Figure Out What You Want In Your Health Care Power of Attorney

power of attorney image, estate planning, Figuring out what you want: The following questions are designed to help you know yourself and to form a basis for discussion with the person you choose to execute your health care power of attorney.

  1. The pleasures of health: How essential are these capabilities to your happiness? (i.e. are they, vital, important, mildly important, not important)
    • Walking
    • Enjoying the outdoors
    • Eating, tasting
    • Drinking
    • Reading
    • Attending religious services
    • Listening to music
    • Watching television
    • Avoiding pain and discomfort
    • Being with loved ones
    • Touching
    • Being self-sufficient
  2. Fear factors: What are your biggest concerns about the end of your life?
  3.  

  4. Spirituality: How much of your comfort and support comes from religion? From personal prayer? From interaction with clergy?
  5.  

  6. End of life: If you had the power to decide, what would the last day of your life be like? Where would you be? With whom? What would you be doing? What would your final words be?
  7.  

  8. Assistance preferences worksheet: It is useful to discuss with your health care agent (and family members as well) the types of assistance you might want, should you need help, and to revisit this issue from time to time, because your preferences could very well change. Looking at each of the different scenarios spelled out below, think through what your preferences would be by asking yourself the following questions:
     

    1. Would I still want to live at home?
    2. Would I want caregivers hired to help me out in my home?
    3. Would I want to be taken to a rehab or assisted living center?
    4. Would I want family members to care for me?
    5. Would I want to live with one of my children?
    6. Would I want one of my children or a relative to live with me?
    7. Would I want my health care agent to make these decisions for me?
    8. Would my answers differ if my spouse were still living at home?
  9.  

    • If you were unable to drive a car
    • If you were unable to climb stairs
    • If physical problems prevented you from being able to dress yourself
    • If you had to use a wheelchair because you were no longer able to walk
    • If you were unable to leave your home
    • If your vision were seriously impaired
    • If your hearing were seriously impaired
    • If you needed kidney dialysis
    • If you needed chemotherapy
    • If you were in physical discomfort most of the time
    • If you could no longer control you bladder
    • If you could no longer control your bowels
    • If you could not think clearly

    The more you take the time now not only to think through whom you wish to choose as a Health Care Proxy, but also how that person would address these future scenarios, the more likely your wishes will be honored in the future.

    Make sure (especially if you are in a second marriage) that you have coordinated the person chosen as your Health Care Agent with the person named as your Trustee and/or your Attorney in fact under a Durable Power of Attorney so that the decisions about your medical care and how to pay for it are coordinated.

     

     

    Patricia Annino is a sought after speaker and nationally recognized authority on women and estate planning. She educates and empowers women to value themselves and their contributions in order to ACCOMPLISH GREAT THINGS in the world – and in so doing PROTECT THEMSELVES, those they love, and the organizations they care about. Annino recently released an updated version of her successful book, Women and Money: A Practical Guide to Estate Planning to include recent changes in the laws that govern how we protect our assets during and beyond our lifetime. To download Annino’s FREE eBook, Estate Planning 101 visit, http://www.patriciaannino.com.

The Pros and Cons of Guardianships for Parents of Impaired Adults

guardianship of elderly parentGuardianship offers additional options, but is hard to obtain, for a very good reason.

When we think of legal guardianship or conservatorship, several types of situations typically come to mind. We imagine instances involving a minor child whose parents may have died young, an elderly parent with dementia, or an adult who has been severely injured and can no longer take care of himself.

But a new category is evolving: an adult child whose decisions are impaired. This category has made headlines in recent years thanks to celebrities such as Britney Spears, whose father has been her court-appointed conservator since 2008. Spears records albums, performs worldwide, and is one of the most recognizable celebrities in America. Yet while she is under conservatorship, she does not have the right to make financial or legal decisions.

When a person is put under guardianship or conservatorship (the specific term used varies by state), that court-appointed fiduciary has the legal right to overrule the decisions the ward makes. The court-appointed fiduciary must report to the court and in certain circumstances, such as ordering antipsychotic medication, must prove to the court that the decisions are necessary.

It’s tricky to determine when it makes sense to appoint a guardian for a young adult whose decision-making is impaired. Many young adults make bad, and sometimes unsafe, decisions. These often involve alcohol or drug addictions. Even so, the key question is whether that is enough to justify taking away their personal liberties and overruling their rights.

Proceedings can divide families

An adversarial protective proceeding is fraught with emotional and legal peril, and the decision to seek a guardianship often divides families. Some family members may think a guardianship is the only alternative, while others might believe it is a mistake. The uncertain outcome of a proceeding complicates the situation. If the adult child “wins” and retains competence, then family relations can break down and any trust or confidence between the parent and adult child can evaporate.

It is noteworthy that in many states the protective proceedings of guardianship or conservatorship can be voluntary—the person involved can agree to have a legal guardian or conservator appointed. A distinct advantage to this type of protective proceeding is that it does not have to be adversarial. Twice in my practice, I have seen a person enter into a voluntary protective proceeding and then have that protection end in a few years, after which the person again took charge of his own legal and financial decisions. But voluntary guardianship isn’t always an option.

It is (and should be) difficult to put adults under guardianship or conservatorship against their will. Courts must tread slowly and carefully on this slippery slope. To complicate matters, many states define competence for legal purposes differently from competence for medical purposes. In all states, however, those seeking to place someone under involuntary guardianship or conservatorship must first produce ample medical evidence to support this course of action.

