Orlando Estate & Elder Law

The Mighty Power of Attorney (POA) - Orlando, Florida

A POA is a legal document that is based on your state’s law that authorizes someone to act on your behalf.

A Power of Attorney (POA) is an essential tool for your estate plans, and a mighty strong one at that. In effect, every adult should have one. Like most legal tools, the POA can be tailored to fit nearly every need.

The broadest POA is the “General Durable POA.” This gives the agent you appoint authority to do nearly every legal and financial act you can do for yourself, even when you are incapacitated. That is broad authority. In the wrong hands, it can be more than dangerous. Think of it as “legal dynamite.” In the right hands, it can be a blessing to you – and your loved ones.

On the other hand, it is possible to grant limited or specific POA authority. For example, you can limit the duration the POA is effective and even the specific acts you authorize. This can provide a degree of safety when you don’t want to grant open-ended authority.

Practically speaking, senior loved ones oftentimes have IRA accounts that need ongoing management and from which minimum required distributions must be taken. If these loved ones become infirm or develop cognitive issues, then their IRA accounts will need to be managed and administered for them. The Slott Report explored this legal and financial fact of life in a recent article titled “Using a Power of Attorney for an IRA.” One if the key take-a-ways from the article is that not all IRA custodians will treat various POAs the same.

In addition to appointing the right agent for your POA and selecting the right type of POA, be sure to confirm that your POA will be accepted by the third parties that will be asked to honor it. In this case, an ounce of prevention is worth more than a pound of cure.

For more information about:  Estate Planning in Orlando, Florida visit: www.lsrlawyer.com

 

Reference: The Slott Report (March 26, 2013) “Using a Power of Attorney for an IRA”

End-Of-Life Wishes - Make Yours Know in Orlando, FL Right Now

This uncomfortable, ethically questionable, confusing scene over Ms. Bayliss’ end of life did not have to happen the way it did.  If you don’t want to be in that kind of situation, you need to be responsible for deciding what you want and communicating it to those who will have to act on your behalf.

You may have heard about a rather unfortunate story that came out in the news a little while ago. It’s the story of Lorraine Bayless and the Glenwood Gardens nursing home.

Spoiler alert: Lorraine fell into cardiac arrest and the facility was utterly unable to administer CPR, despite the pleading 911 operator. Why? “Company policy.”

This matter has been taken up by Forbes in two recent articles, by two different authors. The first, by Howard Gleckman, is titled “The CPR Death At Glenwood Gardens: What Really Happened And Five Lessons You Should Learn.” The second Forbes article is penned by Carolyn Rosenblatt and is titled “Nurse Refuses To Give CPR, Senior Dies: Ethical Problem Or Legal Issue?”

Here are four key facts regarding this story. First, Lorraine was having a stroke and CPR was not likely to help her. Second, the “nursing facility” was actually an independent living facility without skilled nurses. Third, Lorraine herself had not wanted a long drawn out passing; and fourth, Lorraine and her family already had arranged for a Do Not Resuscitate (DNR) order.

Against this backdrop, each of us needs to know two fundamental wishes when it comes to our loved ones:

1)      What does your loved one want and need in a facility? Since the facility in question was not an actual nursing home and the “nurse” was not actually a skilled nurse, the staff was not allowed to perform CPR, both by “company policy” and by law. There are many types of facilities with varying degrees of medical or personal care. Truly, to be in the “wrong” facility may mean not limiting the care your loved one may want.

2)      Likewise, what does your loved one want (or not want) when it comes to end-of-life measures? What decisions has your loved one made regarding emergency care, resuscitation, breathing or other life-sustaining apparatuses? Lorraine purposefully had a DNR, had made her decision, and her family clearly knew her wishes. Nevertheless, there are many additional considerations when it comes to making and communicating your wishes.

As you might imagine, it’s best for your senior loved ones to commit their wishes and decisions to writing. The most common form is known by many different names, but is simply a written record of their healthcare directives made in advance. As with financial matters, your senior loved ones also will want to sign a durable power of attorney for medical matters called a designation of health care surrogate here in Florida and appoint the “agents” they know and trust to carry out their wishes. Another document to evaluate is the Physician’s Orders for Life Sustaining Treatment (POLST), often also called Medical Orders for Life Sustaining Treatment (MOLST).

