What is a health surrogate?


health care surrogate is an adult who is appointed to make healthcare decisions for you when you become unable to make them for yourself.



What does a surrogate do and how would I locate such a person? 



As Baby Boomers advance in years, due to divorce rates, less children, and several other factors, there will be lots of seniors who don't have relatives at the ready to assist with medical and other needs. For those who may not have extra hands on deck, it is an important part of your planning to assemble a care and advocacy team before you need it.   


In 2012, the American Geriatrics Society published a study describing tens of thousands of patients nationwide who had no family members or designated surrogates available to help with medical decision-making. The study found that 16% of patients in intensive care units, 3% of nursing home residents, and a large (unspecified) number of individuals in a variety of settings who were facing end-of-life decisions were all absent a relative or designated surrogate.


A surrogate is a person who can receive your medical information and make medical decisions on your behalf. Although you may not have a relation who can serve in this role, perhaps you may have a trusted friend, community member, professional advocate, or clergyperson who would be a competent advocate. Some states have licensed professional fiduciaries and certified guardians that can serve as your surrogate and assist you in other ways. Some states do not. You may want to look for this as an option if there are no other available people you can think of to help you.


So, what happens if you do not name a surrogate? Look to your state's laws to find out.  Click here to see a chart published by the American Bar Association that lists every state's default surrogate law and who would get priority to serve as your surrogate. The red font on the chart describes what happens if there is no available qualified surrogate (no family, friends, etc., available to serve). 


For example, in Florida, the law gives the following order of priority for a surrogate if an incapacitated person did not make a health care surrogate document:

  1. Judicially appointed guardian
  2. Patient’s spouse
  3. Patient’s parent
  4. Adult sibling. If more than one, a majority of adult siblings available for consultation.
  5. Adult relative who has exhibited special care/concern for patient and who has maintained regular contact with patient
  6. Close friend
  7. Clinical social worker selected by medical provider’s bioethics committee

See that Florida's law starts with a judicially appointed guardian and ends with a licensed clinical social worker? In these circumstances, it is very possible that a stranger would be the person appointed to make your medical decisions for you. It's generally preferable to avoid this.


Also, in Florida, there is the option of making a document called a Declaration of Preneed Guardian. This allows you to name a person who you do want to serve as your guardian should one ever need to be appointed. It also lets you say who you wouldn't want (very important if you are concerned about exploitation, estranged relatives, etc.).  



What is a POST directive?



 A POST is a Physician's Order for Scope of Treatment. It's a medical order for specific types of treatment you want in the event of a medical emergency, as opposed to a legal document like a health care surrogate. These are appropriate to create in the event of a serious illness diagnosis, whereas it is appropriate to create an advance directive like a health care surrogate at any time (preferably when you are young and healthy).


If you would like to read more and find out what is available in your state, click here.



Where can I locate a contact to hear more about a health care surrogate for adults who have medical benefits but no living relatives to make decisions for them?



You may wish to contact your local Area Agency on Aging, State Department of Elder Affairs, or State Bar Association. An attorney who practices Elder Law in your state can advise you on your options. You can find an attorney who practices this type of law by contacting your State and City Bar Associations and by looking up attorneys in your area through the National Academy of Elder Law Attorneys.


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