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Advance Directives

Monday, June 26, 2017

The Four Most Important Legal Documents You Will Need to Manage Your Aging Parent's Affairs

To help your parents get their affairs in order, you should first make sure that you or someone trustworthy has the legal ability to manage your parent’s affairs.  This article is a guide to the four fundamental legal documents you and your parent may need in order to get financial affairs in order.



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Monday, January 23, 2017

Help, I’m Lost in the Medicare Alphabet Maze!


 

Recently, I had to help a relative reinstate her Medicare Part D insurance coverage after she forgot to pay the premiums for several months.  The insurance company sent many notices advising that they would terminate coverage if the past-due premiums were not paid, but she either ignored the notices or could not comprehend what they said and eventually lost coverage.

After spending hours on the phone first with the insurance company and then with Medicare, I realized that Medicare is somewhat of a mystery to me.  Medicare is not yet my health insurance provider, so other than knowing that most of my clients are covered by Medicare and pay a monthly premium for the health insurance, I really had little idea of how Medicare works.  This blog post is a general guide to Medicare, while the next four posts will explore the alphabet of Medicare in more depth.
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Thursday, August 6, 2015

Five Questions to Ask Loved Ones About End of Life Treatment

How do we decide how we want to be treated at the end of life?

What would a good day look like if you were suffering from a terminal illness?

This is one of the questions Dr. Atul Gawande asks in Being Mortal, Medicine and What Matters in the End, New York: Metropolitan Books, Henry Holt and Company, 2014, his book exploring medical treatment at the end of life.

Dr. Gawande looks at how this one question, along with a series of questions most physicians are not asking their patients, might shape the course of medical treatment and care of those who are terminally ill, as well as those frail elderly who are in need of long term care.

In the book, one patient says that he is willing to have medical treatment for his terminal illness so long as the treatment will allow him to eat ice cream and watch football on television.  However, if at the end of the treatment he can’t have that ice cream and television, he does not want the treatment.

Another patient says a great day for her would be to take her grandchildren to Disneyworld.  Unfortunately, by the time she tells her doctor this she has undergone months of aggressive treatment that leaves her tired and weak and no longer able to go to Disneyworld.  The question then might be, if your idea of one good day is to go to Disneyworld, should physicians forgo treatment that will not cure you in order for you to have at least that one good day at Disneyworld with those people you love?

In our office, we spend lots of time helping clients fill out their Advance Directives for Healthcare, a document that allows a person to nominate an agent to make healthcare decisions for them if they are not able to make or communicate those decisions.  We talk about whether the client wants extraordinary medical treatment if they have a terminal illness that will likely end in death and they are not aware of their surroundings.  Most people say that they don’t want aggressive treatment under those circumstances.  However, we don’t have a good way for clients to really communicate their wishes to their loved ones when the question may be quality of life versus quantity of life.  What decisions should a healthcare agent make if treatment will prolong life but may leave that life not worth living for the person for whom the agent is deciding?

Dr. Gawande suggests a series of questions that should be asked while a person is still able to give answers. These questions would also be appropriate to ask someone who is aging and becoming frail :

  1. What is your understanding of where you are and your illness?
  2. What are your fears and worries for the future?
  3. What are your goals and priorities?
  4. What outcomes are unacceptable to you?  What are you willing to sacrifice and not willing to sacrifice?
  5. What does a good day look like for you?

Here is a link to an article about the author, along with a video discussing the five questions:

http://www.nextavenue.org/atul-gawandes-5-questions-ask-lifes-end/

Of course, the answers to these questions will change over time and as diseases progress.  For instance, a young mother facing terminal cancer will have very different goals, fears and worries from the frail 90-year old great-grandmother facing admission to a nursing home.

How would the answers to these questions help if you were the person who has to make or communicate these decisions for someone else?  If you knew a good day for your father was for him to be able to sit and eat ice cream while watching football on T.V., would you make decisions for his care that would allow him to do that?

I know how difficult conversations about end of life can be, but perhaps asking these five questions can at least open up a dialogue that will ultimately lead to better decisions about end of life care.

 

 

 

 

 

 

 

 

 

 

 

 


Thursday, July 16, 2015

The Zen of a Family Meeting: The Five Things You Must Cover When Planning for Your Aging Parents’ Care

 

 

July is Sandwich Generation Awareness Month.  The Sandwich Generation refers to those people, mostly in their mid-40’s to late 50’s, who are caring for aging parents as well as caring for young children or dependent young adult children.  If you are the meat or peanut butter in that sandwich, you might be looking for help from your siblings or other family members.  One of the best ways to plan the care for an aging or disabled family member is by holding a family meeting.  The meeting is designed to do many things:  get information from the aging or disabled person about their needs, figure out what kind of care is needed and brainstorm about ways to find that care, gauge the financial resources available for care, and assign duties to various family members so that one caregiver does not get burned out.

