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Tag: Health care proxy

  • Older adults living alone need not plan ahead alone

    Older adults living alone need not plan ahead alone

    Who would pay your bills or oversee your health care if you were unable to do so? Who has access to your bank account? Do you have a plan? Resources and programs abound to help older adults living alone plan ahead.

    Posts on Just Care USA, like this one, this one and this one, help you understand what you need to do to plan ahead. You can also join a group program that helps you organize your financial, health and insurance information in collaboration with others.

    Judith Graham writes for KFF Health News that Dorot, a NYC nonprofit organization, offers a free course for older adults across the US called Aging Alone Together. There are also many Facebook and in-person groups, as well as printed materials.

    According to AARP, more than three in ten people over 50 live alone without children, or without children they can depend on for assistance. In some cases, their children are estranged from them. In other cases, they don’t believe their children can handle their health and financial matters.

    A range of resources enable older adults living alone to feel less isolated and engage with others. Often having others to speak with about planning for the future makes the difference between an older adult planning ahead and not planning ahead. It’s easy to delay action if no one is expecting you to act.

    The Dorot program involves six sessions over a total of nine hours. Each session is interactive and helps people prioritize their desires when they are unable to help themselves. The sessions focus on helping people build social supports, consider housing options, complete advance directions, such as living wills and health care proxies, and organize financial and legal matters.

    To learn more about Aging Alone Together, email [email protected] or visit the Dorot website.

    Here’s more from Just Care:

  • Plan ahead: Who will pay your bills if you cannot

    Plan ahead: Who will pay your bills if you cannot

    If you’re like most people, you are going through life doing your best to manage your bills, without thinking about who will pay them on your behalf if you are not able to. But, the last thing you want on top of the medical bills you’ll accrue if you are hospitalized or need rehab care is a collection agency coming after you. So, it’s wise to plan ahead, get your affairs in order, and appoint someone you trust to pay those bills through a durable power of attorney.

    A durable power of attorney is a legal document that allows you to name someone to help with your financial affairs whenever you would like, including if you become unable to handle them yourself. The person you name should be someone you trust with your finances, someone who could make decisions about your finances if need be. That person also could be your health care proxy or health care buddy.

    Why should you give someone a durable power of attorney? Giving someone you trust a durable power of attorney should give you peace of mind that your affairs will be taken care as you would like, if you cannot take care of them. Without a durable power of attorney, the person you would want to handle your financial affairs would have to go through an expensive and lengthy court proceeding to make these decisions. Moreover, without the durable power of attorney, a judge might appoint someone you do not trust to handle your affairs.

    How long does a durable power of attorney last? The durable power of attorney lasts until you die or until you change it.

    What is the difference between a durable power of attorney and a power of attorney? If you give someone a power of attorney rather than a durable power of attorney, then the person you designate only has authority over whatever financial matters you specify until you become mentally incompetent. But, if you choose, you can make the power of attorney document a durable power of attorney. You need only include language in the power of attorney that specifies that the person you designate has authority if you become mentally incompetent. Unless you make the power of attorney a durable power of attorney, the person you designate cannot handle your financial affairs if you become mentally incompetent.

    Who should have a copy of your durable power of attorney? You should give a copy of the durable power of attorney to all financial institutions at which you have accounts. And, you should give a copy to the person you name to have your durable power of attorney or, at the very least, let that person know he or she has that authority and where to find the document if needed.

    If I give someone a durable power of attorney, will that person be able to take money from my bank accounts? Yes. The person you name as having durable power of attorney, your financial agent, will be able to take care of your financial affairs using your bank accounts if you give the person that authority. But, this agent does not own the money in your accounts and may not take money from your accounts for himself or herself.

    What should I discuss with the person I name as having durable power of attorney?  You should let your agent know about all institutions with which you have financial arrangements, including your banks, credit card companies, financial advisors and insurance companies.

    Can I cancel my durable power of attorney? You can cancel or change your durable power of attorney at any time by destroying it and notifying the financial institutions at which you have accounts that you have destroyed it or changed it.