Regardless, the object of these kinds of documents is to empower your senior loved ones to inform their loved ones, doctors and medical facilities about their wishes now so those wishes can (and will) be carried out later. Note: Once executed, copies of the health care directives should be liberally distributed among agents, non-agent family members, doctors and medical facilities. As these end-of-life wishes also are emotional decisions, it is best if everyone concerned is informed rather than surprised.

This end-of-life planning isn’t just for senior loved ones. Have you made your wishes known through proper legal planning?  The best way to encourage personal responsibility in others is to lead by example.  If you want to make an appointment to update (or create) your documents, or talk about your options, please get in touch.

Reference: Forbes (March 8, 2013) “Nurse Refuses To Give CPR, Senior Dies: Ethical Problem Or Legal Issue?”

            Forbes (March 6, 2013) “The CPR Death At Glenwood Gardens: What Really Happened And Five Lessons You Should Learn”

Is Your Elderly Love One Having Memory Problems? Be Financially Prepared - Orlando, Florida Estate Planning

Veronica, age 75, is struggling with a dilemma.   Her husband, 10 years older, is “losing it” as she put it. He is dangerous because he is so forgetful. Mort is neglecting to pay the bills and make deposits. She was very shocked and stressed about collection notices and pushy bill collectors on the phone.

Have you noticed that your elderly loved one is having “memory” problems? If yes, what should you do, especially when it comes to financial matters? Preparation is key.

A recent article in Forbes considered these question and others. The article, titled “Is Your Aging Loved One "Losing It"? Five Strategies to Help You Prepare For Managing the Money,” also provides some practical pointers, to include:

1. Learn about the assets and financial responsibilities you and your loved one have.
2. Take time to get to know your loved one’s financial advisor, accountant, broker and banker.
3. Do not accept financial illiteracy.
4. Accept the potential responsibility you may have one day as a way of protecting yourself against fraud and financial abuse.
5. Check your legal documents and be sure that you have what is needed to take over financial management if that time comes.

Each of these points is important. However, I will add my own to the mix – don’t ignore the issue.

While it can be hard admitting that a loved one is “losing it” cognitively, matters are made worse when their financial matters crash and burn, too. If you already are at that point, then it may be wise to have a family meeting to coordinate your plan of action together.

Even closer to home, take a good look in the mirror. Do you have your own estate planning in place so your loved ones could take care of your financial matters? Don’t delay, contact appropriate counsel to ensure your plans are in place.

For more information about Estate Planning and Elder Law in Orlando, Florida, visit: www.lsrlawyer.com

Reference: Forbes (February 14, 013) “Is Your Aging Loved One "Losing It"? Five Strategies to Help You Prepare For Managing the Money

The Trials of Caring for Elderly Parents in Blended Families - Orlando, Florida Estate Planning

Research shows that the ties which lead adult children to become caregivers — depending on how much contact they have with parents, how nearby they live, how obligated they feel — are weaker in stepchildren, Dr. Silverstein said. Money sometimes enters the equation too, Ms. Keller added, if biological children resent a parent’s spending their presumed inheritance on care for an ailing stepparent.

Today’s “modern family” can make good material for divorce courts and sitcoms alike, but it’s also becoming clear that there is a new family crisis brewing in elder care within these blended families. A New Old Age Blog article titled “In Blended Families, Responsibility Blurs” addresses this blended family challenge.

When it’s just parents and just the kids born from those parents, caring for elderly parents can be difficult enough. Generally, most families assume that the adult children can work things out to take care of their elderly parents. In a blended family, however, and especially in one where the parents of those adult children have remarried late in life, the boundaries can get blurry. Moral decisions once clear become blurry.

With elderly parents in such situations, there oftentimes are changes in relationships for the worse that can lead to petty angers which further add to complications. Remember, every family requires ongoing communication and shared understandings to make a family run smoothly. Easier said than done. Nevertheless, you owe it to yourself and to your loved ones to come to that point.

Here is an important takeaway: the coming generations of elderly persons are more likely to be in a blended family, so be prepared now for the challenges that may affect you and those you love.

