Power of Attorney

Some people who thought they had covered all their bases and acted responsibly to care for loved ones in the event of a debilitating illness or incapacity are finding their plans un-done by strict banking policies. Bank of America recently updated their online security procedures, and no longer accepts a power of attorney for online banking.

As Bernard Krooks wrote last week for Forbes, this strict policy came to light when Chicago resident Eva Kripke was blocked from accessing her husband’s Bank of America account. According to Krooks, Mrs. Kripke had been handling her husband Sidney’s bank accounts as agent under a power of attorney ever since he was diagnosed with Lewy body dementia four years ago. Suddenly now, however, she is denied access under the bank’s updated security procedures.

The bank suggested she go to her local branch and get a printout of her husband’s account information. Unfortunately, Mrs. Kripke felt this was unacceptable because her husband’s health status requires close financial oversight. Kripke’s options in this situation are limited because her husband’s illness has rendered him incompetent. Opening a new bank account for her husband elsewhere would require executing a new document, a near impossible task when the grantor is incompetent.

Rules such as these are becoming increasingly prevalent and significant as more people are called upon to care for an aging population and their attendant disabilities.

Understanding Powers of Attorney is just a part of successful estate planning. To ensure a successful plan, we at Idaho Estate Planning will: 1) educate you and your helpers; 2) take the time to get to know you, your family, your desires, your concerns, your goals, and your potential problems; 3) gladly and patiently answer questions until you understand the concept or issue; and, 4) based on experience with the problems and results caused by poor planning, help you design and implement the plan that fits your concerns and goals. Remember, good planning is no accident.

Idaho Estate Planning

Promote Your Page Too

Tweet

Alzheimer’s & Estate Planning

A diagnosis of Alzheimer’s disease can be devastating for everyone involved, including the patient and all of their family members. Should you be facing this diagnosis, there are probably a million thoughts racing through your mind, from keeping your loved one safe to caring for them as the disease progresses. One thing you might not think about is the need for estate planning. As a recent article by Reuter’s explains, if you or someone you love has a family history of dementia, is showing symptoms of Alzheimer’s or is concerned about later-life planning, it’s time to get to work.

You’ll want to assemble a team that specializes in long-term planning and elder care issues. A good place to start is the National Care Planning Council (NCPC). The NCPC and their website www.longtermcarelink.net are a very comprehensive resource for Eldercare (Senior Care) and Long Term Care Planning. Idaho Estate Planning is a founding member of the Idaho Care Planning Council and the Treasure Valley Care Planning Council. Both are a part of the NCPC network.

At Idaho Estate Planning we can help you navigate the elective transfer of decision-making authority through a power of attorney or trust and can help you qualify for needs-based programs like Medicaid and Veterans Pension Benefits if necessary. We set up a legal framework through which the client and his or her family can transfer assets and decision-making responsibilities.

Alzheimer’s is the sixth leading cause of death in the U.S., with 5.4 million Americans suffering from the disease. So, health care proxies will be another important aspect of your legal plan.

You may want to read 2 previously posted blogs titled Maintaining Control of Your Healthcare Options and Recognizing the Signs of Dementia. When dealing with Alzheimer’s and other forms of dementia it is critical to start NOW. At Idaho Estate Planning, we can help you find the resources you need to put your long-term care plan together. We have the experience and expertise to help you maintain your options and protect yourself as well as your loved ones now and into the future. Remember, good planning is no accident!

Idaho Estate Planning

Promote Your Page Too

Tweet

Getting Your Affairs in Order

Recently I had someone in my office wanting to know what his options were for taking care of his In-laws. In 2004, when the first signs of medical troubles appeared, he had, with his wife and her siblings, tried to convince the parents that they needed to get their affairs in order. They needed to do some planning, but as is all too common, no planning was done. Where there could have been many choices and options, now there are few. Where there could have been comfort in their final years, now hard choices must be made that would never have been considered before.

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.”

