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If we had a crystal ball and could see into the future, we would not need to prepare ahead for end-of-life decisions.
James was 62 years old when a stroke made it impossible for him to communicate with his family. Neither his wife nor children knew anything about his financial or medical information. James had always taken care of things himself and left no written directives on his behalf. Besides having to locate important documents, the family was now left to make their own decisions about James long-term care.
The National Institute on Aging gives three simple, but important steps to putting your affairs in order:
- Put your important papers and copies of legal documents in one place. You could set up a file, put everything in a desk or dresser drawer, or just list the information and location of papers in a notebook. If your papers are in a bank safe deposit box, keep copies in a file at home. Check each year to see if there's anything new to add.
- Tell a trusted family member or friend where you put all your important papers. You don't need to tell this friend or family member about your personal affairs, but someone should know where you keep your papers in case of emergency. If you don't have a relative or friend you trust, ask a lawyer to help.
- Give consent in advance for your doctor or lawyer to talk with your caregiver as needed. There may be questions about your care, a bill, or a health insurance claim. Without your consent, your caregiver may not be able to get needed information. You can give your okay in advance to Medicare, a credit card company, your bank, or your doctor. You may need to sign and return a form.
Preparing Advance Directives or Living Will
Advance directives are legal documents that state the kind of medical care or end of life decisions you want made in your behalf. It is a way for you to communicate your wishes to family or health care professionals. Emergency response medical personnel cannot honor Advance directives or living wills. They are required to save and stabilize a person for transfer to a hospital or emergency facility. Once at the facility a physician will honor the directives.
The Living Will as part of your directives gives your consent or refusal for sustained medical treatment when you are not able to give it yourself. If this document is not in place then a family member or physician will decide such things as:
- Resuscitation if breathing or heartbeat stops
- Use of breathing machines
- Use of feeding tubes
- Medications or medical procedures
Advance Directives and Living Wills are legal throughout the United States; however, some states may not honor other states' directive documents. Be sure to check with an attorney licensed in the state that you live in for their requirements.
Review your directives periodically. They do not expire, but your wishes may change! A new or revised Advance Directive (more commonly known now as Health Care Power of Attorney with Living Will) invalidates the old one. Be sure your family member or healthcare agent you have named has a current copy.
Choosing a Power of Attorney: They are not all created equal!
General Power of Attorney - authorizes someone to handle your financial, banking and possibly real estate and government affairs as long as you remain competent.
Special Power of Attorney - authorizes someone you designate to handle certain, specific things you cannot do yourself for a period of time.
Durable Power of Attorney -The general, special and health care powers of attorney can all be made "durable" by adding certain text to the document. This means that the document will remain in effect or take effect even if you become mentally incompetent.
Many people do not know the difference between a general and a durable power of attorney. A general power of attorney is a document by which you appoint a person to act as your agent. Agents are authorized to make decisions for you, sign legal documents, etc. Many people are unaware, however, that a General Power of Attorney is revoked when the person granting that power becomes incompetent or incapacitated. It is the "Durable" Power of Attorney that allows for an agent to continue making decisions on your behalf no matter what happens to you.
A responsible adult child of an aging parent would be given a "Durable Power of Attorney" to act on behalf of the parent. This provides broader authority than just simply adding the child's name to bank accounts and documents.
See the National Care Planning Council for more info or if you are ready to start the planning process, give us a call at 276-629-5381.
In America today, 2.6 million children with special needs will need costly care long after their parents have passed away. A recent special needs survey conducted by The Hartford insurance company found that 62% of parents of these children with special needs have no plan to cover the cost of caring for the child when they no longer are able to do so.
The survey further reported that parents that do have a plan often make mistakes that may disqualify their child for government services on which they now depend.
"When you consider the daily demands already being put on the parents of a special needs child, no one should be surprised that they have not taken time to create a plan for their child's future," said The Hartford's Donna Scalaro, a director in estate and business planning for The Hartford's Individual Life business. "That being said, it is important to acknowledge that doing nothing puts the child's future well-being at risk."
Scalaro suggests that parents take these four steps to help ensure their child is protected:
1. Work with a professional financial advisor to develop a plan capable of funding a lifetime of support for your child with special needs, over and above what the government will provide.
2. Establish a special needs trust to protect the assets and to ensure the child will qualify to receive government benefits and services.
3. Speak with the person you want to be your child's guardian so they fully understand the commitment and are willing to take on the obligation.
4. Buy a permanent life insurance policy to cover the anticipated cost of care.
Click here to read the full article on The Hartford's survey and findings.
Many people, just as they become eligible for Medicare, discover that the insurance rug has been pulled out from under them. Some doctors — often internists but also gastroenterologists, gynecologists, psychiatrists and other specialists — are no longer accepting Medicare, either because they have opted out of the insurance system or they are not accepting new patients with Medicare coverage. The doctors’ reasons: reimbursement rates are too low and paperwork too much of a hassle. When shopping for a doctor, ask if he or she is enrolled with Medicare. If the answer is no, that doctor has opted out of the system. Those who are enrolled fall into two categories, participating and nonparticipating. The latter receive a lower reimbursement from Medicare, and the patient has to pick up more of the bill. Doctors who have opted out of Medicare can charge whatever they want, but they cannot bill Medicare for reimbursement, nor may their patients. Medigap, or supplemental insurance, policies usually do not provide coverage when Medicare doesn’t, so the entire bill is the patient’s responsibility. The solution to this problem is to find doctors who accept Medicare insurance — and to do it well before reaching age 65. But that is not always easy, especially if you are looking for an internist, a primary care doctor who deals with adults. Of the 93 internists affiliated with New York-Presbyterian Hospital, for example, only 37 accept Medicare, according to the hospital’s Web site. Two trends are converging: there is a shortage of internists nationally — the American College of Physicians, the organization for internists, estimates that by 2025 there will be 35,000 to 45,000 fewer than the population needs — and internists are increasingly unwilling to accept new Medicare patients. In a June 2008 report, the Medicare Payment Advisory Commission, an independent federal panel that advises Congress on Medicare, said that 29 percent of the Medicare beneficiaries it surveyed who were looking for a primary care doctor had a problem finding one to treat them, up from 24 percent the year before. And a 2008 survey by the Texas Medical Association found that while 58 percent of the state’s doctors took new Medicare patients, only 38 percent of primary care doctors did.
Source: New York Times (1 April 2009)
Full story: http://www.nytimes.com/2009/04/02/business/retirementspecial/02health.htm
Welcome to the VAElderLaw Blog. As you are probably already aware, a "BLOG" is the name given to a web log. Simply put, it's my regulary updated account of ideas, court decisions, and opinions on Elder law, Estate Planning and Financial Planning.
When I find something interesting, I will post it here with a link to where you can explore the issue further if you wish. It is my hope to add posts daily and to add original posts once or twice a week. So, come by often!
If you have a question or wish to know more about an issue, let me know. I will try to do some research and then post it here.
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