Living Will

What Is an Advance Directive, and Why You Need This Document?

The coronavirus pandemic has had an impact on the entire world. No wonder—it’s a frightening disease that experts are just beginning to understand. Many of us are asking ourselves: Am I ready for a worst-case scenario? Anyone who does not have the health care portion of their estate plan in order, needs to address it now, says the timely article “COVID-19 crisis highlights the importance of completing advance directives” from Cincinnati.com.

The topic of an advance directive used to be introduced with a question about what would happen if a person were in a car accident, rushed to the hospital and unable to convey their wishes for care.  The question has now become, what if a sudden onset of COVID-19 occurred, and you were unable to speak on your own behalf? Would your loved ones know what you would want, or would they have to guess?

All adults—that is, anyone over the age of 18—should have an advance directive. The process of creating this and other health care-related estate planning documents will provide the answers to your loved ones, while helping you work through your wishes. Here’s how to start:

What matters to you? Give this considerable thought. What is important to you, who best knows and understands you and who would you trust to make critical decisions on your behalf, in the event of a medical emergency? What medical treatment would you want—or not want—and who can you count on to carry out your wishes?

Get documents in order, so your wishes are carried out. Your estate planning attorney can help you draft and execute the documents you need, so you can be confident that they will be treated as legitimate by health care providers. The estate planning lawyer will know how to execute the documents, so they are in compliance with your state’s laws. Here’s what you’ll want:

  • A living will, which records your wishes for end of life medical treatment, if you cannot speak on your own behalf.
  • Medical power of attorney, to designate a person to make health care decisions, when you are not able to do so. The person is referred to as an agent, surrogate or proxy.
  • A HIPAA release form, so the person you designate can receive and review information about your condition with your medical care providers.

Note that none of these documents concerns distribution of your personal property and assets. For that, you’ll want a will or revocable living trust, which your estate planning attorney can also prepare for you.

Talk to loved ones now. Consider this conversation a gift to them. This relieves them from a lifetime of wondering if they did the right thing for you. Have a forthright conversation with them, let them know about the documents you have have prepared, where to find them and what your wishes are.

Reference: Cincinnati.com (April 27, 2020) “COVID-19 crisis highlights the importance of completing advance directives”

Preparing for Coronavirus: The #1 Legal Document Every Adult Needs to Have

As the coronavirus continues to disrupt daily life and leave Americans uncertain of the future, you don’t have to feel helpless during this pandemic. In fact, now is a great time to be proactive and plan ahead should you or a loved one fall ill. One of the most important and relatively easy things you can do (and should do) is to select a healthcare surrogate and set up your advance healthcare directive.

What Is a Healthcare Surrogate?

A healthcare surrogate (also called a healthcare agent, medical agent, a healthcare proxy, or a medical proxy) is a person you authorize in a medical power of attorney to make decisions about your medical care if you are too ill to make them yourself or are otherwise unable to communicate your wishes with your healthcare providers.

Why is it important to choose a healthcare surrogate now?

As of April 7, there are 391,665 total cases of coronavirus. Of those, only 9,169 are in critical condition (about 2.34%). So even if you get sick, you’ll most likely have mild symptoms and recover quickly. However, since no one knows exactly how they will be affected by the virus, it’s best to plan for the worst and hope for the best. Part of that planning is making sure someone can make healthcare decisions for you if you fall ill and are unable to make those decisions for yourself.

Factors to Consider in Choosing Your Healthcare Surrogate

A healthcare surrogate is an important role, and the person you choose will have the power to make critical healthcare decisions—like consenting to a treatment plan, whether to accept or refuse medical treatment, and which healthcare providers or hospitals to use for your care. As a result, it is crucial to think carefully about who you choose to fill this role. Many people simply assume that their spouse or their oldest child should take on this role, but they are not always the best suited. Here are some factors to consider when selecting an agent:

Emotional maturity. People handle stress differently, and not everyone is able to set aside their emotions and make level-headed decisions when someone they love is suffering. In addition, some people are simply not assertive enough to act as a strong advocate in the face of differing opinions of other family members–or even health care providers–who suggest a treatment plan you have informed your medical agent you do not want. You should choose someone who is able to think rationally in emotionally difficult circumstances, even if that means you must look outside of your family to find the best person for the job.

