Healthcare

The Health Care Industry’s Push Into Your Privacy

There is a battle for the healthcare market in the US between Amazon, Apple, and Google, and to a lesser extent, Microsoft and Facebook, which are all stepping up their efforts. Some of the businesses are underway, like storing medical records in the cloud for a fee or using patient forms that have been “anonymized” to create new tools. Some products already cater directly to patients, such as wearable medical devices with monitoring capabilities through the internet of things. Lobbying efforts by Silicon Valley “encouraged” the Department of Health and Human Services (HHS) as they defined the rule, known as the Cures Act, improving patient access to all of their electronic health information (EHI) and standardizing their formatting for ease of interoperability. While there is a need to continue the modernization of the health care system, the complexity of the undertaking (legacy computer systems and data), entrenched financial interests, and privacy fears have made a tough go of it.

ONC’s Cures Act Final Rule

From a technology perspective, health care and its associated patient records are no different from data mining other personal information in the age of surveillance capitalism. There is money to be made, vast sums of money based on your health records. Why else would these very cash-rich tech companies wade into such a risky field? Estimates are the healthcare industry will reach 11.9 trillion dollars by 2022, and electronic health care records (EHRs) represent a growing sector of the business. The digital side of healthcare continues to expand as new federal regulations mandate hospitals make changes, and because spiraling health care costs make the sector ripe for disruption. Tech expertise in digital data management, storage, and analysis in other markets translates well into solutions for the behemoth that is health care record keeping. The big tech companies that deliver the best solutions will dominate that market and become an even more intractable part of our lives.

Is your privacy protected? The government outlines eight exceptions to the definition of information blocking when it comes to the Cures Act. The final rule allows for eight categories of reasonable and necessary activities. These activities do not constitute information blocking as long as certain conditions are met, referred to as “exceptions.”

ONC’s Cures Act Final Rule

Google has already garnered bad publicity regarding patient privacy through its subsidiary Google Health in an enterprise-focused known as Project Nightingale. The problems arose when Google got access to some non-anonymized patient data without the patients’ knowledge while creating tools that manage and analyze medical records for doctors and hospitals.

Meanwhile, Amazon Web Services (AWS) enjoys a dominant position in the service-based cloud storage of health records, offering downloadable medical information databases for clients. To side-step privacy responsibilities, an AWS spokesperson said the obligation to comply with patient privacy regulations and policy was the responsibility of customers that sell the medical datasets through AWS. More recently, the joint health care venture Haven (Amazon, Berkshire Hathaway, and JPMorgan) seeking to target innovations in primary care, insurance coverage, and prescription drug costs has shuttered its operations after three years into their business partnership. The business sector is so complex that, most recently, entrenched health care companies are beginning to shake off these tech disrupters and are making deals more traditionally. Tech companies are countering with more joint ventures with established health insurers like Cigna and others.

The continuation of personal, wearable medical devices also sparks many privacy concerns. Like the latest Apple Watch, these devices can take ECGs, detect falls, and phone 911, for example, but the data set created, and communication systems for transferring this data make it hard to protect privacy. Yet you may find in the future that your medical doctor prescribes an Apple Watch, and your insurance will pay for it. Azure, Microsoft’s cloud division, is in direct competition with Google and AWS in the cloud storage business for medical records but declines comment on how patient data is used in its business plan or how it would protect patient privacy. Finally, Facebook already has a health care tool, Facebook Preventive Health, and if you select opt-in, Facebook will use your basic demographic information and recommend medical tests and treatments. The company says the tool does not use your health information or whether you use the tool in advertising. Have you heard this before?

The old hassle of getting paper medical records to prove you have been vaccinated as a child, transferring documents to a new doctor’s office, or even filling out the same medical history information repeatedly may give way to a new set of frustrations. Change is upon US health care and medical record-keeping systems; let’s hope the digitization of and ease in accessing health care records comes with modernized privacy laws that prioritize and protect patients. We hope you found this article helpful. If you have questions or would like to discuss your personal situation, please don’t hesitate to contact our Reno office by calling us at (775) 853-5700.

