How Do I Ensure My Home Care Wishes Are Honored?

This is a very thoughtful and important step, especially with a blended family. You are looking to put legal documents in place now to ensure your future care wishes are followed, and you have the right idea about appointing a specific person to oversee those wishes.

The legal tools you need fall under the umbrella of estate planning and are often called advance directives.

Key Legal Tools You Need for Home Care Wishes

To legally appoint someone to make and oversee your care decisions at home, you need to use a type of power of attorney known as a health care proxy or a medical power of attorney (names vary by state).

1. Health Care Proxy / Medical Power of Attorney (The Oversight Role)

• What it is: This legal document lets you name a trusted person — your agent (or “attorney-in-fact” for health care) — to make medical and health-related decisions for you if you become unable to make or communicate them yourself.
• How it helps with home care: This is the key document for your goal. Your agent will have the authority to:
  • Hire and fire home health care providers.
  • Decide on the specifics of your care, including where it’s provided (like your home), based on your stated wishes.
  • Access your medical records (if combined with a HIPAA release).
  • Work with doctors to ensure your wishes are carried out.
• Your solution: You and your husband can each appoint the chosen family member as your respective agent/proxy. This legally empowers them to oversee the implementation of your care wishes, providing a clear authority figure for the blended family.

2. Living Will / Advance Health Care Directive (The Wishes)

• What it is: A living will is a legal document that outlines your specific instructions regarding life-sustaining treatments and medical interventions (like CPR, feeding tubes, or mechanical ventilation) if you develop an end-stage condition or are permanently unconscious.
• How it helps with home care: It clearly dictates the type of care you want and, just as importantly, the care you don’t want. This document is the ultimate guide your agent must follow.

3. HIPAA Release

• What it is: This form grants your agent (and potentially other family members) the right to access your private medical information.
• Why it’s essential: Without this, even the person you named as your health care agent may be blocked from discussing your care with doctors or facilities.

Planning for Your Blended Family Dynamics

Your concern about a blended family is valid, as disagreements can quickly arise without clear boundaries. Appointing a single family member to oversee your care is a wise move, but you need to prepare the family for this decision.

• Clearly designate successors. Name backup agents (successors) in your health care proxy. For instance, you could name your husband first, your chosen family member second, and another trusted person third. This ensures a clear chain of command and avoids the need for a court to step in.
• Hold a family meeting. Have an open and honest conversation with all your adult children and the chosen agent. Explain why you chose this person (e.g., they live nearby, have the right temperament, or understand your wishes best). Open communication is the single best way to reduce future conflict.
• Financial power of attorney. Appoint a separate individual (or your chosen agent) as your financial power of attorney. This person manages your finances, pays for your care, and handles bank accounts. Separating financial and medical power can sometimes reduce the burden and prevent conflicts of interest.

Next Steps

• Talk to an estate planning attorney. Because state laws vary and blended families have unique complexities, you should consult an attorney who specializes in estate planning and elder law. They can draft all these documents correctly and ensure they meet the legal requirements in your state.
• Speak with your chosen agent. Confirm with the family member you wish to appoint that they are willing, able, and understand the responsibility. Share your specific wishes with them in detail.
• Review financial assets. While focused on care, don’t forget to review your will and trusts to ensure all assets — especially the family home — are structured to protect your spouse and all children/grandchildren according to your wishes.