The person being put under guardianship or conservatorship receives advance notice of the court proceeding and has the right to object to it. Court proceedings, which are public, can take time and can be costly due to legal fees and related bills. If the proceedings involve finances, the court-appointed fiduciary must also file annual accountings.

Other Options

A less severe option, and an important first step for many, is putting in place the basic estate planning documents—durable power of attorney (for financial purposes) and health care proxy (for medical purposes). These documents are important because they start the process of providing another person with the legal authority to act. One advantage of these documents is that they exist outside the court system. Therefore, any financial actions taken by the attorney-in-fact under the durable power of attorney or health care actions taken by the health care proxy are private.

These documents are also important for parents who wish to view the medical or financial records of their adult children. Once young adults reach the age of majority (age 18 or 21 depending on which state they live in), no one has the right to access their records without a Health Insurance Portability and Accountability Act (HIPAA) release. But a durable power of attorney and health care proxy can be used to waive HIPAA privacy rights. In most states, adults have the right in a durable power of attorney to designate whom they would name as their guardian/conservator if protective proceedings commence. The person nominated as a fiduciary has the right to be present in a protective court proceeding, if such a proceeding commences.

For many of our clients, dealing with an adult child who has a significant mental health or addiction issue can be a considerable challenge. In addition to the traditional paths of medical and psychiatric care, the appropriate legal options also should be explored. At a minimum, for any child at the age of majority, a health care proxy and a durable power of attorney should be executed. For more extreme situations, the legal protective proceedings of guardianship or conservatorship may be an answer. To fully explore the available courses of action, clients should consult an estate-planning or disability-planning attorney, a physician, and a psychiatrist.

 

Patricia Annino is a sought after speaker and nationally recognized authority on women and estate planning. She educates and empowers women to value themselves and their contributions in order to ACCOMPLISH GREAT THINGS in the world – and in so doing PROTECT THEMSELVES, those they love, and the organizations they care about. Annino recently released her new book, “It’s More Than Money, Protect Your Legacy” available at Amazon.com. To download Annino’s FREE eBook, Estate Planning 101 visit, http://www.patriciaannino.com.

Harper Lee’s Condition Debated by Friends, Fans and Now State of Alabama

By SERGE F. KOVALESKI, ALEXANDRA ALTER and JENNIFER CROSSLEY HOWARD

MONROEVILLE, Ala. — The doubts arose almost immediately when HarperCollins announced last month that it caregiver for elderlywould release a rediscovered book by Harper Lee: Did Ms. Lee — 88, publicity-shy and famously resistant to producing a follow-up to her masterpiece, “To Kill a Mockingbird” — really want to publish a second novel that she wrote and set aside more than a half-century ago?

Weeks later, that question remains a matter of passionate debate. Despite reassurances from her publisher, lawyer and literary agent that Ms. Lee has enthusiastically endorsed the publication, the controversy over the new book, “Go Set a Watchman,” has divided some residents of her hometown here, as well as longtime friends who live elsewhere. One faction argues that Ms. Lee’s mental health is too shaky for her to have knowingly authorized the new book, while the other just as vigorously affirms her competence.

Now the State of Alabama has been drawn into the debate. Responding to at least one complaint of potential elder abuse related to the publication of “Watchman,” investigators interviewed Ms. Lee last month at the assisted living facility where she resides. They have also interviewed employees at the facility, called the Meadows, as well as several friends and acquaintances.

It remains unclear what, if anything, will come out of the investigation, now more than a month old. One person informed of the substance of the interviews, who did not want to speak for attribution because the inquiry was ongoing, said Ms. Lee appeared capable of understanding questions and provided cogent answers to investigators.

The fact that the state has undertaken an inquiry highlights the scrutiny that Ms. Lee’s publisher and lawyer are facing as they prepare to release one of the most hotly anticipated titles in decades. And the spectacle of a very public debate about Ms. Lee’s mental condition and true intentions has added an operatic blemish to what should have been a triumphant moment for HarperCollins and the millions of fans who have clamored for decades for Ms. Lee to produce another book.

A lot is at stake, including the legacy of one of the country’s most beloved authors. Many wonder whether “Watchman,” which was rejected by a publisher in the mid-1950s and then rewritten as “Mockingbird,” will turn out to be a flawed, amateur work when it is released in July, and a disappointing coda to a career that has been defined by one outsize hit.

With an investigation involving Monroeville’s most famous resident underway, friends and acquaintances who have come forward in recent weeks have offered conflicting accounts of Ms. Lee’s mental state, with some describing her as engaging, lively and sharp, and others painting her as childlike, ornery, depressed and often confused. Several people said that her condition varied depending on the day.

Ms. Lee — known to many as Nelle, her legal first name — had a stroke in 2007 and has severe hearing and vision problems. But friends who visit her regularly say she can communicate well and hold lengthy conversations if visitors yell in her ear or write questions down for her to read under a special machine. (A black marker is kept in her room for this purpose.)

Philip Sanchez, a lawyer who was a pallbearer at the funeral for Ms. Lee’s older sister, Alice, last year, and visits Ms. Lee regularly, said he is not prepared to judge whether Ms. Lee is capable of consenting to publish the book. “It’s a call only God or a doctor can make,” he said. “I am more concerned that Nelle is content than the discussion of her cognizance.”

