Category: DNR

When to have Healthcare conversation with Parents?

When to have Healthcare conversation with Parents?

You have been noticing that your mother or father appears to be in cognitive decline. But you wonder when to have a healthcare conversation with your parents? Waiting until a senior’s decline is apparent may already be too late, says CNBC’s recent article entitled “Waiting to talk finance with an aging parent in cognitive decline is a mistake, experts say.”

Adult children should be talking to their elderly parents about this while they’re still working because they’re still competent and still able to fund long-term care and pay the premiums from income.

Some incidents that could trigger these conversations include a parent thinking about downsizing, claiming Social Security, going on an extended trip, or finding out one of their friends is going into long-term care.

Adult children should ask questions to get a clear sense of their parents’ financial situation. However, they should understand that getting this information may take several discussions.

Here are questions to ask your parents in stages, over a period of time (from least uncomfortable to most):

  • Where do you keep your financial and estate planning documents?
  • What assets do you have and what are your debts?
  • Is it possible to meet with your advisors to have a good understanding in the event of a crisis?
  • Who are your healthcare professionals?
  • What medications do you take and where’s your pharmacy?
  • Do you have long-term care insurance or other plans for long-term care?
  • What are your wishes as to end-of-life care and funeral plans and expenses?
  • If you have a medical crisis, what kind of treatment do you want?

Evaluate your parents’ responses with the help of an elder law attorney to these basic questions and plan the next steps.

There’s some paperwork that should be done at this point, if it hasn’t already. This includes a power of attorney, healthcare directive and a living will. Do not wait to have a healthcare conversation with your parents. Discuss your options and seek advice from an experienced Elder Law attorney. If you are interested in learning more about Elder Law, please visit our previous posts.

Reference: CNBC (Nov. 30, 2021) “Waiting to talk finance with an aging parent in cognitive decline is a mistake, experts say”

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holidays are a good time to have a family meeting

Holidays are a good time for a Family Meeting

Kiplinger’s recent article entitled “Someone Needs to Know Where Your Money Is” recommends that families talk about money with an elderly parent. The holidays are a good time for a family meeting. If it’s really too late, you should know where to find the following:

Get the most recent tax return. This will have the name and contact information of the accountant who prepared the tax return. The tax return will also document income. If you find the income, you can find the assets. The reason is that earned interest, dividends, pension income and withdrawals from retirement accounts will be reported on the tax return. You should also call his or her employer’s human resources department to see if there’s a company life insurance benefit or 401(k) balance.

When a senior is admitted to the hospital, their health can sometimes deteriorate quickly. It’s one example of how everyone needs to have their estate plan updated and make sure their financial affairs are in order at all times. Someone must know all of the financial details and how to access the money, life insurance and other important documents. Here are some actions to consider taking now to ensure this situation doesn’t occur with you or a family member.

Collect key financial documents. During the family meeting, ask your parents to collect copies of the following documents:

  • Their wills;
  • Any trusts;
  • Their financial power of attorney;
  • All bank and brokerage account information;
  • Social Security statements;
  • Their website log-ins for any financial assets and insurance policies;
  • A list of beneficiaries for IRAs, annuities and life insurance policies;
  • A list of any other assets and debts; and
  • Their most recent tax returns.

As you begin gathering these documents, the most crucial one to help uncover current assets is the tax return. It can help describe the parent’s assets and the income they have from pensions, annuities, real estate investments, business interests and Social Security. A Schedule B is filed to report the interest and dividends received each tax year. If you’re unable to locate any paper statements or log-in information to financial websites to track down an asset, ask the tax preparer for a copy of the 1099 form for each asset, so you will know which company to contact.

Make certain key documents are signed. These are a will, financial power of attorney, health care power of attorney and any trust documents. Put these in a safe place, along with a copy of the Social Security card, birth and marriage certificates. You should also provide copies and access to files to people who serve as professional advisers, such as attorneys, accountants, financial planners and insurance agents. In addition, share contents of this collection with your parent’s executor, financial and health care agent and/or another relative who lives nearby. With everyone gathered together, the holidays are a good time to have a family meeting and make sure everyone is on the same page. If you would like to learn more about planning for elderly loved ones, please visit our previous posts. 

Reference: Kiplinger (Nov. 1, 2021) “Someone Needs to Know Where Your Money Is”

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Estate of The Union Episode 12 is out now!