For more information about: Elder Care, Long Term Care and Estate Planning in Orlando, Florida, please visit my website

Reference: The New York Times – The New Old Age Blog (February 5, 2013) “In Blended Families, Responsibility Blurs”

The Latest Edition of DSM May Lead to Rise in Cognitive Diagnosis

The Diagnostic and Statistical Manual of Mental Disorders, published and periodically updated by the American Psychiatric Association, is one of those documents few laypeople ever read, but many of us are affected by.

When you have an elderly loved one, it’s wise to keep abreast on the ever-evolving medical world and all the new findings for mental health as a person ages. One committee with which you should become most familiar is the American Psychiatric Association and their upcoming best-seller, the DSM5. The book may usher in new ways of approaching elders and depression, and some are apprehensive about the book’s impact.

The concern over the DSM5 has come to a slow boil. The conversation about DSM5 has begun seeping out from the academic literature and into the public square with articles like a recent piece in The New York Times titled “Time to Recognize Mild Cognitive Disorder?”

The DSM5 will be the sequel to the Diagnostic and Statistical Manual of Mental Disorder IV (DSM-IV), the utterly necessary reference book and dust-gatherer of psychologists, doctors, insurance companies, bureaucrats, and lawyers alike. DSM-IV chronicles known and diagnosable psychological disorders.

For seniors, the new disorder making the rounds is “mild cognitive disorder.” This diagnosis is an attempt to bring to psychiatry the same awareness to levels of cognitive senility that medical doctors know all too well and yet still understand too little. If the DSM5 is published as is, and becomes the go-to reference, then we’re likely to see many more elderly diagnosed into categories that have only just now been created.

It’s useful to understand the basis for any diagnosis made by doctors when it comes to our elderly loved ones or even ourselves as we age. Don’t forget – proper planning now can give you peace of mind for any future diagnosis concerning your healthcare needs.

Reference: The New York Times – The New Old Age Blog (January 25, 2013) “Time to Recognize Mild Cognitive Disorder?”

The Affordable Care Act (Obamacare) and Its Effect on Medicare

Since the Supreme Court upheld the Affordable care Act, we are hearing a lot of misinformation about the law and its impact on Medicare.

As we begin 2013, it is understood that there will be several provisions to the Affordable Care Act (also known as Obamacare). If you have been following the discussion about the effect of Obamacare on Medicare but remain confused, you are not alone. Most Americans are left scratching their heads surrounding Obamacare’s impact on Medicare.

To learn more about this issue, visit the Center for Medicare Advocacy, Inc.’s website here. The Center is a “national non-profit organization that provides research, analysis, education and advocacy to help older people and people with disabilities obtain fair access to Medicare and quality health care.”

The Center created a “Medicare Facts & Fiction” chart that attempts to dispel misinformation regarding the Affordable Care Act’s effect on Medicare. It also provides links to several detailed articles discussing the Affordable Care Act and its effect on Medicare.

Another organization that prepared a summary of the ways the Affordable Care Act will affect Medicare beneficiaries is the National Academy of Elder Law Attorneys (NAELA). This summary focuses on three important topics – prescription drugs, chronic care and Medicare solvency.

References:  Center for Medicare Advocacy, Inc. – “Medicare Facts & Fiction”

National Academy of Elder Law Attorneys (NAELA) – “How Does Health Care Reform Affect Medicare?”

Speak Out on Affordable Care Act

The Florida Senate has created a web page for people to give their
views and get more information on the Patient Protection and
Affordable Care Act. The page was made public on December 10th.  Everyone can
visit at http://www.flsenate.gov/topics/ppaca.

The page allows you to submit your comments on the state
level, and to write to your Congressional Representatives or Senator
on the federal level.  It also answers frequently asked questions.

The state must decide whether to expand Medicaid.  Governor Scott was
at first opposed, but has since decided to lift his total opposition.  Take a look and speak out!

Post-traumatic Stress Disorder & Veteran’s Benefits

[Vietnam veterans are] part of a class-action lawsuit against the armed forces arguing that [Vietnam veterans] had post-traumatic stress disorder when they were issued other-than-honorable discharges.

Post-traumatic Stress Disorder (PTSD) is a growing issue for many Iraq and Afghanistan veterans, but it has existed and affected veterans since long before it became recognized in 1980. During the Vietnam War, PTSD was not recognized as a psychological symptom of warfare. As such, any symptoms of the disorder that led to dishonorable discharge from the military pre-1980 left many Vietnam veterans unable to collect veteran’s benefits.