Wayne Flynt, the Alabama historian and a friend of Ms. Lee, said the author is mentally fit, engaged and can recite long passages of literature. When he visited her a few weeks ago after hearing reports that she was depressed, they spoke about his grandson and she laughed at the stories he told. He said he believed Ms. Lee was capable of assenting to the publication of “Watchman.”

But he also said she occasionally has problems with her short-term memory. When he asked her about her new novel, he said she seemed to be “in her own world” at first, and asked, “What novel?” Reminding her of “Watchman,” he told her “You must be so proud,” and she responded with “I’m not so sure anymore,” Mr. Flynt recalled.

The only statements from Ms. Lee about the new publication — affirming her enthusiasm — have come through her lawyer, Tonja B. Carter, who handles her day-to-day affairs. Ms. Carter came across the manuscript in August and negotiated the book deal with HarperCollins. Over the course of a week, Ms. Carter did not return a phone call and text messages seeking comment. A lawyer for Ms. Carter, Bobby Segall, declined to comment. In a previous interview with The New York Times, she described Ms. Lee’s excitement that “Go Set a Watchman” would be published, and stressed she would never go against the author’s wishes.

One person who said that he had filed an anonymous complaint with the state is a doctor who has known Ms. Lee for years. The doctor said in an interview that he had called Alabama’s adult protective services hotline and asked the state to investigate whether Ms. Lee was too infirm to have fully consented to the publication of “Watchman.”

The doctor, who has not treated Ms. Lee and asked to remain anonymous because of the divisive nature of the issue, said he had been alarmed by reports of her frailty and by an account from someone he trusted who visited Ms. Lee last fall after the death of her sister, and said she was largely uncommunicative, lying in a fetal position in bed in the middle of the afternoon.

The investigation is being led by the state’s Human Resources Department with the help of the Alabama Securities Commission, which among other things, works to prevent financial fraud against the elderly. Barry Spear, a spokesman for the Human Resources Department, said he could not comment on any investigation, noting that such inquiries are confidential. But he said investigations into elder abuse are done at the discretion of the department, based on an initial assessment of a complaint, and they can involve law enforcement if there is evidence of financial exploitation.

Caseworkers generally talk to people who may be victims to evaluate their physical, mental and emotional state, and they interview doctors, family members, caretakers and friends, Mr. Spear said.

In some cases, an investigation may involve subpoenaing financial and other records. Among the records that may be available are cognitive assessments of Ms. Lee by the staff of the Meadows. The facility agreed to make such monthly assessments on each resident as part of a settlement of a 2014 review by inspectors of the Alabama Department of Public Health.

Several of Ms. Lee’s friends and two of her caretakers said that they had been interviewed by investigators. Marcella Harrington, an aide paid by Ms. Lee’s lawyer to sit with her regularly, said in an interview that investigators had asked her if Ms. Lee could recognize friends and if she was receiving proper care. Ms. Harrington said she told them that Ms. Lee is lucid and aware of the book. Asked by a reporter whether Ms. Lee was mentally alert, Ms. Harrington said, “As far as I know, she is.”

Others who met with investigators painted a different picture of Ms. Lee’s condition. The writer Marja Mills, who lived next to the Lee sisters in Monroeville for about 18 months beginning in the fall of 2004 and wrote a book about the experience, “The Mockingbird Next Door: Life With Harper Lee,” recently met with investigators. She shared excerpts from a transcript of what she said was a recorded conversation she had in 2010 with Alice, who died in November at 103. In the conversation, recorded with Alice’s consent, Alice described her sister as having serious memory lapses during discussions about her personal affairs, Ms. Mills said.

“She doesn’t know from one minute to the other what she’s told anybody,” Alice said of her sister, according to those excerpts. “She’s surprised at anything that she hears because she doesn’t remember anything that’s ever been said about it.”

Ms. Lee’s publisher and literary agent have dismissed suggestions that she is too mentally infirm to consent to publishing “Watchman.”

Michael Morrison, the president and publisher of HarperCollins, said he and Jonathan Burnham, the senior vice president and publisher of Harper, visited Ms. Lee over two days in February, the week after the new book was announced. “She was in great spirits, and we talked about how much we love ‘Go Set a Watchman’ and the details of the publication,” Mr. Morrison said in a statement to The Times. “It was a great meeting, and as expected, she was humorous, intelligent and gracious.”

Through a HarperCollins spokeswoman, Mr. Morrison said the company was aware of the state’s inquiry but had not been contacted by investigators.

Andrew Nurnberg, the agent handling international rights for “Watchman,” has brushed off reports that Ms. Lee is somehow being taken advantage of as “nonsense.”

But skeptics point to a different picture of Ms. Lee that emerged in a 2013 lawsuit she filed against her former literary agent, in which she said he had “engaged in a scheme to dupe” her by hiding royalty payments and appropriating the copyright to “Mockingbird.” In the lawsuit, which was confidentially settled, she was portrayed by one of her lawyers as infirm and vulnerable to those she trusts.

As the debate over Ms. Lee’s condition continues, amplified by the investigation, what was once a source of pride in this small town is now a flash point, with much of the animosity settling on Ms. Carter. Some residents of Monroeville, a town of about 6,300, seem resentful of her, calling her aggressive and needlessly protective of her client in ways that have isolated Ms. Lee from some longtime friends.

Others say Ms. Carter is a dutiful steward of Ms. Lee’s affairs and have noted that Alice Lee had retained Ms. Carter as the lawyer on her will.

“Ms. Carter has been with the Lee sisters for many, many years, and she is a first-rate lawyer,” Greg Norris, a probate judge and president of the Monroe County Commission, said.

