Who Will Be Making Your Difficult Healthcare Decisions?
December 14, 2011
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.
NOW is the Time to Think About Long-Term Care
November 11, 2011
As Baby Boomers begin to retire and to think about life after retirement, many find that one of their primary concerns is that of long-term care. Some news sources seem to think that paying for long-term care is going to be a number one issue in the coming years, not only for elderly individuals and their families, but for our society as a whole.
“The cost of long-term-care itself is not trivial. Nursing homes cost on average $87,235 annually… One year in an assisted-living facility is now $41,724. Adult day services are $70 per day, and home health aides cost $21 per hour… How can the country deliver and finance long-term-care for its rapidly aging population?”
It is comforting to know that AARP takes a somewhat less dramatic view of the issue. While they do agree that most seniors will at some point face the need for long-term care—“even if you’re in good health today, there’s a good chance that you’ll eventually need some type of long-term care, at least for awhile”— they urge people to take a pragmatic approach… and to start planning as early as possible. “The cost goes up with age, but it’s still affordable for many people over age 65. Once you hit the mid-70s, though, the cost of a good long-term care policy becomes very expensive, and it may be difficult to qualify for [it].”
An elder law or estate planning attorney is another resource for seniors and their families who are trying to plan ahead for the possibility of paying for long-term care. We specialize in helping you sort through your options, get your financial ducks in a row (right now and years down the line), and apply for government benefits, if necessary.
Don’t let the need for long-term care catch you by surprise. Contact our office to start planning now.
Plan Ahead to Avoid Court-Ordered Conservatorship
October 12, 2011
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.
Three Estate Planning Documents You Need During Your Lifetime
September 28, 2011
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.
How Does Your State Rank on the Long-Term Care Scorecard?
September 9, 2011
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.
Off to College? Don’t Forget Your HIPAA!
August 8, 2011
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 Form addresses 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.
War Veterans May Be Unaware They Qualify For VA Aid and Attendance Benefits
July 22, 2011
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 Post quotes 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.
Veteran Journalist Shares Her Personal Experiences Entering the Medicare System
June 29, 2011
Trudy Lieberman has had plenty of experience with Medicare—of course up until now most of it was from the outside looking in. As a journalist for more than 40 years specializing in insurance, health care, health care financing and long-term care, one would think that when the time came this year for her to enter the Medicare system herself she’d be an old pro. Unfortunately, as Ms. Lieberman discovered—and shared with the readers of her exceptional five part article series in Time Magazine’s Moneyland—entering the Medicare system as a patient can be confusing for even the most knowledgeable of inside reporters.
While her experience as a reporter may not have made signing up for Medicare any easier for Ms. Lieberman, her willingness to share her entrance into Medicare with readers may make the process easier for the rest of us. Here are just a few of the issues Lieberman has written about thus far:
Sorting through Medicare information and choosing a plan: “Brochures and ‘lead cards’ for Medicare Advantage plans and Medigap policies began flooding my mailbox in January. This stuff can be a real burden, but some of it’s worthwhile – some even important – so you can’t just throw it all away…Hopefully, my sorting system (partly informed by decades of reporting on Medicare, partly by common sense) will make the task easier for you.
Choosing a Medigap Plan to fill in the gaps of Medicare coverage: “It quickly became clear that the push to give consumers more choices and more information has actually made the job of picking a Medigap plan much harder. I ended up having to check out multiple websites, brochures, handouts and make several toll-free calls for assistance.”
Finding a plan to cover the cost of prescription drugs: “I decided to ask my pharmacy about the retail cost of the drugs I currently take. I’ve always had great drug coverage, so it was shocking to learn that my prescriptions would cost $3,131 a year if I had to pay out-of-pocket. (Of course, from interviewing seniors over the years, I know some folks actually pay four or five times that amount.)”
Part five comes out next week, and we look forward to reading the conclusion of this helpful series. We know how confusing and time consuming dealing with Medicare can be, so it’s helpful to know that many elder law attorneys specialize in helping seniors with this very process—we can help you too.
Estate Planning for Beginners Part 4: Healthcare Documents
June 13, 2011
Thus far our “Estate Planning Basics” series has focused primarily on financial documents, but the documents pertaining to your health care are an equally important part of any estate plan.
The most important healthcare document in your estate plan will be your healthcare directive. Depending on where you live, this document naming a healthcare agent and detailing your wishes for decisions made on your behalf and end of life treatment may also be called a living will, an advance healthcare directive, healthcare power of attorney, or a personal directive.
Perhaps the most important part of a healthcare directive is the nomination of your healthcare agent. This is the person who will be making decisions (potentially life-and-death decisions) about your medical treatment in the event that you are unable. The person you choose should be trustworthy, sensitive to the concerns of your other loved ones, and have the strength to ensure that your wishes are followed—even if those wishes are difficult or unpopular.
Like a financial power of attorney, the advance healthcare directive can be very general or very specific in its instructions. In addition to a nomination of agent, most healthcare directives also include (but are not limited to):
- Instructions for life-saving treatment (or your desire for a DNR order)
- Any existing medical conditions
- Your preferences for alternative medical treatment, if any
- The name of your primary care physician
- Your instructions for the final disposition of your remains
While some people have very specific preferences for medical treatment and end-of-life care, others prefer to leave these decisions in the hands of their loved ones, letting those who care about them make the choices that will bring the most comfort. Whether you choose to leave detailed instructions for care or leave the decision-making to others, your healthcare directive should reflect your choice. We all know the tale of Terry Schiavo, whose lack of a living will resulted in a seven year court battle between her husband and her parents over her end of life care… Don’t let the same thing happen to you or your family.
What to Do When Mom Can No Longer Manage Her Own Money
May 4, 2011
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.