Keep the Family Cabin in the Family

For those of you with memories of good times spent at the family cabin, now may be the time to take action to ensure that future family outings will continue to be enjoyed long after you are gone. In other words, ensure the future of the family cabin and the peace and domestic tranquility of your family through proper estate planning. So, how do you do that? The Wall Street Journal Online recently touched on the topic.

The best way to leave an inheritance that includes a family vacation home depends on who will be inheriting it. That is the first essential decision. For example, are you leaving it to one family member or to several? Who will be interested in the home (or more interested in your portfolio)? Who will be able to use the home? The adult child living in New York might not be able to enjoy the cabin in Garden Valley. This is especially true if they have their own vacation property, or if they wouldn’t be able to afford the upkeep, insurance and taxes.

If you’ve settled on a single person to inherit the family vacation home, then it is relatively easy: you can either gift it during your lifetime (before 2013 would be prudent), or leave it through your Revocable Living Trust. If you are leaving it to multiple beneficiaries, like an entire generation of your family, then perhaps consider establishing a specific arrangement for such ownership. For example, many families find the Limited Liability Company (LLC) or various forms of trusts to be practical tools.

If all of the heirs are adults, then an LLC might be a better bet as it allows members a more equal say in what to do, while still providing a framework for decisions or an organizational structure through the use of a solid operating agreement. Of course, you could take it a step further and form a trust that owns an LLC that owns the home, or even specific trusts like a Qualified Personal Residence Trust (QPRT.).

On the other hand, if there are young children in the family, then a trust with a long-term duration might be better. Why? Because it allows parents to pass on the vacation home to their children while still appointing an adult in charge as trustee. In addition, properly drafted with “spendthrift provisions,” such trusts can protect the family home from the potential divorces, lawsuits and bankruptcies of the heirs.

For many, a family cabin is a place of many happy memories shared over a long family history. As a result, it just has to stay in the family. Once you start down the path to make that happen, however, don’t wander too far without appropriate legal counsel. You will need experienced help to navigate the details, figure out what’s best for your unique situation, and eventually put ink to paper.

It doesn’t matter if you’re worried about a family cabin, a family business, a gun collection or your grandmother’s china you need to make sure your wishes are known and your instructions followed. At Idaho Estate Planning, 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!

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Estate Planning & Pre-Nuptial Agreements

Marriage is a tricky institution, enough so to feed a thriving business for therapists and prime-time sitcoms alike. Re-marriage can be even trickier, especially when it comes to your estate planning. If you are considering re-marriage, you may be well advised to also consider a prenuptial agreement. Though it may not seem the most romantic gesture, a prenuptial agreement is simply an honest disclosure of both parties’ assets and agreement as to their distribution should the union dissolve, or at the death of either spouse. Enter re-marriage without one at your own risk – or that of your estate. As recently highlighted on the ElderLawAnswers website, without a prenuptial agreement, your new spouse could invalidate your existing estate plan.

For example, suppose you and your new spouse each have children from a previous marriage. You intend for your house to pass to your children, but without proper planning and a prenuptial agreement in place, your new spouse could inherit your house and then pass it on to her children when she dies. Disinheriting your own children probably was not your plan.

You’ll need to follow special protocol to ensure your prenuptial agreement is valid, to include that it must be in writing, signed without pressure on either party, both spouses must read and understand the agreement, disclosures must be complete and completely honest, and the agreement cannot be grossly unfair or contain illegal provisions (such as a modification to child support obligations).

If you are already re-married and did not sign a prenuptial agreement, it may not be too late for you and your spouse to resolve these issues with a post-nuptial agreement.

No matter your needs we have the tools necessary to create a successful plan that provides for you and your loved ones security for generations to come. Remember, good planning is no accident.

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Family Caregivers of Veterans May Qualify for Compensation

Looking for a way to help Mom and Dad pay for home care or assisted living? Perhaps you are their caregiver. Wouldn’t it be nice to receive some compensation to help you provide their care? There is financial help available for senior veterans and their spouses.

For veterans who served during a time of war or for their surviving spouses, veterans benefits such as the Veterans Aid & Attendance Pension will pay additional income to cover long term care costs. The great news about this program is that VA will allow veterans’ households to include the annual cost of paying any person such as family members, friends or hired help for care when calculating the Pension benefit.

Pension can provide an additional monthly income of up to $1,949 a month for a couple, $1,644 a month for a single veteran or $1,056 a month for a single surviving spouse of a veteran. This money can be used to help pay the cost of home care, adult day services, assisted living or nursing home services.

