Bring It with You

March 6, 2012

Filed under: Medical Care — Tags: , — Alexis @ 12:15 PM

Do you have a Health Care Proxy, HIPAA Statement, and advanced directive (in my office that would be the workbook called Your Way)? If you are in a hospital or rehab and are being transferred to another medical institution, bring copies with you. Do not assume these will be transferred to the new institution!!

We are living in the beginning of the age of electronic medical records, so you would think it would be a no-brainer that your Health Care Proxy, HIPAA Statement, and advanced directive would go with you to your new medical institution. But even the best computer systems are run by humans, and we all know that medical institutions are understaffed.

Be on the safe side and bring these documents with you. When you get to the new institution, make sure these are placed in your chart. And then tell every nurse and doctor who comes to see you that they can find these documents in your chart.

Have an Advanced Directive? Put it into Language that Doctors Understand

February 21, 2012

Filed under: Medical Care — Tags: , — Alexis @ 12:14 PM

If you have an advance directive (in my office, that’s the Your Way workbook), and if you have a terminal or very serious illness, take your advance directive one step further and have your doctor convert it into “doctor’s orders.” If you have been in a hospital, then you know that all care is administered pursuant to doctor’s orders. Frequencies and dosages of medications? Check the doctor’s orders. Which therapies and when? Check the doctor’s orders. Type of diet? Check the doctor’s orders.

Ask your doctor to take your advance directive and convert it into doctor’s orders. That way, in an emergency, hospital staff will look in the chart and immediately see your directives, written in a format that they are used to.

Get Input from Your Doctor to Develop Your Advance Directive

February 10, 2012

Filed under: Medical Care — Tags: , — Alexis @ 12:13 PM

I give the “Your Way” workbook to every client who signs a Health Care Proxy. This workbook allows you to spell out to your family what your end-of-life wishes are.

If you have a serious or terminal illness, complete the Your Way workbook in pencil, and then go over it with your doctor or nurse practitioner. They should be able to help you outline wishes based on what they know may lie in your future as your illness progresses.

Have a hard time getting an appointment with your doctor? Or don’t think he gives you the time you need? There’s an alternative. I work with a wonderful geriatric nurse who can sit down with you, discuss what to expect down the road from your illness and what the medical choices will be at various turns in the road. If you would like to meet with her for a private session, so that she can help you articulate educated, thoughtful end-of-life wishes, please call me.

Who Will Make Your End-Of-Life Decisions When You Are Incapacitated?

December 28, 2010

Filed under: Estate Planning,Medical Care — Tags: — Alexis @ 11:10 AM

As we get older, the threat of illness or injury increases, and many of us wonder what will happen if we fall or get injured.  Who will make important healthcare decisions if we become incapacitated?  How will medical personnel know how to treat us if we cannot communicate with them?  The answer to all of these questions is: Healthcare Agents.

A healthcare agent is the person you name in your Health Care Proxy to make medical decisions for you when you cannot make them for yourself.  This person will talk to doctors, manage your medical care, authorize treatment, and possibly even make life and death decisions.  Knowing all this, it is important to choose someone who thinks clearly under pressure, is not intimidated with medical problems, and who will keep the medical staff in check.  But beyond choosing the right person, it is essential to discuss your wishes with your agent ahead of time.

Executing a healthcare directive and nominating a healthcare agent is not just about choosing the right person to make the big life-and-death decisions for you, it’s also about taking care of the loved ones you leave behind.  Most people have strong wishes about life-support and end-of-life care, but rarely do they want those wishes carried out at the expense of their loved ones.  Creating a healthcare directive which outlines those wishes—and discussing those wishes with your agent and your family—is important not only for your own peace of mind, but also to ensure the peace of mind of your loved ones, those who will be left to mourn your absence after you’re gone.  As a health care directive, I give each client the “Your Way” workbook.

And if you don’t name an agent in a Health Care Proxy?  Your family will be forced to go to court and spend thousands of dollars pursuing a guardianship.

Does Your Special Needs Child Really Need a Guardianship?

