Valentine’s Day falls in February, so this month I wanted to write about love and marriage. With people living longer these days, it’s quite common for people to fall in love and get married later in life. A marriage in one’s 60’s, 70’s, or 80’s is a little different than a first marriage in one’s 20’s. Those twenty-something’s probably do not have much in the way of assets, and they’re certainly not worried about long-term care expenses. They also do not have to worry about how well kids from prior marriages will get along. All of these issues are important in a second marriage.
Many couples who get married late in life understand that they will share the ordinary expenses of life. They usually do not intend that a healthier spouse will have to spend his or her assets to pay for the long-term care of an ill spouse. It is quite a shock for many older people to learn that, if one spouse needs long-term care, the assets of both spouses are considered available to pay for that care. With long-term care costs averaging over $7,000 per month, careful advance planning is necessary to avoid impoverishing both spouses. To get the best result, this planning should be done as much as five years in advance of one spouse needing long-term care.
Another issue in second marriages involves estate planning. Did you know that under Oregon law, marriage revokes an existing will? Many people get married and do not know they need to update their will. In most second marriages, the parties have a pretty clear idea of how they want their property distributed after they pass away. But if you do not get into the lawyer’s office after getting married and do a new will, you won’t decide where your property goes. The State of Oregon will decide for you. So it’s critical to see an experienced elder law or estate planning attorney to update your will immediately after getting married.
A prenuptial agreement is valuable tool for second marriages later in life. In a prenuptial agreement, the parties to the marriage can spell out their agreement about how property will be managed, how bills will be paid, and whose funds will be used to pay for long-term care costs. It can also be used to define the inheritance rights of each spouse and of children from prior marriages. Children from prior marriages are greatly reassured to know that their parents are thoughtfully considering these issues.
As in all matters related to aging, people in second marriages who plan ahead get a much better result in times of crisis. Ideally this planning is done prior to the marriage. If you are already married, updating your wills and planning for long-term care costs should be done right away. The greatest risk is impoverishment of both spouses due to long-term care costs, which can be avoided by careful advance planning with an experienced elder law attorney.
Showing posts with label end of life care. Show all posts
Showing posts with label end of life care. Show all posts
Tuesday, February 22, 2011
Wednesday, January 5, 2011
U.S. Alters Rule on Paying for End-of-Life Planning
By ROBERT PEAR, the New York Times
Published: January 4, 2011
WASHINGTON — The Obama administration, reversing course, will revise a Medicare regulation to delete references to end-of-life planning as part of the annual physical examinations covered under the new health care law, administration officials said Tuesday.
The move is an abrupt shift, coming just days after the new policy took effect on Jan. 1.
Many doctors and providers of hospice care had praised the regulation, which listed “advance care planning” as one of the services that could be offered in the “annual wellness visit” for Medicare beneficiaries.
While administration officials cited procedural reasons for changing the rule, it was clear that political concerns were also a factor. The renewed debate over advance care planning threatened to become a distraction to administration officials who were gearing up to defend the health law against attack by the new Republican majority in the House.
Although the health care bill signed into law in March did not mention end-of-life planning, the topic was included in a huge Medicare regulation setting payment rates for thousands of physician services. The final regulation was published in the Federal Register in late November. The proposed rule, published for public comment in July, did not include advance care planning.
An administration official, authorized by the White House to explain the mix-up, said Tuesday, “We realize that this should have been included in the proposed rule, so more people could have commented on it specifically.”
“We will amend the regulation to take out voluntary advance care planning,” the official said. “This should not affect beneficiaries’ ability to have these voluntary conversations with their doctors.”
The November regulation was issued by Dr. Donald M. Berwick, administrator of the Centers for Medicare and Medicaid Services and a longtime advocate for better end-of-life care. White House officials who work on health care apparently did not focus on the part of the rule that dealt with advance care planning.
The decision to drop the reference to end-of-life care upset some officials at the Department of Health and Human Services, who said the administration ought to promote discussions of such care. Such discussions help ensure that patients get the care they want, the officials said.
During debate on the legislation, Democrats dropped a somewhat similar proposal to encourage end-of-life planning after it touched off a political storm. Republicans said inaccurately that the House version of the bill allowed a government panel to make decisions about end-of-life care for people on Medicare.
Sarah Palin, the 2008 Republican vice-presidential candidate, said in the summer of 2009 that “Obama’s death panel” would decide who was worthy of health care. Representative John A. Boehner of Ohio, the House Republican leader who is to become speaker on Wednesday, said the provision could be a step “down a treacherous path toward government-encouraged euthanasia.”