Is willing/able to serve. Acting as a healthcare surrogate can be a time-consuming and emotionally draining job. Make sure that the person you choose is willing and able to set aside the time necessary to serve as your patient advocate. Don’t just assume the person you want to be your medical agent is willing: Be proactive and ask if he or she is willing to take on that role. Keep in mind that if you are elderly, you may want to avoid naming a friend or family member who also is older, as there is a greater chance that they will experience mental or physical decline at the same time as you, which could impede their ability to serve as your advocate when the time comes.

Will honor your wishes no matter what. Your healthcare surrogate has a duty to make decisions on your behalf that you would have made to the extent that he or she is aware of your wishes. This is the case even if your healthcare surrogate disagrees with your choices. As a result, your healthcare surrogate should be someone who is willing to set aside his or her own opinions and wishes to carry out yours. It may be prudent to appoint someone who has values and religious beliefs that are similar to yours to reduce the instances in which your surrogate’s opinions differ significantly from yours. Do not choose anyone that you do not trust to carry out your wishes.

People You Should Not Choose

Many states have laws prohibiting certain people from acting as your healthcare surrogate, even if they are otherwise well-qualified to act in that role:

Minors. Many states have laws expressly prohibiting a minor from being a patient advocate. The age of majority could be 18, 19, or 21 years of age, depending upon the state. Some states have exceptions to this prohibition for married or emancipated minors.

Your health care providers. Some states not only prohibit your health care providers from acting as your healthcare surrogate, but also preclude the owner, operator, or any employee of any facility in which you are a patient or resident from acting in that role. Some states that have adopted this prohibition make an exception for individuals who are related to you. A few states, such as Kansas, Missouri, and Kentucky, also have an exception if that person is an active member of the same religious organization as you.

Need help?

Medical directives may be among the most important legal documents you prepare – especially in light of COVID-19. Picking a healthcare surrogate can be tricky and we can help you think through your choice. We can also help with any other estate planning needs you may have—whether that’s setting up a financial power of attorney, last will and testament, or a trust. Please give us a call today to discuss how we can help you and your family be prepared should you fall ill from the coronavirus.

Requests for Estate Plans Reflect Fears about Coronavirus

Estate planning lawyers have always known that estate planning is not about “if,” but about “when.” The current health pandemic has given many people a wake-up call. They realize there’s no time to procrastinate, reports the article “Surge on wills: Fearing death by coronavirus, people ask lawyers to write their last wishes” from InsuranceNews.net. Legal professionals urge everyone, not just the elderly or the wealthy, to put their end-of-life plans in writing.

The last time estate planning attorneys saw this type of surge was in 2012, when wealthy people were worried that Congress was about to lower the threshold of the estate tax. Today, everyone is worried.

Top priorities are creating a living will stating your wishes if you become incapacitated, designating a surrogate or a proxy to make medical decisions on your behalf and granting power of attorney to someone who can make legal and financial decisions.

An estate plan, including a last will and testament (and often trusts) that detail what you want to happen to assets and who will be guardian to minor children upon your death, spares your family legal costs, family disagreements and hours in court that can result when there is no estate plan.

The coronavirus has created a new problem for families. In the past, a health care surrogate would be in the hospital with you, talking to healthcare providers and making decisions on your behalf. However, now there are no visitors allowed in hospitals and patients are completely isolated. Estate planning attorneys are recommending that specific language be added to any end of life documents that authorize a surrogate to give instructions by phone, email or during an online conference.

Any prior documents that may have prohibited intubation need to be revised, since intubation is part of treatment for COVID-19 and not necessarily just an end-of-life stage.