    Is there anything more I need to do? Yes! You should be sure to let the person to whom you give your durable power of attorney know and you might want to let other people you trust know that this person has durable power of attorney. You also need to let your bank know about your durable power of attorney. You also need to pull together a list of the bills you pay, your checking account information, and other information needed to make sure your bills are paid and have that available to the person to whom you give your durable power of attorney. Click here for a checklist.

    Here’s more from Just Care:

  • When you cannot act for yourself, have you made your wishes clear?

    When you cannot act for yourself, have you made your wishes clear?

    Planning ahead for the unexpected should include having a written will, living will, durable power of attorney and a health care proxy. All of these documents will help ensure that your wishes are honored when you cannot act for yourself.

    More than one in three people over 60 do not have a will. If you are among them, you should consider engaging an attorney to prepare one for you or writing one on your own. There are many online tools that can help, if you decide to prepare your will without the aid of an attorney. You can find a Just Care post on how to make your own will here. If you already have a will, you should check it periodically to make sure that it’s up to date.

    If you have a will, you will need an executor. The executor is the person who oversees the execution of your will,  taking care of your property, paying any debts you may have, and distributing your assets as you have detailed in your will. The executor is usually a close family member or friend.

    You also want to identify someone to whom you give durable power of attorney and put that in writing. The durable power of attorney gives a person you trust control over your finances and anything else you’d like–to the extent you desire–if you are not able to act on your own behalf. So, for example, if you are unable to pay your bills, the person to whom you give durable power of attorney would be able to do so on your behalf.

    Your health care proxy and living will collectively are the two parts of what is called your advance directive. Your health care proxy is someone you trust to act on your behalf and express your wishes in a medical emergency, if you cannot speak for yourself. For example, do you want to be kept alive on a ventilator or not if your brain is no longer functioning? You can download a health care proxy form online here. A living will states your wishes about your health care if you cannot speak for yourself,

    Keep your will, health care proxy, living will and durable power of attorney documents in a safe place. And, make sure that someone you trust knows where you keep them. You should also make copies to share with your loved ones.

    It’s generally advisable to talk to the people you love and trust about your wishes. You might want to tell them who you’ve named as your executor and health care proxy, as well as who has durable power of attorney. They can be the same or different people.

    Here’s more from Just Care:

  • What’s a durable power of attorney?

    What’s a durable power of attorney?

    A durable power of attorney is a legal document that allows you to name someone to help with your financial affairs whenever you would like and if you become unable to handle them yourself. The person you name should be someone you trust with your finances, someone who could make decisions about your finances if need be. That person also could be your health care proxy or health care buddy.

    Why should you give someone a durable power of attorney? First and foremost, giving someone you trust a durable power of attorney should give you peace of mind that your affairs will be taken care as you would like, if you cannot take care of them. Otherwise, the person you would want to have the durable power of attorney would have to go through an expensive and lengthy court proceeding to make these decisions. Moreover, without the durable power of attorney, a judge might appoint someone you do not trust to handle your affairs. The durable power of attorney lasts until you die.

    What is the difference between a durable power of attorney and a power of attorney? If you simply give someone a power of attorney, then the person you designate only has authority over whatever financial matters you specify until you become mentally incompetent. But, if you choose, you can make the power of attorney document a durable power of attorney. You need only include language in the power of attorney that specifies that the person you designate has authority if you become mentally incompetent. Unless you make the power of attorney a durable power of attorney, the person you designate cannot handle your financial affairs after you become mentally incompetent.

    Who should have a copy of your durable power of attorney? You should give a copy of the durable power of attorney to all financial institutions at which you have accounts.

    If I give someone a durable power of attorney, will that person be able to take money from my bank accounts? Yes. The person you name as having durable power of attorney, your financial agent, will be able to take care of your financial affairs using your bank accounts if you give them that authority. But, this agent does not own the money in your accounts and may not take money from your accounts for himself or herself.

    What should I discuss with the person I name as having durable power of attorney?  You should let your agent know about all institutions with which you have financial arrangements, including your banks, credit card companies, financial advisors and insurance companies.