When it comes to planning for the future, the sad fact is that every year we fail to plan we lose options. Wait long enough and the only options left are those made for us out of desperation. Remember, timing is everything. In order to maintain control as long as possible and have an effect on your own quality of life decisions you must choose to act now. Your decisions need to be made known and documented correctly. Good planning is no accident!

Call us today and let us help.

Idaho Estate Planning

Promote Your Page Too

Tweet

Helping Your Elderly Parent with COPD Related Depression

Experts say that over a million people in the United States have chronic obstructive pulmonary disease (COPD). It is a chronic lung condition that includes bronchitis, emphysema or both.

COPD affects the airways and air sacs within the lungs, which makes breathing difficult and can result in a person becoming less active over time. An elderly person who has COPD will easily become depressed, when dealing not only with breathing difficulties but other age related problems.

One example of COPD related depression is Martin, age 72. Martin had lived a busy lifestyle, playing golf, volunteering at the community center and working in his garden. Diagnosed with COPD six months previous, and uncertain how to manage his breathing difficulty and new medications, Martin stopped all his activities. Giving up the things he loved to do and sitting more at home along with improper diet, he became a victim to depression.

Martin’s son Anthony realized that his father could not handle his new situation and depression alone. A trip together to Martin’s physician began the steps to dissipating the depression and enabling Martin to return to his social life.

Anthony received instructions about his father’s medications from the doctor and how they were to be used and consequently could help his father with medication reminders.

The most common types of daily COPD medicines are:

• Inhaler for daily maintenance – Bronchodilators help relax the muscles around the lungs’ breathing tubes. This reduces shortness of breath and makes breathing easier.
• Steroids – Corticosteroids, taken in pill form or inhaler reduce swelling in breathing tubes to quickly make breathing easier. Not commonly for prolong use.
• Oxygen Treatment – Severe COPD will reduce your lungs’ ability to put oxygen into your blood to be carried throughout your body. Martin’s oxygen level was measured to determine if he would need prescribed oxygen therapy. Oxygen is usually prescribed if the oxygen in the blood is low during sleep, exercise, or while not active. A respiratory therapist from an oxygen supply company or home health service can help with learning how to use oxygen.

An important factor in Martin’s depression and COPD management was his diet.

“A healthy diet can play an important role in the management and treatment of COPD.
Finding the right diet can be tricky for people with chronic obstructive pulmonary disease (COPD), since they need to eat a healthy diet and maintain their optimal weight to keep COPD symptoms in check.”  (Krisha McCoy, MS, Lindsey Marcellin, MD, MPH)

Maintaining the right nutrition and taking vitamins not only keeps the body healthy but heals the mind, providing emotional well being. Fad diets or extreme dieting are not appropriate for COPD patients. Extreme weight loss can be as much a hazard as being overweight. A home care nutritionist can help establish a healthy menu and diet plan.

With medication and diet under control the final steps to overcoming Martin’s depression were to return to his daily activities. With COPD, an elderly person is more hesitant to leave home, especially if that person’s breathing capacity is not as it used to be. There is a lot of available mobility support for the elderly with small portable oxygen units, walkers, electric scooters and other supportive equipment to help these disabled people move about in the community.

With the help of mobile services and his son at his side to start with, Martin returned to the golf course and community activities. His new diet and return to previous activity helped Martin overcome his symptoms of depression.

Studies show that the intervention of family and friends in helping and supporting elderly people with COPD results in a decrease of depression and a healthier outcome for the patient.

The Oxford Journals: Medicine, Age and Ageing states

“It is also worth exploring how family and friends may be involved in supporting the patient and to encourage social interaction. Educating the spouse, family members and friends about depression may help them to understand the consequences of the disease and to develop coping strategies and in turn may reduce the likelihood of isolation. A very recent study that investigated the benefits of emotional support by family and friends and of spiritual beliefs in patients with major depression showed that those with higher perceived emotional support had better outcomes.” (Oxford Journals Medicine Age and Ageing Volume 35, Number 5)

Idaho Estate Planning is part of the Treasure Valley Care Planning Council, a non-profit network of elder care professionals available to provide information on the information discussed above and much more. Let us know your concerns and we will help you find the resources you need.