Elder Law, Healthcare

Caregiving From Afar

A long-distance caregiver is someone who provides care to someone who lives at least an hour away. This type of caregiving takes many forms – from arranging for in-home care, money management, bill paying, and information coordinator. You may also provide respite care for a primary caregiver, conduct safety reviews, create emergency plans, or any combination of these tasks. Legal publisher Nolo cites more than seven million adults in the US acting as long-distance caregivers for elderly parents or relatives.

The greatest success in long-distance caregiving happens when there is a foundation of planning and preparation. If there is a primary caregiver for your parent, ask how you can be most useful. Also, talk to friends who provide care to see if they have helpful suggestions. You will need to identify local resources that can help provide care for your parent. Local providers can include Meals-on-Wheels, senior centers, elder transportation, and more. The National Institute on Aging offers several good websites to use as a starting point. It is best to visit your parent before planning to assess their current living situation, identify their health issues, and gather important information.

Things to consider as you go through each room of the home, the garage, and the yard include

  • Safety – Is there anything that poses a safety problem in the location? Poor lighting, area rugs, clutter, or whatever else might stop your senior from moving safely around the space should be removed or improved.
  • Accessibility – Are things accessible to the senior? Are they within easy reach? Are switches, doors, plugs, and cabinets readily at hand to perform the room’s desired or necessary tasks?
  • Adaptability – Are there ways to adapt things in the room to provide greater accessibility, safety, or ease of use? Will brighter lights or additional railings, grab bars, and even a stairlift help your parent?

Check to see if your loved one is taking proper care of themselves including

  • Home care – Is their living space clean? Is food properly stored and the kitchen clean? Is there any clutter posing a safety hazard?
  • Food – Can your parent prepare themselves a nutritious meal? Are the pantry and refrigerator stocked with good food that is not out of date? Are they drinking enough water? If they have a pet, do they properly provide them with water, food, and outdoor activity?
  • Medical care – Is your loved one taking all of their medications in the right dosages and at the right time? Can they fill their prescriptions at the drug store? Are they able to transport themselves to doctor appointments and labs for blood workups? Do they calendar, remember, and go to their doctor appointments? If they have a pet, do they take them to see a veterinarian for routine examination?
  • Finances – Are there stacks of unopened mail around the house? Are bills left lying around? These warning signs are a good time to take over their bill payment or set them up on auto payments through their bank.
  • Driving ability – If your parent is still operating a car, truck, or even a golf cart, are they doing so safely? If you find increasing numbers of traffic tickets or warning violations, they frequently become lost or experience fender benders while parking, or easily become nervous, angry, or frustrated while driving; it may be time for your parent to hang up the keys.
  • Lifestyle – Does your parent drink alcohol to excess? Do they smoke? Do they participate in medical or recreational marijuana? These activities can cause negative interactions with medications, create mental confusion, and increase the risk of falling.

Gather contact information for neighbors, friends, clergy, or anyone your parent is in contact with regularly. While these relationships are informal, these are people you can rely on to help out in an emergency. Review medical care records, remembering to get doctors’ names, emails, and phone numbers. Include medical insurance information, medications, and other important data on a comprehensive list. Update the list quarterly or anytime you know there is a change. Does your parent live in a “smart home?” Learn the passwords and interact with the audio-video and health monitoring functions to watch for potential problems and communicate with them.

At a bare minimum, know where your parents store their financial information. If it is online, request the passwords. Suppose you need to manage their money remotely. In that case, you will need details about income sources, checking and savings accounts, monthly bills and expenses, social security benefits and other government assistance programs, and investment accounts. Contact information should include accountants, tax preparers, or other people who know about your loved one’s finances.

Get copies of relevant legal documents and know where your parent keeps the originals, including wills, house deeds, and advance health care directives. If your parent has an attorney, get their contact information and introduce yourself to them. If your parent needs an attorney we would be happy to set up a meeting.

Once you conclude your initial assessment, regularly speak with your parents and visit as much as you are able. Build your network of local contacts and coordinate with them to assess changes. Know that your plan is going to change often. Even if your parents can remain in their home, they will require more services and care as they age, and you will need to be responsive to these changes. There is no one solution for every living situation. Begin with a solid assessment of your parent’s current needs and prepare and plan with that information as your starting point.