    Can I change or cancel the durable power of attorney? Yes. You can cancel or change your durable power of attorney at any time by destroying it and notifying the financial institutions at which you have accounts that you have destroyed it or changed it.

    [Note: This post was originally published on March 28, 2018.]

    Here’s more from Just Care:

  • HIPAA and why you need a health care proxy

    HIPAA and why you need a health care proxy

    In 1996, more than 25 years ago, Congress enacted the Health Insurance Portability and Accountability Act, which aims to safeguard people’s private health care information. Keeping people’s health care information private is important. But, HIPAA sometimes also keeps doctors and hospitals from sharing key information with you about the people you love. HIPAA provides all the more reason everyone should have a health care proxy–someone you designate, whom you trust, who can speak for you and ensure your wishes are honored, when you cannot speak for yourself.

    Without a health care proxy (sometimes called a “medical power of attorney” or an “advance directive,”) your family has only limited rights to make health care decisions on your behalf. And, at times, doctors and other care providers are not aware of these rights or misunderstand them, preventing your family from making needed decisions. Stories abound of family members not able to get information from the doctor about a loved one’s condition because of HIPAA. HIPAA does not keep this information from being shared in many cases, but doctors and hospitals often misapply it.

    For your own peace of mind, make sure you and the people you love have signed health care proxies. They are state-specific. You can download them free here. With a signed health care proxy, you know that someone you trust can speak on your behalf if you’re hospitalized and unable to speak for yourself. Without a health care proxy, that person may not be able to help you at all.

    Ideally, you should give a copy of your health care proxy to the person you have designated as your proxy as well as to your doctor. If you don’t share it with the person, make sure your health care proxy knows where to locate it in your home. It’s of no use if your proxy does not have a record of it. For more reasons why health care proxies are so important, click here.

    What does HIPAA allow? HIPAA does allow doctors and other care providers to disclose a person’s health information to family members or close friends when in their professional judgment it’s in the best interest of the patient. And HIPAA only applies to care providers, health insurers and health data collectors, not clubs or churches or other organizations. So an assisted living institution or nursing home can let people know about the condition of their loved one.

    Updated from September 23, 2015 and December 31, 2018.

    Here’s more from Just Care:

  • Roundup: Planning for life’s curve balls

    Roundup: Planning for life’s curve balls

    Life happens. Tomorrow, who knows what will be. At some point down the road, we are all likely to need assistance caring for ourselves. It’s wise to be prepared for life’s curve balls. Here’s a roundup of things to think about and some of the ways you might plan ahead.

    Paperwork

    Medical help

    Care

    End-0f-life choices, funerals and stuff:

  • VSED, an end-of-life choice

    VSED, an end-of-life choice

    When it comes to health care, there seem to be fewer and fewer things that the US health care system gets right. End-of-life matters are no exception, with hospitals generally keeping people alive, even when they have asked to die, and forcing their loved ones to suffer through their slow passing. For this reason, Kevyn Burger reports for Next Avenue that more people are taking their deaths at the end of their lives into their own hands through voluntarily stopping eating and drinking or VSED.

    One way people help ensure a peaceful death is through electing hospice care.  Medicare covers hospice care, usually at home, for people believed to have six months or less to live. Hospice care focuses on easing pain and providing social and emotional supports for patients and their families, To learn more about the hospice benefit, click here.

    At the end of their lives, some people choose to speed up their death by forgoing food and drink, an age-old process. This choice is called “voluntary stopping eating and drinking” or VSED. People typically die in 10 days.

    Three quarters of Americans favor medical assistance in dying. Ten states–California, Colorado, Hawaii, Montana, Maine, New Jersey, New Mexico, Oregon, Vermont, and Washington—and Washington DC permit it. In these places, patients with six months or less to live can ask their doctors for medicines that allow them to die in their sleep. But, in other states, where this is not an option, VSED is an option.

