Category: Elder Care

understanding what a DNR does

Understanding what a DNR Order does

A do-not-resuscitate order, or DNR, is written document with instructions informing healthcare personnel not to perform cardiopulmonary resuscitation (CPR). However, The Petoskey News-Review’s recent article entitled “Do-not-resuscitate orders apply to use of CPR in critical situations” explains that many patients don’t have a complete understanding of what a DNR order does and its application to their medical care. The DNR is a legally binding order signed by a physician at a patient’s request that lets medical professionals know you don’t want to be resuscitated.

CPR is performed in only one situation — if a patient is unresponsive, doesn’t have a pulse and isn’t breathing. If that happens, medical personnel have two courses of action: (i) allow for a natural death; or (ii) try CPR. If you’re unresponsive, have no pulse and aren’t breathing, that is the only situation in which any medical provider should attempt CPR. Having a DNR doesn’t mean don’t treat. The fact that you have a DNR order means you should receive exactly the same treatment that another patient who doesn’t have a DNR receives, with all the same medications and procedures.

As such, patients should know the limitations that come with CPR.

If CPR is successful, it means just one thing – that someone has regained a pulse. That doesn’t have any implications about a patient’s cognitive or mental status after CPR is administered.

Research shows that the likelihood of CPR being successful (in regaining a pulse) is in the range of 15-20% of patients. Thus, out of 100 patients who experience cardiac arrest and have CPR, about 80 to 85 of the patients will still die.

Note that there’s a difference between a hospital DNR and an out-of-hospital DNR. An out-of-hospital DNR is for those who don’t want to be resuscitated, if they have problems at home or anywhere outside of a medical facility. Those forms follow the patient, whether they are at home or not.

You should discuss these sensitive matters and signing a DNR when no one’s under pressure from a medical emergency.

The main part of advance care planning is appointing someone you trust to speak for you, if you can’t speak for yourself. With an advance care directive, you can state your preference or opposition to a DNR order.

In addition, everyone should have a healthcare power of attorney, an advance directive, or a patient advocate designation. This is where you are selecting someone to make medical decisions, when you are unable to do so for yourself. Therefore, it is vital that the person you appoint has a complete understanding of what a DNR order does.

If you would like to learn more about DNRs and advance directives, please visit our previous posts.

Reference: The Petoskey News-Review (Sep. 23, 2021) “Do-not-resuscitate orders apply to use of CPR in critical situations”

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Estate planning for special needs children

Estate Planning for Special Needs Children

Part of providing comprehensive estate planning for families includes being prepared to address the needs of family members with special needs. Estate planning for special needs children comes with its own set of challenges. Some of the tools used are trusts, guardianship and tax planning, according to the article “How to Help Clients With Special Needs Children” from Accounting Web. Your estate planning attorney will be able to create a plan for the future that addresses both legal and financial protections.

A survey from the U.S. Department of Health and Human Services revealed that 12.8 percent of children in our country have special health care needs, while 20 percent of all American households include a child with special needs. The CDC (Center for Disease Control) estimates that 26% of adults in America have some type of disability. In other words, some 61 million Americans have some kind of disability.

Providing for a child with special needs can be expensive, depending upon the severity of the disability. The first estate planning step for families is to have a special needs trust for your children, created through an estate planning attorney with experience in this area. The goal is to have money for the support and care of the child available, but for it not to be in the child’s name. While there are benefits available to the child through the federal government, almost all programs are means-tested, that is, the child or adult with special needs may not have assets of their own.

For many parents, a good option is a substantial life insurance policy, with the beneficiary of the policy being the special needs trust. Depending on the family’s situation, a “second to die” policy may make sense. Both parents are listed as the insured, but the policy does not pay until both parents have passed. Premiums may be lower because of this option.

It is imperative for parents of a child with special needs to have their estate plan created to direct their assets to go to the special needs trust and not to the child directly. This is done to protect the child’s eligibility to receive government benefits.

Parents of a child with special needs also need to consider who will care for their child after they have died, and have this clearly stated in their estate plan. A guardian needs to be named as early as possible in the child’s life, in case something should occur to the parents. The guardianship may end at age 18 for most children, but for an individual with special needs, more protection is needed. The guardian and their role need to be spelled out in documents. It is a grave mistake for parents to assume a family member or sibling will care for their child with special needs. The need to prepare for guardianship cannot be overstated.