 

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Estate Planning for Young Adults

Estate Planning for Young Adults

There are some basic estate planning needs for young adults once they reach 18. This 18th birthday milestone legally notes the transition from minors to official adults, bringing with it major changes in legal status, says NJ Family’s recent article entitled “What You Need to Know (Legally and Medically) On Your Teen’s 18th Birthday.”

Adults—even your 18-year-old— is entitled to privacy rights. This means that anyone not given explicit rights via a power of attorney and HIPAA (the Health Insurance Portability and Accountability Act) release, among other important documents, can be denied info and access—even parents. Here’s what every family should have:

Power of Attorney. A power of attorney (POA) gives an agent (such as you as the parent) the authority to act on behalf of a principal (your adult child) in specific matters stated in the POA.

You can also have a POA for medical decisions and one for finances.

HIPAA Release. When kids become legal adults, they have a right to complete health privacy under HIPAA. That means no one can see their information without permission, even you!

Ask your child to sign a HIPAA release form (which is often included along with the medical power of attorney), to let their health providers share relevant information.

Wills. A simple Will is a good idea. It may also be a good time for you to review your estate plan to see how circumstances changed.

The wisest and safest way to get a credit card for your adult child is to add your child to your account. That way you can monitor transactions. Students also get an immediate bump in their credit score, which is important for renting apartments. However, the main point is to teach them skills and how to be responsible with money.

Talk with an experienced estate planning attorney about drafting all of the necessary estate planning for your newly-minted young adult. If you would like to read more about estate planning for young adults, please visit our previous posts.

Reference: NJ Family (Oct. 6, 2021) “What You Need to Know (Legally and Medically) On Your Teen’s 18th Birthday”

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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”

The Estate of The Union Episode 10 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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Do You Have to Probate an Estate when Someone Dies?

Living Will is an Important part of an Estate Plan

A living will is an important part of an estate plan. Living wills can be used to detail the type of healthcare you do or don’t want to receive in end-of-life situations, or if you become permanently incapacitated or unconscious. A living will tells your healthcare providers and your family what type of care you prefer in these situations, explains Yahoo Finance’s recent article entitled “How to Make a Living Will.” These instructions may address topics, such as resuscitation, life support and pain management. If you don’t want to be on life support in a vegetative state, you can state that in your living will.

A living will can be part of an advance healthcare directive that also includes a healthcare power of attorney. This lets your chosen healthcare proxy make medical decisions on your behalf, when you’re unable. A living will typically only applies to situations where you’re close to death or you’re permanently incapacitated; an advance directive can cover temporary incapacitation.

Ask an experienced estate planning attorney or elder care lawyer about the technical aspects of how to make a living will and include it in your estate plan. You should consider what to include. Every state is different, so your attorney will help you with the specifics. However,  you’ll generally need to leave instructions on the following:

  • Life-prolonging care, like blood transfusions, resuscitation, or use of a respirator;
  • Intravenous feeding if you are incapacitated and cannot feed yourself; and
  • Palliative care can be used to manage pain, if you decide to stop other treatments.

You will want to be as thorough and specific as possible with your wishes, so there is no confusion or stress for your family when or if the day arrives. You next want to communicate these wishes to your loved ones. You should also give copies of your living will to your doctor. If you’re drafting a living will as part of an advance healthcare directive in your estate plan, be certain that you get a copy to your healthcare proxy.

Review your living well regularly to make sure it’s still accurate because you may change your mind about the type of care you’d like to receive.

Ask your attorney to help you draft a living will along with a healthcare power of attorney, so all of the bases are covered as far as healthcare decision-making. When choosing a healthcare proxy, select a person on whom you can rely, to execute your wishes.

A living will is an important part of an estate plan and prepares your family for your death. If you would like to learn more about end-of-life care, please visit our previous posts.

Reference: Yahoo Finance (Feb. 18, 2021) “How to Make a Living Will”

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Can I be paid as a caregiver?

The Difference between Power of Attorney and Guardianship

The difference between power of attorney and guardianship is in the level of decision-making power, although there are many intricacies specific to each appointment, explains Presswire’s recent article entitled “Power of Attorney and Guardianship of an Elderly Parent.”

The interactions with adult protective services, the probate court, elder law attorneys and healthcare providers can create a huge task for an agent under a power of attorney or court-appointed guardian. Children acting as agents or guardians are surprised about the degree of interference by family members who disagree with decisions.