In addition to caring for your parents or other family members, it is also important to consider your own concerns for the future. How will you maintain your independence as you grow older? What effect would a costly health issue have on your quality of life? The more planning you do now the less difficulty there will be later. Good planning is no accident.

Call us today and let us help.

Idaho Estate Planning

Promote Your Page Too

Medical Care at the End-of-Life

Medical Care Immediately Prior to Death

In the first half of the 20th century, most people who died had an accident or contracted a disease or they had physical disorders that inevitably lead to death. Life-saving medical interventions such as sophisticated resuscitation, complicated surgeries, life-saving treatments, ventilators, feeding tubes and other life-support were rarely used or even available. Nowadays there is great emphasis on curing medical problems sometimes to the exclusion of recognizing that death might be a more welcome outcome.

Surveys indicate that older people are often more afraid of death than younger people. But for all Americans — young and old — there is a great fear of death.  Oftentimes, the families of those near death will go to great lengths to try interventions that may be ineffective in prolonging life. Estimates are that about 30% of Medicare reimbursements are spent on people in the last year of their life. It is a fact that much of this medical care did little to prevent death and prolong life.

According to the Dartmouth Atlas study on death:

“The quality of medical intervention is often more a matter of the quality of caring than the quality of curing, and never more so than when life nears its end. Yet medicine’s focus is disproportionately on curing, or at least on the ability to keep patients alive with life-support systems and other medical interventions. This ability to intervene at the end of life has raised a host of medical and ethical issues for patients, physicians, and policy makers.”

The Dartmouth Atlas project uncovered some startling differences in what happens to Americans during their last six months of life. The level of hospitalization during those months varies greatly from one region to the next.

The Atlas researchers asked why this was so.  Why is someone living in Miami so much more likely to receive a great deal of high-tech, expensive medical services, while someone with the same condition who lives in Minneapolis receives so much less? The answer appears to have very little to do with religious or spiritual beliefs or personal preferences.  Rather, the answer appears to be that the capacity of the local health care system – the per-capita supply of hospital beds, doctors, and other forms of medical resources – is the dominating influence. Those who live in areas like Miami, where there are very high per capita supplies of hospital beds, specialists, and other resources, have one kind of end of life experience. Those who live in areas like Minneapolis or San Francisco, where acute care hospital resources are much scarcer, have very different kinds of deaths.

The question, then, is which is better? From the dying person’s perspective, more is not necessarily a good thing.  That is, more visits to doctors for someone who is very sick can be stressful and exhausting. For many people a hospitalized death is something to be avoided if at all possible. From the perspective of the health care system, much of the care being given is futile, and accomplishes little. People who live in areas with very high utilization of hospital resources do not live longer than people who die in areas where utilization is lower – and if extension of life is not the goal of intervention, what is?

Deciding How and When to Stop Curing and Start Caring

Some people are content to leave decisions regarding their death in the hands of others. By doing so, they may expose themselves to unnecessary and futile treatments as outlined above. They may experience numerous visits to the emergency room in the last stages of their life. And their dependency on others often results in great stress to family members when loved ones at the end-of-life lose their capacity and didn’t make their last wishes known. Families are often forced to make decisions about life-support and treatment without knowing whether their loved one would have wanted these interventions.

Advance Directives

These, are the minimum documents you need to make sure your wishes for health and medical care and end of life decisions are honored.

• Durable Power of Attorney for Health Care
• Living Will
• POST (Physician Orders for Scope of Treatment)
• HIPAA Release

A patient or his or her spouse or a family member will typically call 911 in the event of a life-threatening emergency. Very seldom will the advanced directives end up with anyone in the emergency room. Therefore, medical decisions are generally made by family members who show up at the hospital. The actual health treatment wishes of the patient may be at home in the desk drawer. It is therefore extremely important to remember to take these documents to the emergency room whenever a crisis arises. It is also critical that family members be made aware of your wishes and the existence of your advance medical directives as well as where they can be found.