The special needs trust will also require a trustee and a secondary trustee, if at some point the primary trustee cannot or does not want to serve.

It may seem easier to name the same person as the trustee and the guardian, but this could lead to difficult situations. A better way to go is to have one person paying the bills and keeping an eye on costs and a second person taking care of the individual.

Planning for the child’s long-term care needs to be done as soon as possible. A special needs trust should be established and funded early on, wills need to be created and/or updated, and qualified professionals become part of the family’s care for their loved one.

Having a child with special needs is a different kind of parenting. So estate planning for special needs children will also be different. A commonly used analogy is for a person who expected to be taking a trip to Paris but finds themselves in Holland. The trip is not what they expected, but still a wonderful and rewarding experience.

If you would like to read more about special needs planning, please visit our previous posts. 

Reference: Accounting Web (Sep. 13, 2021) “How to Help Clients With Special Needs Children”

The Estate of The Union Episode 9 out now

 

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protect loved ones from financial elder abuse

Protect Loved Ones from Financial Elder Abuse

In 2021, more than 6.2 million people in America live with some form of Alzheimer’s disease and need some type of memory care. At the same time, financial abuse and scams, especially those targeting people 65 and older, are on the rise, says the Better Business Bureau. It is important to protect loved ones from financial elder abuse.

Individuals suffering from Alzheimer’s and other forms of dementia face unique challenges when it comes to financial elder abuse and scams, according to a recent report “Protecting you or a loved one from financial elder abuse and scams” from Idaho News 6. The increasing number of Alzheimer’s diagnoses increases chances of needing in-home, memory care or skilled nursing care at some point, making it increasingly important to plan ahead. When there is no advance planning, financial devastation and the potential for financial elder abuse occurs.

Planning starts with an experienced estate planning attorney who can help the family prepare these four basic documents:

  • Last Will and Testament
  • Financial Power of Attorney
  • Health Care Power of Attorney
  • Living Will/Advanced Directive

There are additional documents, depending upon the individual’s situation, including a Durable Power of Attorney, used to give another person the ability to make decisions for property, business and financial matters. In cases of future incapacity, this is extremely important.

Power of Attorney: This appoints an “agent” who can make financial decisions on behalf of the “principal.” The POA creates a fiduciary relationship between the agent and their principal, wherein the agent must act in the best interest of the principal, above their own interest. The selection of a POA is very important, since it is a big responsibility.

The Principal should also name a successor agent, in case the primary agent is not able or willing to take on their role. Understand the possibility of abuse of power by the agent before finalizing any documents. An agent who abuses their powers or reaches beyond their powers can be prosecuted.  However, it is best to make a good choice from the start and try to avoid problems.

Most of us get all the right protection in place for our homes, cars and have health insurance in place. However, the chances of needing long-term care for a dementia are actually higher than having your house burn down.

Planning for incapacity and protecting loved ones from financial elder abuse can be accomplished with the help of an estate planning attorney. Have the conversations with your attorney and your family early and get going.

If you would like to learn more about elder abuse, please visit our previous posts.

Reference: Idaho News 6 (Sep. 14, 2021) “Protecting you or a loved one from financial elder abuse and scams”

The Estate of The Union Episode 9 out now

 

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understanding of how a conservatorship works

Understanding how a Conservatorship Works

Kiplinger’s recent article titled “Britney Spears’ Sad Song … Warning: This Could Happen to You” says that conservatorship is a topic that’s been in the news lately with Britney’s recent court battle. Most people do not have an understanding of how a conservatorship works.

In Britney’s case, while there has not been any evidence alleged of actual fraud or financial abuse in her conservatorship, she lost nearly all control over her finances, her business affairs and the most personal aspects of her life.

She also doesn’t want her father to be the person to hold that much power or control over her life.

A judge can take charge of an individual’s personal and financial decisions and appoint a third party to make decisions almost on an unlimited basis. These proceedings can exact a significant emotional toll and be tremendously expensive and time-consuming.