Attorneys are finding ways to ensure that documents are properly witnessed and signed. In some states, remote signings are being permitted, while other states, Florida in particular, still require two in-person witnesses, when a will or other estate planning documents are being signed.

There are many stories of people who have put off having their wills prepared, figuring out succession plans that usually take years to plan and people coming to terms with what they want to happen to their assets.

Equally concerning are seniors in nursing homes who have not reviewed their wills in many years and are not able to make changes now. Older adults and relatives are struggling with awkward and urgent circumstances, when they are confined to nursing homes or senior communities with no visitors.

Reference: InsuranceNews.net (April 3, 2020) “Surge on wills: Fearing death by coronavirus, people ask lawyers to write their last wishes”

Planning for Long-Term Care

Starting to plan for elder care should happen when you are in your 50s or 60s. By the time you are 70, it may be too late. With the median annual cost of a private room in a nursing facility coming in at more than $100,000, not having a plan can become one of the most expensive mistakes of your financial life. The article “Four steps you can take to safeguard your retirement savings from this risk” from CNBC says that even if care is provided in your own home, the annual median cost of in-home skilled nursing is $87.50 per visit.

There are fewer and fewer insurance companies that offer long-term care insurance policies, and even with a policy, there are many out-of-pocket expenses that also have to be paid. People often fail to prepare for the indirect cost of caregiving, which primarily impacts women who are taking care of older, infirm spouses and aging parents.

The best time to start planning for the later years is around age 60. That’s when most people have experienced their parent’s aging and understand that planning and conversations with loved ones need to take place.

Living Transitions. Do you want to remain at home as long as is practicable, or would you rather move to a continuing care retirement community? If you are planning on aging in place in your home, what changes will need to be made to your home to ensure that you can live there safely? How will you protect yourself from loneliness, if you plan on staying at home?

Driving Transitions. Knowing when to turn in your car keys is a big issue for seniors. How will you get around, if and when you are no longer able to drive safely? What transportation alternatives are there in your community?

Financial Caretaking. Cognitive decline can start as early as age 53, leading people to make mistakes that cost them dearly. Forgetting to pay bills, paying some bills twice, or forgetting accounts, are signs that you may need some help with your financial affairs.

Healthcare Transitions. If you don’t already have an advance directive, you need to have one created, as part of your overall estate plan. This provides an opportunity for you to state how you want to receive care, if you are not able to communicate your wishes. Not having this document may mean that you are kept alive on a respirator, when your preference is to be allowed to die naturally. You’ll also need a Health Care Power of Attorney, a person you name to make medical decisions on your behalf when you cannot do so. This person does not have to be a spouse or an adult child—sometimes it’s best to have a trusted friend who you will be sure will follow your directions. Make sure this person is willing to serve, even when your documented wishes may be challenged.

Reference: CNBC (Jan. 31, 2020) “Four steps you can take to safeguard your retirement savings from this risk”

Why A Healthcare Power of Attorney Makes Sense

Having a Healthcare Power of Attorney makes sense.  Having it in place before it is needed is one of the best ideas of estate planning, along with having a Power of Attorney in place before it is needed. Why? This is because taking a pro-active approach to both of these documents, means that when the unexpected occurs and that is exactly how things occur—unexpectedly—the person or persons you have named for these important roles will be able to step in quickly and made decisions.

Having a healthcare power of attorney makes sense
A healthcare power of attorney is an often overlooked, but essential part of any good estate plan.

Time is often of the essence, when these documents are needed.

According to the article “Medical guardianship versus power of attorney” from The News Enterprise, a health care power of attorney is a document that grants another person the power to make medical decisions for you, when you no longer have the ability to make those decisions for yourself. It is known by a few other names, depending on the state where you live: health care proxy, a medical power of attorney or a health care surrogate.

It needs to have HIPAA-compliant language, which will allow the person you name the ability to review medical information and discuss protected health information with your health care providers.

A health care power of attorney may also include language for an advance medical directive, which gives instructions for end-of-life decisions. This is often called a “living will,” and is your legal right to reject medical treatment, decisions about feeding tubes and the number of doctors required to determine the probability of recovery and pain management.

