College is full of firsts: first apartment, first job, first time managing money and a schedule with no one else to answer to. Most of these decisions involved in these situations are easy to revisit. For example, a major can be changed, and a roommate arrangement can be reworked. But some choices carry more weight. Naming a person to act as a medical decision-maker in emergencies is one of them. Doing so may be a casual decision after a conversation with a friend and take just a quick signature on a routine form, but doing so gives that chosen person the legal authority to speak to doctors and make healthcare decisions for your child if your child cannot.
It may come as a surprise to you if your adult child has chosen a friend as their medical decision-maker. But once a child is a legal adult, you are no longer the person who can automatically step in. If an emergency happens and you are not the person your child named to act, you may find yourself on the outside looking in at the moment you most want to help.
Parents Can Feel Powerless Over a Power of Attorney
You watched them grow up, you helped them move onto campus, and now that they are an adult, you are wondering how much you can—and should—do for them as they continue the transition to living on their own.
You may have taken for granted that, if something went wrong, you could step in at a moment’s notice. However, now that your child is an adult, that may no longer be the case, especially if they have named a close friend or partner as their medical decision-maker instead of you.
You expect changes from your child as they become an adult and begin to live on their own, including new relationships and perspectives that will shape who they are. And you can understand, from both a practical and a personal standpoint, why they might want somebody nearby to be able to act as medical decision-maker on their behalf in an emergency.
But do you—and they—really understand what a medical power of attorney is, what it does, and what can happen when the person they choose is no longer available or willing to serve?
What a Healthcare Power of Attorney Is and What It Does
Pop quiz: Do you or your college kid know what a healthcare power of attorney (POA) document actually does? Or how it differs from a Health Insurance Portability and Accountability Act (HIPAA) authorization? And what happens if there is no documentation at all? The answers might surprise you—and them.
- A healthcare POA lets your adult child name someone (known as an agent) as a medical decision-maker on their behalf if they are unable to make those decisions themselves (i.e., they become incapacitated). The document they sign may allow that person to speak with doctors, weigh treatment options, consent to or refuse care, and make other healthcare decisions for them, for a certain period or indefinitely.
- A HIPAA authorization, although related to a healthcare POA, serves a different purpose. While it does not give someone medical decision-making authority, it allows designated people to receive protected medical information. A parent might therefore be authorized to speak with providers and obtain updates without necessarily being the person empowered to make healthcare decisions, creating a potentially troublesome mismatch of authority.
When neither document is in place, things can become even more problematic. Parents should not assume that being a mother or father automatically gives them access to an adult child’s medical information or the authority to make decisions for them. Many states have default rules for who can act when no one has been named, and providers may share some information with family in an emergency, but the rules vary. Who can step in may depend as much on state law, the circumstances of the emergency, and the healthcare provider involved as on family ties.
Fast Friends, Fast Times, and Fast Changes
College lasts for only a few years, but it can be one of the most formative periods of a person’s life. Relationships during this time can form quickly—and change just as fast. A roommate can become a best friend in a matter of weeks, and a new partner can suddenly become the person your child trusts most. Just as quickly, though, those relationships can cool, end, or drift apart as life pulls people in different directions and priorities change.
This creates an obvious risk: the person legally empowered to make healthcare decisions for your child today may no longer be the person they would choose a year from now. And since most young adults are not thinking about estate planning documents when a friendship or relationship ends, a healthcare POA signed quickly, perhaps at the suggestion of a college advisor, can be forgotten as fast as material crammed for a midterm exam.
A healthcare POA does not automatically keep pace with changes in relationships. If your child names a friend or partner as their medical agent and later stops speaking to that person, the document generally stays in effect until it is formally updated or revoked. The good news is that your child can change or revoke it at any time while they are capable of making their own decisions.
A Parent’s Study Guide for Estate Planning Medical Documents
Parents who have sent a child off to college must accept a certain loss of control. But they can still play a meaningful role in their child’s medical care plans without insisting on being put in charge.
- Ask what your child has set up: Asking directly, without implying that you should have been named, can keep the conversation productive. You can simply ask whether they have completed a healthcare POA, a HIPAA authorization, or another healthcare or estate planning document. Their answers may not please you, but the goal at this point is to understand the plan, not to demand a particular role in it.
- Suggest naming a backup: Help them see why a backup decision-maker matters. This is where you can gently suggest that you could fill that role, even if only as a backup, if their first choice is unavailable or the relationship has run its course.
- Encourage periodic reviews: A student must hit academic and administrative milestones to stay on track for graduation, such as declaring a major, passing core courses, and meeting with academic advisors. Estate planning documents need checkpoints, too. Reviewing their POA and HIPAA documents regularly, and after any major change in their relationships, can keep their plan current as they “graduate” from phases in life.
A natural time to have these conversations is during a mid-term or seasonal break, when your child is home and already thinking about what comes next and the changes that lie ahead. This can also be a good time to share details from your estate plan. Simply showing them, you have a plan can help by setting a good example and fostering open dialogue around planning.
Give Planning the Ol’ College Try
College is a time of experimentation. Students are encouraged to try new things, meet new people, and have new experiences that will shape who they become. Failure, though not exactly encouraged, is expected. They will not get everything right on the first pass, and learning from mistakes is part of the process.
But some mistakes are harder to fix than others. A medical crisis may leave no time to revisit who is in charge. Plans and authority need to be in place before they are needed. A choice that made sense in the moment can easily fall apart in the harsh light of an emergency.
If that moment comes, you will be glad you talked to your college-aged child about their plans. By reminding them that estate planning is part of being an adult, you can respect their independence while staying involved. Contact McDonald Law Firm, an experienced Howard County, Montgomery County and District of Columbia estate planning, special-needs planning and Medicaid planning firm at (443) 741-1088; (301) 941-7809, (410) 337-8900 or (202) 640-2133; or use this link:https://www.mcdonaldesq.com/#contactWrapper to schedule an initial consultation to discuss your options.
DISCLAIMER: THE INFORMATION POSTED ON THIS BLOG IS INTENDED FOR EDUCATIONAL PURPOSES ONLY AND IS NOT INTENDED TO CONVEY LEGAL, INSURANCE OR TAX ADVICE.