We help seniors plan for the possibility of needing long-term care, and we ensure the proper legal documents are in place so that their wishes regarding their finances and their care will be carried out.  If you or your parents would like to discuss the possibility of long-term care and how to access financial resources to pay for that care, we would be happy to speak with you. We hope you found this article helpful. If you have questions or would like to discuss your personal situation, please don’t hesitate to contact our Reno office by calling us at (775) 853-5700.

Estate Planning, Healthcare

Inoculated Against COVID-19 Successfully? What’s Next?

COVID-19 is being administered to a growing number of people either through the program or becoming eligible for it. According to the medical community, vaccinated individuals are significantly less likely to contract COVID-19; however, they may pose a health risk to others. What then is appropriate behavior for vaccinated Americans when considering the health of others? For the moment, not much has changed.

First of all, experts have told us that the COVID-19 vaccines take at least two weeks from receiving the second dose (or the single dose of Johnson and Johnson) to build up your immune response. The Pfizer vaccine offers 95 percent efficacy, while the Moderna vaccine provides 94 percent efficacy, so you are highly resistant to COVID-19 but not completely immune. According to MarketWatch, Dr. Gregory Poland, infectious disease expert and director of the Mayo Clinic’s Vaccine Research Group in Rochester, Minnesota, the .9 percent difference in efficacy rates is “meaningless.” However, according to preliminary data, those who are vaccinated may still contract coronavirus though, they are more likely to be asymptomatic. In the same MarketWatch post, Dr. Thomas Russo, chief of infectious disease, University at Buffalo in New York, says, “… it’s not clear whether those vaccinated people would be able to pass it to others.” We are still in a time of great uncertainty regarding this pandemic.

There is a low risk of infection when socializing with other fully vaccinated individuals; however, most experts believe it will take months to achieve herd immunity as a nation. Herd immunity occurs when a large enough percentage of the population develops long-lasting immunity through naturally occurring infection resistance or vaccinations to a particular virus or disease.

Should you visit your local grandparent or other older relative now that you have the vaccine? Dr. Russo told MarketWatch if both you and your loved one are fully vaccinated, “the benefits of the visit will outweigh these small risks that they could have of developing a severe case of coronavirus.” The unprecedented rates of social isolation of the American elderly have taken a huge toll on their physical, mental, and emotional well-being. If you and your loved one have been fully vaccinated, make arrangements to meet safely.

The medical community speculates that a vaccination rate of 70 to 80 percent can bring about herd immunity in the US, but we are just beginning the nation’s vaccination journey. The advent of open borders and easing air travel restrictions from other countries continues to provide challenges. In the future, you might need to present a negative COVID-19 test to cross international borders. Currently, those Americans returning from Mexico must now meet this requirement before entering the US. The “slow the spread” protocols remain in place even though you are fully vaccinated.

Once you are fully vaccinated your way of life may not change for a while. It is still important to reach out to friends and loved ones who may still be suffering from feelings of isolation and/or depression. You may be able to visit a loved one in a care facility once you are fully vaccinated. And if you haven’t already, now is a great time to think about your future health, and to make sure you have the correct legal documents in place in case you are unable to make decisions due to illness or incapacity in the future. We would be happy to speak to you about what documents you should be thinking about, including a health care directive, living will, or other documents specific to your wishes and desires. If the past year has taught us anything, it is to expect the unexpected and plan accordingly. We can help! If you have questions or would like to discuss your personal situation, please don’t hesitate to contact us. Please contact our Reno office by calling us at (775) 853-5700.

Healthcare, Our Blog

The Month of March Is Developmental Disability Awareness Month

March of 1987 started Developmental Disabilities Awareness Month, encouraging all Americans to provide people with developmental disabilities with the opportunities and encouragement they need to reach their potential. Since then, the National Association of Councils on Developmental Disabilities (NACDD) holds a campaign each March to communicate the importance of inclusion and story sharing of individuals living with developmental disabilities (DD). The campaign emphasizes that people with DD can live fully in all areas of community life and help create more strong and diverse communities.