When it comes to these very difficult questions timing is everything. In order to maintain control as long as possible and have an effect on your own end of life decisions you must choose to act now. Your decisions need to be made known and documented correctly. Good planning is no accident!

Call us today and let us help.

Idaho Estate Planning

Promote Your Page Too

Hospice Care

Hospice Care

It is unfortunate that many people who died in a hospital emergency room or who received heroic treatments to prolong life in a hospital or nursing home may have had the alternative of dying at home in familiar surroundings, with family or other loved ones at their side.

Most often when it becomes apparent that there is really no hope for recovery, a family calls 911 and starts a process which can result in great stress and great emotional discomfort. The loved one who is dying ends up in a hospital or nursing home in a strange environment, frightened and confused and tied to tubes and monitoring devices. Given the option, this is not how most of us would choose to spend our last hours on earth.

Attending to a dying loved one in the peace and quiet of the home with caring family close at hand can be a comforting and even spiritual experience for all involved. Hospice can allow this to happen. Memories of a loved one passing in peace can provide great comfort for family members in years to come.

When there is no longer hope for prolonging life and especially when the decision is made months in advance, hospice is a viable alternative to other medical intervention.

Hospice care is a valuable service and is generally underused except for terminal cancer patients. Most families wait too long to have their doctor prescribe hospice from Medicare. Doctors or families don’t often consider this care alternative for Alzheimer’s, degenerative old age or other debilitating illnesses where a person is going downhill fast. They should.

Good Hospice Care:

• Manages the patient’s pain and symptoms
• Assists the patient with the emotional and psychosocial and spiritual aspects of dying
• Provides needed medications, medical supplies, and equipment
• Coaches the family on how to care for the patient
• Delivers special services like speech and physical therapy when needed
• Makes short-term inpatient care available when pain or symptoms become too difficult to manage at home, or the caregiver needs respite time
• Provides bereavement care and counseling to surviving family and friends.

A person can receive hospice from Medicare if:

1. He or She is eligible for Medicare Part A (Hospital Insurance), and
2. The doctor and the hospice medical director certify that the person is terminally ill and probably has less than six months to live, and
3. The person or a family member signs a statement choosing hospice care instead of routine Medicare covered benefits for the terminal illness, and
4. Care is received from a Medicare-approved hospice program.

A person may continue to receive regular Medicare benefits from his or her customary doctors for conditions not related to the hospice condition.

Good planning is critical. Good planning leads to more options, more control and greater peace of mind. However, good planning is no accident. All of these decisions and options are best discussed well in advance. To secure your peace of mind as well as your family’s future, get started now.

Idaho Estate Planning

Promote Your Page Too

Medicaid Planning Part III

Introduction

In Medicaid Planning Part II we covered:

• Intent to Return Home
• Medicaid Treatment of a Home
• Special Home Exemption Rule
• Joint Tenancy

Transfer Title of the Property to the Community Spouse

Transfers to a spouse of any assets are exempt from Medicaid eligibility rules. An institutional spouse, anticipating Medicaid, can transfer title in the home to the community spouse and it has no effect on Medicaid eligibility. This can be done either with a quit claim deed or through a trust. With the asset no longer in the name of the care recipient, Medicaid recovery cannot use the house as a basis for recovering its costs. And the community spouse can transfer the house to a member of the family and as long as this is done beyond the five-year look back period, then Medicaid can’t assess a penalty period for a transfer of assets for less than value. It’s important to use a legal adviser to make sure you do this properly.

Trust to Avoid Probate

Common trusts to avoid probate are called “living” or “inter vivos” trusts. A trust never dies, thus it is not subject to probate. Most arrangements make the trust the owner of the property with the original owner(s) as trustee(s) (caretaker as it were) and beneficiaries(s). Thus, the property reverts to the estate at death. Most people initiate these trusts to avoid probate. Assets in these trusts, other than a primary residence, are transparent to Medicaid. These trust assets are subject to Medicaid spend down rules.

