The Power Struggle: Why People with Dementia Often Switch Powers of Attorney
One of the most challenging aspects of dementia caregiving is navigating the legal and financial decisions necessary to provide proper care. A common complication arises when individuals with dementia repeatedly change their designated power of attorney (POA). This behavior can create confusion, family conflict, and significant challenges in managing their care. At its heart, this issue often stems from a deep-seated resistance to losing autonomy.
What Is a Power of Attorney?
A power of attorney is a legal document that grants someone the authority to make decisions on behalf of another person, typically related to health care, finances, or both. For people with dementia, assigning a POA early in the disease process is crucial to ensure their wishes are honored as the condition progresses.
However, this role comes with significant responsibility, and for many with dementia, giving up control can feel like relinquishing their independence—something they may not be emotionally ready to do.
Why Do People with Dementia Change Their POA?
1. Fear of Losing Independence
Dementia gradually erodes a person’s ability to manage daily tasks, finances, and health decisions. This loss of control can feel overwhelming, leading them to resist the idea of someone else making decisions for them. Switching POAs might be their way of asserting control over their situation, even if it’s counterproductive.
2. Fluctuating Relationships
As dementia progresses, people may experience shifting perceptions of their relationships with loved ones. One day, they may trust a child or sibling implicitly; the next, they might accuse that same person of trying to take advantage of them. These perceptions are often influenced by paranoia or confusion, common symptoms of dementia.
3. Family Dynamics and External Influence
Family members often have differing opinions about caregiving, finances, and other critical matters. This can lead to arguments or power struggles that confuse or overwhelm the person with dementia. In some cases, a well-meaning (or manipulative) relative may convince them to change their POA to better align with their own interests.
4. Lack of Understanding About the Role of a POA
Many people don’t fully understand what it means to designate a POA. They may fear that giving someone this authority means losing their voice entirely, rather than realizing that the POA is meant to act in their best interest when they can no longer make decisions.
5. Cognitive Decline and Emotional Instability
Dementia affects decision-making and emotional regulation, leading to impulsive or erratic choices. This cognitive decline often leaves the person vulnerable to making changes without fully grasping the consequences.
The Emotional Root: Resistance to Being "Managed"
At its core, repeatedly changing a POA is often an emotional response. Many people with dementia fear being treated as if they are no longer capable of making meaningful contributions to their own lives. For them, the idea of someone "being in charge" feels like an acknowledgment of their diminishing capacity—a reality they may not want to face.
How Families Can Address This Issue
1. Have the Conversation Early
The earlier families discuss power of attorney decisions, the better. These conversations should take place when the person is still in the early stages of dementia and capable of making rational decisions. Emphasize that a POA is a safeguard, not a means of control.
2. Be Reassuring
Reassure your loved one that their input and wishes will always be prioritized. Acknowledge their fear of losing independence and emphasize that the goal is to honor their values and preferences.
3. Involve a Neutral Third Party
Having a lawyer or mediator present during discussions can help ensure that everyone understands the purpose and responsibilities of a POA. A neutral party can also validate the person's decisions, reducing the likelihood of future changes.
4. Create a Plan Together
Work with your loved one to establish clear guidelines about how and when the POA will take effect. For example, it could be triggered only after a medical professional certifies that they can no longer make decisions for themselves.
5. Stay Patient
Remember that switching POAs is often not a reflection of distrust or malice, but rather confusion, fear, or frustration. Approach these situations with empathy and patience.
Understanding Their Perspective
At the root of repeated POA changes is a natural human desire: the need to feel respected, valued, and in control of one’s own life. For someone with dementia, this desire can manifest in ways that are challenging for families to manage. By addressing their fears with compassion and creating a supportive environment, you can help ease their transition into relying on others for help.
