What triggers an LPA?
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What triggers an LPA?
It started with a poll. In previous blogs I have explored barriers to making a Lasting Power of Attorney (LPA), with results correlating with the Office of the Public Guardian (OPG) findings. OPG research explored reasons or barriers to making an LPA in 2014 and found attitudinal reasons common - people just don’t think it will apply to them. The most common reason or not doing an LPA in the Twitter poll I ran in 2020 was attitudinal too, with people thinking they just didn’t need one. LPAs retain a reputation as documents in older age or ill health rather than a part of normal life planning.
The most recent poll I ran set out to find out triggers to making an LPA – what are the triggers can we increase them to normalise LPAs?
Why does this matter? LPAs are an important part of life planning, they enable you to nominate a trusted person to speak for you if you ever lost capacity. We know many associate losing capacity with age or long-term illness, but any of us could face loss of capacity through sudden illness or accident. Having an LPA in place is a bit like an insurance policy – you hope you won’t need it but it is there just in case. Your next of kin do not have an automatic right to speak for you, a common myth tackled in the OPG #YourVoiceYourDecision campaign. More about the importance of LPAs is included in the Christmas blog
On to the results if the latest – this time I asked what triggers the process of LPAs with options being:
· a change in health
· routine life planning
· other
After a week of voting results showed routine life planning to be the most popular response followed closely by a change in health.
What had me most curious was the “other” category and what could be learned about triggers from these responses. As ever Twitter is a generous platform and people shared the following reasons as triggers to making an LPA:
· Divorce: “Divorced and with children initiated the process for me. I wanted future proofing not only for me but for them too”
· On ambulance transfer: “If transporting people to ED we have 10-15mins alone in the back to chat - it’s a natural time to think of these things”
· Conversation with HCP
· Part of social history taking on assessment
· When completing a will
· Witnessing inappropriate life pro longing treatment “For me it was seeing doctors prolonging life no matter the cost or suffering and knowing that if I was ever in that position that my POA could just tell them to stop”
· Death of a friend or loved one
· Advice from a HCP or social care professional
The discussion generated was informative too and, as well as identifying triggers I hadn’t previously thought of, useful learning points were shared and provided ideas on opportunities to normalise LPA discussion; these included
· A speed dating style learning circuit with stands for discussing different topics related to later life or health failing challenges
· Including the different elements of Advance Care Planning, including LPAs, in Medical/Nursing/HCP education
· To routinely ask about Advance Care Planning when taking the social history - I love this approach: “any ReSPECT or DNACPR forms, ADRT or POA I need to make a note of? No? Let me run through what they are, we should all have at least some of them”
· Making the most of time spend transferring patients via ambulance “If transporting people to ED we have 10-15mins alone in the back to chat - it’s a natural time to think of these things”
· “if discussing with a patient in clinic or home visit-extend the importance to family or others with them”
· “Ambulance attendance and an honest conversation between crew, patient, and loved ones. Whilst it's often not a life-threatening presentation when we arrive, the fact that we are there can start a lot of "what if" convos and crew are well placed to facilitate discussion.”
· “clerking/admission assessments - we ask everything about the individual and so ‘the conversation’ flows and feels natural for both patient and clinician”
Challenges were shared in the responses and included time frames in primary care and hesitancy in family members to discuss LPAs. One fascinating fact to emerge was the discrepancy between the number of Health and Welfare LPAs completed compared to Property and Finance LPAs. 2014 data from a FOI request showed Property and Finance far outweighing Health and Welfare, if anyone knows more recent data I would be interested to hear. Do we really value Property and Finance decision making as more important than Health and Welfare…. possibly another poll coming….?! When I work with clients I always completed the Health and Welfare LPAs first if we are completing both – just a process habit as to me that matters more than finance.
2014 data comparing Health & Welfare LPAs completed to Property & Finance LPAs
This was an interesting poll to run and reflect on and I am grateful to all respondents for engagement, comments and suggestions. Rather like the #makeeverycontactcount for health promotion, including planning ahead in routine interactions and social history taking could maximise these natural trigger points. From a public perception perspective, podcasts, interviews and publications could support public understanding of trigger points such as divorce.
If you would like to find out more about making a Lasting Power of Attorney or enquire about bespoke professional education for Advance Care Planning contact me.