A health care power of attorney does not generally empower another person to make decisions, until you are unable to do so. Unlike a general durable power of attorney, which permits another person to make financial or business decisions with you while you are living, as long as you are able to understand your medical situation, you are still in charge of your medical decisions.

A guardianship is completely different from these documents. A guardian may only be appointed, if a judge or jury finds you wholly or partially disabled in such a way that you cannot manage your own finances or your health. The appointment of a guardian is a big deal. Once someone has been appointed your guardian, you do not have any legal right to make decisions for yourself. A court will also appoint a legal fiduciary, who will make your financial decisions.

There are record-keeping requirements with a guardianship that do not exist for a power of attorney. The court-appointed representative is responsible for reporting to the court any actions that they have taken on your behalf.

To have power of attorney documents executed, the person must be capable of understanding what they are signing. This means that someone receiving a diagnosis of dementia needs to have these documents prepared, as soon as they learn that their capacity will diminish in the near future.

If the documents are not prepared and executed in a timely fashion, a guardianship proceeding may be the only option. Planning in advance is the best way to ensure that the people you trust are the ones making decisions for you. Speak with an experienced estate planning attorney now to have these documents in place.

Reference: The News-Enterprise (Oct. 13, 2019) “Medical guardianship versus power of attorney”

Why Advance Directives are Needed

There are two sad parts to this story that illustrates why advance directives are needed. The first was that the family panicked and had a feeding tube put in, despite their mother’s wishes. The second, says WRAL in the article “Advance directives lift burden of tough decisions at end of life,” was that after the woman died several years later, her family found the advance directive.

Why Advance Directives are Needed
Advance directives are only useful if your family and friends know where you keep them.

Without knowing about a loved one’s wishes for their end-of-life care, it’s hard to honor them. That’s why documentation, like advance directives, are so important. So is telling your family where your important legal documents are.

What is an advance directive?

An advance directive is a broad legal term that can include several different documents, but mostly refers to a Living Will and a Health Care Power of Attorney. These documents give you the ability to express what medical care you want and don’t want.

Cases like the women mentioned above highlight the importance of this kind of document. While her advance directive was misplaced, many people don’t have them at all. These are important to address non-financial end-of-life issues, both for you and for your families.

Most people would prefer not to have life-prolonging measures implemented. Without advance directives, the decision to remove a breathing machine or a heart machine can be even more difficult for a spouse or a child. The burdens are not just emotional.

If there is no decision maker named and family members disagree about what you would have wanted, a battle may break out in the family that results in a court fight.

A few notes on advance directives:

  • They can be created at any time, but most people tend to consider them at midlife or close to retirement.
  • The document can be amended at any time and should be reassessed through the course of your life.
  • One decision maker should be appointed to avoid arguments.
  • A HIPAA release should be included with the advance directives so the decision maker can fully informed of your medical condition by your healthcare providers.

Health care agents, doctors and loved ones should all be provided with copies, and the originals should also be accessible.

Talk with your estate planning attorney about including an advance directive and a health care power of attorney among your estate planning documents. This is a burden that you can make lighter for those you love.

Reference: WRAL (Sep. 18, 2019) “Advance directives lift burden of tough decisions at end of life”

Estate Planning Basics Everyone Should Know

The discomfort most people have with the knowledge of their own mortality makes it challenging for some people to do the estate planning that needs to take place before an emergency occurs. However, according to the Gettysburg Times’ recent article “Essentials necessary for estate planning,” the best course of action is to take care of the estate planning basics now, when there is no urgency. Having detailed plans in place to protect loved ones from possible complications, costs and added stress in the future, is a gift you can give to those you love.

Estate Planning Basics
Taking care of the estate planning basics is a simple but important step for everyone to take.

There are any number of legal documents and strategies used to accommodate the varied situations of life, including family dynamics and asset levels. An estate planning attorney licensed in your state will have the ability to create a plan and the documents that suit your personal situation. The three documents discussed in the following section are generally considered to be the most important for anyone to have.

