Bringing Your Partner Into Care Decisions When You Are Not Legally Married

Many LGBTQ+ couples have spent 30, 40, or even 50 years together without legally marrying. Some chose not to marry for personal reasons, some could not marry before 2015 and never got around to it, and some moved in together long before marriage was a real option. In any care setting, the law treats an unmarried partner very differently from a spouse. Hospitals default to next-of-kin (which means blood relatives) for medical decisions. Nursing homes can restrict visiting hours and limit who attends care conferences. ICUs sometimes still limit visitation to immediate family. Without paperwork, your partner of decades can be shut out at the moment they are most needed.

The paperwork that fixes this is straightforward, and most of it costs nothing. Three documents do most of the work: a healthcare proxy (also called a healthcare power of attorney or healthcare agent), a HIPAA authorization, and a designated visitor form. Together these give your partner the legal authority to make medical decisions if you cannot, the legal right to receive your medical information, and the legal right to visit you in any healthcare facility (including ICUs that otherwise limit visitors to family). All three can be completed without a lawyer using free state-specific forms available at AARP, Honoring Choices, or your state Department of Health website.

The healthcare proxy is the most important. It names your partner as the person who makes medical decisions when you cannot speak for yourself. Forms vary by state, but every state recognizes some version of this document, and federal law requires healthcare facilities to honor a properly executed proxy from any state. The proxy takes effect only when two physicians certify that you cannot make your own decisions, which is the same standard that applies to spouses. Importantly, naming a proxy displaces the default state hierarchy, so your estranged sister cannot override your partner's decisions.

The HIPAA authorization is separate from the proxy and worth completing for additional reasons. HIPAA is the federal medical privacy law. Without a signed HIPAA release, even your appointed proxy may have trouble getting routine information (test results, medication lists, billing info) when you are conscious. The release gives your partner full access to your medical record at any covered provider, hospital, or pharmacy listed on the form. You can list multiple people: your partner, a trusted friend, an adult niece or nephew you are close to. There is no limit.

Designated visitor protections come from a 2010 federal rule and from state laws that followed. Medicare- and Medicaid-participating hospitals and most nursing homes must allow you to designate any person as your visitor, regardless of biological or marital status. Twenty-four states have additional Designated Visitor laws that strengthen these rights. A simple one-page form (often called a Hospital Visitor Designation or Patient Advocate Designation) names your partner, and the hospital is required to honor it. Without the form, the hospital follows its own default policy, which often defaults to family-only visiting in ICUs.

Keep originals with your partner, give copies to your primary care doctor, your home care agency, your senior living facility, and any specialist who treats serious conditions. Update the documents every five years and any time your contact information changes.

(Sources: National Hospice and Palliative Care Organization CaringInfo state advance directive forms; HHS Hospital Visitation Final Rule (2010); SAGE 2024 LGBT Older Adult Legal Toolkit; Lambda Legal Take the Power booklet; HHS Office for Civil Rights HIPAA authorization guidance, accessed May 2026)