Doctors and healthcare providers don’t always recognize the decision-making power of an agent or guardian. Guardians or agents may find themselves fighting the healthcare system because of the difference between legal capacity and medical or clinical capacity.

A family caregiver accepts a legal appointment to provide or oversee care. An agent under power of attorney isn’t appointed to do what he or she wishes. The agent must fulfill the wishes of the principal. In addition, court-appointed guardians are required to deliver regular reports to the court detailing the activities they have completed for elderly parents. Both roles must work in the best interest of the parent.

Some popular misperceptions about power of attorney and guardianship of a parent include:

  • An agent under power of attorney can make decisions that go against the wishes of the principal
  • An agent can’t be removed or fired by the principal for abuse
  • Adult protective services assumes control of family matters and gives power to the government; and
  • Guardians have a responsibility to save money for care, so family members can receive an inheritance.

Those who have a financial interest in inheritance can be upset when an agent under a power of attorney or a court-appointed guardian is appointed. Agents and guardians must make sure of the proper care for an elderly parent. A potential inheritance may be totally spent over time on care.

In truth, the objective isn’t to conserve money for family inheritances, if saving money means that a parent’s care will be in jeopardy.

Adult protective services workers will also look into cases to make certain that vulnerable elderly persons are protected—including being protected from irresponsible family members. In addition, a family member serving as an agent or family court-appointed guardian can be removed, if actions are harmful.

Agents under a medical power of attorney and court-appointed guardians have a duty to go beyond normal efforts in caring for an elderly parent or adult. They must understand the aspects of the health conditions and daily needs of the parent, as well as learning advocacy and other skills to ensure that the care provided is appropriate.

Ask an experienced elder law attorney for help understanding the difference between power of attorney and guardianship. Explain your family’s situation and your need for power of attorney documents with a provision for guardianship. If you would like to learn more about guardianship, please visit our previous posts.

Reference: Presswire (Jan. 14, 2021) “Power of Attorney and Guardianship of an Elderly Parent”

 

when mom refuses to get an Estate Plan

Do You Need a DNR in Your Estate Plan?

The rise of COVID 19 has caused many people to consider estate planning, and that is a good thing. When the discussion arrives at end of life decisions, the subject of a DNR comes up. Do you need a DNR in your estate plan? Forbes’s article entitled “Should “Do Not Resuscitate” Be Part Of Your Estate Plan?” explains the difference between a health care proxy and a DNR.

A health care proxy is a legal document that lets you name an agent to make health care decisions for you. It is used if you’re unable to make those decisions for yourself. When you were again able to communicate, you’d go back to making your decisions for yourself. The ability to create a health care proxy is governed by your state’s laws. Every state’s laws are different.

Ask an experienced estate planning attorney about a DNR and how to comply with your state’s law in creating these directives. He or she will know about health care institutions and whether they will give authority to the documents you created. If they won’t, your named agent would have to go to court to enforce them.

You can also supplement your state’s directives with additional guidance.

Some states’ directives require a set series of instructions for your agent in your estate plan regarding your DNR. For instance, it may include questions as to whether you want life sustaining treatment and medically administered nutrition and hydration. Other states contain language that is broader. They allow the agent more latitude to decide end-of-life decisions. This language usually includes the intention that you want to be taken off life support, if you have a terminal illness or injury and your death is imminent.

A DNR is a medical order informing health care workers that they are not to revive you. It is a document that you put in place with your physician. Some states have also adopted MOLST forms (Medical Orders for Life Sustaining Treatment) to address other situations, like intubation, ventilation and dialysis. These documents require a thorough discussion between the patient and the health care provider. They are typically part of end of life care, when a person has an advanced stage terminal illness.

If you’re relatively healthy, you want to be treated – and resuscitated – if you have a heart attack. There may be a time when you need a DNR, but most likely it’s not now. If and when that time comes, you’ll need to have a talk with your doctor and estate planning attorney about a DNR, and whether you should include it in your estate plan.

However, you should speak with your estate planning attorney about your health care proxy, especially if you don’t have one. Whether it’s during the coronavirus pandemic or not, a health care proxy is a critical part of a complete estate plan. To learn more about other important documents to include in your planning, such as a Power of Attorney or Guardianship, please read our previous posts.

Reference: Forbes (May 28, 2020) “Should “Do Not Resuscitate” Be Part Of Your Estate Plan?”

 

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 Texas Trust Law to schedule a complimentary consultation.
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