October 19, 2009

Last week I gave a presentation to Weymouth parents of special needs young adults, and from our conversation, it was clear that the school system was telling them that when a special needs child turns 18, the family must obtain a guardianship. As I’ve written elsewhere, this costs money, involves lawyers, and requires going to court. And for kids with developmental disabilities, there is the daunting clinical team report, which requires coordinating three different professionals.

Fortunately, guardianship (and its accompanying conservatorship) is not necessarily the answer for every family. For lots of kids, a Health Care Proxy and Durable Power of Attorney are the way to go. I don’t know why school special ed personnel are not educated on this, but the Health Care Proxy and Durable Power of Attorney are much more respectful of the young adult’s autonomy and cost significantly less – thousands of dollars less – with a fraction of the hassle.

To sign her Health Care Proxy and Durable Power of Attorney, the young adult needs to have a basic understanding of what she is appointing the named agents to do (usually her parents, but not necessarily – it’s up to her to decide whom to name). Ask yourself: Does she understand that money buys her things? That money must be saved and spent with care? Does she like to have someone help her manage money and make decisions? Does she like to have someone involved with her medical care? Would she like for someone to be able to tell doctors what to do if she can’t tell them herself?

If you think the answer to these questions is “yes,” then meet with a special needs attorney to discuss a Health Care Proxy and Durable Power of Attorney instead of guardianship and conservatorship. Technically speaking, the question of whether a person has the requisite mental capacity to sign these documents is a legal one, so the attorney will need to meet with the young adult alone – maybe more than once – to make that determination for herself.

And if the attorney decides that indeed this young adult can create and sign these documents, than the small investment you have made is more than outweighed by the savings of avoiding guardianship and conservatorship – in terms of the young adult’s autonomy and your family’s time, money, and emotional capital.

Howard Gleckman’s New Book: Caring for Our Parents

August 25, 2009

Filed under: Estate Planning — Tags: , , , , — Alexis @ 5:27 PM

Driving to work on Friday, I had the treat of listening to NPR’s Robin Young interview Howard Gleckman on his new book, Caring for Our Parents: Inspiring Stories of Families Seeking New Solutions to America’s Most Urgent Health Crisis. I only caught the end of the interview, but it was so reassuring to hear him close with this message: we should all have our health care proxies and end of life wishes in order.

This is what I talk about when I give presentations and when I meet with clients. I’ve blogged about it – read about health care proxies here and about end of life wishes here.  This is such an important message to get across to people. A health care proxy lets someone else make health care decisions for you when you cannot make or communicate them yourself – anesthetic fog? dementia? shock from an accident? Without a health care proxy in place, your family could very well be forced to go to court and waste a lot of money, time, and emotion.

And making your end of life wishes clear will save your family a tremendous amount of anxiety, guilt, grief, and arguments. Give your family the gift of peace by taking the burden off of their collective shoulders – tell them ahead of time what you would want in a difficult situation.

It gives me hope to hear Mr. Gleckman advising a national audience to get their health care proxies and end of life statements in order. So many families would have such an easier time caring for their loved ones with these documents in place.

End of Life Wishes & Living Wills

Clients are always asking about living wills. Massachusetts law does not recognize a living will, and it’s also impossible to write a thorough, well balanced statement of your end of life wishes in just a few paragraphs.

I provide clients with a solution to their goal, but in a much better form. I give my clients a workbook called Your Way. It is published by a nonprofit in California, H.E.L.P.: Helping People Meet Aging-Related Legal & Care Challenges.

This workbook is twelve pages long and very thoughtfully walks the reader through various scenarios you could confront in an end of life situation and what kind of comfort and care you would like to receive. For example, what matters to you the most – being with friends and family? Listening to music? Being able to help dress yourself? Under various scenarios, would you want curative care or to be kept comfortable? Who do you want with you as you are dying? Where would you want to be? A twelve-page work book written by heath care professionals does a much better job elucidating your wishes than an attorney can do in a one-page living will.

If you are not a client of this office, then log onto the Your Way website and order a workbook. If you are my client, then you already have a copy. Complete the exercises and give your family the gift of knowing exactly what you would want them to do in a crisis situation.

