Advance directives and Alzheimer’s: How to plan for future care decisions in Ontario

What are Advance Directives?

Advance directives are legal instructions that outline a person’s wishes for healthcare and personal care in case they become incapable of making decisions due to illness, such as Alzheimer’s. These directives ensure that medical treatments align with the individual's preferences and values.

In Ontario, advance directives typically include:

1. Power of Attorney for Personal Care (POA) – A legal document that appoints a trusted person to make healthcare decisions on behalf of an individual who becomes incapable.
2. Advance Care Plan – A document that outlines specific care preferences, such as resuscitation, long-term care preferences, and life-sustaining treatments.

Why Are Advance Directives Important for Alzheimer’s Patients?

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• Ensures Personal Wishes Are Respected – Individuals can specify how they want to be treated in the later stages of the disease.
• Prevents Family Disputes – Clear instructions reduce conflicts among family members over healthcare decisions.
• Reduces Emotional Stress for Caregivers – Families and caregivers can make informed choices without uncertainty.
• Protects Against Unwanted Medical Treatments – Ensures that the individual does not receive interventions they would not have chosen.

Legal Framework for Advance Directives in Ontario

Ontario has specific laws governing advance directives and decision-making for individuals with dementia. The table below outlines key legal aspects.

Steps to Create an Advance Directive for Alzheimer’s Care in Ontario

1. Choose a Power of Attorney for Personal Care (POA)

Select a trusted family member or friend to make medical and personal care decisions on your behalf if you become unable to do so. The POA should:

• Understand your healthcare preferences
• Be willing to act in your best interest
• Be capable of making informed decisions under pressure

2. Document Your Care Preferences

Create an advance care plan that outlines specific medical treatments and interventions, such as:

• Preferences for life-sustaining treatments (e.g., ventilators, feeding tubes)
• Resuscitation preferences (DNR orders)
• Preferred long-term care settings (nursing home vs. in-home care)

3. Consult a Lawyer or Notary

Although a lawyer is not required to create a POA, consulting an elder law attorney can ensure that your document meets all legal requirements.

4. Communicate Your Wishes

Discuss your advance directive with your chosen POA, family members, and healthcare providers to ensure everyone understands your preferences.

5. Review and Update Periodically

Regularly review and update your directive, especially if:

• Your health condition changes
• Your POA is no longer able to fulfill their role
• New medical treatments or care options become available

FAQ:

1. What is the difference between a Power of Attorney for Personal Care and an Advance Care Directive?
A Power of Attorney for Personal Care (POA) is a legal document that gives someone authority to make healthcare decisions for you. An Advance Care Directive outlines specific medical preferences but is not legally binding unless part of a POA.

2. Can I change my advance directive after being diagnosed with Alzheimer’s?
Yes, as long as you are still mentally capable of making decisions, you can update your advance directive at any time.

3. What happens if an Alzheimer’s patient does not have an advance directive in Ontario?
If no POA for Personal Care is in place, a family member may be appointed as a Substitute Decision-Maker (SDM)under Ontario law. If no suitable family member is available, the Public Guardian and Trustee may step in to make decisions.

4. Do I need a lawyer to create an advance directive in Ontario?
No, but consulting a lawyer is recommended to ensure the document is properly drafted and legally valid.

5. Can my doctor override my advance directive?
Healthcare providers must follow the instructions of a legally appointed POA for Personal Care, as long as the decisions align with Ontario’s Health Care Consent Act.

6. Is a living will the same as an advance directive in Ontario?
No, a living will is a general term for a document stating medical wishes, while an Advance Care Directive is a more specific plan that may be included in a POA for Personal Care.

7. Can I have multiple people as my Power of Attorney for Personal Care?
Yes, you can appoint more than one person, but they must agree on decisions or follow instructions outlined in the POA document.

8. What happens if my Power of Attorney for Personal Care is unavailable in an emergency?
If the POA is unavailable, healthcare providers will turn to the next eligible Substitute Decision-Maker (SDM) under Ontario’s hierarchy of decision-making.

9. Can a nursing home refuse to follow an advance directive?
Long-term care homes must follow legally valid directives unless they conflict with the Health Care Consent Act or the resident’s best interests as assessed by healthcare professionals.

10. Where should I store my advance directive documents?
Keep copies with:

• Your Power of Attorney for Personal Care
• Your doctor and healthcare providers
• A trusted family member or lawyer

Planning for Alzheimer’s care in Ontario requires careful preparation through advance directives and Power of Attorney for Personal Care. These legal tools ensure that personal healthcare decisions align with an individual’s wishes, reducing stress for family members and caregivers.

If you or a loved one are facing an Alzheimer’s diagnosis, take the time to document your care preferences, consult with a legal professional, and discuss your wishes with family members. Proper planning ensures that your medical and personal care needs are met, even if you are unable to make decisions in the future.

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