Health Care Agent Matching Program FAQs
A legally-recognized health care agent (HCA) is an adult with the authority to make health care decisions on behalf of another adult in the event that person becomes unable to make or communicate their own decisions. In Massachusetts, legally recognized HCAs are designated through a Health Care Proxy (HCP) document. Any adult can appoint an HCA to make health care decisions on their behalf. The HCA’s authority begins only after an attending physician has determined that the person lacks the capacity to make or communicate health care decisions on their own.
Competency assessment requires judicial determination, whereas capacity is a clinical determination. In Massachusetts, there are only two legally recognized surrogate decision-makers for adults who lack capacity:
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Health care agents (as designated through a health care proxy document)
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Guardians appointed by a court of law
This program identifies employees from each of the participating organizations willing to volunteer and able to act as an unrepresented patient’s HCA, and matches the volunteers with unrepresented patients who currently have decision-making capacity.
The health care agent’s role is to make a substitute judgment based on what they know about the patient, or what’s in the patient’s best interest. A clinician should not serve as an HCA for any patients they are currently treating as this is considered a conflict of interest. The patient can always disagree with HCA. Autonomous decision-making should be respected, we are endowing individuals with the ability to make their own decisions about their individual futures. The individual must be given adequate information, able to be informed, and free from undue influence.
This is a really big responsibility to take on for someone. We ask that HCAs commit to serving for at least an initial 2-year term by being appointed via an HCP form. Although, you can withdraw and also choose not to step in as an agent at the time of incapacitation. The participant also has a right to terminate the relationship at any point.
HCAs will need to provide their name and cell phone number to be contacted if the participant loses capacity. The initial time commitment will be heavier, including training and following up with the participant to learn and document their goals, values, and preferences for care. The ongoing load is variable. If the patient retains capacity, the HCA should check in at least annually to review goals, values, and preferences. The number of check-ins may increase as the participant's health status worsens. If the participant loses capacity, the HCA's involvement depends on the participant's health situation. You could be an HCA for as short as a few weeks or as long as several years.
HCAs must be appointed as an agent using a health care proxy form, which should then be loaded into the medical record. There may be small financial costs, such as parking if meeting the patient at a hospital, that will not be reimbursed. You are encouraged to volunteer to be a HCA for at least one participant and more if you’d like, but we recommend you limit your involvement to no more than three participants at a time.
There may be lots of confusion about what the HCA is or is not responsible for, and confusion from facility staff since you’re not a family member, friend, next of kin, etc. HCAs should only take on duties within the scope of the HCA responsibilities outlined in training.
Example kinds of decisions one might have to make when someone has lost capacity:
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Transfer/discharge planning
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Release of records
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Blood draw, procedure, testing
In the event that you are the HCA for a participant who becomes your patient (e.g., the participant is admitted to your unit), then you cannot be the HCA while you are also a treating clinician.
The HCA and participant are matched initially when the participant is affiliated with one of the organizations involved in the HCA Matching Program. Once that match is made and the HCA is designated, the match follows the participant regardless of treating facility. For example, a participant could be discharged from hospital A to a skilled nursing facility and then readmitted to hospital B. The HCA-participant match is valid at all of the institutions, with the exception that if HCA becomes a treating clinician (e.g., the participant becomes a patient on your unit) they can no longer act as an HCA.
If you are asked to make decisions about:
1. Tests and other diagnostic procedures: What will be learned from the test? What are the risks involved?
2. Treatments: What is the reason for the proposed treatment? Are there any alternative treatments available?
3. Prescribed Medications: How does the medication interact with other medications or foods? What are the side effects of the medication?
4. Surgery: How often is surgery successful in treating this problem? What will recovery be like after the surgery?
5. Capacity: Can the patient feel and experience pain?
It depends. Check with your Site Lead to determine protocols for remote witnessing.
Volunteer HCAs can reach out to their Site Leads for guidance and advice on particular cases. In addition, any non-urgent questions or comments can be sent to [email protected].
If there’s ever a time when you can no longer serve as the HCA, even within the first 2 years, we will help the patient select a new health care agent. With the patients’ permission, any notes provided by the former health care agent will be shared with the new health care agent.