A family member can be considered an in-home attendant, but that family member has to be paid for services duly rendered. There is potential for fraud here where a family member may move into the home and ostensibly receive payment as a caregiver but not actually provide the level of care paid for. Documentation for this care must be provided to VA, and it is reasonable for VA to question whether the services being purchased from a family member living in the household are legitimate. Such arrangements should be extensively documented and completely arm’s-length.

The care arrangements and payment for home care must be made prior to application and there must be evidence that this care is needed on an ongoing and regular basis. We recommend a formal care contract and monthly invoice billing for services. Money must exchange hands and there must be evidence of this. All of this documentation must be provided as proof to VA when making application for the pension benefit. Costs for these services must be unreimbursed; meaning these costs are not paid by insurance, by contributions from the family or from other sources. Even though the family member being paid for services cannot reimburse the veteran household directly, the family may pay the bills for the veteran household. This indirect form of support is allowed.

In 2007 the AARP released a study on Caregivers in America in which they reported, “Many caregivers make direct out-of pocket expenditures to help support a family member or friend with a disability. Non-spousal caregivers were asked how much money they spend in a typical month for groceries, medicines, or other kinds of cash support for the care recipient. About half of caregivers contributed financially, spending an average of $200 per month ($2,400 per year). Caregivers who had the greatest level of caregiving burden reported spending $324 per month ($3,888per year) out of pocket.”

The study went on to say, “In addition to direct out-of-pocket expenditures made by caregivers, many caregivers experience other significant economic losses. The majority of caregivers in the United States (59 percent) are employed either full or part time. The financial impact of caregiving on caregivers in the workforce can involve multiple aspects of their income security, including their wages, job security and career paths, and employment benefits such as health insurance and retirement savings.

Those family members acting as caregivers for America’s veterans and/or their spouses can help reduce the stress on their own and their families emotional, social and financial well being by making use of the VA Pension Benefit.

The secret for receiving a successful award from the VA is not in filling out the form but in knowing what documents and evidence must be submitted with the application. Knowing the secrets for a successful award – with the special case of long term care recipients – is 95% of the battle. A knowledgeable, accredited consultant can provide information to shorten the VA’s decision window of 6 to 12 months to possibly 3 or 4 months.

At Idaho Estate Planning we understand how to maximize the benefit or avoid a denial. We can also provide guidance for meeting the asset test. We provide the best strategies for reallocating assets through trusts or income conversions to allow for the best possible accommodation of assets for beneficiaries thus avoiding or reducing taxes, family disputes and Medicaid penalties.

We are VA Accredited and we know how to help veterans get the benefits they have earned through their  greatly appreciated service to our country. Remember, good planning in no accident.

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Helping Our Parents Prepare for Their Future

There is a very good chance that you or someone you know is taking care of elderly parents now or looking at that possibility in the near future. In 2008 a USA TODAY/ABC News/Gallup Poll of baby boomers found that 41% who had a living parent were providing care for them — either financial help, personal care or both — and 8% of boomers said their parents had moved in with them.

Of those who were not caring for an aging parent, 37% said they expected to do so in the future. About half said they were concerned about being able to provide such care.

If financial planning and long term care planning have not been done previous to the need for care, the burden falls on the caregiving family member. Decisions about how care will be paid for, who will be responsible for managing the estate as well as how the long term care will be given can cause stress and contention among family members.

It is best for parents and all family members to be involved in planning for future financial needs. The financial resources being used today could change drastically with the occurrence of a stroke, illness or onset of dementia. In order to plan financially for long term care, you need to know what the costs are now and what they will be in the future.

Every year MetLife does a survey of long term care costs. Their 2010 survey shows that the average daily rate for private nursing home is $229 which is up from $219 in 2009. Assisted living monthly base rate cost rose to $3,293 in 2010 from $3131 in 2009. Home health aides average $21 an hour.

Planning financial needs can be very difficult, considering you do not know when long term care will be required or how long it will be needed. Staying in the home for care will require professional home care assistance, travel accommodations to doctor appointments, help with shopping, meals, medical supplies and medication and possibly a 24-hour attendant. Even if a family member is doing most of the care, in most cases professional care will eventually be required or a move to a nursing home facility will be necessary.

When evaluating present income and assets consider how they would work for future needs. Consider the following:

• Care options
• Long Term Care Costs
• Long Term Care Insurance
• Home Care Costs
• Medicaid Planning
• VA Benefits & Planning
• Legal Documents – Estate Planning

Idaho Estate Planning is part of the Treasure Valley Care Planning Council, a non-profit network of elder care professionals available to provide information for and beyond the items discussed above. 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. Better planning now will reduce the stress placed on you and your future caregivers. Good planning is no accident.

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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.

