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You’ve Been Appointed Guardian of Property…Now What?

Your grandfather Martin can no longer make decisions on his own. A court appoints you to be Martin’s guardian of property, to help Martin manage his money. You become Martin’s “fiduciary.” The law now requires you to act to a high standard of good faith and honesty.

There’s a lot of work involved with guardianship, and the high standard could be daunting. To assist you, the Consumer Financial Protection Board (CFPB) has issued a guide: “Managing Someone Else’s Money: Help for Court-Appointed Guardians of Property and Conservators.” Download your free copy here.

The guide details property-guardianship duties. These include keeping careful records, taking care to keep Martin’s money separate from yours, and making sure to spend Martin’s money for Martin’s benefit, only. The court order signed by the judge may provide a list of your duties, or, if not, you can follow the list provided in the CFPB guide. You may be paying Martin’s bills and taxes, overseeing bank accounts, making investments, obtaining insurance, and any other duties contained in the court order appointing you.

The guide recommends that as a first step, you must carefully read the court order. Speak to a lawyer about it if you can, and of course especially if the law in your state requires you to. The guide warns that you may be required to buy a bond, but, if you do not have good credit, you may not be able to get it. If so, the guide directs, inform the judge of this point before you are appointed.

The guide further details the guardian’s duties. These include creating an inventory of Martin’s property, keeping Martin’s goods and home safe, creating a budget for spending on Martin’s behalf and how to document that spending, how to sign checks on Martin’s behalf, and how to create an accounting to submit to the court as often as the court requires.

Also included is valuable advice to consult Martin as much as his condition permits; to resist pressure from others who may not have Martin’s best interests at heart; and, if in doubt, to consult the judge first before acting. You may also be required to consult and work together with other people whom Martin has designated for health-care and other personal matters.

A guardian appointment is a big responsibility, as you must care for the person conscientiously and attentively. Be reassured, though, that help in discharging your duties is available to you from the court and from the CFPB guide.

If we can help you or a loved one understand when a guardianship may be necessary, please don’t hesitate to reach out to the Schulze Law Group in Reno, Nevada by clicking here to send us a message or by dialing (775) 853-5700.

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How to Plan Your Funeral

Thinking about your funeral may not be fun, but planning ahead can be exceedingly helpful for your family. It both lets them know your wishes and assists them during a stressful time. The following are steps you can take to plan ahead:

Name who is in charge. The first step is to designate someone to make funeral arrangements for you. State law dictates how that appointment is made. In some states, an informal note is enough. Other states require you to designate someone in a formal document, such as a health care power of attorney. If you do not designate someone, your spouse or children are usually given the task. 

Put your preferences in writing. Write out detailed funeral preferences as well as the requested disposition of your remains. Would you rather be buried or cremated? Do you want a funeral or a memorial service? Where should the funeral or memorial be held? The document can also include information about who should be invited, what you want to wear, who should speak, what music should be played, and who should be pallbearers, among other information. The writing can be a separate document or part of a health care directive. It should not be included in your will because the will may not be opened until long after the funeral. 

Shop around. It is possible to make arrangements with a funeral home ahead of time, so your family does not have to scramble to set things up while they are grieving. Prices among funeral homes can vary greatly, so it is a good idea to check with a few different ones before settling on the one you want. The Federal Trade Commission’s Funeral Rule requires all funeral homes to supply customers with a general price list that details prices for all possible goods or services. The rule also stipulates what kinds of misrepresentations are prohibited and explains what items consumers cannot be required to purchase, among other things. 

Inform your family members. Make sure you tell your family members about your wishes and let them know where you have written them down. 

Figure out how to pay for it. Funerals are expensive, so you need to think about how to pay for the one you want. You can pre-pay, but this is risky because the funds can be mismanaged or the funeral home could go out of business. Instead of paying ahead, you can set up a payable-on-death account with your bank. Make the person who will be handling your funeral arrangements the beneficiary (and make sure they know your plans). You will maintain control of your money while you are alive, but when you die it is available immediately, without having to go through probate. Another option is to purchase a life insurance policy that is specifically for funeral arrangements. 

