A power of attorney allows someone to appoint a trusted person to make particular decisions on their behalf. It can be essential when illness, dementia, stroke, brain injury or another condition later affects the person’s ability to decide for themselves.
However, being a spouse, adult child or “next of kin” does not automatically give someone legal authority to consent to medical treatment, choose a care home, access every medical record or manage another adult’s money.
The type of authority required depends on the decision and which part of the UK the person lives in. England and Wales use Lasting Powers of Attorney, while Scotland and Northern Ireland have different legal arrangements.
A health or welfare attorney does not take control simply because the person has a diagnosis. The person must still be supported to make each decision whenever they can.
This article provides general UK information, not individual legal advice. Power-of-attorney and mental-capacity law differs between England and Wales, Scotland and Northern Ireland. Seek advice from a solicitor or the relevant public authority for a complex or disputed decision.
What is a power of attorney?
A power of attorney is a legal document in which one person gives another person authority to make specified decisions or act on their behalf.
The person making the document may be called:
- the donor in England and Wales;
- the granter in Scotland;
- the donor in Northern Ireland.
The appointed person is known as the attorney. There can be one attorney or several, depending on how the document is created.
Power of attorney is intended to let the person choose:
- who should help or decide;
- which powers they should have;
- when those powers can be used;
- which instructions must be followed;
- which preferences should guide decisions;
- who should replace an attorney who can no longer act.
The document must be created while the person has sufficient capacity to understand what they are making and the authority they are granting. Once that capacity has been lost, relatives cannot simply create a power of attorney retrospectively.
Is next of kin the same as power of attorney?
No. “Next of kin” is commonly used as an emergency contact or as the relative clinicians should speak to, but it does not automatically provide formal decision-making authority.
A next of kin can:
- share information about the person’s wishes;
- provide relevant background;
- participate in care discussions;
- raise concerns;
- be consulted during a best-interests process.
They cannot automatically:
- override a decision made by a person with capacity;
- consent to treatment on another adult’s behalf;
- refuse care merely because they disagree with it;
- control the person’s bank account;
- sign a care-home contract using the person’s money;
- demand unrestricted access to confidential records.
A relative may have authority if they are a valid attorney, court-appointed deputy or another legally recognised representative, but the title “next of kin” alone is not enough.
Which type of power of attorney is needed?
Health and care authority is separate from authority over money and property. Families often discover they have the wrong document when a crisis occurs.
England and Wales
There are two types of Lasting Power of Attorney:
| Type of LPA | What it may cover |
|---|---|
| Health and welfare | Medical treatment, daily care, living arrangements and personal welfare |
| Property and financial affairs | Banking, bills, benefits, property, investments and care fees |
A health and welfare LPA can only be used when the donor lacks capacity for the particular decision. A property and financial affairs LPA may sometimes be used while the donor still has capacity if the document permits it and the donor agrees.
Both documents must be registered with the Office of the Public Guardian before they can be used.
Scotland
Scotland uses:
- continuing power of attorney for property and financial matters;
- welfare power of attorney for health and personal welfare;
- combined power of attorney containing both types of power.
A welfare attorney can only exercise welfare powers when the granter lacks capacity in relation to the relevant matter. Continuing financial powers may begin after registration or at a later point specified in the document.
The document must be registered with the Office of the Public Guardian in Scotland.
Northern Ireland
Northern Ireland’s established Enduring Power of Attorney system primarily concerns property and financial affairs. It is not equivalent to an England-and-Wales health and welfare LPA.
Healthcare and welfare decisions for someone who cannot decide are governed by Northern Irish capacity and healthcare law, with court involvement available when necessary. Families should obtain advice from a Northern Ireland solicitor or the relevant Health and Social Care service rather than assuming that an enduring attorney can consent to every care or treatment decision.
The official nidirect guidance explains Enduring Powers of Attorney in Northern Ireland.
What about an old Enduring Power of Attorney in England or Wales?
Enduring Powers of Attorney created before October 2007 may still be valid for property and financial matters. They do not provide general authority over health and welfare.
An existing EPA may need to be registered when the donor is becoming or has become unable to manage their financial affairs. Seek guidance from the Office of the Public Guardian if an older document is involved.
How does mental capacity affect care decisions?
A person should be presumed to have capacity unless an appropriate assessment shows otherwise. A diagnosis of dementia, learning disability, mental illness or brain injury does not automatically remove decision-making capacity.