Mr. Norris worries that the fractious debate over the new book could erode Monroeville’s literary legacy.

“I just don’t know why people would be so negative,” he said. “We are a poor rural county and this new book puts us on the map again.”

Serge F. Kovaleski reported from Monroeville, Ala., and Jennifer Crossley Howard reported from Decatur, Ala. Susan Beachy, Elisa Cho and Alain Delaqueriere contributed research.

Source: NY Times http://www.nytimes.com/2015/03/12/arts/artsspecial/harper-lees-ability-to-consent-to-new-book-continues-to-be-questioned.html?_r=1#story-continues-1

 

Patricia Annino is a sought after speaker and nationally recognized authority on women and estate planning. She educates and empowers women to value themselves and their contributions in order to ACCOMPLISH GREAT THINGS in the world – and in so doing PROTECT THEMSELVES, those they love, and the organizations they care about. Annino recently released her new book, “It’s More Than Money, Protect Your Legacy” available at Amazon.com. To download Annino’s FREE eBook, Estate Planning 101 visit, http://www.patriciaannino.com.

Is Harper Lee competent to OK ‘Mockingbird’ sequel?

By Serge F. Kovaleski, Alexandra Alter and Jennifer Crossley Howard

Happer Lee, HarperCollinsMONROEVILLE, Ala. — The doubts arose almost immediately when HarperCollins announced last month that it would release a rediscovered book by Harper Lee: Did Lee — 88, publicity-shy and famously resistant to producing a follow-up to her masterpiece, “To Kill a Mockingbird” — really want to publish a novel that she wrote and set aside more than a half-century ago?

Despite reassurances from her publisher, lawyer, and literary agent that Lee has enthusiastically endorsed the publication, the controversy over the new book, “Go Set a Watchman,” has divided some residents of her hometown here, as well as longtime friends who live elsewhere. One faction argues that Lee’s mental health is too shaky for her to have knowingly authorized the new book, while the other just as vigorously affirms her competence.

Now the state of Alabama has been drawn into the debate. Responding to at least one complaint of potential elder abuse related to the publication, investigators interviewed Lee last month at the assisted living facility where she resides. They have also interviewed employees at the facility, as well as several friends and acquaintances.

It remains unclear what, if anything, will come out of the investigation. One person informed of the substance of the interviews, who did not want to speak for attribution because the inquiry was ongoing, said Lee appeared capable of understanding questions and provided cogent answers.

That the state has undertaken an inquiry highlights the scrutiny that Lee’s publisher and lawyer are facing. And the spectacle of a very public debate about Lee’s mental condition and true intentions has added an operatic blemish to what should have been a triumphant moment for HarperCollins and Lee’s millions of fans.

Source: The Boston Globe for the New York Times

Patricia Annino is a sought after speaker and nationally recognized authority on women and estate planning. She educates and empowers women to value themselves and their contributions in order to ACCOMPLISH GREAT THINGS in the world – and in so doing PROTECT THEMSELVES, those they love, and the organizations they care about. Annino recently released her new book, “It’s More Than Money, Protect Your Legacy” available at Amazon.com. To download Annino’s FREE eBook, Estate Planning 101 visit, http://www.patriciaannino.com.

Creation of a Family Risk Management Policy Statement

risk management policyA solid family risk management policy contains the purpose, principle and procedure for implementation. The purpose of a family risk management policy may be to reduce the risk for family members, both individually and as a whole. Adherence to the policy would go far to protect the family’s human and financial assets and minimize potential liability. The principle of the policy may be to make clear that the responsibility is to identify the areas of high risk and to do whatever possible to mitigate that risk. The procedure of the policy may make it clear that each family member is expected to:
 

  • Achieve financial literacy with regard to his or her own wealth as well as the wealth of the family enterprise.
  • Draft and have both parties sign a pre-nuptial agreement.
  • Contact their insurance providers annually to review their insurance coverage to ensure that they are current and adequate.
  • Have in place basic estate planning documents: will, revocable trust, health care proxy, power of attorney for financial assets.
  • Participate in the development of an investment policy that is aligned with the family’s shared values.
  • Protect the family’s reputation by learning how each individual’s behavior, both positive and negative, can impact the family’s reputation.

 
A family risk management policy statement is dynamic. It should be reviewed and adjusted as the risks that families face evolve and change.

  • Life insurance is a solution and mitigates risk Pay particular attention to gift splitting and use of both exemptions

 
Summary: remember why insurance is an effective solution
 

  • Long term care insurance provides a system of care that accelerates care and makes the conversation easier

 
Long term care insurance preserves dignity, protects inheritances and allows for family harmony by relieving the caregiver spouse and children
 
Long term care insurance protects the income and assets in a second marriage

  • Life insurance can be implemented to utilize the exemption yet take the pressure off current gifting of assets into the hands of the next generation

 
Life insurance and gifting can be effective to utilize otherwise wasted spousal exemptions- look at Non US spouses, same sex marriages, non traditional relationships
 
Life insurance covers the traditional risks of liquidity and equalization.

 
Patricia Annino is a sought after speaker and nationally recognized authority on women and estate planning. She educates and empowers women to value themselves and their contributions in order to ACCOMPLISH GREAT THINGS in the world – and in so doing PROTECT THEMSELVES, those they love, and the organizations they care about. Annino recently released her new book, “It’s More Than Money, Protect Your Legacy” available at Amazon.com. To download Annino’s FREE eBook, Estate Planning 101 visit, http://www.patriciaannino.com.

