Monday, May 14, 2012 The Pros and Cons of Long-Term Care Insurance
Do you have long-term care insurance? SHOULD you have long-term care insurance? These are questions that currently plague many forty-, fifty-, and sixty-somethings, as well as some precocious thirty-somethings. We’ve been hearing and reading more and more about long-term care insurance in recent years, but we still don’t seem to have any kind of firm consensus about whether it’s a good investment—whether it’s a necessary investment—or not.
This recent article from CBS online, entitled Why Long-Term Care Insurance Is Important, argues that “LTCI is a tool that can help preserve and protect financial assets, provide flexibility to choose the type of care, offer the ability to choose where care is received, help to ensure high-quality care, and provide financial and emotional support for the family.” This article helps readers not only understand why LTCI might be important, but what are the important questions to ask when considering whether and which long-term care insurance might benefit you and your family.
Of course, not everyone thinks long-term care insurance is necessary. Another article, this one from the Wall Street Journal, provides both sides of the argument. The pro-LTCI writer argues that “For those who buy and keep their policy it is a no-regret proposition. No one who has paid premiums and receives their benefits from the policy regrets having paid those premiums.” You pay a small regular sum over the course of a few decades, and when the time comes you are saved from bankrupting your family by paying as much as $250 a day, often for months or more.
The opposition writer against long-term care insurance argues that the likelihood that you’ll need to use the insurance policy is exaggerated. “It may be more useful to learn that 67% to 70% of seniors who do go into a nursing home are discharged within 90 days, and that after two years, less than 6% of those admitted will still be there.” This is important information to have, but $250/day for even 30-60 days can quickly wipe out a significant portion of a retiree’s savings.
Whatever you choose, make sure you account for your decision in your retirement and estate plans. Talk about the decisions with your estate planner, your financial advisor, and especially with your children. Long-term care expenses can be significant, and it’s always best to be as prepared as you can possibly be.
Monday, March 19, 2012 The High Emotional—And Financial—Cost of Alzheimer’s Disease
Alzheimer’s is a disease that affects everybody it touches—husbands, wives, children and grandchildren—they all bear witness to their loved one’s slow demise.
Sadly, emotional stress is not the only stress that accompanies Alzheimer’s disease; those loved ones serving as caretakers may carry a huge amount of financial stress as well. The cost of caring for an Alzheimer’s patient can run anywhere from $64 a day to $77,380 a year, and because Alzheimer’s disease can be such a long-lasting disease (a person can suffer from Alzheimer’s for up to 20 years) the costs of care can end up being astronomical. It’s obvious that people can’t do it alone.
Long-term care insurance can be very helpful in paying for the costs of care necessary for a loved one suffering from Alzheimer’s… if your loved one has thought ahead and purchased the policy before they or their spouse began suffering from symptoms of Alzheimer’s. Some people may not have thought ahead and hope that government programs will be able to help with the high cost of care. Medicaid [Medi-Cal in California] can be helpful (Medicare doesn’t cover the cost of long-term care)… if you fall in the right category and know how to navigate the complex system.
Unfortunately, learning how to navigate the system is not something you can do in an hour or two. Because your experience will depend on a number of unique factors we can’t give you an easy set of instructions to follow. The best advice we can give is to say that right now, the best way to navigate the Medicaid/Medi-Cal system is to find someone who knows the system to assist you. Most estate planning and elder law attorneys help their clients with these issues on a regular basis. If you want to ensure that you and your loved ones will be cared for no matter what the future may bring, don’t be afraid to ask your attorney for help.
Wednesday, March 14, 2012 Advice for Executors: How to Manage Final Medical Expenses
Most people die in a hospital; sometimes after a long and slow decline, sometimes after a quick and unexpected tragedy. If you are an executor of the deceased’s estate this is significant because it means that there are usually final medical bills to be paid. What most executors do not know is that these final medical bills are not necessarily just like all the other final expenses, especially when it comes to filing a final tax return for the estate; this article from SmartMoney.com explains why.
