Things You Might Hear — C A MacInroy

Terms used to describe caregivers

Term	What it sounds like	What it actually means
POA (see below)	"I get to make decisions"	A legal document naming who's recognized to decide on someone's behalf. Doesn't require hands-on care, but in practice, it's implied.
SDM (Substitute Decision-Maker)	Sounds like its own legal document	Everyone in Ontario automatically has an SDM. It's a role that goes automatically to whoever's next on a fixed legal hierarchy, spouse, then children, then others. Setting up a POA lets the patient choose who they trust to make health care decisions, instead of leaving it to the hierarchy.
Next of kin	"I'm the one in charge"	Usually just means "who to call." Often carries no decision-making authority at all.
Caregiver	"I help out"	Often 70-80% of the daily work that keeps someone safe, with no authority and no defined limits.
Care Partner	A softer, more equal-sounding version of "caregiver"	Same role as caregiver, increasingly used to sound more collaborative. The work itself doesn't change.

POA, in full

What it gives you

A legal document the patient creates, while they're able to, naming who they trust to carry out their wishes. It gives that person recognized authority. Doctors, hospitals, and agencies have to listen to a POA, it makes navigating an already complicated system easier.

What's never written down

The document only spells out the authority. It doesn't mention that the role also requires your presence, your physical and mental ability, your fluency in the language the system runs in, and the financial resources to cover time off work or other costs. None of that is written down. It's assumed.

What if the POA doesn't answer?

For urgent medical decisions, care can usually proceed under emergency provisions, no patient is left untreated because their POA didn't pick up. For non-urgent decisions, the system looks for a named backup, then, if there isn't one, it can escalate to a government office, like the Public Guardian and Trustee. Notably, it does not fall to whoever's actually there. "Informal caregiver" and "next of kin" aren't legal fallback positions. The person doing the most can have no formal path into the decision at all.

What you can do about it

If the person with authority can't act, or there's no POA at all, there are two ways someone already doing the care can become the recognized decision-maker. One is automatic: there's a built-in order of who's next, spouse, then children, and so on, and if you're high enough on that list, it becomes you. The other is formal: you apply, and a process exists to officially name you. Both paths are real and available right now. They're also rarely explained. Most people only find out by asking the right question, or by stumbling onto it.

Why documenting what you do matters here

If you ever need to make the case that you're the appropriate decision-maker, a record of what you've actually been doing, dates, decisions made, care coordinated, time spent, is exactly the kind of evidence that supports it, for the moment, if it comes, when the system finally asks who's been doing this.

Terms used inside healthcare institutions and research

Term	What it sounds like	What it actually means
Informal caregiver	"Informal" = casual, not a big deal	The standard research term for any unpaid family or friend caregiver. Used constantly in studies and reports.
Actor	A character in a story	In planning and research, whoever's responsible for getting a task done. This includes you, even though you're never called this.
CMI (Caregiver-Mediated Intervention)	Sounds technical, unrelated to you	When a caregiver is formally trained to deliver a specific therapy or program, for example, a parent trained to deliver a communication intervention for a child with autism. A narrow case where "Actor" has already been applied to family.
Dual-role actor	Sounds like two jobs	One person, doing the work (deliverer) and absorbing the cost of doing it, exhaustion, lost time, job risk (recipient), at the same time. For example, a caregiver who is both delivering daily care and the one whose own health and finances are affected by delivering it.