Capacity is:
- decision-specific — someone may understand a simple care choice but not a complex financial contract;
- time-specific — ability may improve, fluctuate or deteriorate;
- support-dependent — information must be presented in an accessible way;
- not determined by the outcome — making an unwise decision does not by itself prove incapacity.
In England and Wales, a person may lack capacity for a particular decision if, because of an impairment or disturbance affecting the mind or brain, they cannot:
- understand the relevant information;
- retain it long enough to decide;
- use or weigh it as part of the decision;
- communicate their decision by any means.
Before concluding that someone lacks capacity, reasonable support should be tried. This may include:
- using simpler language;
- providing pictures or written options;
- using an interpreter;
- involving a speech and language therapist;
- choosing a quieter environment;
- treating pain, infection or delirium;
- waiting for a better time of day;
- allowing more time;
- using the person’s preferred communication method.
Who assesses capacity?
The person responsible for the decision normally assesses capacity for that decision. For example:
- a doctor may assess capacity to consent to an operation;
- a social worker may assess capacity regarding a care arrangement;
- a care professional may assess capacity for a day-to-day care choice;
- a solicitor may assess whether someone can create a legal document.
Complex or disputed assessments may require specialist medical, psychological or legal input.
The NHS guide to the Mental Capacity Act explains the principles used in England and Wales.
What does “best interests” mean?
When someone lacks capacity in England or Wales, a decision made for them must be in their best interests. This is not simply what the attorney, doctor or family personally prefers.
The decision-maker should consider:
- the person’s past and present wishes;
- their feelings, beliefs and values;
- any written statement or care preference;
- the views of relevant family and carers;
- the attorney’s lawful authority;
- clinical benefits and burdens;
- less restrictive alternatives;
- whether the decision can wait until capacity improves;
- the person’s rights and quality of life.
The person should remain involved as far as possible, even when they cannot make the complete decision independently.
Which care decisions can a welfare attorney make?
The exact authority depends on the document, jurisdiction and decision. A health and welfare attorney may be able to decide or participate in decisions about:
- where the person lives;
- whether care is provided at home;
- moving into residential or nursing care;
- daily routines;
- washing, dressing and personal care;
- food and drink;
- social activities;
- contact with particular people, subject to legal limits;
- medical and dental treatment;
- care plans and support arrangements;
- access to relevant information;
- end-of-life care preferences.
In England and Wales, the registered health and welfare attorney can act only when the donor lacks capacity for that particular matter.
The attorney should read the complete document before making any decision. It may contain:
- binding instructions;
- non-binding preferences;
- restrictions on particular decisions;
- requirements to consult named people;
- special arrangements for joint attorneys;
- a choice about life-sustaining treatment.
What if several attorneys are appointed?
Attorneys may be appointed:
- jointly, meaning they must make every relevant decision together;
- jointly and severally, meaning they can act together or individually;
- jointly for specified decisions and jointly and severally for others.
Joint appointment can provide oversight but may create practical problems if an attorney becomes unavailable or the attorneys disagree. The document should also specify replacement attorneys where appropriate.
A care provider should check how the attorneys were appointed rather than accepting a decision from whichever relative contacts it first.
What can an attorney not do?
An attorney does not gain unlimited control over the person’s life.
An attorney cannot:
- override a valid decision made by the person while they have capacity;
- make decisions outside the powers in the document;
- use a financial LPA to make healthcare decisions;
- use a welfare LPA to access or spend money;
- choose what benefits the attorney rather than the donor;
- ignore binding instructions in the document;
- demand treatment that is not clinically available or appropriate;
- make or change the person’s will;
- vote on the person’s behalf;
- consent to marriage or divorce on their behalf;
- make gifts outside the permitted legal limits;
- use unreasonable restraint;
- deprive someone of liberty without appropriate legal authority.
An attorney should not make a blanket declaration that the person “has no capacity”. Each important decision needs its own consideration.
Can an attorney access medical records?
An attorney may need relevant information to make an authorised health decision, but power of attorney does not necessarily provide unrestricted access to every medical record.
The healthcare organisation should check:
- the attorney’s identity;
- that the document is valid and registered;
- which powers it grants;
- whether the person currently has capacity to consent to disclosure;
- whether access is necessary for the attorney’s role;
- whether disclosure is in the person’s interests;
- whether information about another person must be protected.
The Office of the Public Guardian provides guidance on disclosing medical information to attorneys and deputies in England and Wales.