“…When a person incurs medical expenses and dies before they are paid, the executor of the decedent’s estate can elect to treat those medical expenses as if they were paid when incurred – as long as the estate pays the expenses within one year after the date of death. In other words, this election allows those expenses to be deducted on the decedent’s final Form 1040, even though they were not paid by the date of death.”
Many executors may not think of this because medical expenses can only be deducted if they exceed a certain percentage of the deceased’s adjusted gross income (7.5% to be exact); but health care being what it is, final medical expenses can quite often reach this point.
This sounds easy, but be careful if the deceased’s estate exceeds the $3.5 million estate tax exemption—you may want to look into other options. The article suggests that in this case it might be beneficial to “forgo the election and count the unpaid medical expenses as liabilities on the estate tax return.”
As the executor of an estate you may have more options than you are aware of when it comes to taxes, probate, and achieving the best results for the beneficiaries. If you are unsure about any of these—or other—issues, please contact our office, we can help advise you on all angles of the trustee or probate process.
Wednesday, March 07, 2012 Elderly Daycare Can Help Prevent Caregiver Burnout
Many of our clients provide care for elderly loved ones; some even providing constant, around the clock care. Care giving is a demanding, overwhelming, and often grossly underappreciated job. In addition to giving up their own time and interests, caregivers have to watch someone they love slowly regress and lose the ability to do even the most basic of tasks. Often, the senior being cared for eventually loses their ability to even recognize the people around them… including the person giving constant loving care. For all of these reasons, it’s very common for caregivers to experience depression and fatigue… caregiver burnout.
Depression and burnout does not have to be the plight of all caregivers, especially if you know the symptoms and how to combat them. The good news is that there are many preventative strategies which are readily available… the hard part for caregivers is valuing their own time and mental health enough to take advantage of them.
One of the best ways to avoid caregiver burnout is by making time for yourself periodically. Adult day service centers provide personal care, social activities, therapy and meals during the day while caregivers need to be away at work or even taking a much-needed break. If you have a parent who can no longer care for themselves during the day, adult day services might be a good solution for everybody involved.
There is a saying that hardships shared are halved, and joys shared are doubled; this is as true of care giving as it is for anything else. Many caregivers are reluctant to ask for help, but sharing the burden could save you from caregiver burnout. Don’t be afraid to reach out.
Wednesday, February 08, 2012 Will Medicare Provide for You in Your Golden Years?
Many retirees (or soon-to-be-retirees) have been living and saving under the assumption that Medicare would pay for a bulk of their medical costs during retirement, but a recent article in the Wall Street Journal reveals that counting on Medicare may not be the safest bet anymore. According to the article, one of the most important facts that retirees need to understand about Medicare is that “Medicare pays for very little long-term care, and you’ll still need significant savings to cover the rest of your medical expenses.”
This statement may come as a shock to those who fall in the soon-to-be-retired category simply because they likely haven’t had to give much thought to post-retirement medical costs yet; but they may be in for a rude awakening when the time comes to rely on Medicare. “Two-thirds of those on Medicare also said they pay the same, or more, for healthcare now than when they were working. They have been unpleasantly surprised by the cost of Medicare Part B premiums, what you pay for doctor and outpatient coverage, with 44% paying more than they had expected.”
Fortunately, our readers can become aware of this need to be more proactive about their own healthcare, and can start planning now. How you should plan will depend greatly on your age, your current rate of saving, and many other factors. Please contact our office (or your own trusted attorney or financial planner) today.
Monday, February 06, 2012 A Difficult Decision: Choosing a Nursing Home for Yourself or Your Loved One
If and when the time comes to choose a nursing home—either for yourself or for a loved one—how will you know how to choose the right one? A person’s living situation often has a lot to do with how happy they are, so it is important to choose carefully and wisely. When you do begin the process of choosing a nursing home, you don’t have to go into it blind. Here are a few things to consider and questions to ask when you start your search:
A Matter of Money - Nursing care is an expensive prospect, so one of your first considerations when looking for a nursing home will be how much it will cost and how you (or your loved one) will pay for it. Fortunately, it is likely that the entire cost will not have to come out of your personal finances. The Medicare.gov website offers an overview of different strategies to pay for quality nursing care. Your elder law attorney can help you navigate these—and other—options.