Casey Kasem’s wife served with guardianship papers

caregiver for the elderlyWhile the saga continues since Kasem’s recent death, the story is a common one for families around the world. Pre-planning is extremely important so that your wishes are met during difficult times later in life.

BREMERTON, Wash. (AP) — The wife of ailing radio personality Casey Kasem was served Friday with a California court order that temporarily suspends her powers to determine her husband’s medical care amid concerns about his health and welfare.

The order Kitsap County sheriff’s deputies said they delivered also expands daughter Kerri Kasem’s authority to determine whether her father, who’s now in Washington state, is receiving adequate medical care.

Wife Jean Kasem told KING-TV in an interview aired Friday evening that her husband is getting the best possible care and she is “not going to allow anybody to shred (her) family on unfounded facts and malicious accusations.”

“My husband is very happy and comfortable in our family and has told me time and time again that he wishes to remain under my care,” she said.

“Why is she trying to block a doctor from seeing my father?” Kerri Kasem asked in a statement Friday night, telling her stepmother, “If you truly love my father, you will do the right thing and allow him to get proper medical treatment.”

Kerri Kasem’s spokesman Danny Deraney said she has a special Washington state court order that allows her to see her father, but there was no timetable for when that will happen.

On Tuesday, Los Angeles Superior Court Judge Daniel S. Murphy ordered Jean Kasem to comply with court orders allowing doctors to evaluate her husband, and also allow his daughter Kerri to see him. He also ordered Jean Kasem to surrender her husband’s passport and temporarily suspended her powers to determine her husband’s medical care.

In mid-May, Murphy had expressed concerns about Kasem’s whereabouts and safety amid a dispute between his wife and children from another marriage.

The sheriff’s office in Kitsap County, west of Seattle, tracked him down the next day.

Sheriff’s Deputy Scott Wilson said officers who performed a welfare check May 13 on the 82-year-old Kasem found him staying at the home of long-time family friends. Jean Kasem says they are on a family vacation.

Kasem “appeared to be not in distress,” Wilson said Friday. “He couldn’t speak but he appeared to us to be cognizant of what was going on around him and who people were.”

The sheriff’s spokesman said medications were present and those at the home, including Jean Kasem, said appropriate medical care was being provided. Medical professionals, including doctors and visiting nurses, have been “attending him as required,” Wilson said.

Kerri Kasem’s court filings state her father is suffering from a form of dementia called Lewy Body Disease.

The sheriff’s spokesman noted that the officers who delivered the court order were “basically the messengers between the courts in California” and Kasem’s connections in Washington.

“We wouldn’t enforce anything until we were directed by the Washington court and coordinated with our prosecutor’s office,” Wilson said. “That hasn’t happened.”

Kasem gained fame with his radio music countdown shows, “American Top 40” and “Casey’s Top 40,” and he was the voice of Shaggy in the cartoon “Scooby Doo.”

Patricia Annino is a sought after speaker and nationally recognized authority on women and estate planning. She educates and empowers women to value themselves and their contributions in order to ACCOMPLISH GREAT THINGS in the world – and in so doing PROTECT THEMSELVES, those they love, and the organizations they care about. Annino recently released her new book, “It’s More Than Money, Protect Your Legacy” available at Amazon.com. To download Annino’s FREE eBook, Estate Planning 101 visit, http://www.patriciaannino.com.

Figure Out What You Want In Your Health Care Power of Attorney

Figuring out what you want: The following questions are designed to help you know yourself and to form a basis for discussion with the person you choose to execute your health care power of attorney.

1)  The pleasures of health:  How essential are these capabilities to your happiness?  (I.e. are they, vital, important, mildly important, not important)Camping Image

*Walking

*Enjoying the outdoors

*Eating, tasting

*Drinking

*Reading

*Attending religious services

*Listening to music

*Watching television

*Avoiding pain and discomfort

*Being with loved ones

*Touching

*Being self-sufficient

2)  Fear factors:  What are your biggest concerns about the end of your life?

3)  Spirituality:  How much of your comfort and support comes from religion?  From personal prayer?  From interaction with clergy?

4)  End of life: If you had the power to decide, what would the last day of your life be like?  Where would you be?  With whom?  What would you be doing?  What would your final words be?

5) Assistance preferences worksheet:  It is useful to discuss with your health care agent (and family members as well) the types of assistance you might want, should you need help, and to revisit this issue from time to time, because your preferences could very well change. Looking at each of the different scenarios spelled out below, think through what your preferences would be by asking yourself the following questions:

a) Would I still want to live at home?

b) Would I want caregivers hired to help me out in my home?

c) Would I want to be taken to a rehab or assisted living center?

d) Would I want family members to care for me?

e)  Would I want to live with one of my children?

f)  Would I want one of my children or a relative to live with me?

e) Would I want my health care agent to make these decisions for me?

f)  Would my answers differ if my spouse were still living at home?

-If you were unable to drive a car ___

-If you were unable to climb stairs ___

-If physical problems prevented you from being able to dress yourself ___

-If you had to use a wheelchair because you were no longer able to walk ___

-If you were unable to leave your home ___

-If your vision were seriously impaired ____

-If your hearing were seriously impaired ___

-If you needed kidney dialysis ___

-If you needed chemotherapy ____

-If you were in physical discomfort most of the time ___

-If you could no longer control you bladder ___

-If you could no longer control your bowels ___

-If you could not think clearly ___

The more you take the time now not only to think through whom you wish to choose as a Health Care Proxy, but also how that person would address these future scenarios, the more likely your wishes will be honored in the future.