How does power of attorney affect care-home decisions?
A welfare attorney may be involved in deciding whether someone should move into a care home when the person lacks capacity for that decision. The attorney should not start with “Which care home do we want?” but with “What arrangement best meets this person’s needs and wishes?”
Relevant considerations include:
- whether support at home is still safe and sustainable;
- the person’s past and present wishes;
- medical and nursing needs;
- dementia support;
- distance from family and familiar places;
- language, culture and religion;
- access to meaningful activities;
- the least restrictive workable option;
- funding and affordability;
- the effect of moving on wellbeing.
Our guides to signs that it may be time to consider a care home and choosing a care home provide practical assessment checklists.
Can an attorney choose any care home?
Not necessarily. The choice may be affected by:
- which homes can safely meet the assessed needs;
- availability of a suitable room;
- local-authority funding limits;
- NHS Continuing Healthcare arrangements;
- the person’s own resources;
- whether a third-party top-up is required;
- restrictions or court decisions;
- serious disagreement about best interests.
The attorney should be involved in planning but cannot require a care provider or public body to offer a placement that is unavailable, unsafe or outside lawful funding arrangements.
Who signs the care-home contract?
Signing a contract and agreeing how fees will be paid are financial matters. A health and welfare attorney does not automatically have authority to sign financial commitments using the resident’s money.
The person signing may be:
- the resident, if they have capacity;
- a property and financial affairs attorney;
- a continuing attorney in Scotland;
- a valid court-appointed financial representative;
- someone signing only for their own separate top-up commitment.
Relatives should not casually sign as “responsible person” without understanding whether they are accepting personal liability.
See our guides to care-home contracts and third-party top-up fees.
Can an attorney agree to restrictions in a care home?
An attorney cannot by themselves authorise an unlawful deprivation of liberty. Locked doors, continuous supervision, physical restraint or preventing a person from leaving may require a formal legal authorisation.
Care providers should use the least restrictive measures and follow the appropriate safeguards for the UK nation involved. Seek legal advice where restrictions are extensive, disputed or intended to continue for a long period.
How does an attorney make medical and end-of-life decisions?
A welfare attorney should work with clinicians rather than attempting to replace clinical judgement. Doctors recommend treatments they consider clinically appropriate; the attorney considers consent within their authority and the person’s interests.
The attorney may need to:
- provide evidence of the registered power;
- review the document’s instructions;
- explain the person’s values and previous wishes;
- ask about benefits, risks and alternatives;
- consider likely recovery and burdens;
- sign a consent form where legally appropriate;
- participate in a best-interests meeting;
- request a second opinion where justified.
Can an attorney refuse life-sustaining treatment?
In England and Wales, a health and welfare attorney can consent to or refuse life-sustaining treatment only if the LPA specifically gives them that authority.
Life-sustaining treatment can include:
- resuscitation;
- major surgery;
- ventilation;
- antibiotics in a life-threatening infection;
- cancer treatment;
- artificial nutrition or hydration;
- other treatment needed to keep the person alive.
The attorney must act in the donor’s best interests and follow valid instructions in the LPA. They cannot refuse treatment because it would personally inconvenience the family or preserve an inheritance.
If the LPA does not grant life-sustaining-treatment authority, clinicians make the decision under the applicable legal framework, while consulting the attorney and family about the person’s wishes and interests.
What is an advance decision to refuse treatment?
In England and Wales, an advance decision to refuse treatment allows a person with capacity to refuse specified future medical treatment if they later cannot make or communicate the decision.
It is different from:
- an LPA;
- a general advance statement of wishes;
- a DNACPR recommendation;
- a will dealing with property after death.
Special requirements apply when an advance decision refuses life-sustaining treatment. The wording, circumstances and signatures must meet legal rules.
The relationship between an LPA and an advance decision can depend on which was created later and what authority was given. Conflicting documents require careful legal and clinical review.
The NHS explains how an advance decision to refuse treatment works.
Is a DNACPR the same as power of attorney?
No. A Do Not Attempt Cardiopulmonary Resuscitation decision concerns CPR specifically. It does not mean “do not treat” and does not remove the person’s right to other appropriate care.
An attorney should be consulted where legally and practically appropriate, but cannot demand CPR when the clinical team considers it incapable of working or inappropriate to offer. Disagreement should be addressed through explanation, a second opinion and the organisation’s dispute process.
