OBTAINING A DURABLE POWER OF ATTORNEY FOR HEALTH-CARE FROM NURSING-HOME RESIDENTS

Background. A durable power of attorney for health care (DPA) allows a person to appoint a surrogate decision-maker for any future period of mental incapacity. The absence of advance directives can lead to conf usion and the expenditure of resources while trying to exert a substit uted judgment. Methods. The Wisconsin DPA was presented with an organi zed pilot program to 150 residents who had been judged by their social workers to have the capacity to make informed decisions regarding med ical care. The reasons residents gave for accepting or rejecting a DPA were analyzed. Results. Seventy-nine percent prepared a DPA. Reasons for signing included allowing the resident to decide who would make me dical decisions and assuring that specific wishes would be carried out . Twenty-one percent did not execute a DPA. Reasons were categorized a s confusion and misunderstanding regarding the legal system, mistrust, or social isolation. Conclusion. The high rate (79%) of DPA completio n is probably related to individually counseling residents. However, c ompetent residents who despite counseling do not choose to execute a D PA can have detailed advance directives (''living wills'') prepared wi thout appointing a decision-maker.