Taking the time to plan ahead will be a big help to your family and give you peace of mind. 

For more information on planning your funeral from Kiplinger, click here

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5 Things That Can Prolong Your Life

It is no secret that a healthy lifestyle has a significant impact on your well-being and the earlier you implement a healthy lifestyle strategy, the greater the potential benefit regarding your longevity. Your lifespan can be increased by as much as 14 years for a woman and 12.2 years for a man according to the American Heart Association’s journal Circulation study. The United States is one of the wealthiest countries in the world, but according to the World Health Organization, it ranks about 53rd in life expectancy from birth compared to other developed nations, according to 2015 data.

What are these five lifestyle habits? The first is leading a non-smoking life and the second is not subjecting yourself to other people’s second-hand smoke. If you have ever been a smoker, find a way to quit. Try hypnotherapy, patches, gum – whatever it takes – but figure out a way to stop smoking. Breath is life, and without a healthy respiratory system, you are shortening your lifespan. If you do not smoke now or never have, that is great! Stay on that path and do not subject yourself to other people’s smoking.

Exercising for 30 minutes each day is imperative for longevity and coincides with the third thing you can do to extend your lifespan.  Maintain a healthy body mass index (BMI). The best and easiest daily exercise is to walk. If you are currently out of shape and 30 minutes a day seems unachievable, then begin with 10 minutes. Make a plan and increase your time to 20 minutes as you become more physically able to do so. By the time you are ready for 30 minutes of daily exercising, be sure that your pace is moderate to vigorous. Walk every day in the morning at a set time and make it your routine. Walking will help you lose weight, gain muscle, and reduce your body mass index.

The fourth and fifth things to do are eat a healthy diet and consume only moderate amounts of alcohol. Healthier foods are generally found on the outskirts of your supermarket and include fresh fruits and vegetables, dairy and eggs, as well as lean meats. The inside aisles of a supermarket are packed with food products, not real food. Much of this food is so over-processed and chemical-laden that it is not healthy to eat. Consuming moderate levels of alcohol is defined as one drink a day for women and two for men. Adopting a new healthier lifestyle can include days where you choose not to have an alcoholic beverage. If you have fallen into excessive drinking patterns, make changes today. The liver is a restorative organ and can heal itself if excessive damage has not been done.

If these five healthy life choices are something you already do or are willing to implement in your lifestyle and you do add 12 or 14 years to your life expectancy, what if you don’t have the money to survive those additional years? The Social Security Administration says that about one in four Americans 65 or older today will live past age 90 and one out of ten will live past 95. Where will the money come from if you live another decade or longer? Health care costs are skyrocketing and assisted living facilities are expensive. Unless you are already financially independent, 60 is the new 50 and retirement may not come as soon to you. You can make adjustments to your life today that will help you to become more financially fit just as you can make changes to become more physically fit and extend your lifespan.

Saving money aggressively and developing the habit of spending less is possibly the single best way to stretch your retirement assets. Learn to live below your means. Beyond being thrifty, change your trajectory regarding your investment strategy. Talk to a trusted financial advisor to see if you need to shift any investment strategies.

While longevity can only be estimated and everyone will have their own life expectancy experience, increased awareness of healthy lifestyle choices are changing the way seniors are approaching aging. Your longer lifespan will require adequate funding which can be achieved by frugal spending habits, possibly delaying your retirement, and thinking differently about conventional investment strategies in senior years. Getting sound and trusted advice about longevity and your financial aging strategy can bring you peace of mind as well as financial security.

Contact Schulze Law Group in Reno, Nevada today and schedule an appointment to discuss how we can help you with your planning. You can reach us by dialing (775) 853-5700.

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How to Choose the Right Nursing Home

Choosing a nursing home for a loved one is an important decision and should be carefully considered. It is important for families to take the time to explore nursing home options and to carefully assess the nursing home facilities in order to choose the best care for the loved one.  Below are some steps designed to assist families in choosing a nursing home.