For-Profit vs. Non-Profit – Not all nursing homes are created equal, and according to this recent article the choice between a for-profit or non-profit home can be one you’ll want to consider carefully.
Evaluate Staff and Policies – Taking the time you need to evaluate the staff and the policies of the homes on your list will quite possibly be the most important part of your decision-making process. This article from the “Our Parents” website provides a comprehensive list of questions to ask yourself, the nursing home staff, the residents, and more before you make your decision.
Location, Location, Location – Finally, we all know that location is everything, and this is true of nursing homes as well. Issues of location ranging from how close the home is to family and friends, to what kind of view can be seen from the windows can all be of the utmost importance.
Choosing a nursing home may well be one of the most difficult decisions you will ever make, so it’s best to go into it prepared. Don’t be afraid to get in touch with the professionals who can help you make the best possible decision for yourself and your loved ones.
Wednesday, December 21, 2011 New Year’s Resolutions: Taking Control of Your Health in 2012
Without a doubt the most frequent and popular New Year’s Resolutions made each year have to do with health. People resolve to exercise more, to lose weight, to eat better, etc. But far too few people are aware that in addition being healthy in body and mind, there are steps you can (and should) take to protect your medical future and privacy as well.
1. Think about your medical future and put your wishes into writing. How would you like to be cared for in the event that you are incapacitated? How long (and by what measures) would you like to be kept alive if you were to be irrevocably injured or diagnosed with a terminal illness? Who would you like making these decisions for you if you were unable to make them for yourself? These are the issues addressed in an advanced healthcare directive or a living will—documents every adult should have not only for their own peace of mind, but for the peace of mind of their family and loved ones as well.
2. Execute a HIPAA to help protect your medical privacy. A HIPAA Authorization is the document that lets your doctors and other health care providers know who may receive information about your medical status and treatment. Not only does this protect your privacy, but it ensures that the people who should be informed about your medical status will have access to the information they need.
3. Consider your eventual long-term care needs and look into long-term care insurance as a safety net. There is no way to know for sure which of us will need long-term care, but as life-expectancy increases the chances that any of us will need long-term care increase along with it. You can plan for this eventuality and protect yourself and your family from being hit too hard by the expenses of long-term care by investing in long-term care insurance. There are a few options available for long-term care insurance, and our office can help you choose which plan might be best for you.
Wednesday, December 14, 2011 Who Will Be Making Your Difficult Healthcare Decisions?
A recent article in the LA Times reminds us of just how important it is to have some kind of living will or advanced healthcare directive, and that it is absolutely necessary to talk about these things with your loved ones. If you have not done these things it is your loved ones who will be left to make the painful and terrible decisions about your medical treatment and possibly even the heart-wrenching DNR determination.
The author writes of his father—chronically ill, stroke survivor, suffering from mild but advancing dementia—who is currently staying in a nursing home, “where they've put him on a diet of pureed foods and thickened liquids, but he often refuses to eat, demanding to be taken home and fed the home cooking he's always loved. It's hard to tell him that may never happen, and that his options are increasingly grim. If my dad can't eat, a feeding tube will be his only choice. Other than giving up the fight.”
The family is now struggling to decide if a feeding tube is the right course of action, what their father would (or does) want, and how involved he should be in the decision considering his current state of mental health. “We worry... that with mild but advancing dementia, my father won't be able to fully comprehend the implications of being fed through a tube implanted in his gut. And if he declines it, is he competent to make that decision?” These are the heart-breaking decisions that can leave loved ones asking themselves for years after, “Did we do the right thing?”
We often shy away from talking about these issues with our family members and loved ones. We think that they are too sad, too depressing, or too far into the future to worry about yet. The only thing that can make these decisions even the tiniest bit easier, however, is knowing for certain what your loved one would want; and the only way to know for certain is to talk about your feelings with your family, and to put your wishes in writing with a living will or healthcare directive. Our office can help you do this.
More often than not the best that can be hoped for in a situation like the one discussed above is that some measure of peace is attained. We wish this for the author of the article and his family, and we wish this for any of our readers involved in similarly difficult and painful circumstances.
