Legal Documents and Advance Care Planning

Legal Representatives and Agreements on Your Behalf

In the event you are hospitalized, it is important to have an appointed legal representative, as it will grant them the authority to speak on your behalf. An appointed legal representative will have the ability to pay your bills, retrieve your income tax information to help pay home care or facility fees, speak to companies such as ICBC, and make healthcare decisions or living arrangements if you are in a position where you are unable to. Without a legal representative, even a spouse or loved one can be limited in decisions and tasks they can do on your behalf. By appointing a legal representative and having these legal documents in place, it can ease the burden on others, providing you a say over matters affecting your quality-of-life and help avoid the involvement of government or the state in your private and personal affairs. Nidus.ca provides a variety of legal documents that suite the different types of legal document planning.

Types of Legal Document Planning

At Nidus.ca, you can find BC legislative documents available to appoint your legal representatives. Nidus Personal Planning Resource Centre and Registry breaks down planning into two categories:

Personal planning: this planning is when your personal support can make arrangements due to an illness, injury, or disability while you are alive. Personal planning covers four areas of your life: healthcare, personal care, legal affairs, and financial affairs. The purpose of a personal plan is to have legal documents that give specific individuals the legal authority necessary to help you in case you are at end of life, incapacitated, or in need of other support. Nidus.ca, provides two different paths/documents for personal planning. To access their forms and further information on these paths, see here: www.nidus.ca/types-of-planning. Advanced Care Planning falls under the area of Personal Planning.
Estate planning: this planning is for making arrangements for after death. Nidus uses the term Estate Planning to refer to making arrangements for after death. A Will is an essential document for estate planning.

It is important to discuss Advanced Care Planning (ACP), considered part of personal planning, with loved ones and healthcare providers while you are still capable to do so. These conversations will assist your legal Representative in understanding your future healthcare wishes. ACP is an umbrella term for conversations and documentation about your values, beliefs, and preferences for future care when you can’t make your own decisions (Advanced Care Planning Canada, 2022).

It is recommended that you begin your Advanced Care Plan by having conversations about your beliefs, values, and wishes, followed by appointing Temporary Substitute Decision Makers (TDSM) or a representative for your healthcare decisions. Finally, be sure to safely store your Advanced Care Plan, so it is readily available for use. The organization Advance Care Planning Canada emphasizes ACP is important for all adults, no matter the person’s state of health or age.

Advance Directives and Representation Agreements: What’s the difference?

While Advance Directives and Representation Agreements are both used when another individual makes a healthcare decision on your behalf, and part of Advanced Care Planning, there are some notable differences to consider between the two.

Nidus explains that an Advance Directive is a legal document in BC that consists of specific written instructions to give or refuse your consent for certain healthcare matters. It must be made when you can understand the nature and effect of the healthcare treatment you are giving or refusing consent for. An Advance Directive can be standalone, meaning it can be executed without anyone to give input on your behalf. For example, it could provide your consent for a specific healthcare instruction/treatment (ex. blood transfusions, feeding tubes, or life support). The instruction applies to the healthcare situation or circumstance at a time when you are incapable of providing consent. The instruction also must be clear enough that a healthcare provider can confidently act on it without consulting anyone else.

Having an Advance Directive on its own is not recommended as sometimes the wording does not meet the standard of BC legislation and/or the healthcare provider does not know the context for your treatment wishes. This can lead to limitations with the execution of an Advance Directive. Having a Representation Agreement in place will help provide context for your healthcare wishes, and reduce confusion for healthcare professionals around decisions of your care.

A Representation Agreement is a legal document in BC that covers healthcare and personal care matters. It is for authorizing one or more people to assist you with decisions or, if necessary, to act on your behalf (Nidus, 2022). It is recommended to have a trusted personal support as your legal representative as they will be able to carry out your prepared Advanced Care Plan. You appoint a legal representative by filling out a Representation Agreement form that can be found at www.nidus.ca/resources-ra. Your legal representative is an important part to have incorporated in your Advanced Care Plan, as they will represent your healthcare wishes if you are not able to speak for yourself.

Why you Should Have an Advanced Care Plan

Life events are unpredictable. Having an Advanced Care Plan will reduce stress placed on your loved ones and provide them with a guideline for making important decisions about your health when you are unable to (Advanced Care Planning Canada, 2022). It will also equip your legal representative, loved ones, and healthcare workers with the information they need to make the right decisions on your behalf.