Make sure (especially if you are in a second marriage) that you have coordinated the person chosen as your Health Care Agent with the person named as your Trustee and/or your Attorney in fact under a Durable Power of Attorney so that the decisions about your medical care and how to pay for it are coordinated.

 

Patricia Annino is a sought after speaker and nationally recognized authority on women and estate planning.  She educates and empowers women to value themselves and their contributions in order to ACCOMPLISH GREAT THINGS in the world – and in so doing PROTECT THEMSELVES, those they love, and the organizations they care about.  Annino recently released an updated version of her successful book, Women and Money: A Practical Guide to Estate Planning to include recent changes in the laws that govern how we protect our assets during and beyond our lifetime.  To download Annino’s FREE eBook, Estate Planning 101 visit, http://www.patriciaannino.com.

New Risks to Family Cohesiveness Continued!

airplane oxygen imageImpact to individual goals and life plans by the increasing lifespan of baby-boomer generation. Take the Steps Now to Put the Oxygen Over Your Own Face First and Decide Who Will Make Your Health and Financial Decisions If You Are Unable To Do So.

Another risk to family cohesiveness is the impact increased lifespan has on individual goals and life plans. Traditional risks include the illness, death or incapacity of a key family figure. In the family business and in the co-ownership of investment and commercial assets, the new risk is the increased work lifespan of the older generation, which results in the delayed succession of the middle generation. In essence, with the older generation in good physical and mental health and working far longer, the middle generation may, in effect, be knocked out of position and never get its day in the sun. By the time the older generation decides to move along, the individual goals and life plans of the middle generation may have been passed by, and the baton may be passed to the next generation. This new risk can be mitigated by intentional strategic planning and clear communication among all generations as to what the expectations are for the working lifespan and when the baton should/will pass.

Strategies to Mitigate the Risk of Increased Lifespan to the Ability to Control Your Own Health and Affairs and the Risk to Next Generation’s Life Plans:

1. Understand that estate planning is much more than what happens when you die; in an increasingly aging population that is living longer, disability or incapacity planning is essential. Make sure you have in place the legal mechanisms so that you can be taken care of in the way you desire. It is important that we all remember what the flight attendant says every time you board a plane – if the cabin pressure changes and the oxygen mask falls down, put that mask over your own face first – it is only when you put the mask over your own face that you will have the strength to protect others. In other words, protect yourself first.

2. Make sure the documents that will protect you if you are unable to care for yourself (Health Care Proxy and Durable Power of Attorney) are up to date and accurately reflect your wishes.

A Health Care Proxy is a document in which you give the authority to an agent to make medical care decisions if you become unable to make them. The document can authorize everything, including minor and routine medical involvement, and can give the agent access to all your medical records. It can authorize someone to supervise your care if you are incapacitated, to consent to having you undergo certain types of treatment or to withdraw from treatment; to make hospital or nursing care arrangements; and to employ or discharge caregivers.   A Health Care Proxy can also empower the agent to make such major decisions as whether or not to terminate your life.

Under federal law, only one person at a time can be named as health care agent, but a Health Care Proxy can name a succession of people as alternatives.  This is done so that someone else can take over if, for instance, both spouses are in the same car crash, and neither one of them is in a condition to make medical decisions.  A copy of the Health Care Proxy should be given to your primary care physician and becomes part of the medical record.

As with a financial Durable Power of Attorney, in the health care area, couples usually designate each other to make medical care decisions and list their children as successor agents.  The health care agent must be someone you trust, who shares your value system, who is willing to perform the task, and who has a clear understanding of what your preferences are.

It is prudent to update this document regularly, and, when it is updated, to make sure that the contact information is completely up to date for those who have been designated to make health care decisions (including all telephone numbers and cell phone numbers). If the Health Care Proxy was executed prior to The Health Insurance Portability and Accountability Act of 1996 (known as HIPPA), then the document must be updated. Under HIPPA, if you do not expressly waive your right to privacy in writing, hospitals and physicians do not have the legal right to speak with the health care agent or to release medical information to that person.

Choose a Health Care Agent. This important person may have different titles in different states (such as “health care agent,” “health proxy,” “patient advocate,”  “attorney-in-fact,” “health care representative,” or “health surrogate”), but the responsibilities are the same.  The official requirements for health care agents also vary from state to state, but most states simply specify that the person must be an adult (over 18) and must be someone who does not work for your health care provider or for an adult care facility in which you are residing.

It is good to designate both a health care agent and a successor agent (choice #1 and choice # 2), in case you need help at a time when the agent you have chosen is not available.  You should decide which child to choose, and if you have no spouse or children, which friend or relative to choose.

In order for you to choose a health care agent wisely, it is helpful to establish a basis for evaluating potential candidates. That evaluation should include the following criteria:

1) Religious beliefs:  Since the concept of withholding artificial life supports runs contrary to the teachings of several religions – most notably the Catholic Church – it is helpful to find a health care agent who shares your religious beliefs and your position on right-to-die issues.

2) Willingness to take on this task.

3)  Strength to act on your wishes and speak out on your behalf (even if faced with doctors, institutions, or family members who disagree).

4) Communication:  The agent is comfortable talking to you about sensitive issues and capable of listening to and absorbing what it is that you want.