A developmental disability begins anytime during the developmental period, often in utero, and usually lasting throughout a person’s lifetime. The disabilities can be brought about by a complex set of factors, including genetics, parental behavior and health (i.e., smoking and drinking) during pregnancy, complications during birth, any infections present in the mother during pregnancy, and early life exposure to environmental toxins like lead. Some developmental disabilities directly correlate to pregnancy behaviors, such as fetal alcohol syndrome. However, most DD causes are not easy to decipher.

Developmental milestones are key to diagnosing when a DD may be present. Skills like a first smile, waving “bye-bye” and taking the first step, and other general developments like speaking, behaving, learning, playing, and body movement can indicate a need for closer monitoring if the child is not on an average timeline or behavioral spectrum. This observation is known as developmental monitoring and is a partnership between the parents and health care professionals that identify areas of concern.

Developmental disabilities appear before 22 years of age and are life-long, affecting one or both physical and cognitive functioning. If both intellectual and developmental disabilities (IDDs) are present at birth, and without proper intervention and support, it can negatively affect an individual’s emotional, intellectual, and physical development trajectory. The Centers for Disease Prevention and Control (CDC) funds the Study to Explore Early Development (SEED) in a multi-year, multi-diverse site study to identify risk factors for children experiencing autism spectrum disorder (ASD).

Developmental disabilities occur among all socioeconomic, racial, and ethnic groups. Recent estimates for the US show about one in 54 (about 18.5 percent) of children ages 3 to 17 have one or more DDs such as:

  • Autism spectrum disorders
  • Cerebral palsy
  • Attention-deficit/hyperactivity disorder
  • Learning or intellectual disabilities
  • Hearing loss
  • Vision impairment
  • Other developmental delays 

Another CDC program, Autism and Developmental Disabilities Monitoring (ADDM) tracks the number and characteristics of children with ASD, cerebral palsy, and intellectual disability in diverse US communities. The CDC does not study treatment or education programs for individuals with developmental disabilities nor provide direct services to people with DD or their families. However, the CDC does give a list of resources for people affected by developmental disabilities here.

In 2004 the passing of the Individuals with Disabilities Education Act (IDEA) mandating accountability, excellence, and equity in education for children with disabilities guarantees early intervention, special education, and services to transition high schoolers with DDs into adulthood. This IDEA opens a world of possibilities through the resolve of self-advocates and their supporters. Individuals with developmental disabilities need education, health care, and community programs for the same reasons anyone else does — to stay vital, well, active, and an integral part of the community.

Having a disability does not preclude a person from being healthy within their normal range, which is to be as well as possible and stay that way to lead full and active lives. To achieve this includes the need for tools and information to make healthy choices and prevent illness since children with DD commonly suffer additional health conditions such as gastrointestinal symptoms, eczema and skin allergies, asthma, and migraine headaches, to name a few.

The National Association of Councils on Developmental Disabilities (NACDD), partnering with the Association for University Centers on Disabilities (AUCD) and the National Disability Rights Network (NDRN), create a social media campaign for March. This campaign seeks to raise awareness about and the inclusion of those with DDs in all areas of community life and draw attention to the barriers those living with disabilities still face. The goal is to highlight how all people can come together to help those with disabilities form and maintain strong, diverse communities.

If you have a loved one with a disability, it’s important to have a proper estate plan that ensures your loved one is taken care of. We help families with these important planning decisions and would be honored to discuss your particular situation and needs. If you have questions or would like to discuss your personal situation, please don’t hesitate to contact us. Please contact our Reno office by calling us at (775) 853-5700.

Elder Law, Estate Planning, Healthcare

Estate Planning: Talking to Your Parents

One of the most challenging topics to discuss with our parents is estate planning. Even broaching the subject can seem daunting. Despite the challenging nature of this subject, it is one of the most important conversations we can have with our parents. Having a thorough estate plan in place can mitigate confusion and anxiety at the end of one’s life and avoid unnecessary legal fees, taxes, and delays in the dispersion of assets.

The first time our estate plans are likely to come into play will be near the end of our lives and involve decisions concerning our health and finances. These can include what type of medical treatment we want, how the elderly will pay for it, how long, or even if we want to be kept on a life support system. Financial decisions can include reducing taxes when our assets are transferred to our heirs.

