One phone call.
“… cancer.” “… accident.” “… broken hip.” “… had a stroke.” “… had a heart attack.”
“We regret to inform you…”
One phone call can change everything in the blink of an eye.
We had that “one phone call” a few weeks ago, hence, the recent lack of postings. Though the situation is not one of the above examples, nor is it an emergency situation, it is and will be one we will have to deal with for quite some time.
And since that phone call, we have learned a few things as we prepare for future decisions that we hope to share with you to help you practically prepare for the inevitable day you receive your “one phone call.”
For the record, this is not meant to be a fear-mongering post. I know Whose I am. I know Who holds my family members. I know Who is in control even when I am not. I know where grace, peace, and comfort come from. I know that all things work together for good to God’s glory… even when I cannot possibly see how in the present.
Facing difficult situations is much easier to do if you have planned. However, things do not always work out the way we plan, or rather, how we hope. All of this requires hard conversations with spouses, with adult children, with parents.
As parents, we have tried to make sure that we have thought ahead regarding the care of our son should the worst case scenario happen. When he was under the age of 18 we made sure that wills were in place for his protection. In planning, we learned that each state has different laws regarding the care of a minor child should both parents die. Each time we moved to a different state we made sure that the wills were up to date for the state in which we lived. Financial considerations had to be made. Custody decisions had to be made. No, it was not fun to be thinking about these things in our 20’s and 30’s but for the sake of our son, and to ensure that he was going to be cared for by the people we wanted to influence his life if we were no longer here, it had to be done.
As we have gotten older, we also realize that there are no sure things regarding our health. Despite the fact that we both had great-grandparents and grandparents live into their late 90’s, we are not guaranteed the health that they had which allowed them to remain in their own homes until almost the very end. Long term care insurance is an option and can cover home health care up to and including complete facility care depending on the policy. The ages of those purchasing long term care insurance is typically between 45 and 55. The younger you are the lower the payments. Those older can purchase this type of insurance, however, it may be more difficult and more expensive than it is for someone a decade or two younger.
Oh, Melissa, this is so morbid!
I used to think that, too. But, in fact, it is one of the most loving things we can do for our families. The last thing we want our son to do is to worry how to pay for our care or how to make decisions should we not be able to. We want to alleviate that burden from his shoulders.
Children are typically the ones to care for their ill and aging parents. But, the reality is, for some families, that simply is not an option. If you are able to care for your ill and aging parents, GREAT! However, be careful before you pass judgment on those who have to make different, difficult, and alternative decisions. To paraphrase a popular saying: Walk a mile in their shoes first before judging.
In the past, life insurance, retirement accounts, standard wills, and pre-paid funerals seemed to be all that was needed to prepare for the end of life. Although still necessary, it is simply not enough. Laws have changed. Healthcare has changed. Legal documents are now recommended to ensure that our wishes are carried out as well as for the protection of the one who is ill or incapacitated. Regardless of the age of the individual, when faced with a long term illness or a family member who is relatively healthy yet cannot make decisions for themselves due to dementia, Alzheimer’s, or mental disorders, there are many things to consider to ensure they are cared for.
An advanced healthcare directive is more than a simple form explaining your medical desires for treatment. Carefully research what treatment options you wish to have in the event you are incapacitated, particularly if suffering from a chronic or deteriorating illness. Discuss with your doctors all your treatment options so that you can make informed decisions. This form will also list who is to make medical decisions on your behalf if you are unable to. The advanced healthcare directive is the most important form a patient can have to ensure they receive the treatment options they desire. Once established, ensure that each of your doctors has a copy in your files and will carry out your wishes. If they are uncomfortable doing so, you may need to find a new doctor.
A healthcare power of attorney is in addition to the advanced healthcare directive. The healthcare power of attorney designates the individual (agent) who will make healthcare decisions on your behalf should you become incapacitated. The individual you name should be very familiar with your desires up to retaining your advanced healthcare directive, a do not resuscitate order (DNR), or your physician orders of life sustaining treatment (POLST) to be handed over to the hospital or treatment facility should it become necessary.
