Key Facts
- A Health and Welfare Lasting Power of Attorney grants you authority to make decisions about the personal care and welfare of the person who has lost capacity.
- Your role as Health and Welfare Attorney covers a wide range of everyday decisions.
- Equally important is understanding what you cannot decide as an attorney managing day to day care.
- The cornerstone of your authority as a Health and Welfare Attorney is the best interests test.
- Throughout your role, you must balance practical care needs with the donor’s fundamental right to dignity and respect.
As a Health and Welfare Lasting Power of Attorney, you hold significant legal authority to make decisions on behalf of the donor. However, many attorneys struggle to understand exactly where the boundaries lie. Which decisions fall squarely within your daily care responsibilities? Which require specialist involvement or fall outside your remit altogether? For a full overview of how LPAs work, see our complete guide to lasting power of attorney.
What Is Day to day Care Decisions Under a Health and Welfare LPA?
A Health and Welfare Lasting Power of Attorney grants you authority to make decisions about the personal care and welfare of the person who has lost capacity. However, the law distinguishes between everyday care decisions and more significant life choices.
Day to day care decisions are those you would reasonably expect a family member or carer to make during ordinary daily life. These decisions do not require specialist input and relate to the routine management of the donor’s personal care and social wellbeing.
What Daily Care Decisions Fall Under Your Authority?
Your role as Health and Welfare Attorney covers a wide range of everyday decisions. Understanding these boundaries will help you exercise your authority confidently and appropriately.
Diet and Nutrition
You can make decisions about what the donor eats and drinks day to day. This includes choosing meals, deciding on dietary preferences, and purchasing groceries or arranging food delivery. If the donor has preferences or cultural or religious requirements around food, you should respect these where possible. You can also make reasonable decisions about whether to pursue nutritional supplements or specialised diets, provided these do not constitute medical treatment.
Clothing and Appearance
Your authority extends to choices about the donor’s clothing, shoes, and personal grooming. You can select appropriate clothing for the weather and the donor’s preferences, and arrange for haircuts, nail care, or other personal grooming services. These decisions should reflect the donor’s personality and values, ensuring they remain able to express themselves through their appearance.
Hygiene and Personal Cleanliness
You can make decisions about bathing, showering, and general personal hygiene routines. This includes arranging support with washing, dressing, and toileting where needed, as well as choosing appropriate hygiene products. Your decisions should balance practical necessity with the donor’s comfort and preferences, and always protect their dignity during personal care.
Daily Routine and Activities
You have authority to decide how the donor spends their time during ordinary days. This includes arranging social activities, hobbies, visits to local venues, and day centres. You can decide whether the donor attends activities groups, takes part in recreational pursuits, or engages in entertainment. These choices should consider what the donor enjoyed before losing capacity and what brings them satisfaction now.
Social Contact and Visitors
You can make reasonable decisions about who visits the donor and when. If the donor wishes to see friends or family members, you should facilitate these visits where possible. However, you also have authority to restrict contact if you reasonably believe a visitor poses a risk to the donor’s welfare or wellbeing. This might include preventing visits from someone who is abusive, exploitative, or has a harmful influence.
Living Environment and Home Comforts
Within reason, you can make decisions about how the donor’s living space is arranged and maintained. This includes choosing furniture, decorations, and temperature settings, as well as deciding on household cleaning and maintenance. You should aim to keep the donor’s environment comfortable, safe, and reflective of their preferences.
What Falls Outside Day to day Care Decisions?
Equally important is understanding what you cannot decide as an attorney managing day to day care. Certain decisions fall outside this scope and require specialist input or constitute separate legal authority.
Major medical treatment decisions, such as surgery, chemotherapy, or significant medication changes, typically exceed day to day authority. For more information on these decisions, see the article on whether an attorney can refuse medical treatment under a Health LPA. Decisions about moving the donor to a care home or changing their primary living arrangements are also generally considered significant life choices rather than daily care.
Decisions about the donor’s financial affairs or property are entirely separate and require a Property and Financial Affairs LPA if the donor lacks capacity in those areas.
Not sure where to start with your LPA?
Download our free Lasting Power of Attorney checklist to see exactly what’s involved — or book a free consultation and we’ll walk you through it.
What Is Applying the Best Interests Test to Daily Decisions?
The cornerstone of your authority as a Health and Welfare Attorney is the best interests test. This legal framework ensures that every decision you make prioritises the wellbeing and preferences of the donor.
When making a day to day care decision, you must consider what is in the best interests of the donor. This involves considering the donor’s known wishes and preferences, their values and beliefs, their medical condition and current needs, and any relevant advice from family members or healthcare professionals. You should also consider what the donor would likely decide if they retained capacity, and whether there is a less restrictive option that still meets their needs.
The best interests test is not about what you think is best, but about what serves the donor’s wellbeing, dignity, and preferences. If the donor previously expressed strong views about certain activities, foods, or social contact, these should guide your decisions even if the donor cannot express them now.
What Is Maintaining Dignity and Respecting Preferences?
Throughout your role, you must balance practical care needs with the donor’s fundamental right to dignity and respect. Even when the donor has lost capacity, they retain their identity, preferences, and emotional needs.
When making daily care decisions, involve the donor as much as possible. Even if they cannot make formal decisions, the donor may be able to express preferences, reactions, or comfort levels. Always explain what you are doing and involve them in choices where feasible. Protect the donor’s privacy during personal care and ensure they are treated with respect by all carers and professionals involved in their support.
Additionally, strive to support the donor’s independence and autonomy. If the donor is able to do something themselves, even if it takes longer or involves some risk, allowing them to do so respects their dignity and may slow cognitive or physical decline. Document decisions and the reasoning behind them, particularly if you have restricted the donor’s freedom in any way, such as limiting visitors.
What Is Practical Tips for Managing Day to day Care Decisions?
Acting as a Health and Welfare Attorney is a substantial responsibility. These practical tips will help you navigate daily decisions effectively and confidently.
Keep Clear Records
Document significant decisions and your reasoning. Note any discussions you have had with healthcare professionals, carers, or family members. Record the donor’s preferences and reactions to different activities or choices. This creates a clear audit trail and demonstrates that you have acted in the donor’s best interests.
Communicate with the Care Team
Work closely with any carers, nurses, or care home staff involved in the donor’s support. Share information about the donor’s preferences and any special requirements. Regular communication ensures consistency in care and allows professionals to advise you on what works well for the donor.
Seek Specialist Advice When Needed
If a decision borders on the medical or significantly affects the donor’s life, do not hesitate to seek advice from healthcare professionals, the donor’s GP, or a solicitor. Understanding the boundary between day to day decisions and more significant life choices prevents errors and protects both you and the donor.
Review Decisions Regularly
Circumstances change. Regularly review whether your established routines and decisions still serve the donor well. What worked six months ago may not suit the donor now. Flexibility and willingness to adjust approaches based on the donor’s changing needs and preferences demonstrate good stewardship.
Honour the Donor’s Voice
Even when the donor cannot make decisions, their voice matters. Listen to what they communicate through behaviour, reactions, and any expressed wishes. If the donor repeatedly resists a particular activity or food, respect that resistance where safely possible. The donor’s preferences should shape your decisions.
For official guidance, see the gov.uk information on health and welfare LPAs.
Please note: Lasting Powers of Attorney apply in England and Wales only. Different rules apply in Scotland and Northern Ireland.
Frequently Asked Questions
Can I decide where the donor lives if they have a Health and Welfare LPA?
Day to day decisions about the donor’s home environment fall within your authority. However, decisions about major moves, such as relocating the donor to a care home, are typically considered significant life choices that exceed routine day to day authority. These decisions usually require consultation with healthcare professionals and may involve specialist legal consideration. For detailed information on this topic, see the article on care home decisions.
What should I do if the donor disagrees with a daily care decision I have made?
Even though the donor has lost capacity, they may express disagreement or discomfort with your decisions. Listen to these expressions seriously. If possible, adjust your approach to accommodate their preferences. If the donor consistently resists a particular decision, discuss this with their carers or healthcare team. The donor’s expressed wishes should heavily influence your choices, even if they lack full capacity to make formal decisions.
Can I prevent the donor from seeing certain family members or friends?
You can restrict social contact if you have reasonable grounds to believe a visitor poses a genuine risk to the donor’s welfare. This might include an abusive or exploitative individual. However, you cannot arbitrarily limit the donor’s social contact based on your personal preferences. Any restrictions should be documented and justified by reference to the donor’s safety or wellbeing.
Does a Health and Welfare LPA cover financial decisions about care?
A Health and Welfare LPA does not cover financial decisions. If the donor has also lost capacity regarding finances, a separate Property and Financial Affairs Lasting Power of Attorney is needed to manage their money and property. The Health and Welfare Attorney may identify care needs and associated costs, but the Financial Attorney (or another appointed person) handles payment for those needs.
How do I know if a decision exceeds my day to day authority?
If a decision is significant, affects the donor’s life fundamentally, or relates to medical treatment, it likely exceeds routine day to day authority. Consult the article on attorney legal duties and responsibilities and seek professional advice when uncertain. The Health and Welfare LPA complete guide provides further clarity on the scope of your authority.
TL;DR: What Falls Under a Health and Welfare Power of Attorney?
As a Health and Welfare Attorney, you hold authority to make everyday care decisions affecting diet, clothing, hygiene, daily activities, social contact, and home environment. These decisions must be made in the donor’s best interests, respecting their known preferences and maintaining their dignity.
- Day to day care decisions include diet, clothing, hygiene, daily routine, social contact, and living environment.
- Major medical decisions, care home moves, and financial matters fall outside day to day authority.
- Every decision must pass the best interests test, prioritising the donor’s wishes and wellbeing.
- Keep clear records, communicate with the care team, and seek specialist advice when decisions border on the medical.
- Always involve the donor as much as possible and honour their preferences, reactions, and expressed wishes.
More From Elwyn & Mabel
Creating a Lasting Power of Attorney is one of the most important steps in planning for the future. Download the free Lasting Power of Attorney Checklist for a step by step guide to getting your LPA in place, explained in plain language.
For personalised guidance on creating a Lasting Power of Attorney or any aspect of estate planning, book a free consultation with Elwyn & Mabel. The team will answer questions, review individual circumstances, and help put the right plan in place.