After we have passed, our estate plans dictate funeral service arrangements, what will happen to our remains, and how our assets will be distributed. Some people want to leave clear instructions while others leave the decision-making up to relatives or close friends. The most important thing to remember is to choose people who are best suited for the tasks we ask them to carry out.

Preparing for your estate planning conversation with your parents will help you broach the subject and make the most of it. Here are some things to consider.

  • Being familiar with the primary estate plan documents and what they are for will allow you to help them create an outline of how they want their estate plan to function. One way to become familiar with the documents is to create an estate plan for yourself. Having your estate plan could also be an excellent way to encourage your parents to create theirs.
  • Involving other family members, such as your siblings, can create a more collaborative environment and help move the process forward more quickly.
  • Starting the estate planning conversation soon is key for ensuring the best plan is in place. If you are unsure how to get the conversation going, you may want to schedule an initial consultation with an estate planning attorney for your parents.

When you are ready to initiate the conversation with your parents, it may help to start by asking them if they already have any estate planning documents, then proceed in the order situations may arise. Some questions to consider are:

  • Do you have any estate plan documents? If so, where do you keep them?
  • Who do you want to make health care decisions for you? Do you want one person to serve as your health care agent at a time, or do you want two or more people to serve simultaneously?
  • What are your medical and end-of-life preferences?
  • After your death, how do you want your tangible and intangible assets distributed? Who do you want to oversee the distribution of your assets?

Since estate planning is a dynamic process and needs to evolve as conditions change, the estate planning conversation will need to be revisited if, for example, people named in the plan pass away or if a property is sold. Though talking about and creating estate plans can seem daunting, it is helpful to emphasize that one of the most valuable aspects of a thoughtful estate plan is that it gives all involved peace of mind as they move through the end of their loved one’s life.

This article offers a summary of aspects of estate planning law. It is not legal advice, and it does not create an attorney-client relationship. For legal advice, you should contact an attorney. If you have questions or would like to discuss your personal situation, please don’t hesitate to contact us. Please contact our Reno office by calling us at (775) 853-5700.

Elder Living, Healthcare

Termination of Home-Health Care Services Is Becoming More Common

Many Americans are getting their Medicare benefits cut as home health providers, including occupational, speech, and physical therapists, social services, as well as skilled nurses are saying: “Your husband (or whomever) is not going to get better, so we will have to discontinue our services as Medicare will not pay for it.”  Termination of care is swift, often within 48 hours of delivering the message, and the home health care chores fall to the family system or must be paid for out of family funds. So what changed?

PDGM Figure 1

Significant changes began on January 1, 2020, as to how Medicare pays for home health services. Medicare has altered its billing approach from a therapy delivered model (the more therapy you receive, the higher the payments billed to Medicare) and changed it into a reimbursement system known as the Patient-Driven Groupings Model, or PDGM. Medicare Advantage plans have separate rules and are not affected.

The Centers for Medicare and Medicaid Services (CMS) provide Figure 1 as an example of how a 30 day period becomes categorized into 432 case-mixed groups for adjusting payment purchases in the PDGM. These 30 day periods are further broken into the following subgroups: admission sources and timing, twelve clinical principal diagnosis subgroups, three functional impairment levels, and three levels of co-morbidity adjustments. During the 30 days, there is only an allowance for one chosen category under the larger color-coded categories. CMS deems this newer approach to be more holistic regarding patient need assessments.

In 2017, the most recent year for which the data is available, for-profit US home health care agencies (approximately 12,000) provided care to 3.4 million Medicare beneficiaries. Home health rates charged were based on the amount of therapy delivered. The more therapy a patient received, the higher the payout to the agency. Due to the change in payment structure, these agencies are cutting back on therapies provided and even reducing the number of therapists employed. They can’t bill enough to Medicare to remain profitable. These new payment conditions are based on a patient’s underlying diagnosis and other case-specific complicating medical factors. As a result, home health care agencies now have a stronger financial incentive to meet the needs of short-term therapy, post-hospital or rehab facility, as well as caring for patients requiring nursing care for complex situations like post-surgical wounds.

CMS believes this new way to assess payments will strike a balance between costs, efficiencies, needs, and outcomes. The members of the National Association for Home Care and Hospice (NAHC) disagree. Data culled by NAHC from home health agencies indicate there will be a substantial reduction of therapy services offered as a result of the PDGM. William Dombi, the association’s president, states that the cuts “may not be a good move” because medically, patients may deteriorate more rapidly without therapy and seek aid in emergency rooms or hospitals.  He also notes the possibility that if more patients end up worse off and go to emergency rooms or hospitals, that this will reflect poorly on home health agencies and can affect their referrals.

Providing the right patient therapy at the right time by home health care agencies is critical to positive patient outcomes. CMS has done extensive analysis of historical data and, through the use of artificial intelligence tools, feel they can better predict what kind of services and how often a patient will need them through the PDGM. Clarifications are being posted online by CMS that deal with early errors in the program and the ensuing turmoil of therapy provision for patients within the new guidelines. It is the hope that more reviews and revisions to the PDGM will strike a better balance between cost and efficiency, patient therapy needs, and outcomes.

Understanding the role Medicare will play when it comes to long term care services can be confusing. We help families plan for the possibility of needing long term care, and how it could be paid for without causing the family to spend everything they have. If you have questions or would like to discuss your personal situation, please don’t hesitate to contact us. Please contact our Reno office by calling us at (775) 853-5700.

Estate Planning, Healthcare

Your Health Care Power of Attorney State Your Final Health Care Decisions

If you are unable to make decisions for yourself, you can give this legal authority to someone else through a Health Care Power of Attorney, also called a Health Care Proxy or Durable Power of Attorney for Health Care. This prevents the courts from getting involved if there is a disagreement between family members and/or the medical community as to what actions you would want to be taken.

Keep in mind that you will continue to make decisions about your care for as long as you are able. You are only naming someone as a successor, to step in and act for you when you cannot. This document can be valuable even for short periods of time, such as if you are recovering from surgery.

But it is more associated with end-of-life decisions. The person you name as your agent or proxy may make decisions that will extend your life for as long as possible or bring your earthly life to an end. These decisions may include whether or not you should have surgery if life support should be initiated, and/or if nutrition should be stopped. The legal document includes your wishes on these and other end-of-life issues.

This is a difficult subject for some people to even think about, but it is important that you do, and that you discuss these matters with your physician, family members, and friends. The more people who know about your preferences, the easier it will be for your agent/proxy to carry out your instructions. Of course, you might change your mind over time, so let others (especially your agent/proxy) know what you are thinking.

Whom should you name as your agent/proxy? Here are some considerations:

  • Most people name a family member, but you can also name a trusted friend.
  • It should be someone who knows you well, respects your wishes, and will follow your instructions.
  • It might bring you some comfort if this person shares your values about faith, life, and death.
  • You should name more than one person in case your first choice is unable to act. But list them in the order you want them to serve. This would give your agent/proxy others with whom to consult and discuss options, but you want one person (not a committee) making the final decisions.
  • Consider your candidates’ personalities and emotional makeup, and whether they would be able to handle the responsibility.

If you have been asked to be someone’s agent/proxy, consider carefully if you would be able to follow his/her wishes when that time comes. Most people consider it an honor to be asked, knowing this person has chosen you to have his or her life in your hands. If you have questions or would like to discuss your personal situation, please don’t hesitate to contact us. Please contact our Reno office by calling us at (775) 853-5700.

Elder Law, Estate Planning, Healthcare

The Importance of Clear End-of-Life Care Instructions

You would hope your living will is properly prepared and your resuscitation instructions or DNR (do not resuscitate) are in order. While your wishes in a living will may be appropriately documented, that does not guarantee the instructions will be carried out as you stated. The frightening truth is that mistakes about your end-of-life instructions are made while you are at your most vulnerable. Dr. Monica Williams-Murphy, medical director of advance-care planning and end-of-life education for Huntsville Hospital Health System in Alabama has said, “Unfortunately, misunderstandings involving documents meant to guide end-of-life decision-making are surprisingly common.”

The underlying problem is that doctors and nurses have little if any training at all in understanding and interpreting living wills, DNR orders, and Physician Orders for Life-Sustaining Treatment (POLST) forms. Couple the medical professionals’ lack of training with communication breakdowns in high-stress environments like a hospital emergency ward where life and death decisions are often made within minutes, and you have scenarios that can lead to disastrous consequences.

In some instances, mix-ups in end-of-life document interpretation have seen doctors resuscitate patients that do not wish to be. In other cases, medical personnel may not revive a patient when there is the instruction to do so resulting in their death. Still other cases of “near misses” occur where problems were identified and corrected before there was a chance to cause permanent harm. 

There are some frightening worst-case scenarios, yet you are still better off with legal end-of-life documents than without them. It is imperative to understand the differences between them and at what point in your life you may change your choices based on your age or overall health. To understand all of the options available it’s important to meet with trusted counsel for document preparation and to review your documented decisions often as you age. In particular, have discussions with your physician and your appointed medical decision-maker about your end-of-life documents and reiterate what your expectations are. These discussions bring about an understanding of your choices before you may have an unforeseen adverse health event, and provides you with the best advocates while you are unable to speak for yourself.

There are several documents that may be appropriate as part of your overall plan. Each of those is discussed below, and we are available to answer any questions you may have about them.

A living will is a document that allows you to express your wishes about your end-of-life care. For example, you can document whether you want to be given food and hydration to be kept comfortable, or whether you want to be kept alive by artificial means.

A living will is not a binding medical order and thus will allow medical staff to interpret the document based on the situation at hand. Input from your family and your designated living will appointee are also taken into account in your best decision-making strategy while you are incapacitated. A living will become activated when a person is terminally ill and unconscious or in a permanent vegetative state. Terminal illness is defined as an illness from which a person is not expected to recover even though they are receiving treatment. If your illness can be treated this would be regarded as a critical but not terminal illness and would not activate the terms of your living will.

Do not resuscitate orders (DNRs) are binding medical orders that are signed by a physician. This order has a specific application to cardiopulmonary resuscitation (CPR) and directs medical professionals to either administer chest compression techniques or not in the event you stop breathing or your heart stops beating. While your living will may express a preference regarding CPR it is not the same thing as a DNR order. A DNR order is specifically for a person who has gone into cardiac arrest and has no application to other medical assistance such as mechanical ventilation, defibrillation, intubation, medical testing, intravenous antibiotic, or other medical treatments. Unfortunately, many DNR orders are wrongly interpreted by medical professionals to mean not to treat at all.

Physician orders for life-sustaining treatment forms (POLST forms) are specific sets of medical orders for a seriously ill or frail patient who may not survive a year. This form must be signed by a physician, physician assistant, or nurse practitioner to be legally binding. The form will vary from state to state and of the three instructive documents the POLST is the most detailed about a patient’s prognosis, goals, and values, as well as the potential benefits and risks various treatment options may bring about.

A power of attorney for a health care decision, sometimes referred to as a health care directive, allows you to name an agent to make decisions for you if you are unable to. Unlike a living will which only covers end-of-life decisions, a power of attorney for health care decisions allows the agent to act at any time that you cannot make decisions for yourself.

We can help you determine which documents best suit your current needs, and help you clearly state your wishes in those documents. We look forward to hearing from you and helping you with these important planning steps. If you have questions or would like to discuss your personal situation, please don’t hesitate to contact us. Please contact our Reno office by calling us at (775) 853-5700.

Estate Planning, Healthcare

Considerations for Choosing Co-Agents

I have to decide between my two children, who should be my power of attorney when I need help communicating with doctors and handling my financial matters. Can’t I just name them both?

You can, but please don’t. You risk creating conflict or chaos if you name more than one child to serve simultaneously. Instead, pick one child at a time.

What to Consider When Deciding Your Health Care Agent

Think about which child is better suited to the responsibilities. For health care decision-making, your agent should ideally be calm in stressful situations and be able to advocate courteously but firmly with doctors and nurses for the treatment you want. For financial management, your agent should be organized, careful, and good with numbers.

Your health care agent should live nearby, but if the child who lives locally is terrified of things like needles and blood, the other, sturdier child might be a better choice. On the other hand, who can manage finances from afar, but if that child didn’t cope with a checkbook, the other would be better. So if one child is good in one area and the other child is good in the other, the dilemma is solved. You can name the number-proficient daughter for the financial side and your son for the health care. Or, if just one child is altogether more capable than the other, name that one child for both health care and financial powers.

But you do not want to create a situation where children who share the job start arguing about what health care you would want. Busy physicians have little time or patience to mediate fights like that. Likewise, you do not want your children quarreling about how you would want your money to be spent.

That’s why it’s best to give one child decision-making authority at a time. You can name the other as a backup in case the first child becomes unavailable, but naming both to serve simultaneously is generally not a good idea. If you have questions or would like to discuss your personal situation, please don’t hesitate to contact us. Please contact our Reno office by calling us at (775) 853-5700.

Elder Living, Healthcare

Don’t Wait for a Crisis to Discuss Long-Term Care With Your Parent

It is unclear whether or not your parent has a plan in place for long-term care. It is a difficult topic to broach; no one wants to talk about death and the financial realities that come with aging.  Instead of having a proactive conversation early in a parent’s aging process, most families have a reactive discussion under high levels of stress and emotions while their parent is experiencing an adverse health event.  The Public Broadcasting Service (PBS) has reported that 85 percent of the time long-term care decisions are made during a medical crisis. The message is clear, be proactive and start discussing the important financial questions with your parent.

Prepare Yourself

Your parent will feel more comfortable and at ease if you have processed your feelings before talking to them.  Conduct research so that you are knowledgeable enough to present a clear and concise set of options for your parent.  Having options allows your parent and family to make decisions and feel in control of the process.  You are seeking progress, not perfection. It may not all become settled in one conversation, but the price of silence about your parent’s plan may be very costly to you.

Review Documents

Two of the most critical personal legal documents are a durable power of attorney (DPOA) and a healthcare proxy. All older adults should have these documents as it gives legal authority to a designated representative to make financial, legal, and health care decisions on your parent’s behalf. If your parent does not have a DPOA and becomes incapacitated, you will have to go to court to get appointed as your parent’s guardian which can be a complicated legal process at a time when your energy is better spent in the care and decision making for your parent. If they do not have a DPOA and health care proxy in place make arrangements for them to meet with a trusted elder law attorney to properly draft the legal documents.

Often a parent will have a will, retirement account information, and insurance policies that have not been revisited or updated in years, sometimes decades. When was the last time your parent reviewed beneficiary designations? Family circumstances change, and the birth of a child, death, or divorce can affect how your parent may want beneficiaries designated. It is best to review financial and insurance data annually with your parent and make adjustments if necessary. For example, if the parent’s children are grown it might be best to cut back on the amount of life insurance they carry to save money on annual premiums.

Long Term Care Plan

Address the issue of long-term care. According to the PBS, a full 70 percent of all seniors will need some long-term care as they age. Even if your parent is healthy today odds are they will require long-term care and the costs are staggering. Some life insurance companies will add a long-term care rider to an existing policy. Medicaid also can cover some long-term care costs, but neither standard health insurance nor Medicare will cover your parent’s long-term care expenses.

Meet the Team

Ask your parent about their financial advisors and request a brief introduction to them.  Find out who they are and how you might contact them in the event your parent is unable to do so. This information will allow you to keep an eye on your parent’s accounts and be confident the advisors are trusted, objective, and well versed in elder financial issues. Oversight by you in a slightly detached way provides your parent privacy and independence about their finances but allows you to protect them from unscrupulous advisors. 

Understand Filing System

The last thing you need to discuss is where this vital information is filed so that before a crisis hits you know where to find the important documents, online passwords, and forms of ID you will need to facilitate your parents well being. While you do not have to see all the specific contents of the information, particularly the financials, knowing where they keep the data is critical in a crisis. Remember that as your parent ages they may start to change the location of the information. Check with them a couple of times a year to ensure the information is still in the same place and physically look to be sure it is.

Discussing your parent’s strategy is best begun while they are healthy.  Proactive planning is the best way to help your family as your parents age.  Contact our office today and schedule an appointment to discuss how we can help you and your family.