How are care fees and finances managed?
Health and welfare authority does not include control of money. Paying care fees, managing accounts, selling property and claiming benefits generally require separate financial authority.
A financial attorney may be able to:
- manage bank and savings accounts;
- pay household and care bills;
- claim benefits or pensions;
- deal with tax;
- manage investments;
- maintain, rent or sell property;
- pay for clothing, hairdressing and activities;
- fund additional care or equipment.
Every transaction must be for the donor’s benefit and within the document’s authority. Attorneys should:
- keep the person’s money separate from their own;
- retain receipts and statements;
- record major decisions;
- avoid conflicts of interest;
- claim only legitimate expenses;
- follow strict rules on gifts;
- avoid using money to benefit future beneficiaries.
Our guides to social-care funding, care-home fees and self-funding residential care explain the wider financial assessment.
Can an attorney sell the person’s home?
A property and financial affairs attorney may be able to sell a home if the document permits it, the donor cannot or does not manage the transaction themselves and the sale is in the donor’s best interests.
The attorney must consider:
- whether the move is permanent;
- whether the property may still be needed;
- the donor’s wishes;
- market value and independent valuation;
- alternatives such as renting;
- tax and benefits consequences;
- possible conflicts where a family member wants to buy it.
A sale below value or to the attorney may require professional advice or court approval. The attorney must not treat the property as an early inheritance.
What happens if there is no power of attorney?
If the person still has capacity, they may be able to create the appropriate power of attorney. Capacity should not be dismissed merely because planning has become urgent.
If capacity has already been lost, a family member cannot sign an LPA on the person’s behalf.
England and Wales
Depending on the decision, possible routes include:
- a best-interests decision by health or social-care professionals;
- applying to manage benefits as an appointee;
- an application to the Court of Protection for a one-off decision;
- appointment of a property and financial affairs deputy;
- less commonly, appointment of a personal welfare deputy.
The Court of Protection determines whether the person lacks capacity and what order or appointment is needed. A deputy receives only the authority stated in the court order.
GOV.UK explains how to apply to become a deputy.
Scotland
Possible court-based arrangements include guardianship or intervention orders under Scottish incapacity law. The suitable option depends on whether ongoing powers or authority for a specific act are required.
Northern Ireland
The Office of Care and Protection and Northern Irish courts may be involved where financial or welfare authority is required and the person cannot make the relevant decision. Obtain advice based on current Northern Irish law.
Court applications are normally slower, more expensive and less flexible than creating a suitable power of attorney while the person can still make one.
How do you create and use a power of attorney safely?
Discuss power of attorney before a crisis. A diagnosis of early dementia does not necessarily prevent someone from creating one if they still understand the document and its consequences.
Choosing an attorney
A suitable attorney should be:
- trustworthy;
- willing to act;
- able to manage disagreement;
- capable of keeping records;
- prepared to respect the donor’s wishes;
- available when decisions may be needed;
- able to separate their own interests from the donor’s;
- comfortable asking professionals questions.
Do not appoint someone only because they are the oldest child or live closest. Consider reliability, family relationships, financial skills and willingness to take on difficult decisions.
Should you appoint more than one attorney?
Multiple attorneys can provide shared knowledge and oversight, but they can also create delay or conflict.
Consider:
- whether they can work together;
- whether either can act when the other is unavailable;
- which decisions must be joint;
- whether replacement attorneys are needed;
- how disagreements should be handled;
- whether one person is better suited to welfare and another to finance.
How much does an LPA cost in England and Wales?
As of 2026, the Office of the Public Guardian registration fee is £92 for each LPA. Registering both health and welfare and property and financial affairs LPAs therefore costs £184 before any solicitor’s fees.
Fee reductions or exemptions may be available according to the donor’s income and benefits. GOV.UK advises that registration normally takes approximately eight to ten weeks when there are no mistakes.
You do not have to use a solicitor, but legal advice may be worthwhile when:
- the family situation is difficult;
- the donor has business or overseas assets;
- complex instructions are proposed;
- there is doubt about capacity;
- attorneys may face conflicts of interest;
- life-sustaining-treatment wishes need careful drafting.
Official forms and guidance are available through GOV.UK’s lasting power of attorney service.
What should families do after registration?