The health care bill passed by the House in 2009 allowed Medicare to pay doctors for discussions of end-of-life care, including advance directives, in which patients can indicate whether they want to forgo or receive aggressive life-sustaining treatment.
The provision for advance care planning was not included in the final health care overhaul signed into law by President Obama. Health policy experts assumed that the proposal had been set aside — until a similar idea showed up in the final Medicare regulation in November.
Published: January 4, 2011
WASHINGTON — The Obama administration, reversing course, will revise a Medicare regulation to delete references to end-of-life planning as part of the annual physical examinations covered under the new health care law, administration officials said Tuesday.
The move is an abrupt shift, coming just days after the new policy took effect on Jan. 1.
Many doctors and providers of hospice care had praised the regulation, which listed “advance care planning” as one of the services that could be offered in the “annual wellness visit” for Medicare beneficiaries.
While administration officials cited procedural reasons for changing the rule, it was clear that political concerns were also a factor. The renewed debate over advance care planning threatened to become a distraction to administration officials who were gearing up to defend the health law against attack by the new Republican majority in the House.
Although the health care bill signed into law in March did not mention end-of-life planning, the topic was included in a huge Medicare regulation setting payment rates for thousands of physician services. The final regulation was published in the Federal Register in late November. The proposed rule, published for public comment in July, did not include advance care planning.
An administration official, authorized by the White House to explain the mix-up, said Tuesday, “We realize that this should have been included in the proposed rule, so more people could have commented on it specifically.”
“We will amend the regulation to take out voluntary advance care planning,” the official said. “This should not affect beneficiaries’ ability to have these voluntary conversations with their doctors.”
The November regulation was issued by Dr. Donald M. Berwick, administrator of the Centers for Medicare and Medicaid Services and a longtime advocate for better end-of-life care. White House officials who work on health care apparently did not focus on the part of the rule that dealt with advance care planning.
The decision to drop the reference to end-of-life care upset some officials at the Department of Health and Human Services, who said the administration ought to promote discussions of such care. Such discussions help ensure that patients get the care they want, the officials said.
During debate on the legislation, Democrats dropped a somewhat similar proposal to encourage end-of-life planning after it touched off a political storm. Republicans said inaccurately that the House version of the bill allowed a government panel to make decisions about end-of-life care for people on Medicare.
Sarah Palin, the 2008 Republican vice-presidential candidate, said in the summer of 2009 that “Obama’s death panel” would decide who was worthy of health care. Representative John A. Boehner of Ohio, the House Republican leader who is to become speaker on Wednesday, said the provision could be a step “down a treacherous path toward government-encouraged euthanasia.”
The health care bill passed by the House in 2009 allowed Medicare to pay doctors for discussions of end-of-life care, including advance directives, in which patients can indicate whether they want to forgo or receive aggressive life-sustaining treatment.
The provision for advance care planning was not included in the final health care overhaul signed into law by President Obama. Health policy experts assumed that the proposal had been set aside — until a similar idea showed up in the final Medicare regulation in November.
Tuesday, July 6, 2010
Power of Attorney for Finances: An Essential Tool for Elder Care Planning
Most people understand the need to have a will, so that when they pass away, assets will go to their chosen beneficiaries. Most people do not realize that they also need to appoint a power of attorney to make financial decisions and manage assets for them, if they become incapacitated.
If you think about it, most any financial decision we make requires a signature. Selling a house, writing a check, entering into agreements, etc., all require that we be able to sign documents. A signature itself is not even enough; the law imposes a requirement that the person signing the document have sufficient mental capacity to understand what they are signing.
As we age, there is a greater possibility that a time will come when we are not able to sign important legal documents. Or, even if we can sign our name, we may not understand what we are signing. At that point, assets are frozen unless someone has been given the legal authority to make financial decisions for you. The best way to do this is through a power of attorney for finances.
A power of attorney for finances is a document you can sign to appoint another person to make important financial decisions for you in the event you become incapacitated. The person you appoint is called your “agent.” It is a good idea to name one or more alternate agents, in the event your first choice is unable or unwilling to serve in that role.
As an Elder Law attorney, one of the most common phone calls we receive is “I need to get power of attorney for my Mom.” My answer is always, “that’s great, we’d love to help your Mom. Let’s schedule a time for her to come in and discuss it.” “Well, that’s a problem,” replies the caller “because Mom has Alzheimer’s Disease, and she won’t understand what you are talking about.”