5)  Separation:  This is a person who can differentiate between his/her feelings and yours and be able to do what you want done.

6)  Proximity: This is someone who either lives close or could travel quickly to be there when needed.

7)  Availability:  This person is likely to be accessible and capable of performing tasks well into the future.

8)  Personal understanding:  He/she knows you well enough to intuit what is important to you.

9)  Negotiation skills:  He/she can mediate conflicts between family members, friends, and medical personnel.


Patricia Annino
is a sought after speaker and nationally recognized authority on women and estate planning.  She educates and empowers women to value themselves and their contributions in order to ACCOMPLISH GREAT THINGS in the world – and in so doing PROTECT THEMSELVES, those they love, and the organizations they care about.  Annino recently released an updated version of her successful book, Women and Money: A Practical Guide to Estate Planning to include recent changes in the laws that govern how we protect our assets during and beyond our lifetime.  To download Annino’s FREE eBook, Estate Planning 101 visit, http://www.patriciaannino.com.

How Psychedelic Drugs Can Help Patients Face Death & What it Means to Estate Planning Effected Towards the End

I recently read an article in the New York Times (read article here: http://nyti.ms/Kp9yct) about a study using Psychedelic Drugs to help patients cope with facing death as the result of a life-ending diagnosis, like cancer.  In the article it indicated that these end-of-life researchers only included otherwise healthy patients, those with no indication of mental illness, in the study.

These drugs are also being examined as treatment for alcoholism and other addictions.  While I can see the advantages of such treatment for those facing the end of their lives due to grave illnesses, it also makes me very aware of how this might affect the ability for someone to consider and finalize their estate planning needs at a time when they are not only facing their own demise, but while under the influence of psychedelic drugs.

Could this open up their decisions to scrutiny after their death?  Even though they are otherwise considered of sound mind, does this open the door for others to challenge a person’s Will or other estate planning functions finalized after such diagnosis, and while using psychedelic drugs.

I am an advocate for putting your affairs in order early on, long before you might be facing something like this, but the reality is, even if plans had been made, depending upon the individual situation, such a diagnosis could cause someone to rethink or alter their plans.

It seems like we would need to take some sort of extra steps during this process to make sure we can forego any challenges that could or would be made to change your final wishes.  I’m not exactly sure what that might look like, how we could provide verification of your ‘sound’ mind at such a time.

What do you think?  Leave your comments or questions below and expand the discussion!

Patricia Annino is a sought after speaker and nationally recognized authority on women and estate planning.  She educates and empowers women to value themselves and their contributions in order to ACCOMPLISH GREAT THINGS in the world – and in so doing PROTECT THEMSELVES, those they love, and the organizations they care about.  Annino recently released an updated version of her successful book, Women and Money: A Practical Guide to Estate Planning to include recent changes in the laws that govern how we protect our assets during and beyond our lifetime.  To download Annino’s FREE eBook, Estate Planning 101 visit, http://www.patriciaannino.com.

New Risk to Family Cohesiveness: Impact to individual goals and life plans

New Risk to Family Cohesiveness: Impact to individual goals and life plans by the increasing lifespan of baby-boomer generation. Take the Steps Now to Put the Oxygen Over Your Own Face First and Decide Who Will Make Your Health and Financial Decisions If You Are Unable To Do So.

Another risk to family cohesiveness is the impact of increased lifespan to individual goals and life plans. Traditional risks included the illness, death or incapacity of a key family figure. In the family business and in the co-ownership of investment and commercial assets, the new risk is the increased work lifespan of the older generation, which results in the delayed succession of the middle generation. In essence, with the older generation in good physical and mental health and working far longer, the middle generation may in effect be knocked out of position and never get its day in the sun. By the time the older generation decides to move along, the individual goals and life plans of the middle generation may have been passed by; and the baton may be passed to the next generation. This new risk can be mitigated by intentional strategic planning and clear communication among all generations as to what the expectations are for the working lifespan and when the baton should/will pass.

Strategies to Mitigate the Risk of Increased Lifespan to the Ability to Control Your Own Health and Affairs and the Risk to Next Generation’s Life Plans:

1. Understand that estate planning is much more than what happens when you die; in an increasingly aging population that is living longer disability or incapacity planning is essential. Make sure you have in place the legal mechanisms so that you can be taken care of in the way you desire. It is important we all remember what the flight attendant says every time you board a plane- if the cabin pressure changes and the oxygen mask falls down put that mask over your own face first –it is only when you do put the mask over your own face that you will have the strength to protect others. In other words, protect yourself first.

2. Make sure the documents that will protect you if you are unable to care for yourself (Health Care Proxy and Durable Power of Attorney) are up to date and the way you want them.

A Health Care Proxy is a document in which you give the authority to an agent to make medical care decisions if he/she becomes unable to make them. The document can authorize everything, including minor and routine medical involvement, and can give the agent access to all your medical records. It can authorize someone to supervise your care if you are incapacitated, to consent to have you undergo certain types of treatment or to have them withdraw from treatment; to make hospital or nursing care arrangements; and to employ or discharge caregivers.   It can also empower the agent to make such major decisions as whether or not to terminate your life.

Under federal law, only one person at a time can be named as health care agent, but a Health Care Proxy can name a succession of people as alternatives.  This is done so that someone else can take over if, for instance, both spouses are in the same car crash, and neither one of them is in a condition to make medical decisions.  A copy of the Health Care Proxy should be given to your primary care physician and becomes part of the medical record.