Wednesday, October 12, 2011 Plan Ahead to Avoid Court-Ordered Conservatorship
Young adults are often urged to plan ahead and take control of their future; whether that means getting good grades and planning for college, searching for internships in their career area of interest, or saving money for the day when they are out on their own. Older adults, on the other hand (aside from being advised to save for retirement) may not know that there is one very important way to plan for their own future: choosing a guardian or conservator.
As the elderly population moves into their 70s, 80s and 90s it is not unusual to lose the ability to drive, manage their own finances, or even care for their own daily physical needs. When this happens, and the ability to care for yourself is lost, the courts will often give care over to a guardian or conservator—someone who will manage your money, medication, household tasks (or all of the above) for you.
If you have not taken steps ahead of time to name the person or people you trust to serve as your guardian or conservator then the courts will name one for you. Often the person named as guardian or conservator is the first person to petition the court for the job—although this may not be the person you would choose to manage your money or your care.
The best way to ensure that you have the right person managing your finances or your health care when the time comes is to plan ahead and execute a Nomination of Conservator, a Healthcare Directive, and a Durable Power of Attorney. Together these three documents let the courts know who you trust with your physical or medical care, and who you feel is qualified to properly manage your money without taking advantage. These three documents will help you take control of your own future, even at a time when losing some of that control may seem inevitable.
Wednesday, September 28, 2011 Three Estate Planning Documents You Need During Your Lifetime
There are a number of very important documents in your estate plan which come into play after your death, but as this article in Forbes reminds us, there are two or three estate planning documents that are of the utmost importance while you are still alive: your Healthcare Proxy, your Advance Directive (also called a Living Will), and your Power of Attorney. Together, these three documents ensure that your medical and financial affairs will be taken care of and that your wishes will be followed should you somehow become incapacitated.
Healthcare Proxy: This document nominates the person (or people) who will interact with medical staff, have access to your medical records, and make healthcare decisions for you if you are ever unable to do so yourself. This can be a standalone document, but it can also be wrapped up as part of the next document;
Advance Healthcare Directive (or Living Will): This is the document that describes in as great or as little detail as you wish your preferences for medical treatment, your wishes for resuscitation (or lack thereof) and even your wishes for the disposition of your remains. An Advance Healthcare Directive also often includes a section nominating a healthcare agent (or healthcare proxy) to make decisions for you if you cannot.
Financial Power of Attorney: If you ever become incapacitated you will still have bills to be paid, investments to be monitored, and financial decisions to be made; the Financial Power of Attorney gives the person you nominate the power to keep all those various financial balls up in the air. The person named as your power of attorney will have the power to access your bank (and other financial) accounts, so be sure the person you choose is someone you trust.
The Forbes article mentions that “One in eight baby boomers will get Alzheimer’s after they turn 65. Sure, you hope you won’t be one of them. But the risk of a slow decline and incapacity, meaning that you don’t know what assets you have, what you want to do with them and who your family members are, lurks for us all.” Having the three above-mentioned documents ensures that you—and your family—will be ready for whatever the future may hold. Friday, September 09, 2011 How Does Your State Rank on the Long-Term Care Scorecard?
One of the primary concerns of the aging population is long-term care. As the life expectancy of Americans goes up so does the expectation that they will someday need some form of long-term care. You may not know whether that care will happen in a hospital, a nursing home, or in your own home, but you can be sure that it will be expensive.
How expensive will long term care be? It turns out the answer to this question depends a great deal on where you live. The AARP, The Commonwealth Fund, and The SCAN Foundation recently released a report which they call “The Long Term Scorecard,” which compares states and ranks them according to categories. The website Web MD has an article explaining how to use the scorecard and what it means.
The article in Web MD states that “Long-term care is unaffordable for middle income families, according to [The Long Term Scorecard report.] Even in states where nursing home care is most affordable, such care averages 171% of an older person's household income. The national average is 241%.”
