Financial POA Asking for Health Information, and a Treatment Refusal
Mr. Brennan, 70, is alert and oriented. He has told you that he does not want his medical information shared with his adult son, who holds his durable power of attorney for finances only. The son stops you in the hallway and says, 'What did the doctor say about his kidneys, and what pills is he on now? I'm his POA, you have to tell me.' Ten minutes later Mr. Brennan says he wants to skip his breathing treatment because 'it doesn't do anything,' and the treatment is due in five minutes. Two other residents are within earshot in the hallway.
1. What do you say to the son, and what do you not say?
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Do not confirm or deny anything - not the kidney results, not the medication list, and not 'well, he's doing okay.' A financial power of attorney does not carry authority over healthcare information, and even a healthcare agent does not override the stated wish of a resident who is alert and oriented and has capacity for that decision.
Move it off the hallway floor, because two other residents can hear:
'I can't discuss his medical information - that has to come from the nurse. Let's step over here and I'll get her for you.'
Then actually get the nurse. Being warm and non-deceptive matters: 'I can't' rather than 'I don't know,' and never 'I'll tell him you asked' followed by silence. This is his right to confidentiality, not your personal gatekeeping.
2. Mr. Brennan wants to skip the breathing treatment. What is your response, and what do you document?
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Accept the refusal and report it immediately. It is his right, and he is alert and oriented. Do not argue, do not threaten, do not hint at consequences you are not qualified to explain, and never let a treatment 'happen anyway.'
'Okay - I'll let the nurse know right now.'
The nurse explains the risks and documents the informed refusal; your job is to make sure the information reaches her while the treatment window still exists, not at end of shift.
Document: the time, exactly what he said in his own words, that you notified the nurse and her name, and her follow-up. Do not chart 'noncompliant' or 'uncooperative' - those are judgments about a person exercising a right, and they contaminate the record.
3. The son later catches you and says, 'Fine - just tell me whether he's eating.' How do you handle that?
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'Whether he's eating' is still protected health information, so the answer is the same: no confirmation, no denial, no general reassurance that reveals anything.
'I really can't share details about his care. The nurse can talk with you - I'll let her know you'd like to speak with her.'
What you may do: listen to his worry, take a message, and tell him when the nurse is available. General information about visiting hours is fine; anything about the resident is not.
Finally, tell the nurse that Mr. Brennan asked that his son not be given information and that the son is pressing staff. The team needs one consistent answer, or the son will simply ask the next aide until someone talks.