Power of Attorney or POA—This document gives legal authority to another person or entity, referred to as your “Agent”, to perform certain acts on your behalf, when you cannot do so because of illness, injury or incapacity. There are many different types of POA, from a “full” POA with no limitations, to a “limited” POA that is created solely for a specific purpose. This document comes into action, when you are incapacitated and becomes void upon your death.

Living Will—This is a detailed health care directive that allows you to list your wishes regarding several medical procedures and life-sustaining treatments. These treatments include resuscitations, breathing assistance, feeding tubes and similar medical matters. You want to have this in place to spare your loved ones the emotional anguish of trying to decide what you would have wanted. They’ll know, because you specifically told them in this document.

Last Will and Testament—When prepared correctly, and that includes signed, witnessed, and notarized, a will is used by the “testator” (the person making the will) to provide the legal wishes regarding what should happen to their minor children (if any) and assets upon death.

What happens if you don’t have these documents? It is likely that your loved ones will need to go to court to have someone named as your agent or executor, which is the person who is in charge of your estate. Depending upon the laws of your state, that person may be a family member, or it may end up being a family member who you haven’t spoken to in decades. It is far better to take the time to have these estate planning basics taken care of by an estate planning attorney, so your family is protected, and your wishes are fulfilled.

The best time to do this, is when there is no crisis. Estate plans also require regular monitoring and updating. Life circumstances change, estate and tax laws change, and new opportunities may present themselves. Speak with your estate planning attorney now and create your plan for the future.

Reference: Gettysburg Times (July 27, 2019) “Essentials necessary for estate planning”

Do I Need a Medical Power of Attorney?

A medical power of attorney is a legal document, also called a healthcare power of attorney or durable power of attorney for healthcare. This document lets you designate an agent to make medical decisions on your behalf. This can give you peace of mind, even if you don’t think you’ll need it, says SmartAsset in the recent article “How to Set Up Medical Power of Attorney.”  

Do I need a medical power of attorney
A medical power of attorney allows you to name another person to make medical decisions on your behalf if you can’t speak for yourself.

A medical power of attorney isn’t the same as a living will. A living will is a document that directs what you’d want healthcare professionals to do if you become incapacitated. This could include the implementation of life support and tube feeding, resuscitation attempts and organ donations.

A medical power of attorney doesn’t simply record your wishes as a living will does. It appoints a specific person to make medical decisions for you if you can’t speak for yourself. You might have both a living will and a medical power of attorney. If decisions need to be made about resuscitation and life support, recording those wishes in a living will takes those difficult decisions out of your agent’s hands.

When you’re deciding on someone to serve as your healthcare agent, find a person with whom you’re comfortable talking about your health-related issues.  This person should be your advocate, follow your wishes and make sound decisions—even if family says otherwise.

The Commission on Law and Aging of the American Bar Association advises that you select an agent you truly trust. It also offers some general guidelines for agents that you should probably avoid. The ABA says don’t choose an agent:

  • Who owns a health or residential facility that is in charge of your care;
  • Who’s a spouse or employee of anyone that currently serves you medically, like a doctor or residential facility owner;
  • Whose job it is to medically evaluate you, like a doctor;
  • Who’s the same person as your court-approved guardian or conservator; or
  • Who is already a healthcare agent for more than 10 people.

Be sure to name a backup agent, in the event your medical power of attorney can’t make decisions on your behalf.

Talk to a qualified estate planning attorney to get help with this and other legal documents, and to be sure that your documents meet your state’s requirements.

Reference: SmartAsset (May 8, 2019) “How to Set Up Medical Power of Attorney”

How Do I Create a Medical Power of Attorney?

A medical power of attorney is a legal document (also called a healthcare power of attorney or durable power of attorney for healthcare) that names an agent to make medical decisions on your behalf, explains Yahoo Finance’s recent article, “How to Set Up Medical Power of Attorney.” A medical power of attorney gives a family member or a trusted friend (a “healthcare agent”) the legal authority to make health decisions for you.