Some states, however, have been making the issue of long-term care a priority, and have been wrestling with questions such as how to make it more affordable to residents and how to provide support to family caregivers. According to the article in Web MD, they’ve broken down the information in “The Scorecard” to help readers understand which states provide the best support (either financial, social, emotional or legal) for the elderly and their caregivers.
The article “ranks states' performance according to four categories: 1. Affordability and access, 2. Patient choice of both provider and setting, 3. Quality of life and care, and 4. Support for family caregivers.” The states ranked highest overall were Minnesota, Washington, Oregon, Hawaii and Wisconsin; while the lowest ranking states turned out to be Mississippi, Alabama, West Virginia, Oklahoma and Indiana. (For more information on how the states were ranked and what each ranking means please read the article here.)
Perhaps the most important lesson to take from all this is that no matter where you live, or what your health is like right now, it is very likely that you will need some kind of long-term care in the future, and that that care will be expensive. Burying your head in the sand or choosing to “think about it when the time comes” will only make things worse for you and for your family. Call our office and let us help you prepare now for whatever the future may bring. Monday, August 08, 2011 Off to College? Don’t Forget Your HIPAA!
The hot and lazy days of summer are almost over; parents are thinking about back-to-school sales, kids are making the most of their final days of freedom, and college freshmen are getting ready to embark on their first year of adult-hood. Most of these college students have a list (whether mental or physical) of all the things they’ll need as they leave the nest for the first time, but most of these lists will be missing two key items: A Healthcare Directive and a HIPAA Form.
You may be wondering why a college student needs estate planning documents—aren’t those just for older, established people? Not at all.
Most incoming college students are now (or will soon be) 18, and considered adults under the law. This means that hospitals and medical personnel are no longer required to ask the parent’s permission before performing medical procedures. In fact, once your child is 18 health care providers are no longer required to share information with the parents at all.
Most college students (and parents) are unaware of this side-effect of turning 18, and parents and children alike can run into frustrating roadblocks should an accident occur. You can avoid these roadblocks by simply having your young adult execute the two simple documents mentioned in this blog post.
A Healthcare Directive (or Living Will)can be an in depth document or a very simple one, but the most important part for your new 18 year old will be the nomination of a healthcare agent. A healthcare agent is the person who will make medical decisions for your child if he or she is unable to make them alone.
A HIPPA Authorization Formaddresses the issue of security and privacy of health data. In a HIPAA form your child can list the people who have permission to receive information about his or her medical records and status.
For a fledgling 18 year old these two documents are of the utmost importance, and with the right help, they are very easy to execute. Don’t wait until it’s too late; make sure your young adult has these documents completed before they leave the nest. Friday, July 22, 2011 War Veterans May Be Unaware They Qualify For VA Aid and Attendance Benefits
One of the services Elder Law and Estate Planning attorneys often provide is helping clients navigate the application procedures and bureaucratic systems for the various state and federal medical insurance programs; and one thing that remains a surprise throughout the years is how many people forget about the VA Aid and Attendance Program for war veterans.
According to the Department of Veterans Affairs website, VA Aid and Attendance is “a benefit paid to wartime veterans [or their spouses] who have limited or no income, and who are age 65 or older, or, if under 65, who are permanently and totally disabled.” Unfortunately, too many veterans and their spouses are unaware that they qualify for this benefit, or even worse, have never been informed that the program exists.
An informative article in the Washington Postquotes the VA’s deputy undersecretary for disability assistance as saying that he believes they are only reaching “about one in four eligible veterans.” Part of the reason for this is that “there are a lot of veterans where it’s been 40 years or more since they’ve been on active duty. It just doesn’t occur to them there may be a benefit from the VA.”
If you are a war veteran over the age of 65 it is very likely that you and/or your spouse qualify for Aid and Attendance Benefits. Eligibility requirements include:
· You served at least 90 days of active military service 1 day of which was during a war time period. (If you entered active duty after September 7, 1980, generally you must have served at least 24 months, or the full period for which called or ordered to active duty.)
· You were discharged from service under conditions other than dishonorable.
· Your countable family income is below a yearly limit set by law (The yearly limit on income is set by Congress.)