 Recently, as presented by the New York Times article “Vietnam Veterans, Discharged Under Cloud, File Suit Saying Trauma Was Cause,” Vietnam veterans that suffered from PTSD have filed a lawsuit against the armed forces to recover medical benefits that were denied due to discharges related to PTSD. Chiefly, “can they be given a diagnosis of PTSD retroactively, to their time in service, though the disorder was not identified until 1980? And if they can, should recently instituted policies intended to protect troops with PTSD be applied retroactively to their cases?”

 The outcome of this case could have a serious effect for Vietnam veterans dishonorably discharged due to PTSD symptoms. If the suit is successful, then thousands of Vietnam veterans dishonorably discharged due to PTSD will have the ability to reapply for lost veteran’s benefits.

 As anyone who has experienced this trauma knows, PTSD can be a crippling lifelong condition. Many families and relationships struggle daily because a veteran in their family is silently suffering from PTSD. Signs of PTSD are recurring and distressing recollections or nightmares of a traumatic event, emotional detachment or estrangement, poor concentration, and irritability. Visit www.military.com, an online military community, to learn more.

If you think you or a loved one may be suffering from PTSD, consider visiting an attorney specializing in veteran’s benefits to ensure your right to medical benefits is not lost due to a dishonorable discharge that may have been caused by PTSD. 

 

References: The New York Times (December 2, 2012) “Vietnam Veterans, Discharged Under Cloud, File Suit Saying Trauma Was Cause”

 

Military.com “PTSD: What You Need to Know”

The Fiscal Cliff & Your Health

If President Barack Obama and Congress cannot reach an agreement on the fiscal cliff…it would likely send the country back into recession…and ultimately, it could hurt your physical and emotional health.

Financial health and physical health can go hand-in-hand. In these trying economic times it is important to make sure your finances are secure, not only for the health of your bank account, but for your physical health as well.

This issue was recently taken up in a CNN article titled, “10 ways falling off the fiscal cliff could hurt your health.”

According to the Congressional Budget Office, if the fiscal cliff is not avoided, the scheduled reduction in Medicare’s payment rates for physicians will lower Medicare spending by $11 billion. This overall spending reduction results in a 2% cut in existing Medicare budgets. Consequently, these reductions will mean a decrease of available Medicare funds to help pay for essential healthcare needs.

 In many instances, Medicare funds are used to pay for vital services like nursing home and hospice care, which are crucial to the wellbeing of our elderly population. Reduced Medicare funds mean reduced payments to health care providers which, in turn, may cause hospitals and care providers to stop accepting Medicare patients.

 As we prepare for the possible approach of the fiscal cliff, a consultation with an experienced elder law attorney can ensure that your access to healthcare is protected. An experienced elder law attorney also may help file an appeal in the event your health care provider denies your Medicare payments.

 

Reference: CNN (November 30, 2012) “10 ways falling off the fiscal cliff could hurt your health”

 

Congressional Budget Office (May 30, 2012) “Economic Effects of Reducing the Fiscal Restraint That Is Scheduled to Occur in 2013”

Negotiating The Cost of Elder Care

People who identify the specific services their loved ones need, haggle aggressively on price and explore alternative-care options can save money—or at least get more care for the money they do spend, experts say.

 

It’s no secret that people are living longer due to advancements in medicine.  The cost for extended long-term care services, a direct result of people living longer, however, may not be so apparent to everyone.  Significantly, over the past year, long-term care costs in a number of categories rose faster than inflation. 

Long-term care includes a variety of health and daily-living services, either in facilities or in people’s homes, for people with chronic illnesses or disabilities.  According to a recent article in the Wall Street Journal, “The Cost of Living Longer,” “[a] growing number of families are wrestling with the same dilemma: rising costs for long-term care and a mind-boggling array of options.” 

The article offers some strategies families are using to stretch their long-term-care dollars further.  The first step is to discuss how you will pay for the long-term care of a family member.  Next, determine the level of care needed.  The article discusses pros and cons of each option available – assisted living, independent living, home health care, adult-day services, respite-care, etc. 

This article is a good starting point, but it does not replace the advice of a financial planner or an estate planning attorney. 

 

Reference:  The Wall Street Journal (October 26, 2012) “The Cost of Living Longer”