Conservatorship can happen to anyone, if and when you’re too disabled (due to an accident or illness) or too incompetent (due to infirmity of mind, old age or dementia, or a similar condition) to handle your own affairs.

If your estate plan addresses this with a chain of command to act on your behalf, no formal court proceedings would be required. Your wishes can be honored, and all the drama like that which Britney Spears has endured can be avoided.

If you are under age 60, there is a four to five times greater likelihood that you’ll become disabled, due to an accident or illness, for a period of more than one year, than your chances of dying. This is because modern medicine can often prevent death but not cure the illness or condition causing the disability. If you’re over age 60, there’s a 70% chance that, during your remaining lifetime, you’ll be too disabled or incompetent to act for yourself, for a period of at least two to 2½ years.

However, Britney Spears’ battle to end her court-ordered conservatorship took an unexpected turn recently, when her father and the conservator of her estate, Jamie Spears, filed a petition to end the arrangement. Mr. Spears cited his daughter’s pleas at two separate court hearings over the summer in his request to terminate the 13-year conservatorship.

“Recent events related to this conservatorship have called into question whether circumstances have changed to such an extent that grounds for establishment of a conservatorship may no longer exist,” the filing states. The bottom line is this: if you, or a loved one come to that point in life, understanding how a conservatorship works is the first step toward beginning that process – and avoiding some of the more difficult problems reflected in Britney Spears’ case.

If you would like to learn more about conservatorship, please visit our previous posts. 

Reference: Kiplinger (July 14, 2021) “Britney Spears’ Sad Song … Warning: This Could Happen to You”

The Estate of The Union Episode 9 out now

 

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What should women know about long-term care

What Should Women Know about Long-Term Care?

A longer retirement increases the odds of needing long-term care. An AARP study found more than 70% of nursing home residents were women, says Kiplinger’s recent article entitled “A Woman’s Guide to Long-Term Care.”  What should women know about long-term care?

Living longer also increases the chances of living it alone because living longer may mean outliving a spouse. According to the Joint Center for Housing Studies of Harvard University, “In 2018, women comprised 74% of solo households age 80 and over.”

The first step is to review your retirement projections. It’s wise to look at “what-if” scenarios: What-if the husband passes early? How does that impact their retirement? What if a female client lives to 100? Will she have enough to live on? What if a single woman needs long-term care for dementia? Alzheimer’s and dementia can last for years, eating up a retiree’s nest egg.

Medicare and Medicaid. Government programs, such as Medicare and Medicaid, are complicated. For instance, Medicare may cover some long-term care expenses, but only for the first 100 days. Medicare doesn’t pay for custodial care (at home long-term care). Medicaid pays for long-term care. However, you must qualify financially.

Planning for long-term care. If a woman has a high retirement success rate, she may want to self-insure her future long-term care expenses. This can mean setting up a designated long-term care investment account solely to be used for future long-term care expenses. If a woman has a modest degree of retirement success, she may want to lower her current expenses to save more for the future. She may also want to look at long-term care insurance.

Social Security. Women can also think about waiting to claim Social Security until age 70. If women live longer, the extra benefits accrued by waiting can help with long-term care. Women with a higher-earning husband may want to ask the higher-earning spouse to delay until age 70, if possible. When the higher-earning spouse dies, the widow can step into the higher benefit. The average break-even age is generally around 77-83 for Social Security. If an individual can live longer than 83, the more dollars and sense it makes to delay collecting until age 70.

Estate Planning. Having a comprehensive estate plan is a must. Women (and men) should have a power of attorney (POA). A POA gives a trusted agent the ability to write checks and send money to pay for long-term care.

When it comes to long-term care, women should know their own health and the potential drain on the retirement savings. Work with a financial advisor and estate planning attorney to make sure your later years are secure.

If you would like to learn more about long-term care, please visit our previous posts.

Reference: Kiplinger (July 11, 2021) “A Woman’s Guide to Long-Term Care”

 

Difference between Conservatorship and Guardianship

Difference between Conservatorship and Guardianship

It is common for people to misunderstand and confuse the difference between a conservatorship and a guardianship. A conservatorship is created to let one person manage another’s finances. The conservator is court- appointed and may be responsible for financial decisions, such as retirement planning, the purchase or sale of property and the transfer of other financial assets.