Identify Nursing Homes in the Area

The first step in choosing the right nursing home is to identify all the possible nursing home options in the area. Asking friends, family, and other people you trust is an excellent way to begin the search for possible options, especially if have had personal contact with the nursing home. Doctors and hospitals can also help identify nursing home options that provide the type of care a loved one may require.

Another option is using the internet to locate nursing home facilities. The Medicare website has a locator for nursing homes and even provides some comparisons of nursing homes – an important benefit highlighted in the next step below.

Research the Quality of Care Provided by the Nursing Home

Using comparisons like those found on the Medicare and Medicaid websites can be a very helpful starting place for gathering information on nursing homes and the quality of care provided. This information along with information from other sources like the long-term care ombudsman. Many facilities may provide survey results that can give insight into the facility’s care.

Other sites that allow consumers to post reviews, like Yelp.com, can also be an important way to compare nursing homes. While best known for its restaurant reviews, Yelp also includes reviews of skilled nursing facilities and rehabilitation centers.

Visit the Nursing Homes in Person

After doing ample research, it is time to visit the nursing home. Nursing homes will schedule tours for prospective residents.  While there, pay close attention to the cleanliness of the facility, and the appearance of the residents. Make note of what the residents are doing and how they look. Are they engaged in activities, is there evidence of neglect, is there enough staff to attend to the patients? Ask about patient to caregiver ratios so you can compare it with other nursing homes.

Other things to consider include how the facility provides for social, religious, recreational, or cultural needs, and the types of meals they prepare.  You may have the opportunity to have a meal during your visit, which will allow you to sample a meal, but also observe how the residents are treated during meal times.

Before leaving, find out who you can call if you have additional questions.  Then, make a second unplanned visit at a different time or on a different day. An unplanned visit will allow you to observe the nursing home and its residents on a “normal” day.

Choose a Nursing Home

Making notes during the first three steps can help families go back and carefully look at the information gathered to make a decision. If more than one facility fits the needs of the loved one, then it is important to consider cost and what is most important to the family.

Once a nursing home is chosen, an agreement will need to be signed. It is important to have an elder law attorney review this agreement to make sure there are no hidden provisions, like holding a child responsible for non-payment, or a minimum number of months before a resident can apply for Medicaid.

These steps will allow families to make the best nursing home choice possible. Although many families find themselves in sudden need of a nursing home facility after hospitalization, most have time to make preparations. If time is not a factor, following these steps can help to avoid making a decision that is not best for the loved one in need of care. Any long-term care decision is made best when families are armed with as much information as possible.

If you have any questions about something you have read or would like additional information, please feel free to contact the Schulze Law Group in Reno, Nevada by sending us a message here or by calling us at (775) 853-5700.

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VA Changes Pension Eligibility Rules

New rules regarding eligibility for VA pension were implemented by the Department of Veterans Affairs (VA).  The new rules are quite comprehensive, however, they also provide more opportunities to qualify for these important benefits.

The major changes are outlined below:

  1. Lookback and penalty period. There is now a look-back period of 36 months when applying for needs-based pension benefits.  Any asset that was transferred for less than fair market value during the 36-month period immediately preceding the pension application will result in a penalty period, not to exceed five years.
    1. Exceptions. There are a few exceptions to the new transfer penalty rule.  1) No penalty will be assessed if the transfer was to a trust established for a child who was incapable of self-support prior to age 18.  2) There is no transfer penalty imposed if the claimant’s net worth would have been below the net worth limit already, regardless of the transfer.  3) A claimant will not be subject to a penalty period if the transfer was the result of fraud, misrepresentation, or unfair business practices related to the sale of financial products.  4) Only transfers that occur on or after October 18, 2018, will be subject to the lookback and transfer penalty rules.
    2. Annuities may be penalized. If the annuity can be liquidated, then it is counted as an asset.  If the annuity cannot be liquidated, then distributions from the annuity are considered income.  If the annuity was purchased during the look-back period, then a penalty will be imposed.
    3. Calculating the penalty period. The divisor used to calculate the penalty is the Maximum Annual Pension Rate in effect as of the pension application date, at the rate of the aid and attendance level for a Veteran with one dependent. In 2018 this number is $2,169, and is applicable to all claimants, regardless of marital status. The penalty period will be recalculated if all or part of the gifted money is returned (also referred to as a partial or total cure).
  2. Net worth. There is now a bright-line rule regarding the net worth of a Veteran.  This amount is currently set at $123,600.00, which is also the maximum Community Spouse Resource Allowance amount allowed by Medicaid. This number will increase annually with the increase in Social Security benefits.  If the Veteran or other claimant has net worth over the threshold and thus does not qualify for benefits, he or she can spend-down assets by purchasing goods or services for fair market value for any household relative.
    1. A homestead owned by the Veteran is not included in the net worth calculation.  However, there is a two-acre limit imposed on the homestead. If the claimant’s homestead is over two acres, then other rules apply and the value of the property in excess of two acres may be included in the net worth calculation.
    2. The value of “personal effects suitable to and consistent with a reasonable mode of life” is not included in the asset calculation.  This would include personal transportation vehicles and most household goods.
    3. The annual income of the claimant and certain dependents is included in the calculation of net worth.  However, reasonable and predictable unreimbursed medical expenses can be deducted from income.
  3. More medical expense deductions. The new rules provided an additional Activity of Daily Living (ADL) to include assistance with ambulating within the home. The rules also define Instrumental Activities of Daily Living (IADLs) and set out specific instances when expenses for care that include ADLs and IADLs may be deducted from income. The rules also specify when room and board at a care facility other than a nursing home may be deducted from income as a medical expense.

Please contact the Schulze Law Group in Reno, Nevada if you have questions about these new rules, or if you would like to discuss whether you or a loved one could qualify for VA pension benefits. Call us directly at (775) 853-5700.

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Welcome to the Age of the Smart Personal Assistant

The smart personal assistant revolution is moving forward at a breakneck pace. It took approximately 30 years for the cellular telephone to begin outnumbering people on the planet, but smart personal assistants are projected to outnumber humans in half of that amount of time by 2021. The technology-research firm Canalys expects 100 million smart speakers (smart personal assistants) will be installed worldwide by the beginning of 2020 and also estimates the number of smart assistant compatible devices will reach 1.6 billion in the US that same year. The numbers are staggering.

It is precisely because of these numbers that manufacturers of smart personal assistants like Amazon, Google, Microsoft, and Apple are pushing sales of their devices. Not only does a smart personal assistant allow for corporate monetization post-purchase from user data collection it is at the forefront of taking over your everyday space whether that be your home, car, or office. The corporation that garners the biggest market share with its smart assistant technology will lock in-app developers, appliance manufacturers, and consumers into their company’s proprietary platform also called the ecosystem which ensures frictionless interoperability. Home automation and lighting is forecast to make up 49 percent of the market segment, followed by home security and surveillance (18 percent), audio and video entertainment (13 percent) and “other” appliance segment (20 percent).

The smart assistant with its voice technology is a significant boon to US seniors as more baby boomers are opting to age in place and smart voice technology simplifies remaining at home. There are the obvious uses for a smart assistant like calendaring events, medication reminders, home environmental controls, age-appropriate learning activities, and much more. Some of the newer applications of voice technology are pushing smart personal assistants into newer realms like a digital therapist, companion, and caregiver. For the senior who is living at home and alone, these are wonderful new developments.

Research in the field of prosody, the patterns of stress and intonation in a language, are making smart assistants capable of detecting depression, loneliness, anxiety, joy, and anger to name a few. Initial research of emotion enabled artificial intelligence focused on emotion detection through facial expressions but quickly turned to the spoken word. Vocal signatures carry an incredible array of information from how you string the words in a sentence together, to tone, depth, rhythm, pitch, resonance, pronunciation, tempo, and more. These vocal features are then analyzed to suggest a person’s mood and subsequent best action practice for the senior.