Who should attend the meeting?  I recommend that all of the parents and siblings attend a meeting, preferably where they can meet face to face to talk about the issues facing the aging parent now, and those issues that may come up in the future.  If grandchildren, aunts and uncles or friends will be responsible for some of the care, invite them along.    The parent or person with a disability should be in attendance so long as they are physically able to be there. 

It is usually best to hold the meeting in a neutral place, such as a meeting room in a hotel or community center.  I also recommend there be a fairly impartial facilitator to keep the meeting on track, if possible.  And, there should be plenty of snacks and drinks so people won’t want to leave before you’ve discussed all the important points.

With so many families spread out over the world, it can be difficult to get everyone together.  If the family has a regular family reunion, perhaps the reunion time can be extended to allow the family to get together for this meeting.  If there is no regularly scheduled reunion, you can use scheduling programs such as www.doodle.com to find out when the most attendees will be available. If some family members absolutely cannot meet in person, you can use tools such as Skype www.skype.com or Google Hangouts www.google.com/hangouts‎ to bring those other family members in by video.

Once you have set the time and place, have everyone agree to an agenda.  Appoint someone to come up with a proposed agenda in advance of the meeting, and then circulate that proposed agenda for comments, additions and changes.

Here are the five basic items that should be covered in the meeting:

 

  1. The Health and Safety of the aging parent or person with a disability

     

    How do they feel about their own healthcare and safety and what are they concerned about?

    Are there any disease or illness diagnoses?

    Are they paying attention to personal hygiene?

    Have there been any instances where the safety of the parent has been compromised, such as falling, leaving the stove on, wandering, etc.?

    Who are their physicians, dentists, therapists, professional and volunteer caregivers?

    What medications are they taking and are they remembering to take them regularly? 

     

    What health insurance do they have?  If they are on Medicare, is there supplemental insurance or prescription medication coverage?

    How are the premiums paid and is there someone who will be informed if the premiums are not paid?

     

    How are their finances? 

    What financial resources do they have? 

    What are their regular bills and how do those bills get paid?  How will you know if they forget to pay the bills?

     

  2. The current living and care arrangements, whether those arrangements are working, and a plan for future living arrangements

 

 If the parent’s condition is changing, what living and care arrangements will be necessary in the future?

How will you find appropriate housing and care?

 

  1. The legal documents do they have and the legal documents they need

     

    Who is their lawyer and when was the last time they saw a lawyer?  Where are the legal documents stored?

    Who is named as Agent, Personal Representative, etc. in those documents?

    Who are their beneficiaries on their IRA’s, 401(k)’s, life insurance policies and annuities?

     

  2. A plan to pay for long-term care

    Is there long-term insurance available?  If so, what are the terms?  Where is the policy and how are the premiums paid for? 

    If there is no long-term care insurance, can the parent or person with disability afford to pay for care by him or herself?  Are there any government programs, such as Veterans benefits or Medicaid, that can help pay for long-term care?

     

  3. The family caregivers – who will do what and when

Sometimes family members volunteer to perform the tasks for which they have talent.  The brother who is a nurse may be the natural fit for the person to oversee the parent’s healthcare and the sister who is the CPA will take over the finances.  What if it isn’t so clear or if no one wants to take on the tasks?  Can people be hired to perform some of the tasks such as paying the bills? 

Can the family agree that it may not be fair to one of the children to take on all of the responsibility for care?

If one family member is taking on the bulk of the care, can the others agree to take a turn to provide relief to the primary caregiver? 

 

The topics may vary from family to family, and for those families who may find it especially hard to discuss these items you might consider having a professional or a mediator to assist in these discussions.

 

 

 

 


Wednesday, April 3, 2013

What are Advance Directives?

Are you prepared if a tragedy strikes making you or a loved one go to the hospital?

Fortunately we have the right to make our own decisions when it comes to our healthcare, but what if that ability was taken away? How will you and your loved ones wishes be protected? The solution: Advance Directives.

Advance Directives are legal documents stating your wishes for the doctors and rest of your healthcare team to follow when you are unable to make decisions for yourself. During critical times, these documents can make a world a difference.

In recognition of Advance Directive Day on April 16th, our firm will be hosting a Lunch and Learn.

Lunch will be provided and we are honored to have guest speakers Reverend Ed Hampton and Community Outreach Representative for EverCare Hospice Carol Mullen. We invite anyone to join to learn useful information, resources and receive answers to your questions on the importance of Advance Directives.    