The trust can be used in states where Medicaid recovery only uses primary residences passing through probate as being subject to recovery. However, a growing number of states do not recognize these arrangements to avoid probate estate recovery and go after primary residences in revocable trusts regardless of ownership.  Idaho does not ignore the trust, however, Health and Welfare will require that the trustees of the revocable or living trust transfer the primary residence back out of the trust to the beneficiaries.  This, then, allows Health and Welfare to recover the value of benefits paid from the house now destined to go through probate.

To do it right for these states requires an irrevocable trust with no life interest, set up 5 years or more before a Medicaid claim. Very few people are willing to do these kinds of trusts.

Some people also include a so-called “life interest” in property in arrangements where property is gifted or in irrevocable trusts. The life interest gives them use of the property until their death even though they don’t own it. Medicaid in many states does not recognize life interest and the property is considered to be in the ownership of the person who gifted it and subject to look back rules and recovery.

Move Loved One Needing Care to Another State

A person needing Medicaid covered care in one state may not qualify under that state’s rules but might qualify under the rules of a neighboring state. Of particular concern are candidates suffering from dementia or Alzheimer’s. It’s difficult to quantify their need for care and in some states, those people who are cognitively impaired might not get help with Medicaid even though their needs might be greater than the needs of those who are physically disabled.

Families should consider moving loved ones who have been declined in one state, to live with a member of the family in another state and possibly qualifying in that state. In addition the new state may be more lenient with Medicaid recovery procedures.

A second reason may be that the current state of residence has a very tight supply of Medicaid beds and there is a waiting list. Moving the loved one to a state where there are more available Medicaid beds may avoid the family having to temporarily cover the cost of a non-Medicaid nursing home bed while waiting for one to become available.

Give Away Assets

We have already discussed the moral implications of using Medicaid planning strategies for unfairly qualifying for Medicaid and shifting the burden of cost to the taxpayers. New look back rules under the Deficit Reduction Act have effectively done away with gifting strategies used in the past to accelerate eligibility for Medicaid. This does not mean that gifts cannot be used, but planning must be done many years in advance. Under these new circumstances the whole concept of gifting in order to qualify for Medicaid is much more complicated and consulting with a professional familiar with the Medicaid requirements is essential..

Good planning is no accident. All of the issues discussed above are best handled in advance. To secure your future care, get started now.

Idaho Estate Planning

Promote Your Page Too

4 Steps of Long Term Care Planning Part I

The Importance of Planning for Eldercare

According to some sources, 60% of us will need long term care sometime during our lives. It is important for all of us to prepare for that day when we will need to help loved ones with care or we will need long term care for ourselves.

We may prepare financially for unexpected disasters by covering our homes, automobiles and health with insurance policies. But no other life event can be as devastating to an elderly person’s lifestyle, finances and security as needing long term care. It drastically alters or completely eliminates the three principal retirement dreams of elderly Americans:

1. Remaining independent in the home without intervention from others
2. Maintaining good health and receiving adequate health care
3. Having enough money for everyday needs and not outliving assets and income

Sadly, the majority of the American public does not plan for the devastating crisis of needing eldercare. This lack of planning also has an adverse effect on the family, with sacrifices made in time, money, family lifestyles and even affecting the family’s or caregiver’s medical and emotional health.

Because of changing demographics and potential changes in government funding, the current generation, more than any before them, needs to plan for long term care before the elder years are upon them.

What Is Long Term Care?

The need for long term care arises when an individual requires, from someone else, assistance with medical care, daily living activities, comfort, supervision or advice. This need for care may be caused by an accident, disease process, or frailty. Such conditions may require help with the ability to move about, dress, bathe, eat, use a toilet, medicate, and avoid incontinence.

Also care may be needed to help the disabled person with household cleaning, preparing meals, transportation, shopping, paying bills, visiting the doctor and answering the phone. Oftentimes, long term care in the form of supervision or confinement is needed due to cognitive impairment from stroke, mental retardation, depression, dementia, Alzheimer’s, Parkinson’s Disease and so on. Most long term care is provided at home by family members.

What Is Long Term Care or Eldercare Planning?

For seniors, the terms “long term care” and “eldercare” are synonymous. For younger people, “long term care” is the more appropriate phrase.

