Healthcare

Preserving Quality when Planning for End of Life

When our clients can no longer act for themselves, powers-of-attorney documents are prepared, the documents will convey on other trusted people the authority to act on our clients’ behalf.

But when it comes to actually using those documents at the time of a health-care crisis, clear and powerful documents are just the beginning. The decision-points can (and must) be put down on paper in advance, but when it comes to end-of-life situations, the clarity on which we lawyers thrive can be very hard to find.

Sitting in her lawyer’s office, the client may have been quite certain about health-care decisions. She does not want her life prolonged by a battery of aggressive treatments, where these would not preserve her quality of life. She does not want blood transfusions, dialysis, repeated courses of antibiotics and chemotherapy, cardiopulmonary resuscitation, or breathing and feeding tubes. She does not want to die inert in the ICU, surrounded by machines and strangers. She wants to die at home, surrounded by loved ones, at a time when she retains presence of mind to make her peace.

But that goal doesn’t just happen from wishing it and stating it. It happens with additional careful preparation for the realities. As the end of life approaches, the clarity we lawyers enjoy can be elusive. When a person gets a prognosis of two to five years (maybe), where, along that continuum, would be the time to start declining aggressive treatment? When there’s always one more intervention that may (or may not) produce a good result? When one decision could create an ever-widening array of complications? When, step by step, the patient becomes less and less able to exercise autonomy, and where treatment decisions by caregivers are not in line with the care the patient was clear about when she was sitting in the lawyer’s office?

No matter how clear the powers-of-attorney documents, with all these imponderables, the patient can end up in a situation many miles away from what she wanted. And there’s no possible do-over.

Powerful and clear power-of-attorney documents are an essential first step and we lawyers are glad to take care of that part. Beyond that, though, thorough preparation is essential.

Consider that the best result may be one that cares for comfort right now, in the moment. The question is not necessarily about how long life can be prolonged. The question may be, rather, how comfort can be maintained – in this moment, and then the next moment, and the next. The question is how life can be made better right now. Watch a video by palliative-care physician B.J. Miller, on why this is so important, here.

Make concrete plans. These include specifying what you want to happen if you’re no longer able to live independently; choosing wisely whom you want to act for you, to make sure your plans will be followed; being ready with your health-care documents before you find yourself deposited in the emergency room or ICU; and seeking the reassurance that your loved ones will be cared-for when you’re no longer there. Judy MacDonald Johnson has prepared simple, forthright worksheets to help with this process, here.  She speaks about these worksheets in this moving video.

There is no doubt that the process in safeguarding quality of life at the end of it is possibly the most challenging of all. But if that process can create as much pleasure as possible through an extremely difficult time of life, and if forthrightly engaging in that process would facilitate a passing more in line with what we would envision, the worth of the process will be felt. The transition will be smoother and more meaningful for the dying person, and a kinder legacy will be left behind for those who accompany us on this journey.

Learn more about your health care planning options and 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.

Estate Planning

Steps to Discussing Finances and Estate Planning with Aging Parents

Sometimes these conversations can be difficult but it’s essential that as your parents’ age, you have conversations with them about their finances. To broach the topic, you might bring up current events like the coronavirus pandemic, its effect on economic conditions, and how it relates to the security of their financial future. The conversation should come from a calming place of love and concern. Speak to them respectfully about how the coronavirus pandemic has you thinking about the importance of their planning and preparedness.

Once you begin the conversation, move away from the pandemic as your introductory technique as you do not want to create a sense of panic or fear.  Instead, delve into legal and financial reviews, processes, and parameters. US News reports that your parents’ financial analysis should include essential legal documents, financial accounts, and associated vital contacts, long-term care decisions, and claims. If you live apart, lay the groundwork to help them with their finances remotely.

It is generally most comfortable to begin your conversation with legal documents that hopefully your parents already have in place like a will, trust, living will, and a health care proxy. If your parents do not have these documents, they must retain an attorney and create the ones that best suit their needs. If you need to help your parents manage their finances, you must have a durable power of attorney. A durable power of attorney allows you to make financial decisions for your parents in the event they become incapacitated. This is an essential estate planning document. In the absence of a durable power of attorney, the courts become involved, and solving health or financial issues becomes a lengthy, expensive process over which you have little control. If your parents already have their legal documents drawn up, find out where they keep them and review them carefully. If any documents need to be amended, suggest that your parents meet with an attorney to make the relevant changes. Be sure their documents reflect the state law in which they reside.

Once you have assessed your parents’ legal documents, it is time for some financial discovery. Even if your parents do not currently need help, having an overview of their finances and a durable power of attorney to help them in the future is crucial to their aging success. Begin by listing all of their accounts, account numbers, usernames, and passwords as well as employee contact names. Include insurance policies, the agent’s name, and where the policy is, as well as how they pay their premiums. Include any online medical accounts or list their doctors’ names and office numbers. The idea is to create a comprehensive list of all of these accounts. Gather your parents’ Medicare and Social Security numbers and their drivers’ license numbers. Know where they keep this information so that in the future you will know where to look. Also, learn about any online bill paying or automated, re-occurring activity. These usually include monthly bills like electricity, natural gas, water, etc. but may also include quarterly payments or annual subscriptions.

If your parents still live in their long-time home, discuss if it is viable that they live out their days there, or if downsizing to a retirement community or moving closer to where you live appeals to them. Help them come to a decision that is best for their set of circumstances.  If they do not have long-term care insurance or some other mechanism to aid them in times of need, talk about the topic, and try to come up with a solution. If they do have long-term care, be sure you have a copy of the policy, contact information, and the name of the insurer and agent. Review the requirements for receiving benefits so you can help them when they need to file a claim as most policies have a waiting period of 30 to 90 days before benefits begin. Know what to expect.

Digital technology has made oversight of parents and their finances easier than ever as long as you have a durable power of attorney and access to their account information. If they do not yet pay their bills online, or use auto payment, help them set up this option for their monthly bills. Remind them you will provide oversight to ensure proper billing. Offer to help them with their annual tax filings. Your help relieves some pressure on them and provides you with information about the goings-on in your parents’ accounts. For your parents’ peace of mind, you can establish a monthly video chat to let them know their bill payments are progressing normally. Your involvement will allow you to identify any abnormalities in account activity, which may indicate scam attempts.

Having these financial and planning conversations with your parents today can help them live more securely and with less stress as they age. Most parents will try to avoid these discussions with their children because they may not be adequately prepared for what can lie ahead. Conversations that focus on proper legal documents and gathering financial account information will give you the data you need to help protect your parents.

We would be happy to help you and your parents with critical planning documents. We are open and taking new clients, and we hope to talk with you soon about your particular needs. If you have questions, please do not hesitate to contact our Reno office by calling us at (775) 853-5700.