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  • 4-Minute Article
  • |
  • Mar 15, 2019

Choosing Who Will Manage Your Long-Term Care Needs: What to Know

Know the roles of those who can help protect you and your family if you need long-term care.

Happy mother and daughter featured in article about managing long term care needs

Choosing people for the roles they can fill to help manage long-term care needs, if you ever need it, could be one of the most important decisions you and your family face.1

Here are three roles to consider:

1. Agent or Attorney-in-fact, under a Power of Attorney- Provides a trusted person or family member to make legal and financial decisions on your behalf.

2. Healthcare Surrogate/Agent- Someone to make healthcare decisions in the event you are unable to do so, and who may dictate who has legal access to your medical records.

3. Legal Guardian- State courts can play a role in protecting your property and health as well.

Can one person serve multiple roles? Yes. The benefits of having someone to fill these roles include:

Taking steps to choose the right people before you need care can help you feel confident that decisions will be made in your best interest. It also gives your family clear direction on your wishes. Here are some tips for selecting the right people for these key roles.

Power of Attorney

A Comprehensive Decision-Maker

By signing a durable general power of attorney, you’re choosing someone who will make nonmedical decisions and act on your behalf in certain matters you elect from housing to finances. Giving a power of attorney “durable” status generally means it stays in effect if you become mentally or physically incapacitated.

“They are obligated to act in your best interests, but, in general, you should trust that person implicitly."


Keep in mind:
“They are obligated to act in your best interests, but, in general, you should trust that person implicitly,” says Jenny Boyer, a North Carolina attorney. It could be a family member, close friend, or anyone else who can faithfully handle your affairs, particularly your finances. You can also grant expansive or more limited powers, depending on your wishes, level of trust, or other factors.

She says you should also consult with an attorney to ensure that any legal document you’re signing meets your needs and complies with the laws in your state.2

Healthcare Surrogate

Knows Your Medical Conditions, Doctors, and Health Wishes

A healthcare surrogate – called a healthcare agent in some states ­– oversees medical matters. That person will make your medical decisions if you are unable to do so. If this person does not already have legal access to your medical records under federal HIPAA Privacy Rule guidelines, you can execute a HIPAA release indicating that the surrogate can receive your private health information to ensure he or she is making informed decisions on your behalf, Boyer says. That person should be someone you’re comfortable with accompanying you on doctor appointments or supporting you during your hospital stay.

In the event you need long-term care, they may take on greater decision-making power for your medical treatments and your arrangements. They (or your agent under a durable general power of attorney, if different) also may assume the responsibility of getting out-of-pocket expenses submitted and reimbursed (if you have a reimbursement long-term care policy) and can help make sure you get other benefits you may be eligible for, such as Medicaid and Medicare.

"In the event you need long-term care, they may take on greater decision-making power for your medical treatments and your arrangements."


Keep in mind:
Boyer says that the person you name as your healthcare surrogate does not need to be the same individual who is your agent under your durable general power of attorney – the roles sometimes demand different personal strengths.

Also, if you have long-term care insurance, you’ll need medical information to properly file claims. Make sure you keep an up-to-date list for your healthcare surrogate, including medical history, current medical conditions, prescriptions, and physician contact information.

Legal Guardian

Nominating a Court-Appointed Protector

Legal guardians protect the property and decision-making of adults who are unable to do so themselves and are overseen by state courts.

When you sign powers of attorney (both general and healthcare-related) before you need care, you can nominate the person you would like to serve as guardian of your estate or guardian of your person, if that ever becomes necessary.

The guardian will be required to report periodically to the court on how your money is being spent and the type of care you’re receiving.

Keep in mind:
Boyer says the general goal of having an agent under a durable general power of attorney and a healthcare surrogate is to avoid having the need for a court-appointed guardianship in the first place.

"The general goal of having an agent under a durable power of attorney and a healthcare surrogate is to avoid having the need for a court-appointed guardianship in the first place."

Questions to Ask Your Advisor

Here are some questions to help begin a conversation with your legal advisor and financial advisor about whom to choose to manage your care:

  • What are the key characteristics/qualities to look for when selecting someone for each role?
  • What is the process for establishing each person in this role?
  • What steps should I take to ensure each person is properly informed to be able to carry out his or her role?