The laws for conservatorships and guardianships can vary widely in different states. A conservatorship or guardianship is typically necessitated by a disability or injury that prevents a person from caring for themselves.

US News & World Report’s recent article entitled “How Conservatorships Can Prop Up or Tear Down a Loved One” explains that once you have a conservator in place, the burden is on you to prove you no longer need it. The biggest issue in most cases is abuse of power or neglect. Either (the conservator) is doing something self-serving, such as spending money on something other than the senior’s care, or they’re not helping the conservatee, or providing the care they need.

Estate planning attorneys may recommend a conservatorship or guardianship in standard estate planning documents, like a power of attorney. A conservator can be any adult, possibly a family member, who is tasked with the responsibility of managing the person’s finances.

Because a conservator would be in charge of a person’s assets, it’s common for the same person to be named to serve as attorney-in-fact or agent with a power of attorney. However, because a guardian is in charge of the person themselves, it’s wise to nominate the same people who are named to serve as health care agents in the client’s health care proxy. Sometimes, these are the same, but if they’re different, it is important for that difference to be stated.

A guardianship is created in cases when a person can’t take care of themselves and requires another person to make some or all of their personal decisions. This might include decisions about his or her medical care, support services, housing, or finances. While a court appoints both a conservator and a guardian, a conservatorship is generally limited to financial decisions. In contrast, a guardianship deals with personal decisions, like medical care, and may, in some instances, also cover financial decisions.

Just about every state has laws designed to protect those placed in a conservatorship or guardianship. For example, in New York, individuals must satisfy medical requirements to be determined unable to care for oneself. The burden of proof to meet such restrictions is high.

In addition, individuals can seek professional help in preparing for future circumstances that may prevent them from managing their finances and personal affairs. This includes estate planning documents, such as wills, powers of attorney, beneficiary forms and health care proxies. An estate planning attorney can help you better understand the difference between a conservatorship and a guardianship, and advise you which is the best option for you and your family.

If you would like to learn more about conservatorship and guardianship, please visit our previous posts. 

Reference: US News & World Report (Aug. 19, 2021) “How Conservatorships Can Prop Up or Tear Down a Loved One”

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choosing between assisted living or memory care

Choosing between Assisted Living or Memory Care

When considering a long-term care facility, it can be difficult choosing between assisted living or memory care options. Forbes’ recent article entitled “Assisted Living vs. Memory Care: Which Is Right for You?” explains that assisted living is a long-term care facility that lets seniors remain independent, while providing help with daily tasks. It often provides a small apartment, housekeeping, community meals and activities.

It’s critical to thoroughly review the support needs and challenges facing the person you’re supporting and to try to look honestly at what’s working and what’s not.

The best candidate for assisted living is a person who needs assistance with their activities of daily living but still has their reasoning skills intact. Residents can enjoy socialization and activities with people their own age. This helps with isolation after spouses and friends are no longer with them.

Assisted living residents frequently require personal care support. However, these seniors are able to communicate their needs. Residents may receive help with taking medicine, bathing, toileting and other activities of daily living, or ADLs.

Memory care facilities are secured facilities that serve the needs of those with some form of dementia. These facilities typically have smaller bedrooms but more available, open and inviting common spaces. Research shows the way memory care facilities are designed can be helpful in easing the stressful transition from home to a long-term care community. This includes softer colors, a lack of clutter and clear signage.

Confusion and memory loss can cause anxiety. That’s why having a predictable routine can help. As dementia progresses, a patient may forget how to do normal activities of daily living, such as brushing their teeth, eating, showering and dressing. Memory care facilities ensure that these needs are met.

A memory care facility typically has a smaller staff-to-patient ratio than assisted living because an individual suffering from dementia has greater care needs. Staff will frequently undergo additional training in dementia care.

A memory care facility isn’t always a standalone community. Assisted living or skilled nursing homes may have a separate memory care wing where seniors get the same socialization and activities but with 24/7 protection.

Rather than choosing between assisted living and memory care facilities, having both options in one place can be a plus. The person can start in a less restrictive type of setting in assisted living with the option to transition to memory care as needs, abilities and interests are changed by the condition.