The practical applications of this technology are numerous. A medical doctor with a smart personal assistant in their office can more readily pick up on identifiers that suggest patient depression. A smart car speaker in a semi-autonomous car can make informed judgments about the safety of handing over the controls to the driver based on vocal characteristics indicating stress or confusion. A smart personal assistant might pick up on loneliness in a stay at home senior and offer suggestions of music or other activities to engage the senior and lift their spirits. The smart personal assistant is also “someone” an elderly person can tell their troubles without shame, recrimination or judgment. The smart assistant is programmed so that it never gets tired, never becomes distracted or bored with the content of “its person.” It is a bit like a therapist allowing the senior to get out all of their frustrations about growing old and losing their physical and cognitive abilities; even expressing fears for their future.

While smart personal assistant technology is currently not able to provide all of the benefits of a professionally trained human caregiver, therapist, or companion it is readily available, overall inexpensive, and can help alleviate the problems of too many seniors with too few attainable human caregivers to meet their needs. The technology may also outpace its human counterpart in the not too distant future if current research and development is any indication of success. The market forces for profit will continue to drive the expansion of the smart personal assistant and its associated products allowing for newer market segments and more importantly the ability for stay-at-home seniors to live their best quality of life.

If you have questions about what you have read, please don’t hesitate to reach out to the Schulze Law Group in Reno, Nevada by clicking here to send us a message or by calling us at (775) 853-5700.

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Planning for Caregiving with Family

A family caregiving meeting is an essential tool when dealing with the care of an aging loved one. These meetings are beneficial for helping to keep all family members abreast of decisions that need to be made, changes in diagnosis or prognosis, and help to ensure that all family members feel that they have a voice. Family meetings can also help to keep caregiving responsibilities from falling solely on the shoulders of one family member. In addition, family caregiving meetings can foster cooperation among family members and lessen the stress associated with caring for an aging loved one.

Who should attend a family caregiving meeting?

There are a number of people who should be included in a family caregiving meeting. First and foremost, it is important to include the aging loved one in the meeting whenever possible. This helps the aging loved one to feel that they are being heard and that their opinions and thoughts are being considered. If a spouse is living, the spouse should be included, as well as any children and possibly siblings of the aging person. Some families may choose to include other family members, but this really varies from one family to another. Anyone else involved in care for the person should also be there. This could include paid caregivers, family friends, or neighbors. Depending on family dynamics, a facilitator can be helpful in running the meeting.

When should a family have a caregiving meeting?

First, it is important to note that family caregiving meetings are not a one and done event. They must occur on a regular basis. The first family meeting can occur before an aging loved one actually needs care. This can give the person who may eventually need care more say in their future care, but oftentimes this does not occur. Most families find that the initial meeting needs to occur when an aging loved when begins to show signs of needing care or when a diagnosis is given that determines care will soon be needed. In addition, meetings should be scheduled regularly to discuss changes in the diagnosis, prognosis, or general needs of the loved one or the caregivers.

How can a family hold a successful caregiving meeting?

The key to having a successful caregiving meeting is cooperation. This doesn’t mean that family members will agree on everything, but it is important that all family members are respectfully heard and considered. Families must be willing to compromise and seek the best plan for their aging loved ones. Additionally, a smoothly run meeting should have an agenda and families should try to stay focused on the items included on the agenda. When holding a meeting, always put things in writing and be sure that all those involved get a copy of the important information and everyone’s responsibilities.

What challenges do families face in caregiving meetings?

One of the biggest challenges to family caregiving meetings is the family’s history. All families have their own dynamics that can cause problems in a caregiving meeting. There may be members of the family who are at odds with one another, creating an obstacle to having a successful caregiving meeting. The role that each family member plays can be a challenge. Some members may be overbearing and demand control, while others are peacemakers and do not feel free to share their thoughts. Another challenge is that some family members may be in denial of the severity of an aging loved one’s needs which could make it difficult to get a consensus for care.