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Legal Issues with Veterans Benefits

Accreditation

The VA Pension Benefit helps veterans and surviving spouses pay for assisted living care in the home, nursing home, or assisted living facility. It pays up to $1,949 per month to provide care for single or married veterans, or their surviving spouses. Applicants must meet certain medical and financial thresholds. Many find the application process complicated and seek help preparing the forms. It is important to understand federal law dictates that no one may help a veteran in the preparation, presentation and prosecution of an initial claim for VA benefits unless that person is accredited by the VA. The only exception to this law is that any one person can help any veteran – one-time only – with a claim. To help any veteran a second time requires accreditation.

VA recognizes 3 types of individuals for purposes of accreditation.

1. Accredited attorneys
2. Accredited agents and
3. Accredited representatives of service organizations. (Veterans Service Officers)

In order to be accredited to help veterans with new claims, an individual desiring this certification from VA must submit a formal application, must meet certain character requirements and work history requirements and – except for attorneys – must pass a comprehensive test relating to veterans claims and benefits. There are also requirements for ongoing continuing education.

What Does It Mean to Help a Veteran with a Claim?

VA interprets its prohibition on preparing, presenting and prosecuting a claim to mean that talking to a veteran or a veteran’s qualifying spouse or dependent after that person has indicated an intent to file a specific claim for benefits requires accreditation. Anyone can talk about veterans benefits in general with any veteran and need not be accredited. The point at which discussion narrows down to specific information about the veteran’s service record, medical conditions, financial situation including income and assets and other issues relating to a claim specific to a veteran or dependent triggers accreditation. According to VA, discussing the specifics of the claim means that the veteran has expressed an intent to file an application for veterans benefits, and at this point, the consultant helping the veteran must be accredited.

This bears repeating: An individual cannot advise a veteran or other eligible beneficiary about that person’s specific claim for VA benefits unless that individual is accredited.

Using an Accredited Agent

The secret for receiving a successful award from the VA is not in filling out the form but in knowing what documents and evidence must be submitted with the application. Knowing the secrets for a successful award – with the special case of long term care recipients – is 95% of the battle. A knowledgeable, accredited consultant can provide information to shorten the VA’s decision window of 6 to 12 months to possibly 3 or 4 months.

At Idaho Estate Planning we understand how to maximize the benefit or avoid a denial. We can also provide guidance for meeting the asset test. We provide the best strategies for reallocating assets through trusts or income conversions to allow for the best possible accommodation of assets for beneficiaries thus avoiding or reducing taxes, family disputes and Medicaid penalties.

We are VA Accredited and we know how to help you get the benefits you earned through your greatly appreciated service to our country. Remember, good planning in no accident.

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Strategies to Reduce Caregiver Stress Part IV

Understanding Caregiver Stress

A 2003 study of caregivers by a research team at Ohio State University has proven the off-repeated adage “stress can kill you” is true. The focus of the investigation was the effect the stress of caregiving had on caregivers. The team, led by Dr. Janice Kiecolt-Glaser, reports on a 6-year study of elderly people caring for spouses with Alzheimer’s Disease. The study not only found a significant deterioration in the health of caregivers when compared to a similar group of non-caregivers but also found the caregivers had a 63% higher death rate than the control group.

Controlling Stress with Calming Techniques

Music Therapy

Listening to music is a wonderful way to alleviate stress. In doing extensive research on what any given piece of music produces as a physiological response, many unexpected things were found. Many of the so-called Meditation and Relaxation recordings actually produce adverse EEG patterns in the brain–just as bad as Hard Rock and Heavy Metal. A British study involving stress and surgery found “music of a style selected by the patient appeared to be more effective overall in reducing stress.” Another study found that any music performed live and even at moderately loud volumes even if it is somewhat discordant can have a very a beneficial response. Basically, listen to music that makes you feel good, and if you can go listen to it live – all the better.

Pet Therapy

There is a saying that “dog is man’s best friend.” This is certainly true when it comes to dealing with your body’s stress response. Many people feel more relaxed when companion animals are present. Several studies have shown that pets are good for us in numerous ways. For example, petting an animal is known to lower your heart rate, lower your blood pressure and brighten your mood. Another study found that simply watching fish in an aquarium made patients waiting to undergo medical procedures less anxious. In fact, “pet therapy” is frequently used in hospitals and nursing homes to increase socialization and to reduce depression, loneliness, anger, and stress

Secondly, having tender physical contact with your pet is also good for you. Having an animal to hold, cuddle and caress has positive effects on people. Especially those who might have limited means to give or receive physical expressions of affection. Most of us have felt a warm fuzzy feeling inside just by getting your face licked by a puppy. After a hard day at work, this kind of attention can really help you to calm down and relax.