See attached flyer for more details. Lunch provided. RSVP REQUIRED!


Friday, January 4, 2013

Know More: What are Advance Directives?

    Are you prepared if a tragedy strikes making you or a loved one is sent to the hospital? Fortunately we have the right to make our own decisions when it comes to our healthcare, but what if that ability was taken away? How will you and your loved ones wishes be protected? The solution: Advance Directives. Advance Directives are legal documents stating your wishes for the doctors and rest of your healthcare team to follow when you are unable to make decisions for yourself. During critical times, these documents can make a world a difference

To learn more about the importance of an Advance Directive clink on the link below:

http://seniorcarecorner.com/health-care-decisions-dnr-advance-directives


Monday, January 9, 2012

Happy 2012! Make Getting Your Affairs in Order Your Goal for the New Year

 

Each year, I make a list of goals that I want to accomplish for the year.  Some years, the goals have a theme – unfortunately, the theme is almost always the same:  lose weight, exercise more. . .

This year, I’m challenging you to make one of your New Year’s goals to get your estate planning affairs in order.  This is one goal that is easy to accomplish – I promise!

Here are 5 easy steps you can take to accomplish this goal.

1.         Get educated about estate planning.  Attend an estate planning workshop or two.  Estate planning attorneys like me are always giving seminars and workshops to educate people about estate planning.  Yes, these workshops help attorneys attract clients, but the goal of these workshops is really to educate people about the basics of estate planning so clients can have meaningful conversations and can make thoughtful decisions about their own estates. 

2.         Review your old documents.  Do you have a will or trust?  Advanced Directives or Healthcare Powers of Attorney and Living Wills?  Do you have a Durable Financial Power of Attorney?  How old are your documents?  If your wills name guardians for your children who are now 30 years old, your documents are definitely out of date.  Did you name an executor who is now dead or is your ex-wife named as your executor?  Probably time to revise your will. 

            What about your health care documents? If they were done in Georgia before 2007, you may want to update them to the Advance Health Care Directive that went into effect in 2007.  Who have you named to make healthcare decisions for you?  Is that person still the right person to make decisions for you?           

3.         Look at the ownership of all of your accounts.  How is your bank account titled?  Title indicates who owns the account.  Are you the sole owner or is it a joint account?  Who is the joint owner and is this someone who should be a joint owner of your account?  Here’s a link to a blog I wrote last year about the pros and cons of joint ownership of accounts:  http://bit.ly/xm8W5o

4.         Check the beneficiary designations of your accounts.  The beneficiary is the person who would receive the proceeds of the account at your death.  Is the beneficiary your estate?  If so, why did you make your estate the beneficiary?  Having your estate as the beneficiary pretty much ensures that your estate will have to be probated.  Is your beneficiary under the age of 18 or someone with special needs?  It may not be the best thing to give someone under the age of 18 a large inheritance.  Although the court will put protections in place for those under 18, those protections can be expensive and once the beneficiary has their 18th birthday, the money is all theirs – to spend however they wish. Yikes!

             If the beneficiary has special needs, a gift may mean they lose governmental benefits.

            Distributions from IRA’s and 401(k)’s have income tax consequences, so have you considered how your beneficiary designations will affect the tax liability of your beneficiaries?

5.         Make an appointment with an estate planning lawyer, a CPA and your financial advisor.  A good, comprehensive plan involves a group of professionals who can guide  and counsel you in making decisions about your estate. 

Will you accept thechallenge to make getting your New Years Goal getting your affairs in order?

Here's to a great new year!

 


Tuesday, December 20, 2011

Holiday Traditions: Really Check in With Your Neighbors and Relatives

On Friday night, we gathered with neighbors old and new to celebrate a cherished tradition – our annual progressive dinner.  Traditionally, we begin the year.  We find out about the new babies, weddings and graduations to come.  We learn what colleges the children will attend, and where soon-to-be college graduates will start their careers.  We also check in on aging neighbors to find out about their health scares, their difficulties, the loss of their loved ones.  After moving from house to house for salads, and main courses, we end up with more wine and sweet treats to reminisce about dinners past.  How many have we had?  No one can remember.  But by the end of the evening, we’re looking forward to next year’s dinner, and assigning tasks to make it happen.

Continuing this tradition is important to my family and my neighborhood because it allows us to connect with our neighbors, to get to know them when times are good so that we can help each other when times are not so good.  Without our traditional yearly gathering, we might not realize when our neighbors need our help.

In my practice, I see many people who see their aging or ill family members and friends at the holidays and realize that all is not well.  Sometimes, all has not been well for so long that those family members are now in crisis.