Step 1: Conversation Starters for Advanced Care Planning

To begin the Advanced Care Planning Process, Connie Jorsvik, an independent healthcare navigator & patient advocate, recommends answering the following questions either by yourself, with a caregiver, or a loved one:

What makes your life worth living? (i.e. beliefs – what gives your life meaning?)
What can or can’t be sacrificed or comprised?
What needs to be completed before death?
What special faith-based or cultural preferences should be considered?
Would you want live-saving measures? (i.e. breathing tubes, feeding tubes, life support)
What do you or your loved ones value? (i.e. food, family dinners – what do you care about in life?)
How do you feel about quality versus quantity of life?
Where would you/they want to spend the last hours or days of life? (i.e. home, hospice, residential care)

Answering and discussing these questions provides an opportunity to have your loved ones understand your values, beliefs, and preferences for care.

Step 2: Assign a Legal Representative

After answering and discussing the conversations starters surrounding you believes and values, the next step is to appoint a trusted individual who will make your healthcare decisions on your behalf. Creating an Advanced Care Plan provides you the opportunity to decide who will be your Representative – the person who you entrust to make healthcare decisions for you.

You can file your Representation Agreement at registry@nidus.ca. It is also recommended that you provide paper copies to your Representative. If there is no legal Representative, as per BC Law, healthcare facilities will use a list of possible Temporary Substitute Decision Makers (TSDM) contacts in the following order: your spouse, your adult child, your parent, your sibling, a grandparent, a grandchild, anyone related to you by birth or adoption, a close friend, and a person immediately related by marriage (British Columbia, 2022). The BC government recommends collecting all contact information from the above list and placing it in your ACP documents. This way, a TSDM can be easily contacted by healthcare professionals. If you prefer not to have the healthcare system assign TDSM contacts, choose to name one person as your legal representative in a Representation Agreement. No lawyer is needed to name a person as your representative; however, it is recommended that you use the free Representation Agreement Forms from the nidus.ca website. A completed Representation Agreement Form can allow your representative to make healthcare decisions for you.

Whether you rely on a TSDM or naming a legal representative, the key is to collect their most upto-date contact information, and have it listed in your Representation Agreement and your Advanced Care Plan document, so it may be easily found by your healthcare providers.

Step 3: Record your Plan in a Document

To assist your decision makers, there are a variety of ways to record your wishes in an Advanced Care Plan (ACP) document. There is the option to write down the contents of your ACP in your own documents, or by using ACP templates made available by different organizations.

The BC government provides an ACP template called My Voice: Expressing My Wishes for Future Health Care starting on page 27 of the document, found here: My Voice

Advanced Care Planning Canada provides another template option called Speak Up: Start the Conversation About End-of-Life Care. This template can be found on page 12 of the Speak Up document here: Speak Up

Additionally, Patient Pathways provides a template called In Case of Medical Emergency (ICE). ICE is designed to speak for you when you are unable to speak for yourself or a loved one. This form gathers key information about you, your health, and your household. It makes the information readily available to first responders, paramedics, friends, and family (ICE Form Instructions). This can be found here: In Case of Medical Emergency

Once your Advanced Care Plan is written down in a document, it is recommended that you make multiple photocopies of the original document. It is best to place your ACP in a clear folder binder, or green sleeve, and to keep it on or beside your fridge. Your note on the fridge should state the location of the copies of the ACP and where the original copy can be found. Copies of these important documents should be handed out to your TDSM so they are prepared to have this information readily available for your healthcare providers.

Advanced Care Planning is important for all adults, no matter the person’s state of their health or age. It is best to continue to review your plan at regular intervals and/or if anything changes related to the plan’s contents.

Sources

Advance Care Planning Canada. (2022). Speak up: Start the conversation about end-of-life care. www.advancecareplanning.ca/wpcontent/uploads/2020/06/acpworkbook_form_en.pdf

Government of British Columbia. (2022). Advanced care planning. www2.gov.bc.ca/gov/content/family-social-supports/seniors/health-safety/advance-careplanning

Government of British Columbia. (2022). My voice expressing my wishes for future health care treatment. www.health.gov.bc.ca/library/publications/year/2013/MyVoiceAdvanceCarePlanningGuide.pdf

Jorsvik, C. (2020). Advanced care planning for family caregivers and those they are caring for. www.youtube.com/watch?v=-2N4AsNTo64

Nidus. Personal Planning Resource Centre and Registry. (2022). Advanced Directive. www.nidus.ca/advance-directive

Nidus. Personal Planning Resource Centre and Registry. (2022). Types of Planning. www.nidus.ca/types-of-planning

Nidus. Personal Planning Resource Centre and Registry. (2022). Representation Agreement. www.nidus.ca/resources-ra

Patient Pathways. (2020). Advanced care planning for family caregivers and those they are caring for. www.parkinson.bc.ca/media/237813/tofc-2-advance-care-planning-003.pdf

This content was published in the April 2022 edition of our monthly support group newsletter, GroupLink. The content was accurate as of this publication date.

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