My Spouse Died – What Do I Need to Do to Protect Myself?

July 24, 2009

After a spouse dies and the family gets through the funeral, the immediate concern is to square away the couple’s assets and make sure the surviving spouse has enough to live on. After that, there is one more step to take: protecting yourself.

One area where you need to be proactive is to consider who will be able to assist you with financial and health matters if you become ill or incapacitated. Before, you and your spouse relied on each other to serve in these roles. Now you need to legally appoint someone to be able to step in and help you. At this point, you definitely need to execute a Durable Power of Attorney and Health Care Proxy. And many people like to add a child to their bank account so she can easily help with paying bills. See my blog post on how to do this appropriately (don’t add her as a joint owner!).

If you go to see your elder law attorney after your spouse has passed away, in addition to helping you transfer your spouse’s assets to your name, she will also help you put in place these fundamental documents that will serve to protect you, should you ever become unable to handle your affairs or medical decisions yourself.

Why Should My Elder Law Attorney Draft My Health Care Proxy? I Have the Form from the Hospital.

May 10, 2009

Filed under: Estate Planning — Tags: , , , , — Alexis @ 4:58 PM

Massachusetts hospitals hand patients a two-page Health Care Proxy form that was developed in 1999 and does not accommodate for changes in the law since then or for issues pertinent to elders. 

You probably have signed a “HIPAA” form by now at your doctor’s office.  This form allows the doctor’s office to share your confidential information with anyone in particular you name, such as your spouse or children – while you are competent.  (The Health Care Proxy kicks in when you cannot make or communicate your own decisions.)  Without this form in place, your medical team is well within its rights to refuse to discuss your case with your family.  Many elders like to know that the doctor will speak with their child later in the day to review the results of the appointment.  A well drafted Health Care Proxy with your Elder Law Attorney will enable this.  The state form does not.

The hospital form can also lead to expensive guardianship proceedings, because it lacks several important items.  It does not allow the person you have named to authorize anti-psychotic medications, which can be critical to an elder with dementia, depression, or anxiety, or a combination of all three.   It does not allow the agent to sign for a nursing home admission, nor to permit extraordinary measures (ex. feeding tube).  If you have only the state form and you need any of these actions later, your family will have to commence a lengthy and time-consuming guardianship process.

Contact your elder law attorney today and ask to draft a new Health Care Proxy form and save your family considerable expense and headache later.

It Just Got More Expensive to Ignore Your Estate Planning in Massachusetts

May 3, 2009

As part of your estate planning work, your attorney will prepare a Durable Power of Attorney and Health Care Proxy.  These documents are critical to allow another person whom you appoint to legally care for you when you are unable to manage your own affairs, for example, if you are in a car accident, develop dementia, or are having a rough patch after a surgery.

What happens if you don’t sign these documents when you are able to and later need someone to act for you?  Your family will need to go to court and pursue a guardianship, which is an involved court proceeding.  When everything goes smoothly, this can take several weeks, usually requires hiring a lawyer, and then there are annual reports that your agent must make to the court.  All this is paid for out of your bank account, and it can easily add up to thousands of dollars.

Starting on July 1, 2009, the Massachusetts guardianship process will be even more involved and more expensive.  The legislature added several components which will do a much better job at upholding the due process rights of the public than our existing laws.  Doctors will have to complete lengthy, detailed reports attesting to the fact that the patient cannot manage her own affairs – these reports are not covered by health insurance.  Lawyers will need to draft documents that are much more detailed pleadings concerning the incapacitated person’s need for assistance.  And the lawyer and the family together will need to draw up a detailed plan for the person’s care complete with milestones and goals.  Annually, the family will need to write and file with the court a report specifically detailing the incapacitated person’s living situation, health status, and finances, and consider whether the person has improved so that perhaps the guardianship is no longer needed. 

All of this will cost a lot of money and take up a good deal of time.  Instead, you can today plan to meet with your elder law attorney and for only a few hundred dollars, write and sign a Durable Power of Attorney and Health Care Proxy.  It’s that simple.

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