able to be present when some of the “bigger” decisions have to be made, at least their wishes will already be in writing.

Step 3: Stay Informed

Being a health care proxy requires more than just being able to decide when to let your loved one pass away naturally.

One of the purposes and responsibilities of being a health care proxy is to legally obtain confidential information about the patient’s health and medical care so that you can make informed decisions. Without a health care proxy or medical power of attorney and HIPAA release, no doctors will release information about the patient.

As a health care proxy, it is likely that you will have to remain in contact with the patient’s primary physician and other healthcare providers.

You cannot rely on the self-reporting of your loved one for accurate information about their condition and treatment plans, which they are not likely to remember after they leave a doctor’s visit. You must stay informed about all of their medical records, diagnoses, medications, and future appointments.

But remember, you do not necessarily have to be physically present to do this. You can do this over the phone, by video-conferencing, emailing, and sharing digital medical records. It is not your proximity that matters, but your involvement.   

Step 4: Delegate

Once you are informed about the patient’s needs, you then have to see that their needs are satisfied so that you can continue to make informed decisions about their care. This may require:

  • Frequent doctor visits
  • Filling prescriptions
  • Taking daily medications
  • Self-care needs such as bathing, dressing, toileting, and getting in and out of bed
  • Paying bills

These daily responsibilities can pile up quickly. Depending on your location, the mere travel alone, can quickly become impractical (if not impossible) and prohibitively expensive. So, you may have to delegate duties.

Consider your options. You may have other family members closer in proximity that are willing to share some of the daily responsibilities. Or perhaps there are neighbors willing to look-in on your loved one who can update you about their physical condition, hygiene, emotional state, and resources in the house, like food and proper utilities.

Friends may be willing to accompany your loved one to any doctor visits that you are unable to attend. And let us not forget, neighborhood kids may be more than willing to do chores if you pay them. 

If you are far away, please remember that you cannot fully satisfy—or stay informed about—your loved one’s health and medical needs by yourself. But you can easily delegate responsibilities to others who can and who are willing to report to you regularly.

A trusted support network can provide information you may need to make necessary decisions about your loved one’s health care needs. Remember, it takes a village.

Step 5: Take Advantage of Local Resources

More than 10 percent of all family caregivers live more than an hour away from their loved one who needs care. The only way to sustain this long-distance care for any significant length of time is to take advantage of local resources.

Services that assist with practical needs like transportation, food preparation, daily grooming, and self-care are usually available in most communities. The local senior center or hospital may have information on reliable services that you can use.

Step 6: Stay Organized

Whether you hire an in-home service or take a more hands-on approach to your loved one’s care, your legal responsibility as a health care proxy is to make decisions when necessary. And with these kinds of decisions, remember that you should always be up-to-date and informed.

Sometimes you have to make important, “life or death” decisions quickly. In order to do this, it is critical that you organize records so that the pertinent information that you or a doctor needs to make informed decisions is readily available. You should always have organized access to all:

  • Legal documents
  • Medical records
  • Medical histories
  • Medical bills
  • Prescription names and required doses
  • Contact information for all doctors and health care providers
  • Contact information for all family members, friends, and neighbors
  • Insurance information

Your duty to make decisions as a health care proxy is dependent on accurate information. However, information is of no use to you if you cannot access it. You must maintain organized records.

You can make this happen by carrying a multi-pocket folder with appropriate labels, or making sure to have these documents digitally and remotely available.

Step 7: Become Tech-Savvy

There is no better way to compensate for distance separating two people than technology. However, like information that you do not know how to access, technology that you do not know how to use is not going to help you.

If you are going to stay informed as a long-distance health care proxy, you must be willing to rely on technical, visual, and audio technologies that enable you to access information from a different location.

This may include everything from being able to use a computer for sending and receiving simple emails to installing video, audio, or motion-sensitive electronic devices or medical instruments that warn you about:

  • Safety concerns — like leaving a pot on a heated stove or opening a door and wandering out of the house at night
  • Health issues — like dangerously high blood pressure or debilitating heart conditions
  • Accidents — such as falling out of bed, slipping in the tub, or falling down the stairs
  • Injuries — like broken hips that leave your loved one unable to reach a phone or head injuries that render them unconscious and unable to push a medical alert button
  • Self-care difficulties — such as the inability to take medicine as prescribed

These are all concerns that could impact your responsibilities as a health care proxy. There are technologies available that provide information about these concerns and may be necessary if you are to fulfill your duties as a long-distance health care proxy.

Step 8: Consider a Geriatric Care Manager

For more personal health care needs that require hands-on attention, there are in-home services available that can provide daily assistance to your loved one and report on your loved one’s condition on a regular basis. If you have more specific health care needs and a broader range of services, it may be more helpful to hire a geriatric case manager. 

This is a trained professional, such as a nurse or social worker, that is able to assess needs and coordinate comprehensive services like nutrition, transportation, health services, and doctor visits.

The case manager can serve as a direct point-person for you to stay informed about all aspects of your loved one’s medical care and provide advice about what issues you should be aware of and what decisions you may need to make.

Step 9: Plan Purposeful Visits for the Future

No matter how much assistance you have while you are serving as a health care proxy from afar, you will want and need to make personal visits to be with your loved one.

Like with everything else, you should plan your visits well in advance. This will provide time for you to make appointments to see your loved one’s doctor, health care providers, friends, neighbors, bank, attorney, accountant, or even their estate planner. 

You should take advantage of your visits to get to know those with whom your loved one interacts and relies on for daily assistance. You should make yourself known as the health care proxy and exchange contact information with everyone who may be able to provide information about your loved one’s medical, financial, and personal affairs when you need to make decisions on their behalf.

Step 10: Follow-Up

Serving as a health care proxy is difficult even when you are local. Being distant is only more difficult. If you follow all of these steps, it should at least be possible for you to serve as a long-distance health care proxy. However, as with all the information presented above, this is not a “one-and-done” deal.

To serve effectively, you must regularly review all the information you have collected and digested by following these steps and then following them again. And as always, you should continue to talk to your loved one about their care and stay involved and informed so that you are ready to make the important decisions when necessary.  

You Can Be an Effective Long-Distance Health Care Proxy

Serving as a health care proxy is not just a badge of honor among family members. It is also a legal responsibility. There is no point in accepting this responsibility if you are not willing or able to do all that is necessary to be effective in this role, especially if you live far away. For many, it simply may be impractical to serve in this capacity. But it is not impossible. 

There are many resources available to assist you should you take on the role. However, it is important that you are aware of all the resources and fully understand all the responsibilities before you undertake to serve as a long-distance health care proxy. By being a health care proxy, you can relieve additional stress that your loved one may have, and also take on an important role in their life when they may need you most.


Sources

  1. R. Sean Morrison, Luis H. Zayas, Michael Mulvihill, Shari A. Baskin and Diane E. Meier, Barriers to Completion of Health Care Proxies: An Examination of Ethnic Differences, 158 ARCH. INTERN. MED. 2493 (1998).
  2. Family Caregiver Alliance, National Center on Caregiving, Caregiver Statistics: Demographics, Geographic Distance Between Caregiver and Care Recipient, Apr. 17, 2019, at www.caregiver.org/caregiver-statistics-demographics
  3. UW Health, Long-Distance Caregiving: How to Help from Afar, Mar. 15, 2018, at www.uwhealth.org/health-wellness/long-distance-caregiving-how-to-help-from-afar/51836.
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