The following two medical forms can be considered controversial for many. I list them because they are something that each individual needs to research and to decide for themselves. Personally, I have yet to decide how I feel about these documents. I will say that for the most part I do not believe they are necessary for every individual, but they might be considered by those who suffer from a deteriorating or terminal illness. These forms do not promote euthanasia. However, they do help an individual having to make end of life decisions make ones they believe are in their best interests and provide them with dignity in their final days. (Again, walk a mile.)
For those who do not wish resuscitation measures taken on their behalf by medical personnel you may wish to have in place a do not resuscitate order (DNR). It is important that the document expresses your desires. Once enacted medical personnel will enforce it. If you are uncomfortable with this form, please note that it is not required.
An alternate form to consider is a physician orders for life sustaining treatment (POLST). It may also be known as other names in various states. This order allows you to specify your desires regarding hydration and nutrition, comfort measures, and resuscitation. This form is also not required. For both of these orders it is imperative that you fully understand the implications of the documents. Once these orders are enacted medical personnel will no long consult with you or your designated agent. Therefore, your desires should be very clearly expressed.
At the very least, a long, difficult talk should be had with family members before decisions must be made so that your wishes regarding medical care will be followed. Often, especially in an emergency situation, emotions will take over decision making. Ensuring that multiple family members understand your desires will help to keep everyone calm and to follow your instructions.
A power of attorney is not the same as a healthcare power of attorney. The power of attorney allows an individual (principal) to designate someone (agent) to manage finances and assets, and to make other decisions should the individual become incapacitated. The power of attorney should also indicate successor(s) in the event the originally named agent is unable or unwilling to serve. The document should also be written to be “durable” in that it will be valid even when the individual is incapacitated and no longer able to make decisions.
A living will is a type of advance directive. It may provide instructions on how to be treated medically. The living will becomes active when a doctor declares that someone is no longer able to make decisions for themselves. The type of living will needed varies from state to state; therefore, it is wise to research what is needed for you. A living will may also be drafted by an attorney.
A standard will is something that most of us are familiar with. A standard will establishes an executor(s) who will ensure that your final wishes are met. A standard will also establishes beneficiaries of the estate. The will can be as specific as one desires it to be. If there are minor children in the home, a standard will should designate who will become the guardian of the child(ren). A standard will only goes into effect upon the death of the individual.
A living trust is another means by which an individual (trustee) can manage his or her property. It is usually established by the individual and should also include a successor(s) in the event the individual trustee is unable to continue to manage the trust. Typically, all assets (bank and retirement accounts, property, etc.) are transferred to the trust in order to be managed efficiently. Depending on the state, a trust may help to avoid probate in the event of the death of the individual.
Guardianship, or conservatorship, may become necessary in the event the family member can no longer make their own financial or health care decisions. This is a court appointed position. It is not a common practice and typically occurs when family members disagree on the care of the one who has become incapacitated. The process varies by state and provides both the individual as well as other family members the option to object. The court must first determine that the individual is legally incapacitated. At that point, the court may appoint a guardian for the individual to make decisions regarding the person’s care and custody.
This information is not meant to be legal or medical advice by any means. We simply have provided information we have discovered as we plan for future difficult decisions. Will we need all of these items? Probably not. However, there is much more needed today than there was even 15 years ago. Details of what is needed, how to proceed, and options available vary from state to state. Elder care associations have a wealth of information to help in making plans. It would be wise to seek the counsel of a lawyer familiar with end of life decisions to assist you with any forms or needs that you may have in planning.
No two family situations will be the same. Each individual and family needs to have these difficult discussions in order to determine what each person’s wishes are. Unfortunately, we have seen far too many families split apart in disagreement at a time when they need to be drawn together simply because the hard talks never took place. Additionally, we have seen many go through financial ruin because they did not have their assets set up to be managed in their best interests. As stated previously, these difficult discussions and decisions are the most loving acts you can do for your family.
Don’t delay. Start talking.