· You must need help with at least one activity of daily living: dressing, eating, walking, bathing, adjusting prosthetic devices or using the toilet. Those who are blind, living in nursing homes or require in-home care may also be eligible.
For many veterans and their families the financial assistance they receive from their VA Aid and Attendance benefits can be an incredible help. Unfortunately, the application process required to receive the benefits can be daunting. “It’s not a simple process. A&A applicants must mail the forms, copies of service records, marriage certificates, proof of insurance and medical records to the regional VA office. If a third party is making the application, an additional form, 21-22-a or 21-0845, must be completed.”
This is why many veterans ask a knowledgeable Elder Law or Estate Planning attorney to help with the application process. The right attorney can help you find and fill out the correct forms, gather the necessary records and materials, and keep track of progress throughout the entire process. If you think you may be eligible for VA Aid & Attendance Benefits please don’t hesitate to contact our office. Wednesday, May 04, 2011 What to Do When Mom Can No Longer Manage Her Own Money
One of the most difficult aspects of caring for an elderly parent (or helping an aging parent who lives far away) is keeping one step ahead when that parent begins to lose the ability to manage his or her own finances. Many seniors can be very resistant to discussing what they feel is an extremely private and sensitive topic. Furthermore, according to this article in AgingCare.com, “for many elders, being able to take care of their own finances is an important symbol of independence and self-worth,” and one that they are not likely to relinquish easily.
Unfortunately, an elderly parent’s ability to manage their own money may cease before they are willing to ask for help. In these cases, it may be up to their children and loved ones to step in and help as best they can. What follows is a list of some non-invasive, non-offensive steps adult children and caregivers can take to help aging parents manage their finances.
· Ask for a list of important people and information you might need in case of emergency. This list would include contact information for an attorney, financial advisor, primary care physician, and insurance agent.
· Ask where your parent keeps important documents and how an executor or advisor could access those documents upon your parent’s death or incapacity.
· If your parent is willing, discuss their estate plan with them, including who they have chosen as their agent or executor, and what you can do if something happens.
· Ask your parent to make a list of monthly bills, expenses and account numbers. Although your parent may not want to hand over this information right away, the list should be stored with other important estate planning documents so that it can be accessed in case of emergency.
· As you keep track of your own financial deadlines (tax filing deadlines and the like) set up reminders for your parent as well.
· Ask that your parent list you as an “emergency contact” with their utility services, this means that you would be informed if your parent’s service is in danger of being terminated.
· And finally, talk to your parent as often as you can. Keeping open lines of communication is the very best way to stay informed about the abilities and well-being of your aging parent. Friday, April 22, 2011 New Criteria for Alzheimer’s Can Lead to Early Diagnosis, Better Treatment and Planning
Alzheimer’s Disease is a devastating illness which affects families all over the country; from the adult child who fears that her father’s recent forgetfulness might be a harbinger of something more sinister, to the elderly gentleman who wonders how he will possible pay for the care his beloved wife requires.
Over the years, the treatment received by Alzheimer’s patients has depended in part on how the disease is diagnosed; and according to this article from a New York Times blog, “new criteria [for diagnosis], unveiled on Tuesday by the National Institute on Aging and the Alzheimer’s Association, will have consequences for family caregivers. Informed by research showing that changes in the brain may be under way a decade before any symptoms appear, the guidelines are likely to lead to increasingly early diagnoses.”
One of the most significant results of these new criteria is the establishment of three distinct stages of Alzheimer’s disease:
Pre-Clinical Dementia, wherein “There’s some biological or structural brain evidence that the Alzheimer’s process is under way, but the person’s not disabled and the family doesn’t notice any problem.”
Mild Cognitive Impairment, in which “someone has problems that don’t cause disability, but they’re evident enough that the patient and a family member or another observer agree, ‘Yes, it’s noticeable.’”
And finally, actual Dementia, which includes the signs and symptoms we all already associate with Alzheimer’s disease.
One of the most practical implications of these new criteria will be the early diagnosis—and thus the earlier treatment—of Alzheimer’s. The article mentions that these treatments are not yet curative, but there are medications that can help with the symptoms, and there is some evidence that “if you optimize the treatments for other diseases that make Alzheimer’s worse, like diabetes and heart disease, that increases the likelihood that Alzheimer’s will not accelerate.”