As with a financial Durable Power of Attorney, in the health care area, couples usually designate each other to make medical care decisions and list their children as successor agents.  The health care agent must be someone they trust, who shares your value system, who is willing to perform the task and who has a clear understanding of what your preferences are.

It is prudent to update this document regularly, and, when it is updated, to make sure that the most recent contact information for those who have been designated to make health care decisions (including all telephone numbers and cell phone numbers) are current. If the Health Care Proxy was executed prior to The Health Insurance Portability and Accountability Act of 1996 (known as HIPPA) then the document must be updated. Under HIPPA, if you do not expressly waive your right to privacy in writing, hospitals and physicians do not have the legal right to speak with the health care agent or to release medical information to that person.

Choose a Health Care Agent. This important person may have different titles in different states (such as “health care agent,” “health proxy,” “patient advocate,”  “attorney-in-fact,” “health care representative,” or “health surrogate”), but the responsibilities are the same.  The official requirements for health care agents also vary from state to state, but most states simply specify that the person must be an adult (over 18) and must be someone who does not work for your health care provider or for an adult care facility in which you are residing.

It is good to designate both a health care agent and a successor agent (choice #1 and choice # 2), in case you need help at a time when the agent you have chosen is not available.  You should decide which child to choose, and if you have  no spouse or children, which friend or relative to choose.

In order for you to choose a health care agent wisely, it is helpful to establish a basis for evaluating potential candidates. That evaluation should include the following criteria:

1) Religious beliefs:  Since the concept of withholding artificial life supports runs contrary to the teachings of several religions – most notably the Catholic Church – it is helpful to find a health care agent who shares your  religious beliefs and your position on right-to-die issues.

2) Willingness to take on this task.

3)  Strength to act on your wishes and speak out on your behalf (even if faced with doctors, institutions, or family members who disagree).

4) Communication:  The agent is comfortable talking to you about sensitive issues and capable of listening to and absorbing what it is that you want.

5)  Separation:  This is a person who can differentiate between his/her feelings and yours and be able to do what you want done.

6)  Proximity: This is someone who either lives close or could travel quickly to be there when needed.

7)  Availability:  This person is likely to be accessible and capable of performing tasks well into the future.

8)  Personal Understanding:  He/she knows you well enough to intuit what is important to your.

9)  Negotiation skills:  He/she can mediate conflicts between family members, friends, and medical personnel.

Figuring Out What You Want: The following questions are designed to help you know yourself and to form a basis for discussion with the person you choose to execute your health care power of attorney.

1)  The Pleasures of Health:  How essential are these capabilities to your happiness?  (I.e. are they, Vital, Important, Mildly Important, Not important)

*Walking

*Enjoying the outdoors

*Eating, tasting

*Drinking

*Reading

*Attending religious services

*Listening to Music

*Watching television

*Avoiding pain and discomfort

*Being with loved ones

*Touching

*Being self-sufficient

2)  Fear Factors:  What are your biggest concerns about the end of your life?

3)  Spirituality:  How much of your comfort and support comes from religion?  From personal prayer?  From interaction with clergy?

4)  End of life: If you had the power to decide, what would the last day of your life be like?  Where would you be?  With whom?  What would you be doing?  What would your final words be?

5) Assistance Preferences Worksheet:  It is useful to discuss with your health care agent (and family members as well) the types of assistance you might want, should you need help, and to revisit this issue from time to time, because your preferences could very well change. Looking at each of the different scenarios spelled out below, think through what your preferences would be by asking yourself the following questions:

a) Would I still want to live at home?

b) Would I want caregivers hired to help me out in my home?

c) Would I want to be taken to a rehab or assisted living center?

d) Would I want family members to care for me?

e)  Would I want to live with one of my children?

f)  Would I want one of my children or a relative to live with me?

g) Would I want my health care agent to make these decisions for me?

h)  Would my answers differ if my spouse were still living at home?

-If you were unable to drive a car ___

-If you were unable to climb stairs ___

-If physical problems prevented you from being able to dress yourself ___

-If you had to use a wheelchair because you were no longer able to walk ___

-If you were unable to leave your home ___

-If your vision were seriously impaired ____

-If your hearing were seriously impaired ___

-If you needed kidney dialysis ___

-If you needed chemotherapy ____

-If you were in physical discomfort most of the time ___

-If you could no longer control you bladder ___

-If you could no longer control your bowels ___

-If you could not think clearly ___

The more you take the time now not only to think through who you wish to choose as a Health Care Proxy, but also how who would want various future scenarios to be addressed by that person, the more likely your wishes will be honored in the future.

Make sure (especially if you are in a second marriage) that you have coordinated the person chosen as your Health Care Agent with the person named as your Trustee and/or your Attorney in fact under a Durable Power of Attorney so that the decisions about your medical care and how to pay for it are coordinated.

What challenges are you facing in your estate individual goals and life plan?  Share your stores in the comment section below.

Patricia Annino is a sought after speaker and nationally recognized authority on women and estate planning.  She educates and empowers women to value themselves and their contributions in order to ACCOMPLISH GREAT THINGS in the world – and in so doing PROTECT THEMSELVES, those they love, and the organizations they care about.  Annino recently released an updated version of her successful book, Women and Money: A Practical Guide to Estate Planning to include recent changes in the laws that govern how we protect our assets during and beyond our lifetime.  To download Annino’s FREE eBook, Estate Planning 101 visit, http://www.patriciaannino.com.

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