For the uninformed family member, eldercare or long term care might appear to be a very straightforward and easy-to-understand process. Unfortunately, the reality is that long term care is very complicated and finding care systems and providers is a frustrating and time-consuming process. There is no one single source to help caregivers find services or solve problems with a simple phone call or a single community contact. For this reason, planning for care requires a great deal of prior knowledge in order to avoid operating in a crisis mode trying to find help when the need for care suddenly arises.

However, knowledge of long term care systems is not enough. Because it can happen suddenly, at any time, you must take action now to prepare for the day when you will need to deal with eldercare for your loved ones or for yourself. This action involves

• Determining the care settings and services you or a loved one most likely would want.
• Providing funding for paying the cost of care, especially when government support programs are lacking or require sacrifice of assets.
• Completing a survey to determine necessary financial and legal arrangements to be made.
• Completing a written long term care planning document to provide instructions to caregivers and to your care coordinator in advance of needing eldercare.
• Assigning a care coordinator and determining the role of other family members, friends or advisers involved in caregiving.
• Holding a planning meeting and drawing up a written agreement for involvement between all those who are willing to participate in future caregiving for you or a loved one.

There are four crucial steps necessary in this process for long term care planning. The four steps are based on the following concepts:

1. Knowledge and preparation are the keys to success.
2. Having funds to pay for care greatly expands the choices for care settings and providers.
3. Using professional help relieves stress, reduces conflict, and saves time and money.
4. Success is assured through a written plan accepted by all parties involved.

In Part II we will discuss these steps in greater depth.

The Importance of Planning for Eldercare

According to some sources, 60% of us will need long term care sometime during our lives. It is important for all of us to prepare for that day when we will need to help loved ones with care or we will need long term care for ourselves.

We may prepare financially for unexpected disasters by covering our homes, automobiles and health with insurance policies. But no other life event can be as devastating to an elderly person’s lifestyle, finances and security as needing long term care. It drastically alters or completely eliminates the three principal retirement dreams of elderly Americans:

1. Remaining independent in the home without intervention from others
2. Maintaining good health and receiving adequate health care
3. Having enough money for everyday needs and not outliving assets and income

Sadly, the majority of the American public does not plan for the devastating crisis of needing eldercare. This lack of planning also has an adverse effect on the family, with sacrifices made in time, money, family lifestyles and even affecting the family’s or caregiver’s medical and emotional health.

Because of changing demographics and potential changes in government funding, the current generation, more than any before them, needs to plan for long term care before the elder years are upon them.

What Is Long Term Care?

The need for long term care arises when an individual requires, from someone else, assistance with medical care, daily living activities, comfort, supervision or advice. This need for care may be caused by an accident, disease process, or frailty. Such conditions may require help with the ability to move about, dress, bathe, eat, use a toilet, medicate, and avoid incontinence.

Also care may be needed to help the disabled person with household cleaning, preparing meals, transportation, shopping, paying bills, visiting the doctor and answering the phone. Oftentimes, long term care in the form of supervision or confinement is needed due to cognitive impairment from stroke, mental retardation, depression, dementia, Alzheimer’s, Parkinson’s Disease and so on. Most long term care is provided at home by family members.

What Is Long Term Care or Eldercare Planning?

For seniors, the terms “long term care” and “eldercare” are synonymous. For younger people, “long term care” is the more appropriate phrase.

For the uninformed family member, eldercare or long term care might appear to be a very straightforward and easy-to-understand process. Unfortunately, the reality is that long term care is very complicated and finding care systems and providers is a frustrating and time-consuming process. There is no one single source to help caregivers find services or solve problems with a simple phone call or a single community contact. For this reason, planning for care requires a great deal of prior knowledge in order to avoid operating in a crisis mode trying to find help when the need for care suddenly arises.