Both types of care have some autonomy but help with hygiene and medication management. However, staff in a memory care unit is specifically trained to work with people with cognitive impairments.

If you would like to learn more about long term care options, please visit our previous posts. 

Reference: Forbes (Aug. 16, 2021) “Assisted Living vs. Memory Care: Which Is Right for You?”

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New Installment of The Estate of The Union Podcast

 

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solutions to help seniors live well

Solutions to help Seniors live Well

With our aging population, we need more solutions to help seniors live well. That’s where universal design comes in: it’s a concept that tries to make products and structures usable by everyone, regardless of age, ability, or other factors.

Money Talks News’s  article entitled “8 Essential Home Features for Aging in Place” says that aging in place requires homes that accommodate our needs as we age. The article sets out a list of eight design features buyers focused on accessibility are looking for based on survey data from the National Association of Home Builders’ 2021 “What Home Buyers Really Want” report.

  1. Lower countertops. The kitchen is the center of most homes, and it’s an important part of universal design. Countertops that are three inches lower than the standard height of 36 inches lets seniors and those with limited mobility to fully participate in meal prep. You can round all countertop edges and corners because fewer 90-degree angles may reduce bumping and bruising and minimize injury in the event of a fall.
  2. Lower kitchen cabinets. According to Aging in Place, upper kitchen cabinets that are three inches lower than standard height lessens the tendency to overreach and potentially lose balance. Lower cabinets that feature pull-out shelves, “lazy Susan” corner cabinets and easy-pull handles offer additional convenience for seniors and those who rely on a wheelchair or mobility scooter.
  3. Bathroom aids. For seniors, using the bathroom safely can a challenge. Aging-in-place design recommends these features to make bathrooms more practical and convenient:
  • A walk-in tub or a shower with non-slip seating
  • An adjustable or hand-held showerhead
  • A comfort-height toilet
  • Ground-fault interrupter (GFI) outlets that reduce the risk of shock; and
  • Grab bars near the toilet and shower.
  1. A Stepless entrance. To age in place safely, AgingCare recommends that a home’s main entrance not have steps and should have a threshold height of no more than a half an inch. Here are a couple of ways that an entryway without steps can make life better for seniors:
  • It facilitates smooth entrance/exit by wheelchair, scooters, or walker
  • It decreases the risk of falls, particularly in snowy or icy conditions; and
  • It makes it easier to get deliveries and enter the home carrying groceries.
  1. Non slip floors. According to the CDC, more than 35 million older adults fell at least once in 2018, and 32,000 died from fall-related injuries. To help, non-slip surfaces like low-pile carpet, cork and slip-resistant vinyl can minimize the risk.
  2. Wide hallways. Wide hallways (defined as at least four feet wide) let seniors access every space in their home with a walker, wheelchair, or scooter, or with the assistance of a home health aide.
  3. Wide doorways. A standard doorway can be as narrow as 24 inches, which is a tight fit for seniors who rely on wheelchairs, scooters, or walkers. Seniors like wide doorways, defined as at least three feet wide. According to the ADA, doorways should have at least 32 inches of clear width. To help with an easy transition from room to room, thresholds should be as flush to the floor as possible.
  4. Full bath on main level. Not just convenient, it’s a critical safety feature for seniors. Besides eliminating the need to go up and down stairs several times a day, main floor bathrooms also allow the elderly to (i) respond to incontinence issues more quickly; (ii) practice regular self-care; and (iii) access a private space when required.

Elder care can be a complicated. These, and many more solutions help seniors live well and comfortably.  If you would like to learn more about elder care, please visit our previous posts.

Reference: Money Talks News (Aug. 5, 2021) “8 Essential Home Features for Aging in Place”

Episode 8 of The Estate of The Union podcast is out now

 

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what a power of attorney should include

What a Power of Attorney Should Include

The pandemic has taught us how swiftly our lives can change, and interest in having a power of attorney (POA) has increased as a result. But you need to know how this powerful document is and what it’s limits are. It is important to understand what a power of attorney should include. A recent article from Forbes titled “4 Power of Attorney Clauses You Need To Focus On” explains it all.

