Power of Attorney and Dementia: Making Decisions for Someone You Love in Ontario
by Joy Birch, President, Highview Residences
When someone you love is living with dementia, there may come a time when you begin to wonder:
Are they still able to make decisions safely?
It’s a difficult place to be. You may notice changes—missed medications, safety concerns, or increasing confusion—but when you try to talk about it, they don’t see a problem.
Everything feels fine to them.
At the same time, your concern is growing. And you may begin to feel that if someone doesn’t step in, something serious could happen.
Before Stepping In: A Pause
Before taking action, it’s important to step back and ask:
Is the person unable to understand the risks they are facing?
Or do they understand—but are choosing not to act?
This distinction matters.
Even when someone has dementia, they may still be capable of making certain decisions. And in Ontario, people have the right to make decisions others may not agree with—so long as they are capable of doing so.
What Does “Capacity” Mean?
In Ontario, a person is considered incapable of making a decision if they are not able to:
understand the information relevant to that decision, or
appreciate what could happen as a result of that decision
This applies to personal care decisions such as:
medical treatment
where to live
daily care (meals, hygiene, safety)
Capacity is decision-specific.
A person may be able to decide what to wear or eat—but not be able to understand a complex medical treatment or the risks of living alone.
How Power of Attorney for Personal Care Works
Many people, while they are still capable, choose someone they trust to make decisions on their behalf if needed. This is called a Power of Attorney for Personal Care.
That person—often a spouse, adult child, or close family member—becomes a substitute decision maker.
Their role is to step in only when the person is no longer capable of making a specific decision themselves.
In most cases, the Power of Attorney determines capacity for day-to-day decisions.
However, for certain decisions—such as medical treatment or admission to long-term care—a regulated health professional must determine whether the person is capable.
Capacity Can Change
One of the more complex parts of dementia is that a person’s ability to understand and process information can fluctuate.
Someone may seem clear and engaged in one moment, and more confused the next.
Because of this, capacity is often assessed at the time a decision needs to be made—not based on a past interaction.
What If There Is No Power of Attorney?
If a person has not named a Power of Attorney, Ontario has a defined hierarchy of substitute decision makers.
A health care professional will identify who is authorized to make decisions, which may include a spouse, child, or other family member.
Simply being a relative does not automatically mean you can make decisions—there is a formal order that must be followed.
Making Decisions on Someone’s Behalf
When you are acting as a substitute decision maker, your role is not to decide what you would choose.
Instead, you are asked to:
Follow any wishes the person expressed when they were capable, or
If those wishes are not known, act in their best interests
This can be one of the most emotionally difficult parts of the journey.
You are weighing safety, quality of life, and the likely outcomes of different choices—often without complete clarity.
Considering a Move
At some point, safety may become a concern.
You may notice:
Medications are not being taken
Meals are missed
The person is getting lost or disoriented
Living alone is no longer manageable
Even when these signs are clear, the person may strongly resist the idea of moving.
This is where many families feel stuck—wanting to respect independence, while also recognizing risk.
If a move to long-term care is being considered, a health care professional must determine that the person is incapable of making that decision themselves.
Only then can a substitute decision maker consent on their behalf.
A Difficult Balance
These decisions are rarely straightforward.
There can be a tension between:
protecting safety
honouring independence
respecting the person’s wishes
It is not about taking control—it is about stepping in, carefully and thoughtfully, when it becomes necessary.
You Don’t Have to Navigate This Alone
If you are in this position, it can help to speak with professionals who understand both the practical and emotional sides of these decisions.
At Highview, we work with families every day who are navigating questions around safety, timing, and next steps.
Our Homes in London, Kitchener, and Lucan are thoughtfully arranged to support people living with dementia in a way that feels familiar, calm, and truly like home.
We take the time to understand your situation and help you think through what comes next.
Highview offers thoughtfully designed homes where people living with dementia are cared for in ways that feel familiar, calm, and truly like home.
The goal is to create a place where people are supported to live with independence, connection, and purpose in daily life.
For dementia care in London, Kitchener, and Lucan, we are here to help.