How to make durable powers of attorney work better

Last week I wrote about a growing problem: what to do when an older person who has dementia hasn't named anyone she trusts to make decisions for her. This week I'll tackle a tougher issue: what to do when the person she names does a poor job.

Durable Powers of Attorney (DPOAs) for finances allow us to name people we trust (called "agents") to make decisions regarding our money, care, taxes, real estate and other financial matters if we become mentally incapacitated. Every adult needs a DPOA — we can never predict our futures — and they're essential as we grow older. Without one, we place enormous and unfair burdens on our family, friends and neighbors.

The key to making a DPOA work, however, is naming someone who's honest, wise, reliable and will act in our best interests. Here are some e-mails I've received recently where this isn't the case:

"My great-aunt needs help. She lives alone in her home of 48 years, but she's not taking care of herself. The house is a mess, the laundry goes undone, her food rots in the fridge, she's eating poorly and her dog looks very thin.

"My mom's nephew stays there occasionally — my great-aunt named him power of attorney several years ago, but he sees nothing wrong, and he refuses to let me find services for her. She does what he says. I don't think she's going to make it unless someone intervenes."

"I'm very close to my 89-year-old grandfather. A few years ago, his daughter — as his power of attorney — sold everything he owned while he was visiting relatives and moved him to another relative's home.

"The shock exacerbated his slight dementia, but he's doing much better now. He's living in an assisted-living community where he has friends (the only guy on his floor!), his memory has improved, he has privacy and he's happy.

"Unfortunately, his daughter is now talking of moving him to a nursing home where he'd share a room and have nothing but a bed. He walks fine, dresses himself and is otherwise in pretty good shape. I'm trying to figure out what to do."

"Years ago, my 82-year-old mother named her 'younger' friend of 79 who lives 2,000 miles away as her power of attorney. The woman has no idea how demented my mom has become, because they talk on the phone occasionally; she thinks she can tell everything's just fine.

"My mother currently lives in assisted living, but now she needs a place that specializes in dementia care. My mom's friend refuses."

What to do? One of the first things: Determine whether the agent knows what to do, says Janet L. Smith, a Seattle attorney specializing in guardianship and protecting vulnerable adults. There's no training for this role, no guidelines, and dementia is unlike any health diagnosis any of us will encounter. Knowledge about this illness is critical.

If the agent is willing to seek help, a geriatric-care manager — a nurse or social worker experienced in older adult needs — can be an invaluable resource. For instance, the grandfather in the example above isn't appropriate for a nursing home, while the great aunt needs help with household chores and probably a great deal more. A care manger can guide an agent to take the right steps — and recommend other professionals as well, such as a bill-paying service, home-care agency, moving experts and others.

If the older person still has the ability to execute a new DPOA, he or she can revoke the old document and name a new agent. When there are no other trustworthy or capable family members to serve in this role, a professional fiduciary or professional guardian may be the appropriate choice.

It's always good to name more than one person to serve as someone's agent (in sequential order, not at the same time). Then, if the first person named can't or doesn't want the job, someone else is available.

But let's say the situation is worse — you suspect the agent is neglecting or abusing the older person. Any concerned citizen should call Adult Protective Services. You can also ask the police to make a welfare check. Make the same calls if you think financial exploitation is involved — commingling-mingling funds, stealing, or giving assets away inappropriately. Helpful information is available at www.metrokc.gov/proatty/elder/faqs.htm.

The most complicated scenarios, says Smith, involve fights among family members. A daughter, say, has power of attorney, but her siblings are furious with how she's handling their mom's care or finances. A first step: Try holding a family conference mediated by an experienced care manager to see if a consensus can be reached. If not, a court is likely to appoint a neutral guardian, rather than a family member, to serve instead.

For information on dementia, contact the Alzheimer's Association in Seattle at www.alzwa.org or 800-848-7097.

Liz Taylor's column runs Mondays in the Northwest Life section. With 30 years experience in the field, she writes and lectures on a host of aging topics. E-mail her at growingolder@seattletimes.com, or write to Liz Taylor, P.O. Box 11601, Bainbridge Island, WA 98110. You can see all of her columns at www.seattletimes.com/growingolder.