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.

Elder Law, Estate Planning

A Good Estate Plan Should Include the Following Five Items

Everyone should plan their estate, but as we age, it becomes even more necessary to do so. Many people avoid estate planning because they do not want to think about the end of life, failing health, or disability. Others believe that an estate plan is only for rich people. However, an estate plan is helpful for the senior adult and their families regardless of overall wealth.

The estate is all the property owned both individually and jointly, including bank accounts, real estate, jewelry, etc., and what is owed. Without an estate plan, it is very difficult to carry out a person’s wishes and can bring on a long, drawn-out probate that can be very expensive for the family. If an estate plan is in place, it can provide peace of mind for the senior adult and their family, as well as protection for the wishes of the senior.

Below are some basic guidelines for what should be included in an estate plan.

1. Will.  A will provides for an executor of the estate, who will take care of managing the estate, paying debts, and distributing property as specified. The distribution of assets can be outlined in the will. This can be as broad or detailed as a person wishes. In a will, beneficiaries and guardians for minor children should be assigned. It may not seem necessary to discuss minor children when discussing seniors and estate planning, but with the rise of grandparents raising grandchildren, this may indeed be an important part of the will. A senior adult can spell out, in the will, how they want their funeral and burial to be carried out as well.

2. Living Will. A living will outline a senior’s wishes for end-of-life medical care. It can include, in as much detail as the senior wishes, what medical treatments the senior would or would not like to have in specific situations. A living will takes the stress of making those decisions off of family members and helps to keep peace in families during times that can be difficult and emotional.

3. Healthcare Power of Attorney. A healthcare power of attorney is also a key part of an estate plan. This legal document provides for someone to legally make healthcare decisions for a senior adult. A durable power of attorney will remain in effect for the senior if the senior becomes unable to make decisions.

4. Financial Power of Attorney. A financial power of attorney names an agent who has the power to act in the place of the senior adult for matters relating to finances. The durable financial power of attorney stays in effect if the senior adult becomes unable to handle their affairs. By having a financial power of attorney in place, the stress and expense of a guardianship can be avoided, and the senior has the final say in who will make decisions relating to finances.

5. Trust. Setting up a trust can be beneficial for the distribution of specific assets or pieces of property. The benefit of a trust is that it does not go through probate, as compared to a will. Property is still distributed at the death of the trustmaker, but it is done without the need of a court.  This also allows for privacy of the trustmaker, where with a will and a probate, all of the deceased person’s assets and the terms of their will are made public.

Having an estate plan is necessary if you or your senior loved one wishes to have a say in what happens at the end of life and with assets after death. Consulting and planning with an elder law attorney will help to ensure that all options are explored and the best possible solution is utilized. The elder law attorney can walk you through all of the necessary parts of the estate plan, provide an explanation, and prepare the paperwork. Elder law attorneys will help take the guesswork out of estate planning.

If you have any questions about something you have read or would like additional information, please feel free to 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

You got the COVID-19 Vaccine, Now What?

Eligibility to receive the COVID-19 vaccine is becoming more and more widespread. 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

Understanding HealthCare Power of Attorney: Specific VS. General

You have the right to decide what kind of medical treatment you want to receive from doctors and health-care providers. If you can speak up at the time, you can express your wishes yourself. But if you become incapable because you’re ill or injured, you need to plan in advance. Designate a person whom you trust to speak for you. You do this by creating what’s known as an “advance directive” or health care power of attorney.

You also have a choice about the kind of document you prefer. You can ask for a short document that simply conveys general authority on your agent to make health-care decisions for you – or you can opt for a longer document that details the specific powers you give to your agent.

For both versions, we offer a checklist to assist you in discussing your wishes with your agent beforehand.

The General Version

This version is short, clear, and easy to understand. It states, generally, that you have given your agent the authority to speak for you. Your agent knows your wishes, because you have discussed those wishes with him or her beforehand.

The Specific Version

This version goes into detail about what you would like your agent to do for you. For example, it includes the request that providers and your agent consult with you if possible. If not possible, it includes a list of procedures that you authorize your agent to decide on your behalf. Included are decisions about what kind of residential facility you want to be placed in, that an agent can visit you and bar others from visiting if appropriate, can advocate for pain relief, can consent to psychiatric treatment, can decide about anatomical gifts and organ donation, and the document provides procedural details about enforcement.

You will be covered with either version. The choice is yours.

Living Will

You may also want a separate Living Will for end-of-life decisions. This document becomes effective when you can no longer care for yourself, walk, talk, recognize loved ones, or are in the final stage of an incurable illness. At that point, you can decline expensive, high-intensity care that likely would not improve quality of life.

Choosing Your Agent

The person you choose to be your health-care agent must be someone you can depend on to have good communication skills, remain calm in difficult situations, and deal flexibly with complexity that might arise in reconciling your wishes with available medical options. Choose that person carefully.

Health Care Preferences Checklist

We can offer you a checklist, to help you discuss your wishes with your agent. This is not an easy conversation. It’s hard to contemplate a time when our health has declined or we suffer injury or accident. It is also challenging to try to imagine various scenarios involving situations that can be complicated by numerous medical contingencies.

Still, your agent needs to know what you would want in a variety of situations. These include whether to decline or accept life support and mechanical interventions, when you would opt for or decline surgery, and your preferences about blood transfusions, medication, and religious observance.

For certain states, the checklist also contains a signature line that proves you have discussed your wishes as to feeding and hydration tubes. Otherwise, if your agent doesn’t know what you would decide, the law in some states would take away from your agent the right to decide about those kinds of measures.

Don’t hide your documents!

When it comes time to use your documents but they 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. Make sure your documents are readily available. Give a copy of them to your agent and ask your doctors to include them in your medical records.

You will have done your best to see that your values and health-care choices will be honored. We are here to help, please contact our Reno office by calling us at (775) 853-5700.