Do not leave the registered document forgotten in a drawer. With the donor’s agreement where they have capacity:
- tell the GP that an LPA exists;
- give relevant providers proof when authority becomes necessary;
- keep certified copies secure;
- record the Office of the Public Guardian access details;
- make sure attorneys know where the original is kept;
- review care and end-of-life preferences;
- update emergency contacts;
- keep financial records from the first transaction.
What if attorneys, relatives and professionals disagree?
Disagreement does not automatically mean that one side has acted improperly. Families may interpret the person’s wishes differently, while clinicians and social workers may have concerns about safety or legality.
Start by clarifying:
- which decision is being made;
- whether the person has capacity for it;
- who legally holds authority;
- what the document actually says;
- which evidence supports each option;
- what the person previously said or wrote;
- whether a less restrictive option exists.
Possible next steps include:
- a formal capacity assessment;
- a multidisciplinary or best-interests meeting;
- an independent advocate;
- a second clinical opinion;
- mediation;
- the provider’s complaints process;
- legal advice;
- an application to the appropriate court.
Serious medical-treatment disputes should be resolved through appropriate legal processes rather than one party acting unilaterally.
What if an attorney is misusing their position?
Warning signs include:
- unexplained withdrawals or transfers;
- care bills being left unpaid despite available money;
- large gifts to the attorney;
- selling property below value;
- isolating the person without a valid reason;
- ignoring the person’s wishes;
- preventing professionals from seeing the person alone;
- using threats, restraint or intimidation;
- refusing to provide accounts;
- making decisions that primarily benefit the attorney.
In England and Wales, concerns about an attorney or deputy can be reported to the Office of the Public Guardian. Immediate risk, theft, assault or coercion may also require contact with adult safeguarding services or the police.
In Scotland, concerns can be raised with the Office of the Public Guardian, local authority, Mental Welfare Commission or another relevant body depending on the issue. Northern Ireland has its own safeguarding and court routes.
Our guide to safeguarding adults in care homes explains common warning signs and how families can report concerns.
Frequently asked questions
Does a spouse automatically have power of attorney?
No. Marriage or civil partnership does not automatically authorise one adult to make all medical, care or financial decisions for the other.
Can adult children make decisions for a parent?
They can provide information and be consulted, but they need valid legal authority to make a binding decision on the parent’s behalf.
Can someone with dementia make a power of attorney?
Possibly. The question is whether they understand the nature and effect of the document when creating it, not whether they have a diagnosis. Early legal advice can be valuable.
Can an attorney act while the person still has capacity?
A health and welfare attorney in England and Wales cannot make decisions while the donor has capacity for them. A financial attorney may sometimes act with the donor’s permission, depending on the document.
Does capacity have to be lost permanently?
No. Capacity can fluctuate. An attorney may be able to act during a period of incapacity, but the person resumes control of a decision whenever they can make it themselves.
Can a health attorney manage care-home fees?
Not solely under a health and welfare LPA. Managing money and signing financial commitments usually requires property and financial authority.
Can a financial attorney choose a care home?
A financial attorney can manage payment but does not automatically hold welfare authority to decide where the person should live. The two roles may need to work together.
Can an attorney force someone into a care home?
Not simply because the attorney thinks it is best. Capacity, legal authority, best interests, objections and restrictions on liberty must all be considered. Disputed cases may require court involvement.
Can an attorney refuse all medical treatment?
No. Authority depends on the document and circumstances. Decisions must be made individually and in the donor’s best interests. Special authority is required for life-sustaining treatment in an England-and-Wales LPA.
Can doctors overrule an attorney?
Clinicians do not have to provide treatment they consider clinically inappropriate. If a valid attorney and clinical team cannot agree about a serious decision, a second opinion, mediation or court decision may be required.
Can an attorney change the person’s will?
No. An attorney cannot simply create or amend the donor’s will. A statutory will requires a specific court process.
Can an attorney give away the person’s money?
Only limited gifts are normally permitted. Substantial gifts, transfers or inheritance planning may require court approval.
Does power of attorney continue after death?
No. An attorney’s authority ends when the donor dies. The executors or administrators of the estate then become responsible.
Can a person cancel their power of attorney?
Usually yes, while they retain the capacity required to revoke it and follow the correct legal process.
Is a solicitor required?
Not always. Official forms can be completed without a solicitor, but legal advice is sensible where instructions, finances, capacity or family relationships are complex.
When is the best time to make a power of attorney?
Before it is urgently needed. Making and registering the documents while the person is well enough to consider their choices avoids many of the delays and costs associated with court applications later.