Family caregiving meetings are beneficial and necessary when an aging loved one can no longer care for themselves. These meetings can help to divide the responsibilities of caregiving and reduce the stress placed on the family members. It is important that families remember that the meetings are for the care of their loved one and cooperate with one another to help the process to run more smoothly and successfully.

If you have any questions about something you have read or would like additional information, please feel free to contact Schulze Law Group in Reno, Nevada by clicking here to send us a message or by calling us at (775) 853-5700.

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Assisted Living’s Future is Complex

With changes in medicine, technology, and socioeconomics, it’s no surprise that assisted living is changing, too. The rising cost of assisted living means that some families are looking to new alternatives, while those who consider traditional assisted living have new options to consider.

Alternatives to assisted living include multigenerational housing and in-home care. As these options become more popular due to the rising costs associated with other, traditional options, the home health care industry will boom in response; the Bureau of Labor Statistics predicts job growth of 70% in the next ten years for personal care aides and home health care professionals. Technology designed to assist in senior care will likewise play a role in alternatives to assisted living, from computer systems tracking medicine intake and remotes for windows, lights, and thermostats to reminiscence therapy and memory care to assist those suffering from dementia. And not only will technology designed for individual users continue to develop, so will platforms for home care agencies and other professionals engaged in the long term care process.

Meanwhile, the nursing home model of care will continue to decline, while other forms of senior living will take its place. These will include cultural- and lifestyle-based communities, green senior housing like LEED-certified homes and communities, senior-friendly neighborhoods in city centers, and senior co-housing with shared spaces and shared duties. Assisted communities are likely going to emphasize meaningful socialization and recreational activities, while the buildings themselves are likely going to include amenities that remind Boomers of home and improve their independence, such as kitchenettes. Certain design trends may arise for enriched living experience and wellness enhancement, from restaurant-style dining to wellness centers.

These changes are a part of the trend of a widening gap between the increasingly pricey assisted living options, and what people can pay for their long term care. As life expectancy lengthens and the quality (and therefore price) of assisted living rises, many will find the costs post-retirement to be beyond their means. That is one of many reasons why it is so important to plan in advance! There may be government programs available that can help with the costs of long term care.

See these articles for more details.

You can reach the Schulze Law Group at our Reno, Nevada office by clicking here to send us a message or by calling us at (775) 853-5700.

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Sandwich Generation Gets Squeezed

Dorothy Miller, a social worker, first created the term “sandwich generation” in 1981. A Journalist, Carol Abaya, continued to study and add to what the term means. In 2006, Miriam Webster included the term, sandwich generation, in the dictionary for the first time.  The sandwich generation is defined as a generation of people who care for their aging parents while supporting their own children. It is believed that this is occurring because of the increase in life span for adults and also because of delayed parenting. This means that medicine and technology are allowing people to live longer and couples are waiting to start families at a later age. Therefore, leaving people sandwiched between caring for aging loved ones and young children. This can lead to some potential problems for the sandwich generation.

Issues for the Sandwich Generation

One major issue for the sandwich generation is financial burdens. Because many in the sandwich generation may not have anticipated having to provide for the needs of their aging parents, they may be stretched thin financially. Another issue for this group that is often compounded by financial struggle is stress. When pulling double duty of caring for children and aging parents, stress is an understandable and expected side effect. Whatever the living situation of the aging parent, the responsibilities of caring for the aging parent often adds to the already busy schedule related to parenting their own children. The sandwich generation then fills pulled in too many directions. This can often leave them feeling as though they do not have enough of themselves to give to everyone they need which in turn leads to guilt and burnout.

If these issues continue to mount, then depression can become another issue for the sandwich generation. Depression can set in when the sandwich generation has little time for hobbies or social interactions, leaving them feeling isolated. The stress and financial burdens can contribute to feelings of depression. The bottom line is that the sandwich generation must recognize these potential problems and find ways to deal with them. Otherwise, they will be ineffective in their care for aging parents and their own children and the pressure will continue to mount.