Perhaps of the most significance to elder law attorneys is the fact that early diagnosis can allow families to make the legal arrangements they need before the disease progresses to the point where it is too late. If the disease can be diagnosed in the Pre-Clinical stage, or even the stage of Mild Cognitive Impairment, the person receiving the diagnosis may have the time to consult with an attorney and put their affairs in order, helping to ensure that they—and their family—are provided for in the years ahead. Monday, April 11, 2011 6 Things You Should Know About Your Healthcare Directive
We have recently seen one or two stories in the news that have brought the issue of health care directives to forefront of people’s minds. Most people know that a healthcare directive is one of the primary documents of any complete estate plan, but not everybody knows exactly what should be included in the document itself. Do you have to specifically name your spouse if you want that person making decisions for you? Is the healthcare directive the place to include a DNR (Do Not Resuscitate) statement? What about funeral arrangements or organ donation—does a healthcare directive deal with things that happen after death?
These are all good questions; here we attempt to answer these questions and more, as well as list some of the important things to know about—and include in—your healthcare directive:
1. Healthcare directives can have many names depending on where you live and the exact nature of the document. Some common names are: Advanced healthcare directive, Advance directive, Healthcare power of attorney, or living will. (Note: These are not all the same document with different names, but they do all serve similar or related functions. Contact our office for more information)
2. A healthcare directive should first and foremost name your healthcare agent: the person you want making decisions for you when you are unable.
3. A healthcare directive should absolutely include your wishes and preferences for healthcare treatment, including a DNR statement, preferences for artificial nutrition and hydration, antibiotics, pain relief, and other medications.
4. Your healthcare directive should include the name of your primary care physician, if you have one, as well as any pertinent medical history or conditions.
5. Healthcare directives can be written to reflect your religious or spiritual beliefs, including religious beliefs relating to blood transfusions, end of life care, and pregnancy.
6. A healthcare directive can and should make reference to post-mortem issues such as organ donation and funeral arrangements. Whether or not your wishes can be enforced may depend on your family and the state in which you live, but including your wishes may be of considerable help and comfort to your family. Monday, March 21, 2011 New POLST Program Raises Awareness About End-Of-Life Decisions
A recent article in the Wall Street Journalshines the light on a new program being instituted by a growing number of states called “Physician-Orders for Life Sustaining Treatment,” or POLST. “A POLST, which is signed by both the patient and the doctor, spells out such choices as whether a patient wants to be on a mechanical breathing machine or feeding tube and receive antibiotics.”
Creating a POLST is an important step toward getting the care and medical treatment you want at a time when you may no longer be able to communicate those wishes to your family or medical staff. As estate planners we know just how important it is to communicate these preferences for health care; in fact, creating an estate plan with our office includes drafting a document called an advance directive, in which you specify which medical treatments or interventions you would or would not like, and more importantly, it is the document in which you nominate a health care agent to serve as your proxy if and when you are unable to speak for yourself.
Keep in mind that although the POLST is an important step in making your wishes known, the POLST is not intended to replace an advance directive. The POLST programs “are meant to complement advance directives, sometimes known as living wills, in which people state in broad terms how much medical intervention they will want when their condition no longer allows them to communicate.”
The WSJ article states that “A study supported by the National Institutes of Health last year found that patients with POLST forms were more likely to have treatment preferences documented than patients who used traditional documents such as living wills and do-not-resuscitate orders.“ This comes as no surprise, considering that executing a POLST includes getting the document signed by your doctor, thus ensuring that you doctor is not only aware that you’ve expressed your wishes for end-of-life care, but has also likely had a part in helping you understand exactly what your options are.
Our office recommends that our clients go one step further—in addition to having your doctor sign your POLST, give your doctor a copy of your advance directive as well. Once you have things squared away with your doctor we also recommend sending a copy of your POLST and your advance directive to the person you’ve named as your healthcare agent.
The more informed you doctors and family are about your wishes for end-of-life care, the more likely it is that you will receive the treatment you prefer. |