The nurse asks who will handle things after discharge. Your parent points to you.

Pause before you say, “I will.” There are three different jobs hiding inside that answer:

Helping your parent understand and carry out the plan. Receiving information your parent permits the hospital to share. Making health care decisions if your parent cannot make them.

Local option: New Plan Care gives families in the St. Louis area in-home help so a parent can stay home: companionship, help with bathing and dressing, meals, and overnight care. Call (314) 405-0887.

One person may do all three. But the jobs do not come from the same authority. Being an adult child, emergency contact, driver, or person standing at the bed does not by itself settle who can make decisions.

Day 0, still in the bed: ask which job the hospital is giving you

Start with your parent. If your parent can understand the decision and communicate a choice, speak to your parent first. Ask, “Do you want me to listen, take notes, and help with the discharge plan?” Then ask the nurse to record that permission and identify you as the main contact.

HIPAA allows a hospital to share information directly relevant to your involvement in care when the patient agrees, does not object, or when professional judgment supports sharing in the patient’s best interest. That permission is not the same as appointing you to make decisions. A legally authorized personal representative has a different role under the federal privacy rule. Those distinctions appear in 45 CFR 164.510(b) and 164.502(g), as explained by the U.S. Department of Health and Human Services.

Use exact questions:

“Is my parent making their own decisions right now?”

“Am I listed only as a contact, or does the chart show me as an authorized decision-maker?”

“What document are you relying on?”

“Does that document apply now, or only after a finding of incapacity?”

Do not accept “You are family” as the whole answer. Ask the staff member to show you the document name, the named agent, any alternate agent, and the page that describes when the authority begins.

If your parent brought a durable power of attorney, read it. Do not assume a financial power of attorney includes health care decisions. Under Missouri law, authority to consent to or prohibit health care must be granted within the limits of the state’s Durable Power of Attorney for Health Care Act. Some powers, including particular end-of-life decisions, require specific language rather than a general grant of authority. See Missouri Revised Statutes sections 404.710 and 404.820.

Check five things on the paper:

The principal’s name matches your parent. The agent’s name matches the person expected to act. A successor is named if the first agent is unavailable. The required signatures and acknowledgment are present. The document has not been replaced or revoked.

Then ask Health Information Management, Patient Relations, or the unit social worker to confirm that the complete document has been placed in the medical record. Missouri Revised Statutes section 404.840 addresses placing a durable power of attorney for health care in the patient’s medical record and the effect of notice to the provider.

The hospital cannot require your parent to sign a durable power of attorney for health care as a condition of treatment or admission. Missouri Revised Statutes section 404.835 says so. Mercy’s public patient-rights materials also state that patients may formulate advance directives and have them followed in accordance with law.

Before the car pulls in: test whether the authority will travel

A document in the hospital chart does not automatically appear in the records of the primary care office, pharmacy, home care agency, rehabilitation facility, or emergency department.

Ask for one clean paper copy and one readable electronic copy. Make sure every page is included. A signature page without the pages that grant and limit authority may not answer the next provider’s question.

Write this short list on the front:

Agent’s full name and phone number. Alternate agent’s full name and phone number. Where the original is kept. Which clinician or process determines when the authority becomes active, if the document requires that step. Any limits on the agent’s authority.

Ask the discharging clinician, “Does the chart say my parent has decision-making capacity for this discharge plan?” Capacity can depend on the decision being made and may change. You are not being asked to decide capacity yourself. You are asking who assessed it, what was concluded, and whether the next provider needs that information.

If the staff say you are now acting as agent, ask them to document why the authority is active. If they say your parent is still deciding, keep directing questions to your parent. You can take notes and help without taking over.

The National Institute on Aging explains that a health care proxy generally acts when the person cannot communicate health care decisions and should follow the person’s known wishes and values. It also recommends giving the proxy and health care providers copies of the signed documents.

Day 1, the car pulls in: do not let access depend on one phone

Place a copy where it can be found without searching through a discharge bag. Keep another copy with the person who is most likely to accompany your parent to care.

Do not post the entire document where every visitor can read it. Use a labeled envelope or folder. On the outside, write the agent’s name, phone number, and where the original is stored.

If your parent can still give permission, help each provider record it. Ask the primary care office and pharmacy what form they use to speak with a family helper. A verbal permission, a HIPAA authorization, portal proxy access, and a health care power of attorney are not interchangeable.

Test the route with one ordinary call. Call the office listed for follow-up. Say, “I am helping with the discharge plan. What permission or document do you have on file, and what can you discuss with me?” Write down the answer and the staff member’s department.

Do not ask for another person’s portal password. Ask whether the system offers proxy or caregiver access. Separate access creates a record of who used the account and can remain limited to the authority granted.

Day 2 to Day 3, the first full days: separate helping from deciding

Most first-week work does not require you to make a substitute health care decision. You can arrange a ride, place paperwork in order, write questions, and help your parent call the clinic while your parent remains the decision-maker.

Before a call, ask your parent what result they want. During the call, let your parent answer first when possible. After the call, write down the instruction, the person who gave it, and who will carry it out.

If a new decision arises and your parent seems unable to follow the explanation or communicate a stable choice, do not simply announce that you are taking over. Call the treating clinician. Ask for an assessment and for the chart to state who currently has authority to decide.

If two relatives both claim the role, stop using family seniority as the test. Return to the document and the chart. Ask Patient Relations or the organization’s legal or ethics resource to identify the process the hospital or clinic follows. The National Institute on Aging advises choosing a main contact and making the person’s wishes and advance directives available to the care team.

Day 3 to Day 7, the week: compare the paper with the real work

By now you know where the document fails in practice. One office may have only the signature page. Another may list an old phone number. A pharmacy may have permission to discuss prescriptions but no copy of a health care power of attorney. Fix each gap at the place where it appeared.

Review the actual document with your parent if your parent can participate. Ask:

“Is this still the person you want?”

“Is the alternate still available?”

“Does this person know what matters to you?”

“Are there decisions you want to keep for yourself or limit?”

Do not edit a signed document by crossing out names or writing instructions in the margin. If your parent wants a change, ask how to execute and distribute a valid replacement. Missouri law provides procedures for revocation in Missouri Revised Statutes section 404.850. A lawyer can help when the document is unclear, relatives disagree, authority crosses state lines, or your parent’s ability to execute a new document is uncertain.

Make a distribution list. Include the named agent, alternate agent, primary care office, and any provider likely to need the document. Add the hospital record location and the place where the original is kept. When a document changes, retrieve or clearly mark old copies so the next person does not rely on the wrong one.

The commitment test

Before you agree to be the person who makes health decisions, you should be able to answer these questions:

Is your parent still making this decision? What document names you? When does your authority begin? What decisions does it cover? What decisions are limited or excluded? Who acts if you cannot? Which providers have the complete document? What did your parent say matters most?

If one answer is missing, name the gap. Do not cover it with “I am the daughter.” Ask the hospital to put the right document, contact, and authority in the record before the next decision arrives.

This guide is practical information, not legal advice. For the source standards used at this desk, see How We Write and the Sources page.

Before You Agree to Make Health Decisions, Check What Authority You Actually Have