Dealing with Issues for the Sandwich Generation

In order to be a good caregiver, the sandwich generation must find ways to take care of themselves and to ask for and accept help when necessary. One way for the sandwich generation to find times for themselves is respite care. Respite care provides short-term relief from caregiving responsibilities. Respite care provides a way for caregivers to can find time for themselves and take care of family responsibilities.

Caregivers can plan ahead for tasks and finances to help tackle stress and financial burdens. Having a family meeting to delegate responsibilities to other family members can be very beneficial. This means giving up some things to the spouse and children. Extended family can also help to share the responsibility of caregiving, so meeting with siblings or other involved family members to share the task of caring for the aging parent can help to lessen the burden on one person.  Having a close friend to talk to about the struggles can also be a very therapeutic way to deal with the stress experienced by the sandwich generation.

Being a member of the sandwich generation has many challenges. The demands of a person caring for aging parents while also raising their own family can be overwhelming. Self-care is essential to avoid the pitfalls associated with caregiving. In addition, it is important to remember that it is perfectly acceptable to seek or ask for help in order to maintain mental health and provide good care for everyone.

If you have any questions about something you have read or would like additional information, please feel free to contact us. You can reach the Schulze Law Group at our offices in Reno, Nevada by clicking here to send us a message or by calling us at (775) 853-5700.

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A Step-by-Step Process to Leaving Well

Contemplating our own death is one of the hardest challenges we will ever have to face. Yet, if we want our dying to be meaningful and merciful, it is imperative that we think about it while we still can. Most of us want to die at home, in a familiar and peaceful setting surrounded by loved ones. We would much rather not spend our last moments in an emergency room or ICU, with strangers futilely pounding on our chests and our families relegated to the waiting room.

With those two alternatives in mind, we need to do all we can to keep control, as much as possible, of decisions that need to be made long before our final moments. We need to think carefully, well in advance, about what makes life worth living, and where pain and limitation have so eroded that quality of life that we would prefer not to go there.

These are notoriously difficult questions, but it is vital to address them anyway. For example, Terri Schiavo spent nearly half her young life unconscious in a condition known as a “persistent vegetative state,” being kept alive by a feeding tube. Her husband and friends claimed that before her severe brain injury, she said that she would not want her life sustained by machines. Unfortunately, she never put that wish in writing. On the other side, her devout family and right-to-life supporters insisted that she be kept alive despite her dire condition. After protracted litigation, Ms. Schiavo’s husband prevailed, the feeding tube was withdrawn, and, fifteen years after she was injured and never having regained consciousness, she was finally allowed to die.

Since her passing, the law has evolved nationwide to encourage us all to document final wishes, to avoid the anguish and uncertainty of Ms. Schiavo’s situation. There are a number of documents available in your state for that purpose. The umbrella term for these is “advance health-care directives.”

It’s our job as lawyers to help you sort through the various directives needed to express your wishes. Here is a step-by-step guide to begin the conversation about final wishes, and to understand which document does what when.

1. If you are over the age of 18, appoint a health-care agent to speak for you when you can’t.

Decide who, among those who know you well, is best suited to take on this responsibility. That person must possess good communication skills, remain calm in difficult situations, and be able to deal flexibly with the complexity that might arise in reconciling your wishes with available medical options. Depending on which state you live in, your agent can also be called a “health care proxy.”

Sit down with that person and discuss your wishes in various scenarios. This is not an easy conversation to have, but there are guides available to help you. Visit “The Conversation” and download the starter kit.

2. Health Care Power of Attorney (HCPOA)

Once you have had that conversation, visit your lawyer to name your agent formally in an HCPOA document. HCPOA conveys legal authority on your agent or proxy to express your health-care decisions when you are unable to.

