Understanding the Role of a Patient Advocate or Ombudsman in California Estate Planning

When most people think about estate planning, they think of wills, trusts, and naming beneficiaries. But another equally important part of planning for the future is deciding who will speak for you if you cannot speak for yourself—especially in medical situations.

In California, two related—but distinct—roles often come up in this conversation:

• Patient Advocate (also called a Health Care Agent or Health Care Proxy)

• Long-Term Care Ombudsman

Although their duties may sound similar, they serve very different purposes in your estate plan and during your lifetime.

1. What Is a Patient Advocate in California?

In the context of estate planning, your Patient Advocate is the person you legally appoint through your:

• Advance Health Care Directive (AHCD)

• Sometimes called a “Power of Attorney for Health Care”

This person (your Agent) is authorized to:

• Communicate with doctors and hospitals on your behalf

• Access your medical information (HIPAA-compliant)

• Make medical decisions if you lose the ability to make them yourself

• Carry out your wishes regarding life support, pain management, treatment, and end-of-life care

Your Patient Advocate = YOUR chosen decision maker.

This person can be:

• A spouse

• An adult child

• A trusted friend

• Anyone over 18 who understands your values and can stay calm in a crisis

Key Point: Your Patient Advocate’s authority comes from your estate planning documents.

2. What Is a Long-Term Care Ombudsman?

A Long-Term Care Ombudsman is not your medical decision-maker and is not chosen in your estate planning documents.

Instead, the Ombudsman is a state-mandated advocate who protects the rights of residents in:

• Nursing homes

• Assisted living facilities

• Memory care units

• Adult residential care homes

Ombudsmen:

• Investigate complaints about care, safety, or facility conditions

• Help resolve conflicts between residents and staff

• Ensure residents are not abused, neglected, or mistreated

• Review issues like eviction notices, medication concerns, or lack of proper care

• Are free, confidential, and available statewide

Key Point: The Ombudsman is a neutral, government-backed advocate—not a family member and not someone who makes medical decisions for you.

3. How Do These Roles Work Together in Your Estate Plan?

While your Patient Advocate makes health care decisions, the Ombudsman ensures you are treated fairly if you live in a care facility.

Here’s how they complement each other:

Scenario A: You Are in a Nursing Home

• Your Patient Advocate talks to doctors and approves medical treatment.

• The Ombudsman helps resolve concerns about staffing, cleanliness, meals, safety, or facility policies.

Scenario B: There Is a Dispute with the Facility

• The Ombudsman steps in to advocate for your rights.

• Your Patient Advocate provides information about your wishes and instructions from your Advance Health Care Directive.

Scenario C: You Have No Family Nearby

Many Californians rely on both:

• A trusted friend (or professional fiduciary) as their Patient Advocate, and

• The Ombudsman for facility-related support.

4. Why Estate Planning Should Include Choosing a Patient Advocate

Your medical wishes are only as strong as the person empowered to carry them out.

Choosing the right Patient Advocate ensures:

• Your end-of-life wishes are respected

• You avoid family conflict during medical emergencies

• There is someone who understands your values and priorities

Without a designated advocate:

• California law decides who has authority

• Hospitals may turn to relatives who disagree or are unavailable

• Delays in care or conflicts can arise

This is why an Advance Health Care Directive is one of the core documents in a complete estate plan.

5. What an Estate Plan Typically Includes Regarding Patient Advocacy

A comprehensive estate plan will often include:

• Advance Health Care Directive (AHCD)

• HIPAA Authorization

• Living Will instructions

• Successor Agents in case your primary cannot act

• Preferences for:

  • Life support

  • Pain management

  • Organ donation

  • Comfort-focused care vs. treatment-focused care

This document gives your family clarity and gives your advocate the power to protect your wishes.

6. When the Ombudsman Becomes Especially Important

An Ombudsman becomes essential when:

• You live in a nursing home or memory care unit

• You suspect poor care, neglect, or unsafe conditions

• Staff are not responsive

• You feel intimidated or afraid to complain

• You don’t have family nearby to check on you

The Ombudsman can investigate and help resolve the issue, without cost or retaliation.

7. Estate Planning Tip: Put the Ombudsman Contact Information in Your Binder

Many estate planners in California recommend:

• Adding Ombudsman contact info to the Health Care Power of Attorney packet

• Making sure your Patient Advocate knows they can call the Ombudsman if needed

A simple step, but extremely helpful.

Conclusion

Estate planning isn’t just about distributing assets—it’s about protecting your health, dignity, and voice while you’re alive.

• Your Patient Advocate speaks for you.

• The Long-Term Care Ombudsman protects your rights.

• Your estate plan ties it all together so your wishes are honored in every situation.

If you haven’t chosen a Patient Advocate—or if your documents are outdated—this is one of the most important areas to review.