The agent acting under the authority of your POA only controls assets in your name. Assets in a trust are not owned by you, so your agent can’t access them. The trustee (you or a successor trustee, if you are incapacitated) appointed in your trust document would have control of the trust and its assets.

There are several different types of POAs. The Durable Power of Attorney goes into effect the moment it is signed and continues to be valid if you become incapacitated. The Springing Power of Attorney becomes valid only when you become incapacitated.

Most estate planning attorneys will advise you to use the Durable Power of Attorney, as the Springing Power of Attorney requires extra steps (perhaps even a court) to determine your capacity.

All authority under a Power of Attorney ceases to be effective when you die.

There are challenges to the POA. Deciding who will be your agent is not always easy. The agent has complete control over your financial life outside of assets held in trust. If you chose to appoint two different people to share the responsibility and they don’t get along, time-sensitive decisions could become tangled and delayed.

Determine gifting parameters. Will your agent be authorized to make gifts? Depending upon your estate, you may want your agent to be able to make gifts, which is useful if you want to reduce estate taxes or if you’ll need to apply for government benefits in the near future. You can also give directions as to who gets gifts and how much. Most people limit the size of gifts to the annual exclusion amount of $15,000.

Can the POA agent change beneficiary designations? Chances are a lot of your assets will pass to loved ones through a beneficiary designation: life insurance, investment, retirement accounts, etc. Do you want your POA agent to have the ability to change these? Most people do not, and the POA must specifically state this. Your estate planning attorney will be able to custom design your POA to protect your beneficiary designations.

Can the POA amend a trust? Depending upon your circumstances, you may or may not want your POA to have the ability to make changes to trusts. This would allow the POA to change beneficiaries and change the terms of the trust. Most folks have planned their trusts to work with their estate plan, and do not wish a POA agent to have the power to make changes.

The POA and the guardian. A POA may be used to name a guardian, who would be appointed by the court. This person is often the same person as the POA, with the idea that the same person you trust enough to be your POA would also be trusted to be your guardian.

The POA is a more powerful document than people think. You need to know what a power of attorney should include to make it work the way you want. Downloading a POA and hoping for the best can undo a lifetime of financial and estate planning. It’s best to have a POA created that is uniquely drafted for your family and your situation.

If you are interested in learning more about powers of attorney, please visit our previous posts. 

Reference: Forbes (July 19, 2021) “4 Power of Attorney Clauses You Need To Focus On”

Episode 7 of The Estate of The Union podcast is out now

 

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The Estate of The Union Episode 10 out now

Episode 7 of The Estate of The Union Podcast

We are estate planning and probate attorneys and we experience death weekly. The saddest aspect of our work is knowing that most, if not all, of the great stories of our clients’ lives have died with them. This can be heartbreaking for future generations. The solution to this dilemma is to capture those memories NOW. In episode 7 of The Estate of the Union podcast, Brad interviews Michael O’Krent with Life Stories Alive.

Mike’s company videotapes life stories so that generations of family members can grasp the essence of the individual loved one, not just the inheritance. Brad and Mike discuss what to expect when recording your life story and how the process works with Life Stories Alive. Brad talks about his personal experience recording his story for his loved ones, and Mike shares some touching stories of how impactful these video presentations can be for both the storyteller and the viewer.

Take the time to record these special stories while you can. The Money will be spent, but the memories can endure forever.

In each episode of The Estate of The Union podcast, host and lawyer Brad Wiewel will give valuable insight into estate planning, making an often daunting subject easier to understand.

It is Estate Planning Made Simple!

The Estate of The Union can be found on Spotify, Apple podcasts, or anywhere you get your podcasts. Please click on the link below to listen. We hope you enjoy it.

If you would like to learn more about Michael O’Krent and Life Stories Alive, please visit their website www.lifestoriesalive.com

Episode 7 of The Estate of The Union podcast is out now

www.LifeStoriesAlive.com

The Wiewel Law Firm focuses its practice exclusively in the area of wills, probate, estate planning, asset protection, and special needs planning. Brad Wiewel is Board Certified in Estate Planning and Probate Law by the Texas Board of Legal Specialization. 

Information in our blogs is very general in nature and should not be acted upon without first consulting with an attorney. Please feel free to contact The Wiewel Law Firm to schedule a complimentary consultation.
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