However, knowledge of long term care systems is not enough. Because it can happen suddenly, at any time, you must take action now to prepare for the day when you will need to deal with eldercare for your loved ones or for yourself. This action involves

• Determining the care settings and services you or a loved one most likely would want.
• Providing funding for paying the cost of care, especially when government support programs are lacking or require sacrifice of assets.
• Completing a survey to determine necessary financial and legal arrangements to be made.
• Completing a written long term care planning document to provide instructions to caregivers and to your care coordinator in advance of needing eldercare.
• Assigning a care coordinator and determining the role of other family members, friends or advisers involved in caregiving.
• Holding a planning meeting and drawing up a written agreement for involvement between all those who are willing to participate in future caregiving for you or a loved one.

There are four crucial steps necessary in this process for long term care planning. The four steps are based on the following concepts:

1. Knowledge and preparation are the keys to success.
2. Having funds to pay for care greatly expands the choices for care settings and providers.
3. Using professional help relieves stress, reduces conflict, and saves time and money.
4. Success is assured through a written plan accepted by all parties involved.

In Part II we will discuss these steps in greater depth.

Maintaining Control of Your Health Care Options

Being In Control
Perhaps the most important goal of any estate plan is to allow the client to maintain control. Most of our clients here at Idaho Estate Planning are very intent on “being in control” as long as possible. They want to make their own decisions about whether to go into a “facility” or stay in their house. (Usually the choice is to stay at home as long as possible.) However, the ability to be in control and stay at home is challenged constantly.

Some of the challenges to being in control consist of those disabilities we all fear:  Alzheimer’s disease, dementia, other mental challenges and numerous physical disabilities. The biggest question becomes, “How do I maintain control if I suffer one of these disabilities?” While these situations are varied (and extremely difficult), there are some basics that will allow you to exercise control, that is, allow you to voice your opinion is such a situation.

Durable Power of Attorney for Health Care
First and foremost, you need to execute a Durable Power of Attorney for Health Care. This is a legal document that allows you to personally choose who will make decisions or give instructions if you are not able to, whether from mental or physical disability. This is an extremely important document to have in your estate plan. It is, therefore, extremely important to carefully consider who you want giving instructions to health care providers on your behalf. Typically, this is a spouse.

But, if the spouse is unable to fulfill this responsibility, who will take over? This requires great thought and consideration. Who has the skill set to take on this responsibility? Who understands what you want to have happen? These are not easy decisions and should not be undertaken lightly.

Living Will
A Living Will is a form created by statute that allows you to express a preference if it is determined by two doctors that you are in a terminal state and being kept alive by artificial life support measures. The Living Will also applies if you are determined to be in a persistent vegetative state (some call this being “brain dead”). The Living Will allows you three basic choices: 1) to forego all life preserving efforts being applied whether artificial or natural; 2) to forego any life preserving efforts applied; or 3) only natural efforts applied including food or water or both. In reality, while these situations do occur, they are rare.

The POST
The Physician Orders for Scope of Treatment or “POST” is a more detailed legal document that allows you be very specific in how treatment, whether artificial or natural is applied to you. You can choose to forego intravenous feeding or the use of a feeding tube. You can choose to forego intubation to keep you breathing. You can choose to forego “aggressive methods” to preserve your life. Each of these is an option that you choose.

HIPAA
If your Living Will or POST is needed, it is your Health Care Agent as established in your Power of Attorney for Health Care who gives the instructions to the health care professionals. These documents, then, work together to help you maintain control of your own situation. One more document that makes all the others work better is the HIPAA release. This is an informational release in which you give the health care professionals permission to provide your health information to your Health Care Agent or other family members. In essence, the Power of Attorney allows your Health Care Agent to talk to the doctor. The HIPAA release allows your doctor to talk to your Health Care Agent.

These, then, are the minimum documents you need to make sure your wishes for health and medical care and end of life decisions are honored. Now is the time to address these concerns and plan for the most difficult of times. Once it starts raining (or hailing as it did yesterday), it’s a little late to start fixing the roof. Once you are incapacitated, it’s too late to do this planning.

IDAHO ESTATE PLANNING – THE LEGACY EXPERTS
We are your best source for legacy planning and the only source for the Life Plan™ in Idaho.
Estate Planning – Living Wills – Advance Directives – Veterans Planning – Medicare Planning