    You need assistance with VSED to ensure your pain and other symptoms are well managed. Medicines should be available to you. It’s best for patients who are in very poor health to understand the process and be committed to it. Even with help from a doctor, it is not considered assisted suicide. But, a family member who helps with VSED should have written authority through a health care proxy document or durable medical power of attorney that he or she is carrying out the patient’s wishes if the patient cannot speak for himself or herself.

    A new book! “Voluntarily Stopping Eating and Drinking, A Compassionate, Widely-Available Option for Hastening Death” explains the process, including practical and ethical details.  It also provides case examples.

    On day one, patients can engage with their loved ones and say good goodbye. With no food or drink, they get weaker and are less able to engage. With no liquids, their organs fail. Quite quickly, they tend not to be hungry but they are thirsty. Water will extend life, so generally mists and swabs of the patient’s mouth are the treatment.

    With VSED, it’s common for patients to become delirious and agitated right before death. They are often given tranquilizers and anti-anxiety medicines.  Then, their heart stops, and they stop breathing.

    Here’s more from Just Care:

  • More people benefiting from Medicare coverage of advance care planning

    More people benefiting from Medicare coverage of advance care planning

    A new report in Health Affairs reveals that substantially more people with Medicare are benefiting from Medicare’s coverage of advance care planning during a Medicare annual wellness visit, but it’s still just a small percentage of the people who could. The advance care planning benefit, which has been available for only five years, is designed to provide people with help from their doctors in deciding their end-of-life wishes. It helps you plan ahead.

    For background, Medicare covers the full cost of an annual wellness visit whether you are enrolled in traditional Medicare or a Medicare Advantage plan. During the visit, you can discuss your medical history with your doctor and any health risks. Your doctor might conduct a depression screening, assess your ability to care for yourself and provide you with any preventive care services that you need.

    You can also discuss your health wishes with your doctor should you not be able to speak for yourself, at no cost to you. This advance care planning helps ensure that you get the care you want later in life and the people you love are best able to respect your wishes. Who would you want to make decisions on your behalf? That person is your health care proxy. What instructions would you give the person with regard to life-sustaining treatment? This is a living will.

    Whether you are enrolled in traditional Medicare or a Medicare Advantage plan, Medicare covers the full cost of advance care planning during an annual wellness visit. The visit is different from a physical, which Medicare does not cover.

    The researchers found that only about one in 12 people with Medicare took advantage of the annual wellness visit to do advance care planning. More people should do so in order to discuss their wishes should they become seriously ill and unable to express their wishes.

    Your doctor also can help with advance care planning during other types of outpatient visits and still bill Medicare for it. But, if done outside of the annual wellness visit, it could cost you more. You or your supplemental coverage is responsible for the 20 percent coinsurance if you’re enrolled in traditional Medicare or a copay if you’re enrolled in a Medicare Advantage plan.

    Here’s more from Just Care:

  • Coronavirus: Planning ahead for a medical emergency

    Coronavirus: Planning ahead for a medical emergency

    The novel coronavirus pandemic led many more Americans to buy life insurance in 2020 than in the past. Even younger adults have a fear that they could die at any time. You might not need life insurance, but if you have not yet done so, it might be time to plan ahead for a medical emergency: designate a health care proxy, prepare or revisit your will, do some estate planning and otherwise put your affairs in order. Here’s what you might want to think about:

