As people age, making or communicating important decisions can become difficult. This may be because of dementia, serious illness or just that we cannot process information as well as before. Or maybe people simply need a bit more time to understand things. Sometimes, too, they are happy to make simple decisions but need help with important ones – like choosing to move into a care home.

If you or a loved one are suffering from ill-health, approaching the end of life or have dementia and are concerned about the effects of this, it is important to ensure that there is someone trustworthy to make decisions about healthcare, money and property.

It is best to have this done in good time, if possible. It’s not always pleasant or easy to have to think about practicalities such as wills, Power of Attorney or other legal safeguards – especially in a hurry. But getting these sorted out well ahead of time enables someone’s health, end-of-life care and financial affairs to be managed according to their own wishes, providing peace of mind and freeing everyone up to focus on loved ones during those all-important last weeks or months.

What is mental capacity?

Mental capacity is the ability to make or communicate decisions for yourself at the appropriate times. To have mental capacity you need to be able to understand the decision to be made, why you need to make it and what is likely to happen as a result. As we age, making important decisions can become difficult.

The Mental Capacity Act 2005 explains how to decide if someone can make their own decisions or not. It also advises on how family and carers can help them and make decisions on their behalf, if necessary. Following the guidance contained in the Act helps to ensure that your loved one’s wishes concerning their care are followed, and gives you the confidence that you are making the right decisions on their behalf.

Sorting out the practicalities

Making plans for your future care, should you become unable to make such decisions for yourself later on, involves talking about your needs and wishes with your family, friends and any professionals such as a GP or social worker. It can also involve getting help with practicalities such as financing your care, putting in place a Power of Attorney or making a will.

Although it can all be an emotional strain to think about, making important decisions in advance means that you do not have to worry about the practicalities if and when you are ill, and avoids the need for family and friends making rushed decisions amidst the throes of grief.

You may need to decide on some complex arrangements in advance so that you can be sure that your wishes will be carried out when the time comes. These include:

Lasting Power of Attorney (LPA)

LPA allows you to choose a person (or people) to make decisions for you if you become unable to do so yourself. Although you may be happy to make your own decisions now, there may come a time when this is not possible for you.

To arrange LPA in England you must still be able to make sound decisions, so it is advisable to plan ahead and do this while you are well. You can choose to arrange either one or both types of LPA. You can choose one or more people – many people prefer family or friends, but it could be a professional person like a lawyer or accountant – but they must be over 18, have sound mental capacity themselves and (if in charge of a property and financial affairs LPA) financially solvent.

There are two types of LPA:

Health and Welfare LPA

This is designed to help you if you have lost the capacity to make decisions about your healthcare and treatment options, and covers decisions like moving into a care home, as well as details to do with your day-to-day care. Your chosen person will be able to make these decisions on your behalf.

Property and Financial Affairs LPA

This allows your chosen representative to manage your money (like paying bills or looking after your bank account) and to make big decisions like whether to sell property. It particularly helps people with dementia, but you may also find it useful if you find dealing with these things stressful, confusing or time consuming.

How to do it?

You appoint LPAs through the Office of the Public Guardian. You can choose more than one person to appoint, and can also decide whether decisions need the signature of just one attorney or all of them. You need to fill in the forms for each person (who must agree to becoming an attorney), and then register them. This can take up to 10 weeks, so if you are concerned about your health deteriorating it is best to start the process as soon as possible.


Deputyship is another way of making sure that there is someone able to make decisions on your behalf. Deputyship is usually used where there is no LPA in place and a person already has dementia, or is severely ill and unable to make decisions.

Like LPA, there are two types of deputy:

  • Personal welfare
  • Property and financial affairs

To become a deputy you also have to apply to the Court of Protection. If you are appointed, you will get a court order which tells you what you can and cannot do on that person’s behalf.

Making an Advance Statement

You might want to consider what could happen if you become unable to make decisions or communicate your wishes yourself. An Advance Statement sets out ‘in writing’ your wishes and preferences for your future care, including any values and beliefs that are important to you. It can cover any area of your health or social care in the future, such as:

  • where you want to be cared for – at home, in a nursing home, a hospital or a hospice
  • how you prefer certain things to be done, from whether you prefer a bath or a shower to your favourite foods
  • any practical issues such as arrangements for looking after a pet, for example

Although an Advance Statement is not legally binding, it must be considered by anyone making decisions about your care. It does not have to be witnessed but you should sign it as a clear indication of your wishes. You can choose who sees it and where it is kept – many people include a copy in their medical notes.

An Advance Decision

Also known as a living will, an advance decision is a decision you can make now about refusing certain treatments in the future, and is a legally binding record of your wishes if you are unable to communicate them yourself at some point in the future. If you wish to refuse certain treatments in some circumstances or do not wish to be resuscitated, these must be named in the document so that everything is clear. If you decide to refuse life-sustaining treatment in the future, you need to:

  • write it down
  • sign it in the presence of a witness
  • have the witness sign it

Do Not Resuscitate (DNACPR) decision

This is a written instruction to medical staff not to attempt to bring you back to life if your heart stops beating or you stop breathing. It is a written instruction to medical staff not to attempt to bring you back to life if this happens. It is usually recorded on a special DNAR form completed by a doctor. It only covers CPR (cardiopulmonary resuscitation) so, if you are still breathing and your heart is beating, you will receive other treatment and care to ensure that you are pain free and comfortable. You cannot make a DNAR decision yourself, but you can ask your doctor to issue one.

Making a will

This is the only way you can make sure that the people you choose benefit from your estate, particularly if you are unmarried and wish your partner to inherit.

Inheritance Tax

Making your will can also help you to understand what Inheritance Tax might have to be paid on your estate.

Making funeral arrangements

It is a good idea to talk about (and write down) your wishes for your funeral, especially if you have strong beliefs or values which you want reflected in the arrangements. Having a plan in place for your funeral also helps your loved ones, as it takes away some of the pressure to make decisions when they are dealing with bereavement. You might also consider a pre-paid funeral plan to spare your family the cost of your funeral.