In this situation, it may be too late to get a power of attorney. A power of attorney must be signed by a person who is legally competent. This means the signer must have the ability to understand the nature and importance of the document. If someone already has Alzheimer’s Disease, or dementia, or has suffered a stroke, it may be too late to sign a power of attorney. Therefore, it is important to sign a power of attorney while a person has mental capacity to understand the document.
When deciding who should be your agent, remember that the most important qualities are honesty and good financial management skills. The main disadvantage to having a power of attorney is, a dishonest agent could use the power of attorney to misappropriate your assets. Therefore, only appoint the most trustworthy people to serve in this role. There are also professional trust companies that may agree to serve as your agent.
A power of attorney should always be prepared by an experienced elder law attorney. It is possible to obtain a generic power of attorney from a legal stationery store. However, this form will not give the agent the ability to make many types of important decisions for a disabled person. An experienced elder law attorney can provide a power of attorney that will give your agent flexibility to make important financial decisions if you are not able to make them yourself, such as disability planning, creating trusts, long-term care cost planning and tax planning.
If you think about it, most any financial decision we make requires a signature. Selling a house, writing a check, entering into agreements, etc., all require that we be able to sign documents. A signature itself is not even enough; the law imposes a requirement that the person signing the document have sufficient mental capacity to understand what they are signing.
As we age, there is a greater possibility that a time will come when we are not able to sign important legal documents. Or, even if we can sign our name, we may not understand what we are signing. At that point, assets are frozen unless someone has been given the legal authority to make financial decisions for you. The best way to do this is through a power of attorney for finances.
A power of attorney for finances is a document you can sign to appoint another person to make important financial decisions for you in the event you become incapacitated. The person you appoint is called your “agent.” It is a good idea to name one or more alternate agents, in the event your first choice is unable or unwilling to serve in that role.
As an Elder Law attorney, one of the most common phone calls we receive is “I need to get power of attorney for my Mom.” My answer is always, “that’s great, we’d love to help your Mom. Let’s schedule a time for her to come in and discuss it.” “Well, that’s a problem,” replies the caller “because Mom has Alzheimer’s Disease, and she won’t understand what you are talking about.”
In this situation, it may be too late to get a power of attorney. A power of attorney must be signed by a person who is legally competent. This means the signer must have the ability to understand the nature and importance of the document. If someone already has Alzheimer’s Disease, or dementia, or has suffered a stroke, it may be too late to sign a power of attorney. Therefore, it is important to sign a power of attorney while a person has mental capacity to understand the document.
When deciding who should be your agent, remember that the most important qualities are honesty and good financial management skills. The main disadvantage to having a power of attorney is, a dishonest agent could use the power of attorney to misappropriate your assets. Therefore, only appoint the most trustworthy people to serve in this role. There are also professional trust companies that may agree to serve as your agent.
A power of attorney should always be prepared by an experienced elder law attorney. It is possible to obtain a generic power of attorney from a legal stationery store. However, this form will not give the agent the ability to make many types of important decisions for a disabled person. An experienced elder law attorney can provide a power of attorney that will give your agent flexibility to make important financial decisions if you are not able to make them yourself, such as disability planning, creating trusts, long-term care cost planning and tax planning.
Tuesday, February 23, 2010
Understanding Life Sustaining Measures
You have decided to follow your doctor’s advice and complete an Advance Directive for Health Care thus providing a clear understanding of your wishes as they relate to life sustaining measures. You understand the significance of having an Advance Directive, but as you research the process, you are confronted with a lack of understanding regarding what life sustaining measures encompass.
Life sustaining measures can be defined as, “Any medical treatment in which the primary goal is to prolong life rather than treat the underlying condition.” In such cases an individual’s own body is not capable of sustaining proper functioning on its own without medical intervention. Some examples of life sustaining measures are:
Artificial nutrition and hydration are utilized when an individual is not receiving the nutrients necessary for health and well being. Artificial nutrition (tube feeding) requires a tube be placed into the stomach or the upper intestine. Hydration (fluid replacement) involves tube placement intravenously (IV) via a needle.
Cardiopulmonary resuscitation (CPR) is used when an individual’s heart beat and/or breathing has stopped. CPR includes treatments such as mouth-to-mouth resuscitation, chest compressions, electric shock and/or drugs to restart the heart. CPR can be life saving, however, there is a risk of broken or cracked ribs, punctured lungs and death.