    • A living will and health care proxy: These “advance directives” let your loved ones know your health care wishes if you are unable to express them yourself. The living will states your wishes about your health care if you cannot speak for yourself and your health care proxy is someone you name to act on your behalf regarding your medical treatment if you are unable to speak for yourself. Completing these advance directives and sharing them with the people you love helps bring your family together and provides comfort to them that they are following your wishes should they need to act on your behalf. A signed advance directive for your state is a legal document that doctors and hospitals must honor. The advance directive also ensures that the people you love can make decisions on your behalf.  Without a health care proxy, if you became unable to care for yourself, it is possible that the state would appoint a legal guardian, unknown to you, to act on your behalf. To get a free advance directive for your state, click here.
    • A durable power of attorney: A durable power of attorney is a legal document that allows you to name someone to help with your financial affairs whenever you would like and if you become unable to handle them yourself. The person you name should be someone you trust with your finances, someone who could make decisions about your finances if need be. That person also could be your health care proxy. Completing a durable power of attorney and sharing it with the person whom you name to handle your affairs should provide comfort to the people you love. You should also share it with all financial institutions with which you have accounts.
    • Long-term care insurance: If you don’t have it, no worries. It’s likely not worth having. The cost of the policy is generally very high relative to the benefits. For most people with means, it’s better to put aside money to pay for long-term services and supports, such as home care and nursing home care.
    • Your stuff: You might want to set aside time to go through your possessions with your loved ones. Yes, it can be stressful, conjuring up all kinds of feelings and emotions; your children may not want the items you hoped they would take, even if you give these items special meaning and importance. And, it can cause conflicts among siblings if you want one child to have something another child values. But, going through your possessions with your loved ones also can be comforting. Your family can feel good that there’s a plan in place for your things and that you support it.
    • In case of emergency: Create a file with:
      • A list of your family members, friends and neighbors and their contact information
      • A list of important medical, business, financial and legal contacts, including your doctors, bankers, lawyers, as well as the names of your health and life insurance companies and their contact informaiton
      • Your will, your health care proxy, living will, durable power of attorney and other legal documents
      • Your most recent tax return
      • Your car title and deed to you house, if you own it
      • Copies of your Medicare and Social Security cards, as well as other insurance cards, including supplemental coverage and life insurance, as well as policy numbers and contact information
      • Your medical records and a list of all your medications
      • Mortgage or rent information, as well as utilities information
      • Digital account information, including passwords
      • Information with provisions you have made for your pets, your funeral and other matters of importance to you

    Here’s more from Just Care:

  • Coronavirus: The importance of health care proxies

    Coronavirus: The importance of health care proxies

    Sadly, the novel coronavirus is wreaking havoc on the lives of older adults. Many more older adults are becoming very ill and dying from COVID-19 than younger people. Now, more than ever, it’s important to have advance directives–health care proxies and living wills–which make clear your health care treatment wishes if you cannot speak for yourself. If you’re diagnosed with COVID-19, you are likely to be better off if you have thought through the end-of-life care you want.

    No matter how old you are, it is always helpful to have designated someone to speak for you if there comes a time when you cannot speak for yourself. This person is your health care proxy. It is equally important for your peace of mind and your loved ones’ to talk about your health care wishes.

    Right now, many people are infected with or at risk of being infected with COVID-19 and dying, but anyone can get hit by a car or come down with a life-threatening illness at any time. Through a health care proxy, you can help ensure that you get the care you want. Palliative care–care that is comforting, that eases pain and improves quality of life for patients, involves no aggressive interventions. Curative care is intended to extend patients’ lives through aggressive interventions. The decision between palliative and curative care can take time, so it’s good to plan in advance and talk the decision through with the people you love.

    N.B. Medicare covers the cost of speaking with your doctor about your end-of-life wishes as part of the annual wellness benefit.

    Having a health care proxy is all the more important during a pandemic. Patients with COVID-19 tend to be socially isolated from their families. They generally cannot meet in person with their doctors. They need to have difficult conversations and understand their chance of living. Without a health care proxy, they might need to make rushed decisions about the care they want in the most stressful of situations.

    Hospitals often will help a person make end-of-life decisions on intake. But, in the midst of this health care pandemic, hospitals might not be able to. In some cases, hospitals will simply ask patients whether they want life support. Without understanding the benefits and risks or having the time to consider them, it can be hard to make good decisions. People might not understand that a decision to elect life support could mean two weeks alone on a ventilator, apart from your kids and grandkids, and then death.

    The choice of palliative care in the case of COVID-19 should mean that the palliative care provider is in touch with the patient’s kids and grandkids, keeping them apprised of the patient’s health. Patients are comfortable and will not go to the ICU or get put on a ventilator. Instead, patients might be able to spend time with their loved ones.

    Here’s more from Just Care: