AARP Hearing Center
5 Tips for Becoming a Health Proxy
When illness leaves a loved one unable to make medical decisions, you may face tough choices
Sisters Leah Salazar (left) and Rachelle Wong (right) are co-health care proxies to safeguard their mother’s medical wishes.
AARP (Courtesy Rachelle Wong, Getty Images)
Key takeaways
- Health care proxies are entrusted to make medical decisions for a loved one who can’t.
- Early legal planning and open communication can help health care proxies make informed decisions and navigate difficult choices.
- Proxies must sometimes make urgent decisions, relying on their loved one’s values when legal documents don’t have the answers.
For years, sisters Rachelle Wong, 47, and Leah Salazar, 52, watched subtle changes in their mother, Mary, that they couldn’t ignore. The once fiercely independent 80-year-old from Arizona was forgetting familiar places, misplacing everyday objects and struggling with decisions that had once come naturally. As Alzheimer’s disease tightened its grip, the sisters found themselves stepping into unfamiliar roles, not just as daughters but also as advocates and health care decision-makers.
Navigating that transition required difficult conversations, legal planning and a willingness to confront realities their mom initially wanted to ignore. With guidance from an elder law attorney, Wong and Salazar had legal documents prepared naming them as co-health care proxies so they could make medical decisions when their mom no longer could. It became a guidepost for preserving their mom’s wishes, coordinating her care and helping the sisters present a united voice. Mary now lives in a group home in Peoria, Arizona, only a few minutes from her daughters.
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Their experience underscores an issue many families face as a loved one progresses with a chronic disease or disability: deciding who will advocate for them when they can no longer speak up for themselves.
Having those plans in place before a crisis occurs can make all the difference.
What is a health care proxy?
A health care proxy, also known in many states as a medical power of attorney, is a legal document that allows a person to appoint someone they trust to make medical decisions on their behalf if they become unable to communicate or make decisions for themselves. The term can be confusing because “health care proxy” refers to both the legal document and the person appointed to be in that role. Signing the paperwork does not immediately transfer decision-making authority.
A proxy’s authority typically begins only when a loved one is no longer able to make or communicate informed health care decisions. Legal experts say the document is most effective when it is accompanied by ongoing conversations about health care goals, end-of-life preferences and quality-of-life priorities, providing family members with clear guidance during a medical crisis.
“There’s no playbook for when a caregiver suddenly becomes a health care proxy. People often step into the role without fully understanding what it requires,” says Eric Einhart, partner at Russo Law Group in New York and board president of the National Academy of Elder Law Attorneys. “People think they are there to decide what’s best, when in fact they are there to reflect what was already decided by the individual.”
When more time never comes
As a surgical nurse, Matthew Elwood, 51, of Peoria, Arizona, understood how quickly health conditions could change. His wife, Heather, 53, is a family-practice physician. Between them, and with attorneys in the family, they assumed they would recognize when it was time to finalize health care and legal plans for loved ones.
Instead, life moved faster than anyone expected. Heather’s mother, Eva, was undergoing treatment for pancreatic cancer when her condition deteriorated. “Suddenly, doctors were saying that she only had two weeks to live,” says Matthew.
The family rushed to put legal documents in place before she died, in July 2025 at age 79. The shock of his mother-in-law’s decline was only the beginning for Matthew and Heather. For years, Eva had served as health care proxy and executor for her younger sister, Mary, who lived with cerebral palsy and lived in an assisted living facility.
Mary was devastated by the loss of her sister, and her health declined rapidly. When she developed aspiration pneumonia in early 2026, the family again believed they had time to update documents and transfer authority. Within a day, she was basically unresponsive. She died in March 2026.
Despite serving as her aunt’s health care decision-maker, Heather was unable to access Mary’s financial accounts because beneficiary and transfer-on-death paperwork had not been finalized. The accounts were frozen, forcing Heather to pay funeral expenses out of her own pocket while waiting for the estate to be settled. “We thought we had more time both times, and all of a sudden, we didn’t,” says Matthew.
Leah and Rachelle worked with an elder care law attorney to develop a medical power of attorney.
Courtesy Rachelle Wong
Value of talking about the hard stuff
Terry Berthelot, 60, thought she knew exactly what her mother, Mary, wanted at the end of life. The two had spent years talking openly about death and dying, a reflection of her mom’s career as a nurse and their family’s willingness to confront difficult conversations head-on. Yet during the early days of the COVID-19 pandemic, when fears about ventilator shortages dominated the news, Mary reminded her of a critical detail: She never wanted to be placed on a ventilator.
As her mother’s health care proxy, Berthelot, who lives in Mansfield, Connecticut, realized that even families who communicate well need to revisit these discussions regularly, as circumstances and medical conditions change.
When Mary’s lung cancer worsened, and a stroke left her unable to make decisions for herself, Berthelot was called upon to put those wishes into action. She made the difficult decision to forgo additional treatment and arrange hospice care at home, honoring her mom’s long-stated desire to spend her final days surrounded by family. Her mother died in August 2020.
The experience reinforced lessons Berthelot now shares professionally as an associate professor in residence in human development and family sciences at the University of Connecticut. She credits her mother’s transparency and openness for helping her family make end-of-life decisions with confidence.
“Because expectations and wishes had been openly discussed long before a crisis emerged, there were no surprises or disagreements when difficult decisions had to be made,” Berthelot says.
Five ways to prepare for a health proxy role
Serving as a health care proxy is one of the most consequential responsibilities a caregiver can assume, yet many people take on the role without fully understanding what it entails until a medical emergency forces rapid decisions. These approaches can help caregivers prepare for that responsibility before a crisis unfolds.
1. Start legal and medical planning early
Like many families confronting dementia, Wong and Salazar recognized that something wasn’t quite right long before their mother received an Alzheimer’s diagnosis. “It probably took three or four years after we started seeing things to get her to undergo exams,” says Wong. By the time she was diagnosed, the family had to make some quick decisions, from managing finances to taking away her car and assuming greater responsibility for her care.
Looking back, Wong believes those early years offered an opportunity for conversations many families postpone: Who would make medical decisions if her mom no longer could? What were her wishes for future care, and how should legal documents such as wills, trusts, advance directives, physician orders for life-sustaining treatment, and powers of attorney for financial and medical matters be structured?
2. Understand your loved one’s wishes
Medical decisions are complicated by emotion, family dynamics and uncertainty about prognosis. “Amid the chaos, it can be hard to remember that the proxy’s mission is to fulfill their loved one’s wishes,” says Einhart. “The responsibility is to honor their values and beliefs, even if you would choose differently for yourself.”
3. Divide responsibilities among family members
For the Elwoods, serving as a health care proxy became a family effort, even though much of the formal responsibility rested on Heather’s shoulders. While she handled difficult conversations with care facilities, attorneys and financial institutions, Matthew supported her through the medical, legal and logistical challenges that followed.
Together, they handled funeral arrangements, estate issues and difficult end-of-life decisions, leaning on each other’s health care experience to carry out their loved ones’ wishes.
Maintaining ongoing communication has allowed Wong and Salazar to coordinate care, troubleshoot problems and navigate difficult decisions together as their mom's needs have become increasingly complex. "We are a united front for our mom," says Wong.
4. Revisit legal documents
Einhart notes that families frequently discover too late that their existing plans contain gaps or fail to account for changing circumstances. Outdated documents, conflicting instructions or unfit decision-makers can create confusion at the very moment families need clear direction. In some cases, disagreements over care or finances can delay important decisions and even lead to court involvement. Consider consulting an elder law attorney, who to help your family evaluate who is best suited to serve as health care proxy (or proxies), ensure plans remain current and identify strategies to protect assets while preparing for future care needs.
5. Be prepared for decisions that have no perfect answer
Certain medical crises can leave families facing unexpected and urgent decisions. While legal documents can provide important guidance, they do not always address every scenario. Wong experienced this firsthand when her mother fell and fractured her hip shortly after moving into memory care. Wong and Salazar were suddenly confronted with a difficult choice: whether to pursue surgery or focus on keeping their mother comfortable. They ultimately decided not to move forward with the surgery. "The role of health proxy often requires individuals to make the best possible choices based on what they believe their loved one would want," says Caleb Lihn, an elder law attorney in Scottsdale, Arizona.
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