Mechanical ventilation supports a person’s breathing when they can no longer breath on their own. In this situation a machine called a ventilator forces air into the lungs via tubing in the mouth or nose.
Dialysis is the artificial process by which waste products and excess water are removed from the blood. It is used when the kidneys are no longer able to do this adequately.
These examples of life sustaining treatments are just a few of the more common measures taken to continue life when one or more body systems are not working properly. Deciding what, if any, treatments are right for you should depend on several factors:
Does the treatment relieve suffering, restore functioning, or enhance the quality of life? If so, these would be some of the benefits of treatment. Conversely, a treatment may be considered problematic if it is painful, prolongs the dying process or negatively effects the quality of life. Other questions to ask yourself might be: What are my values as they relate to life prolonging measures? Who will carry out my wishes should I become incapacitated? If I start treatment and it does not improve my status will I want to continue that treatment? If so, when? (It should be noted that it is ethically and legally acceptable to discontinue a treatment that is no longer of benefit. It is the disease not the withdrawal of treatment that causes death.)
How you choose to complete your Advance Directive and what measures you choose to take are up to you. Talk to your doctor and don’t be afraid to ask questions if you find the terminology confusing or you simply don’t understand. Ultimately understanding your Advance Directive and the medical terminology associated with it will enable you to communicate your wishes to those providing your health care and increase the likelihood that your wishes will be honored.
Finally, understand that completing an Advance Directive for Health Care is a gift to your loved ones. Instead of guessing about what your wishes might be, they have a clear, written, and legally binding expression of your wishes, enabling them to serve as your advocate.
Life sustaining measures can be defined as, “Any medical treatment in which the primary goal is to prolong life rather than treat the underlying condition.” In such cases an individual’s own body is not capable of sustaining proper functioning on its own without medical intervention. Some examples of life sustaining measures are:
Artificial nutrition and hydration are utilized when an individual is not receiving the nutrients necessary for health and well being. Artificial nutrition (tube feeding) requires a tube be placed into the stomach or the upper intestine. Hydration (fluid replacement) involves tube placement intravenously (IV) via a needle.
Cardiopulmonary resuscitation (CPR) is used when an individual’s heart beat and/or breathing has stopped. CPR includes treatments such as mouth-to-mouth resuscitation, chest compressions, electric shock and/or drugs to restart the heart. CPR can be life saving, however, there is a risk of broken or cracked ribs, punctured lungs and death.
Mechanical ventilation supports a person’s breathing when they can no longer breath on their own. In this situation a machine called a ventilator forces air into the lungs via tubing in the mouth or nose.
Dialysis is the artificial process by which waste products and excess water are removed from the blood. It is used when the kidneys are no longer able to do this adequately.
These examples of life sustaining treatments are just a few of the more common measures taken to continue life when one or more body systems are not working properly. Deciding what, if any, treatments are right for you should depend on several factors:
Does the treatment relieve suffering, restore functioning, or enhance the quality of life? If so, these would be some of the benefits of treatment. Conversely, a treatment may be considered problematic if it is painful, prolongs the dying process or negatively effects the quality of life. Other questions to ask yourself might be: What are my values as they relate to life prolonging measures? Who will carry out my wishes should I become incapacitated? If I start treatment and it does not improve my status will I want to continue that treatment? If so, when? (It should be noted that it is ethically and legally acceptable to discontinue a treatment that is no longer of benefit. It is the disease not the withdrawal of treatment that causes death.)
How you choose to complete your Advance Directive and what measures you choose to take are up to you. Talk to your doctor and don’t be afraid to ask questions if you find the terminology confusing or you simply don’t understand. Ultimately understanding your Advance Directive and the medical terminology associated with it will enable you to communicate your wishes to those providing your health care and increase the likelihood that your wishes will be honored.
Finally, understand that completing an Advance Directive for Health Care is a gift to your loved ones. Instead of guessing about what your wishes might be, they have a clear, written, and legally binding expression of your wishes, enabling them to serve as your advocate.
Tuesday, September 29, 2009
New York Times on Geriatric Care Managers
The New York Times ran a piece on September 26th that explores the value of geriatric care managers in caring for the elderly. http://www.nytimes.com/2009/09/26/health/26patient.html?_r=1
Let us know what you think of this article. What would you like the public to know about services provided by care managers? Are there other avenues families should explore to help them weed through the medical, housing, and legal complications that surround the elderly in crisis?
By LESLEY ALDERMAN
Published: September 25, 2009
CARING for an elderly parent is emotionally and mentally draining. There are diagnoses to decipher, housing issues to consider, health aides to vet and a raft of legal documents to complete. It can seem overwhelming, even when families are in complete agreement on how to care for an elderly relative. And often they are not.
Last week, my colleague Walecia Konrad offered advice on how to find “respite care” — someone to temporarily help you tend to an elderly parent or loved one so you can have some time for your own life. This week, I am writing about what to do when you feel the situation calls for the equivalent of a case worker.
Happily, such case workers can be found. They are called geriatric care managers.
Yes, you must pay these professionals out of your own pocket. Regular insurance does not cover them, although some long-term care policies do. But a good care manager can buy you time and some peace of mind so you can concentrate on your job, your family and your own health.
Let us know what you think of this article. What would you like the public to know about services provided by care managers? Are there other avenues families should explore to help them weed through the medical, housing, and legal complications that surround the elderly in crisis?
By LESLEY ALDERMAN
Published: September 25, 2009
CARING for an elderly parent is emotionally and mentally draining. There are diagnoses to decipher, housing issues to consider, health aides to vet and a raft of legal documents to complete. It can seem overwhelming, even when families are in complete agreement on how to care for an elderly relative. And often they are not.
Last week, my colleague Walecia Konrad offered advice on how to find “respite care” — someone to temporarily help you tend to an elderly parent or loved one so you can have some time for your own life. This week, I am writing about what to do when you feel the situation calls for the equivalent of a case worker.
Happily, such case workers can be found. They are called geriatric care managers.
Yes, you must pay these professionals out of your own pocket. Regular insurance does not cover them, although some long-term care policies do. But a good care manager can buy you time and some peace of mind so you can concentrate on your job, your family and your own health.
Tuesday, September 1, 2009
Salute Our Veterans With Quality Care
When families come to see me regarding the long-term care needs of a loved one, we always identify two goals. The first, and most important goal is good quality care. The second is to obtain that care in a manner that does not completely impoverish the older person and his or her spouse. In developing a plan to pay for good care, we have to identify all sources of funds to help pay for that care. The most overlooked source of help with long-term care costs is a Veteran’s Administration (VA) benefit that pays monthly income to veterans and their spouses, and to the surviving spouses of deceased veterans. This benefit is commonly known as “Aid and Attendance Benefits.”
Tuesday, August 25, 2009
Have You Been Told Your Loved One Needs a Guardianship?
We often receive calls from potential clients who have been told that their loved one needs the assistance of a legal guardian. In the most common situation, the person has been living independently, but is showing signs of dementia, and has been doing things that put themselves or others at risk of harm. Examples include leaving the stove burners on, locking themselves out of their home, wandering out of their home and getting lost, and mixing-up their medications. Other times a senior will have a behavioral disturbance, such as striking out at care center staff and fellow residents, and a guardian is needed to consent to psychiatric medical treatment and consent to placement in a secure care facility.
When Should You Refer to an Elder Law Attorney for Medicaid Planning ?
Elder Law attorneys help older people and their families with all of the legal consequences of aging. These consequences tend to fall into three categories: surrogate decision making for finances and health care; estate planning; and long-term care cost planning. We use powers of attorney for finances and advance directives for health care, wills and trusts, and a variety of strategies to help people get and pay for good care. When an older person lacks the ability to pay for care over their life expectancy using private savings or long-term care insurance, an elder law attorney will advise him or her on qualifying for long-term care assistance through the Medicaid program.
Tuesday, August 18, 2009
Understanding Life Sustaining Measures
There was an excellent show on NPR's Talk of the Nation on End of Life Decisions and the Health Care Bill on 8-10-09. You can listen to it here: http://www.npr.org/templates/rundowns/rundown.php?prgId=5&prgDate=8-10-2009
You have decided to follow your doctor’s advice and complete an Advance Directive for Health Care thus providing a clear understanding of your wishes as they relate to life sustaining measures. You understand the significance of having an Advance Directive, but as you research the process, you are confronted with a lack of understanding regarding what life sustaining measures encompass.
You have decided to follow your doctor’s advice and complete an Advance Directive for Health Care thus providing a clear understanding of your wishes as they relate to life sustaining measures. You understand the significance of having an Advance Directive, but as you research the process, you are confronted with a lack of understanding regarding what life sustaining measures encompass.
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