Advocacy in the Margins

An advocate is one who speaks for another, usually another whose voice is less articulate, weaker, more vulnerable, or silent.

A fiduciary is a trustworthy person who acts in the best interests of a vulnerable person. The term most often applies to financial interests, but can apply to any relationship of trust and loyalty.

"Betty" - photo by Chris Belding

“Betty” – photo by Chris Belding

People who are aging or ill often need a trusted other to advocate for them in circumstances where the person cannot well-represent their own values and wishes.

I have helped dozens of people gain peace of mind by correctly creating the documents, advance directives, that state their wishes, their values, and their choice of whom they trust to speak for them  should they not be able to speak and act for themselves.

For people who wish to join with others in small communities of proactive aging discussions, I have helped to create such circles.

Visit http://www.secondjourney.org/newsltr/Archives/Trenshaw1.htm.

Medical Advocate

A Medical Advocate is a person who accompanies a client to medical appointments, helps them to understand what is being said about their healthcare, helps them to think through their decisions, advocates for the client within the medical system by knowing the values and wishes of the client and seeing that physicians and hospital staff understand what their patient wants and doesn’t want. This relationship is usually formalized through a legal document called a Durable Power of Attorney for Healthcare.

Professional Fiduciary

A Professional Fiduciary is a trained and experienced person who holds the best interests of a client, along with the client’s particular values and wishes concerning their wellbeing (usually financial), and fulfills those interests by handling any bill-paying, banking, investment oversight, correspondence, and any other administrative tasks and estate management at times when the client is unable to do so. Again, this relationship is usually formalized through a legal document, this one called Durable Power of Attorney for Finances.

Advance Directives

Should you become physically or mentally incapacitated in the future, the most certain way for your healthcare and your finances to be handled in the ways you would have chosen for yourself, and to avoid a Court-established guardianship in which your personal and civil rights may be lost, is to complete documents called Advance Directives.

These documents include a Durable Power of Attorney for Healthcare, a Durable Power of Attorney for Financial Decisions, a Healthcare Directive, a Values Declaration, a Physician-Ordered Life-Sustaining Treatment (POLST) form, and a Will.

The POLST form is an at-a-glance document recognized and honored by paramedics, hospitals, emergency rooms and nursing homes, stating your do/do-not resuscitate orders and other emergency orders. This document must be discussed with and signed by a physician. In my opinion it is the single most-valuable Advance Directive you can create. POLST is available and recognized in Washington, Oregon, Pennsylvania, West Virginia, California, Utah, and several other states. Check online to see whether your state has a POLST program. Some states are in the process of developing POLST , and in the meantime they may have Do Not Resuscitate forms to prevent the violence and futility of resuscitation attempts, particularly on the elderly.

Your Will should be discussed with an attorney, especially if you have a complex estate.

The Durable Power of Attorney for Healthcare, the Durable Power of Attorney for Financial Decisions, a Healthcare Directive and/or a Values Declaration can be composed and distributed by you, with advice from anyone familiar with the purposes and the practicable language that will accomplish what you intend. [click here for a List of Resources]

Please do NOT wait until “someday when you’re old” to create these documents. That day may be painfully too late. Even people in their 30’s or younger should have made these arrangements for their futures. All such documents can be altered or revoked as life circumstances change, but they cannot be created after your capacity is compromised.

Circles of Caring/Proactive Aging

As I have worked among the elders of our society in their homes, in hospitals, in nursing homes, and in homeless shelters, my own aging and mortality have taken up more and more of my thoughts. Often this is what it sounds like:

These changes that I notice in my body – do they mean I am already old – or is there time to prepare for my aging? 
 Who will care about me when I am old?
 What will happen when I can’t care for myself?
 Will I still have my mind?  Please, God, let me still have my mind.
 What if I actually DO live to be 100?*

And it sounds like this:

Who cares about who I have been, who I am now, and who I am becoming? 
 Who shares my interests?  Who inspires me?  Who listens to my story, honors my history, and invites me into their story? 
 Now that my family is scattered/preoccupied/gone, who feels like “kin” to me? 
 How can I pass on the wisdom I’ve accumulated through my life’s experiences?*

*From A Harvest of Years ©2004, 2010 by Cynthia Trenshaw and PeerSpirit, Inc.
  Available for purchase at Amazon.com

I became an advocate of proactive aging when those kinds of questions roused me in the night, and when I discovered that I’m not alone in my concerns. I realized that I yearned not so much for answers, but for a way to explore my concerns out loud, in a circle of people who could listen deeply, who could hold and honor my deepest questions. These questions were explored in Circle of Caring, an organization I helped to found.  Read an article in the Seattle Times on Circle of Caring.

Such a circle can happen when people dare to switch from socializing to dialogue – what I call “circle talk.” This profound way of being together was pioneered by Christina Baldwin and Ann Linnea, of PeerSpirit, Inc. (See Calling the Circle: The First and Future Culture by Christina Baldwin, available at www.PeerSpirit.com. Now, as a teaching colleague of PeerSpirit, I help groups learn a simple yet deeply meaningful format of gathering in intentional circles. I am especially interested in helping to form “proactive aging circles” to meet the growing needs of people like myself who, in the middle of the night, struggle with all those nagging questions, and who long for others with whom to share them.

The issues of pro-active aging have also led me, and others, to consider how to arrange for our needs to be met in ways not currently available to us. Who will connect us with the community resources we need, how will our social and spiritual preferences be taken into account, who will help with follow-through when the roofer or the caregiver doesn’t do what we expected? We are hoping to create a quality-of-life-advocacy program for ourselves, an organization that will already know our needs and our values, our friends and our families, and be able to advocate for us when advocacy seems more than we can manage for ourselves.

Guardian ad Litem

When the Superior Court of a county is petitioned to order a guardianship for someone thought to be incapacitated, the Court must investigate the case. Since judges can’t take the time to do this themselves, they assign a Guardian ad Litem to be the eyes and the ears of the Court, and to represent the best interests of the “alleged incapacitated person.”

I have been trained to do these investigations for several Washington State counties, and I am required to take annual continuing education as well. When I am appointed to a case, I interview any family, friends, neighbors of the alleged incapacitated person; arrange for a medical/psychiatric evaluation; investigate all financial accounts and assess the assets of the estate; determine whether the person wants or needs representation by an attorney; determine who would be the most appropriate guardian, if one is needed, and what would be the appropriate extent of their guardianship authority. Within six weeks of the filing of the guardianship petition, I submit my report of recommendations to the Superior Court judge who will hear the case.

Guardianship is a serious matter; in a full guardianship the incapacitated person can lose all of their civil rights, including their right to marry or divorce, to sign contracts, to make medical decisions, to draw up a will, and even to vote.

The final decisions about incapacity and guardianship rest with the Court. Whatever decision is reached at the guardianship hearing, it should always be the least restrictive action available, allowing the person to retain the most individual freedom possible within the limitations of their life circumstances.