Seven separate permissions, and why holding one does not get you the others

Most families believe they have handled this once a power of attorney is signed. Then they discover, one counter at a time, that authority in this country is granted institution by institution, and that each one has its own paper.

Here is the whole map, so you can collect it in one deliberate month instead of discovering each piece under pressure.

1. Durable power of attorney

Covers money and property: banking, bills, the house, insurance, contracts. The word durable is the one that matters, because it means the authority survives your parent's loss of capacity. A power of attorney that is not durable ends exactly when you need it.

It must be signed while your parent still has legal capacity to sign it. There is no way around this later except guardianship, which means a court process, several thousand dollars in most states, months of time, and a judge rather than your family making decisions.

2. Health care proxy or medical power of attorney

Names the person who makes medical decisions when your parent cannot. The name of the document varies by state. In Massachusetts it is a health care proxy. Elsewhere it is a medical power of attorney or a health care agent designation. It is a separate document from the financial power of attorney, and one does not imply the other.

3. HIPAA authorization, at every practice

This is the one that surprises people most. A health care proxy generally activates only when your parent is unable to make decisions. Until then, the cardiologist's office can decline to speak with you at all. A signed HIPAA authorization lets them talk with you now, while your parent is fully competent and simply wants your help.

It has to be signed at each practice separately, on that practice's form, in most cases. Primary care, cardiology, neurology, the hospital system's patient portal. Collect them the way you would collect keys.

4. The bank's own form

Banks and brokerages routinely refuse a valid, notarized durable power of attorney and require their own internal form, signed at a branch, sometimes with a signature guarantee. This is not a misunderstanding you can argue your way out of at the counter. Call each institution and ask what they require before you need to use it.

5. Social Security representative payee

Social Security does not recognize powers of attorney. Full stop. To manage a parent's Social Security benefits you must apply to become a representative payee, which is a separate application with its own process and its own reporting duties. Families discover this when a benefit needs redirecting and nothing they hold is accepted.

6. IRS Form 2848 or Form 8821

To speak with the IRS about your parent's taxes, or to receive their tax information, you need a power of attorney filed on the IRS's own form. Form 2848 grants representation. Form 8821 grants information access only. Your parent's accountant can prepare these.

7. VA fiduciary, if applicable

The Department of Veterans Affairs runs its own fiduciary program and, like Social Security, does not accept an ordinary power of attorney for benefit management. If your parent receives VA benefits, this is a separate track with its own timeline.

The order to do this in

1. Durable power of attorney and health care proxy first, because both require capacity and both have a closing window.
2. HIPAA authorizations next, because they cost nothing and immediately make ordinary life easier.
3. Call every bank and brokerage and ask what they require. Start their forms the same week.
4. Social Security, IRS, and VA, which are slower and can proceed in parallel.
5. Store one copy where you can reach it from your phone, and tell your siblings where the originals are.

An elder law attorney can prepare the first two properly for your state, usually in one appointment. That is the single highest value hour in this entire process, and it is the one families most often postpone.