Next, simply talking to your pet can be very therapeutic. People often talk to their pets to share their thoughts, feelings, troubles and worries. Although your pet won’t give you any solutions for your problems, the very act of talking about your concerns with a good listener may help you find your own solutions. And you must admit pets are great listeners.

Finally, if you have a dog for a pet, you get to go for a walk at least 3 or four times a day. This affords you the perfect excuse to take time to yourself away from your stressors. These walks give you time to breathe fresh air, join with nature, collect your thoughts, make plans for the day, or just daydream. The light exercise you get from walking your pet helps you to deal with the physical stress reactions you have acquired in the course of your day. Specifically, walking with your dog helps you to burn up the pent up energy your stressors have caused.

Gardening

Gardening has an important impact on the health of individuals through direct interaction with plants and the natural environment. Horticulture promotes individual health through exercise, stress reduction, social interaction and mental stimulation. Gardening is recommended by such groups as the American Heart Association as a technique to improve general physical health and thus prevent many diseases. In addition, urban agriculture can plan a role in improved health through access to high quality fresh produce either locally produced or self-produced.

Prepare Now to Reduce Stress Later

Idaho Estate Planning is part of the Treasure Valley Care Planning Council, a non-profit network of elder care professionals available to provide information beyond the items discussed above. 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. Better planning now will reduce the stress placed on you and your future caregivers. Good planning is no accident.

Idaho Estate Planning

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Strategies to Reduce Caregiver Stress Part II

Understanding Caregiver Stress

A 2003 study of caregivers by a research team at Ohio State University has proven the off-repeated adage “stress can kill you” is true. The focus of the investigation was the effect the stress of caregiving had on caregivers. The team, led by Dr. Janice Kiecolt-Glaser, reports on a 6-year study of elderly people caring for spouses with Alzheimer’s Disease. The study not only found a significant deterioration in the health of caregivers when compared to a similar group of non-caregivers but also found the caregivers had a 63% higher death rate than the control group.

Lifestyle Changes to Reduce Stress

Exercise

Exercise is a powerful and effective way to fight stress. It is recommended you do about 30 minutes of moderate exercise at least 3 days a week. Here are a few reasons why exercise works.

• Distraction–Exercise provides time away from the stresses of the day.
• Endorphins–Endorphins are opiate-like chemicals that the body produces naturally during periods of stress or physical exertion to relieve pain.
• Neurotransmitters–During exercise, the body releases higher levels of dopamine. These hormones improve the thought process by facilitating transfer of information between neurons.
• Self-esteem–Exercise can be a gratifying and fulfilling activity for people. The act of doing something good for self can promote self-esteem.

Support Groups

Participating in a support group can help manage stress. Sharing coping strategies in a group setting lets you help others while helping yourself. It may also help you to realize that some problems have no solutions and that accepting the situation is reality. Social support has a huge impact on reducing stress. Those who suffer alone, suffer a lot.

Get Adequate Sleep

The catch-22 with sleep is that if you are over-stressed, you are likely to experience a disturbed sleeping pattern, and if you are experiencing a disturbed sleeping pattern, you are likely to become over-stressed!

Sleep isn’t a luxury; it’s a necessity. Sleep restores the body and mind and helps us maintain our mental and physical health. Studies have shown that people who get seven to eight hours of sleep each night enjoy better health and live longer than people who get less sleep.

To ensure that you get enough sleep, try some of the following suggestions:

• Develop a sleep schedule and stick to it.
• Get 30 or more minutes of physical activity each day. Avoid working out during the three hours before bedtime.
• Avoid caffeine, nicotine, and alcohol. Quit smoking. An alcoholic beverage (a “night cap”) before bed may make you drowsy but it actually deprives you of deep, restorative sleep.
• Engage in relaxing activities before bed.
• Leave your troubles outside the bedroom door. Make your bedroom a worry-free zone.
• Create a cozy sleep environment free of distractions.

Pursue Diversions, Hobbies and Relaxing Activities

Another simple way to reduce stress is to distract yourself — go to a movie, play a sport, immerse yourself in a hobby, listen to some favorite music or take a walk. It cannot be emphasized enough how important it is as a caregiver you spend some quality time alone every week, doing exactly what it is you like to do.

Prepare Now to Reduce Stress Later

Idaho Estate Planning is part of the Treasure Valley Care Planning Council, a non-profit network of elder care professionals available to provide information beyond the items discussed above. 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. Better planning now will reduce the stress placed on you and your future caregivers. Good planning is no accident.

Idaho Estate Planning

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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

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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

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