If you are visiting family members who are aging or ill, take the time to talk with them to find out about their health.  Are they seeing a doctor?  What medications are they taking?  How do they keep track of their medications on a daily basis?  Ask them if they have a healthcare proxy or advance directive for healthcare?  Who will make healthcare decisions for them if they are not able?

Although it can be difficult to have a conversation with parents about their finances, ask them if they have appointed someone to make financial decisions for them if they are not able.  Look around the house and see if there are stacks of unopened bills.  Find out if they have long-term care insurance.  Ask where their important financial and legal documents can be found.  If they haven’t appointed anyone to make decisions for them, urge them to do that while they still can.

If your aging family members are still driving, ride with them to see if they are still able to drive safely.  Are they stopping at the stop signs?  Do they forget to look before making a turn?  Do they still remember how to get to places they have been to many times before or do they forget where they are going?  If they are having trouble driving, would a driving school help?  Or, can you help them find transportation so they won’t need to drive anymore?

With married couples, try to talk with each one alone.  Sometimes couples get so good at covering for each other, you don’t realize that one of them might be suffering from dementia.  If one of the couple is ailing, find out how the well spouse is coping.  Is he or she eating and sleeping right?  Is he or she getting help in the home so he or she can get out to see friends, or just get some time to rest and recharge?

Look in the refrigerator, freezer and cupboard.  Is the food in the refrigerator or cupboards moldy or out of date?  Are they going to the grocery store on a regular basis?  If you suspect that they are not eating right, is there a meals-on-wheels program that they might qualify for?

I hope that you will enjoy holiday traditions with family, friends, and neighbors this year.  Will you take time to talk with your family and friends to see whether they might need help in the coming year?

Happy Holidays!

Patti Elrod-Hill

 

 

 

 


Sunday, July 3, 2011

When Bridget Came To Visit: On Being Prepared

 When Bridget came to visit, she wanted to take my blue and white teacups home with her.  They were shiny and pretty, and fit in her hand just perfectly.  Dick promised they would go to the mall and buy some teacups just like them.

Bridget was in the mid to late stages of Alzheimer’s disease when she and Dick first visited my office.  Dick, a wonderful, patient husband and caregiver to Bridget, was determined to be prepared for whatever legal and financial zingers might hit the couple.  Years before, after Bridget was first diagnosed with Cognitive Memory Impairment, Dick and Bridget had prepared living trusts, powers of attorneys, and healthcare directives.  They came to me to make a few changes to Dick’s living trust and financial power of attorney.   I always recommend that clients update advance directives and powers of attorney to avoid having someone decide that the documents are “stale” and, therefore, not valid.  We prepared new advance directives for Bridget and Dick.  On the day Bridget came to sign, she could not remember that the children whom she had nominated as agents were adults.  In fact, I’m really not sure she could remember who her children were.

With sadness, I told Dick that Bridget could not sign any documents that day.  We agreed to try another day, since those with dementia often have times when they are very alert, and other times when they are not.  Bridget never was able to sign her new advance directive, and soon went to stay in a wonderful memory care facility.   The health care and financial proxies she had already signed worked fine for her, and Dick was able to make her healthcare and financial decisions without any challenges.

Susan, on the other hand, had never executed advance directives for healthcare, financial powers of attorney, or any wills or trusts.  She didn’t think she needed to, since her husband made most of the financial decisions for the couple.  Her family did not push her to do any planning, since they thought it would upset her.  When I visited Susan at the nursing home after her husband died, she told me the nurses were stealing her underwear, she no longer recognized her family members, and she wondered why I was visiting her at work.   Susan swore like a sailor, and insisted that she would not sign “any g. . d. . . papers”, believing that I was trying to steal from her, too.

As a result, her family had to spend months and thousands of dollars to seek guardianship and conservatorship of Susan, a court proceeding which is expensive financially and emotionally for all involved. 

Many folks with Alzheimer’s and other dementias become paranoid and distrustful.  When they hit that stage, it is extremely difficult to get them to agree to do advance directives, financial powers of attorney, or wills.  Why would they agree to sign something that they believe allows folks to steal from them?

As an attorney, I preach that every adult needs to have an advance directive for healthcare, a financial power of attorney, and at least a basic will.   In Susan’s case, her fear of planning led to heartache and hardship for her family.   Could all of this expense and difficulty have been avoided by visiting an attorney’s office while Susan was able to plan for her and her family’s future?

As a footnote, I want to tell you all about Dick, Richard J. Farrell, whom I mentioned above.  Dick has written a book Alzheimer’s Caregiving about his life with Bridget, joys and trials of caregiving, and about his grief when Bridget died after living with Alzheimer’s for nearly 20 years.  Check out his website at www.alzheimerscaregivingbook.com to see how you can order a copy.

 


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