How to Choose a Healthcare Proxy When You Have No Family

A healthcare proxy (also called a healthcare agent, medical power of attorney, or healthcare surrogate depending on your state) is the person who speaks for you when you cannot speak for yourself. If you are unconscious after a fall, in a coma, or in the middle of dementia that takes away your ability to make decisions, the proxy is the one who tells the doctors what you would have wanted. For solo agers, this choice is harder because the default family hierarchy does not apply.

Legally, almost any competent adult can serve. In most states the only people who cannot serve are your treating doctors, employees of the hospital where you are being treated, and (in some states) employees of the nursing home where you live. That leaves the field wide open: a close friend, a neighbor, a member of your faith community, a former coworker, a niece or nephew who lives in another state, or a paid professional fiduciary.

The right choice has three traits. First, the person must be willing to follow YOUR wishes even if they disagree. A friend who would refuse to authorize hospice because they cannot let you go is not the right pick, no matter how much they love you. Second, the person must be reachable. A proxy who never answers the phone or lives in a place with bad cell service cannot do the job. Third, the person should be at least 10 to 20 years younger than you, because proxies often outlive multiple appointments.

If no friend or community member fits, solo agers can hire a professional fiduciary or care manager to serve. Cost varies by state but usually runs $100 to $200 per hour when activated, with annual retainers of $300 to $1,500 to keep them on file. Many states maintain a registry of certified professional fiduciaries.

(Sources: AARP — Choosing a Healthcare Agent; National Hospice and Palliative Care Organization; American Bar Association Commission on Law and Aging)