How do I create a medical power of attorney
The medical power of attorney is one of several documents that should be part of your estate plan.

This isn’t the same as a living will, which is a document that details what you’d like your healthcare team to do, if you become incapacitated. You may have a living will and a medical power of attorney. If decisions must be made about resuscitation and life support, recording those wishes in a living will, removes those difficult decisions from your agent.

When you’re thinking about a person to be your healthcare agent, find someone with whom you’re comfortable discussing health-related issues. Select a person you trust with your life and who will assume this responsibility if and when the time comes. Your agent must be your advocate, execute your wishes and make wise decisions, even when friends and family are telling them otherwise.

Here are some general guidelines for healthcare agents that you should avoid. Don’t choose:

  • Your healthcare provider or the person who owns a health or residential facility in which you’re residing;
  • A person whose job it is to medically evaluate you, such as a physician;
  • A person who works for a government agency that is financially responsible for your care unless she’s a blood relative;
  • The same person as your court-approved guardian or conservator; or
  • A person who’s already a healthcare agent for more than 10 other people.

It’s important to also name a backup agent, in the event that your primary healthcare agent can’t make decisions on your behalf.

The medical power of attorney is one of several documents that should be part of your estate plan. Meet with an estate planning attorney to make sure that you have the correctly prepared documents you need to protect yourself and your family.

Reference: Yahoo Finance (May 8, 2019) “How to Set Up Medical Power of Attorney”

Do I Need to Update My Estate Plan if I Relocate for Retirement?

Update my estate plan when I relocate
Anytime you relocate to another state you should have your estate planning documents reviewed to make sure they comply with the law in the state you’ve moved to.

Anyone who moves to another state, for retirement, a new job or to be closer to family, needs to have a look at their estate plan to make sure it is valid in their new state, advises the Boca Newspaper in the recent article “I’ve Relocated To Florida…Should I Update My Estate Plan?”  

If an estate plan hasn’t been created, a relocation is the perfect opportunity to get this important task done. Think of it as preparation for your new life in your new home.

Because so many retirees do relocate to Florida, there are some general rules that make this easier. For one thing, most wills that are valid in another state are recognized in Florida. There’s a specific law in the Florida statutes that confirms that “other than a holographic or nuncupative will, executed by a nonresident of Florida… is valid as a will in this state if valid under the laws of the state or country where the will was executed.”

In other words, if the estate plan was prepared by an estate planning attorney and is legally valid in the prior state, it will be valid in Florida. Exceptions are a holographic will, which is a handwritten will that is signed by the person with no witnesses, or a nuncupative will, which is a verbal statement made in front of witnesses.

However, just because your will is recognized in Florida, does not mean that it doesn’t need a review.

There are distinctions in Florida law that may make certain provisions invalid or change their meaning. In one well-known case, a will was missing one sentence—known as a “residual clause,” a catch-all that distributes assets that are otherwise not specified. The maker of the will wanted everything to go to her brother. However, without that one clause, property acquired after the will was created was not included. The court determined that the property that was acquired after the will was created, would go to other relatives, despite the wishes of the decedent.

Little details mean a lot when it comes to estate plans.

It’s important to ensure that the last will and testament properly expresses intentions under the laws of your new home state. As you review or begin the process, this might be the time to speak with your estate planning attorney about whether any trusts are applicable to your estate. A revocable living trust, for example, would avoid the assets placed in the trust having to go through probate.

This is also the time to review your Durable Power of Attorney, designation of a Health Care Surrogate, Living Will and nomination of a pre-need Guardian.

Estate planning gives peace of mind, knowing that the legal side of your life is all taken care of. It avoids stress and unnecessary costs and delays to your family. It should be reviewed and updated, if needed, at big events in your life, including a relocation, the sale or purchase of a home or when you retire.

Reference: Boca Newspaper (May 1, 2019) “I’ve Relocated To Florida…Should I Update My Estate Plan?”

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