3. HIPAA authorization

Your agent or proxy will also need access to your otherwise-private medical information. This is best done by a standardized document that complies with the federal Health Insurance Portability and Accountability Act (HIPAA). Without this authorization, your agent will be unable to obtain the medical information necessary to exercise the authority you want him or her to have.

Now armed with your agent and the HCPOA and HIPAA documents, you will know that if you were to meet with an accident or lose consciousness, you have chosen and empowered an advocate to speak for you. You should review and update these documents every five years or so.

The next three documents are important at the end of life. All these documents should stipulate that you desire comfort care, to keep you clean and as pain-free as possible. Remember, though, that you must create these documents while you are still able to know and communicate your wishes, so it’s best to do the next two documents at the same time that you do your HCPOA and HIPAA.

4. Living Will (also known as Physician’s Directive)

This document is for use when you are not enjoying quality of life. Either death is imminent; you are in a persistent vegetative state; or you are permanently unconscious, permanently confused, or unable to care for yourself. If you have no awareness of others; can’t remember or understand or express yourself; or are unable to move, bathe, or dress yourself, it’s advisable to have expressed, in advance, the kind of treatment you want to receive or not receive.

A living will expresses your choice as to whether you do, or do not, want artificial measures that will merely prolong your life but not improve it. Those measures, among others, may include CPR if your heart stops, or breathing or feeding tubes, or repeated courses of antibiotics or chemotherapy.

You may also require physicians, and not your agent, to be the ones to decide whether to cease life-prolonging procedures as you would like. This decision will relieve your agent from the heavy responsibility of making that irreversible choice.

Living wills are legal in almost every state. Ask your lawyer. Don’t make this kind of document yourself. Otherwise, you risk that the document may be misinterpreted, with drastic consequences.

5. Specialized Directives

Medical decision-making varies depending on specific health conditions, so specific directives may be tailor-made for those conditions. For example, people suffering from advanced dementia benefit from a directive, in addition to the HCPOA or living will, specifically requesting that hand-feeding be ceased when the person can no longer speak, recognize loved ones, or move purposefully. Otherwise, caregivers are obligated to cajole or demand that the patient be fed by hand, taking advantage of a primitive reflex to open the mouth. This risks that the person may inhale the mush instead of swallowing it, in some cases causing pneumonia.

For this kind of condition, ask your lawyer to prepare a specific directive tailored for advanced dementia, using the directives created by End of Life Washington or End of Life Choices New York.

If, however, you suffer from a neurological illness like Lou Gehrig’s disease (ALS) or advanced Parkinson’s, even though most of us would decline mechanical treatments, those same treatments may be important aids to preserve the quality of life for people with those conditions.

Again, remember that you must create these documents while you still have the capacity to communicate your wishes. Living wills should be reviewed every six months because wishes can change depending on the progress of the illness.

6. POLST or MOLST

This is a brightly colored, short-form document that is primarily intended for emergency responders when the patient is frail and is likely to die within a year. It is designed to be immediately recognizable by hospitals and EMS personnel, to express that when the patient is unresponsive, cardio-pulmonary resuscitation (CPR) and other aggressive treatments are desired or not desired (DNR).

This document should be filled out in consultation with the patient’s physician. The acronyms stand for “physicians’ orders for life-sustaining treatment” or “medical orders for life-sustaining treatment.”  Many states provide for this kind of document.

7. Make Your Documents Known

When it comes time to use your documents, they must be readily available. Give a copy of them to your agent or proxy, make sure they are included in your medical records, and, if you are in need of the POLST or MOLST, post it beside your bed or on your fridge where EMT knows to look for it. If your documents can’t be found, or if your agent or family don’t understand them or ignore them, you will have spent your time, effort, and money in vain.

But if all goes according to your wishes, you will have done your best to create a good death, one that is as meaningful as possible for all concerned.

If we can assist in helping you with any of the documents above, we would be honored to do so. You may get in touch with Schulze Law Group at our Reno, Nevada office by sending us a message here, or by calling (775) 853-5700.