Orlando Estate & Elder Law

Advance Directives Part of Legal Health

“Advance directives come up frequently in conversations about health care decision-making, as people age. Their purpose is to provide written instructions for medical care, in instances where a patient is unable to communicate them herself.

An advance directive is a legal document that states a person’s preferences for medical treatment and medical decision-making, reports Valley News in an informative article titled “Advance Directives Provide Clear Guidance for Care.”

There are two components that make up an advance directive: a designation of health care surrogate or durable power of attorney for health care and a treatment preferences section.

The designation of health care surrogate allows you to appoint someone to make medical decisions if you lack the capacity to make those decisions for yourself.

The treatment preference, which is sometimes referred to as a living will, lets you specify what kind of treatment you would want in a difficult circumstance. Treatment and care preferences usually focus on what you would want at the end of life or if you were in a permanently unconscious state. There are other preferences that can be expressed, including pain control, blood transfusions, mental health care and spiritual care. Another preference: who should—and should not—be involved in discussions about treatment.

Most people want to express their wishes to avoid aggressive measures being taken to extend their lives when the end result will be suffering and a delay of their passing. Others chose to avoid the financial burdens that may or may not result in any kind of change in their health or the quality of their life.

Some have these documents prepared to make it clear that they want to spend their final months, weeks or days at home with loved ones with care only to relieve pain or care, so they can be conscious and able to speak with those around them.

Advance directives are a blessing to loved ones since they do not have to make hard choices in a crisis situation. They know what their aging parent or spouses wishes.

It’s important to choose the person you want to be responsible for your care well in advance. Make sure it’s someone you trust, who knows you well and will be able to make hard decisions in a highly emotional time. They’ll also have to be able to communicate with your doctors and family members.

These documents are bound by the laws of your state, so speak with an estate planning attorney who practices law in your state of residence. They’ll be able to prepare these documents on your behalf, along with a will and other estate planning documents.

For more information about estate planning in Orlando, FL (and throughout the rest of Central Florida), visit our estate planning website and be sure to subscribe to our complimentary estate planning e-newsletter while you are there.

Reference: Valley News (Sep. 1, 2018) “Advance Directives Provide Clear Guidance for Care”

Let's Start Here

“Estate planning is not a topic that anyone really wants to think or talk about. In fact, many people might not even know what it means, so let’s start there.”

Estate planning is important for anyone over the age of 18. It does matter if you have a small or large bank account, if you are a parent or not, or if you are old or young. A typical estate plan includes a will, durable power of attorney and advance health care directive, says the Pensacola News Journal in the article “Let’s Talk About: Estate Planning.”

What makes up an estate? Your home, cars, investments, bank accounts, retirement accounts and any belongings you own. Your will, which is also known as a “Last Will and Testament”, is a way to create a legally binding document with instructions as to who should get these possessions when you have died. Your will should also include directions about who will care for your children, if they are still minors under the legal age of adulthood.

If you die without a will, your family will have to deal with more than the grief of losing you. They’ll have to go through a legal quagmire to settle your estate. Family members often end up in expensive and emotionally devastating legal battles when there is no clear instructions from the deceased.

A durable power of attorney lets you name someone to make important decisions on your behalf if you are unable to speak for yourself. This is especially important for elderly people but can also come into play for any age adult.

The advance health care directive allows someone to make decisions about your health. We think about this as concerning older people.  However, there are tragic instances where younger people also need to have this document. It also allows family members to access medical records and talk with physicians. Without it, doctors are not legally permitted to discuss care or decisions, even with a young adult’s own parents. It can also allow you to designate the treatment you would authorize (or not authorize) and when.

A living will  focuses on end-of-life care. Do you want to be placed on a respirator if you cannot breathe for yourself? What about being an organ donor?

These are tough questions and the contemplation of one’s own mortality is never pleasant.  However, by having these conversations with your family members and by making sure you have an estate plan in place prepared by an experienced estate planning attorney, you can spare your family, loved ones and yourself, a good deal of stress and worry.

Make an appointment to meet with an estate planning attorney. They’ll be able to create the documents you need to protect your family and ensure that your wishes are followed. There could be other planning tools, such as trusts that may be useful in your estate plan.

For more information about estate planning in Orlando, FL (and throughout the rest of Central Florida), visit our estate planning website and be sure to subscribe to our complimentary estate planning e-newsletter while you are there.

Resource: Pensacola News Journal (July 24, 2018) Let’s Talk About: Estate Planning

Advance Planning for Incapacitating Dementia

New York recently became the first state to allow a new advanced directive that allows people to decide not to be given food or water if they are incapacitated by dementia.

Many people who suffer from dementia appear to be suffering greatly at the end of their lives, because the dementia has progressed to the point where they have become completely incapacitated. Consequently, they can no longer perform the basic tasks of “daily living” necessary to survive and cannot express their wishes regarding how they would like to be treated.

A dementia victim can live for a long time, if fed and given water. With the ready availability of advanced medical directives, it might seem easy to get one, whereby you refuse food and/or water if you are incapacitated by dementia. However, you cannot provide that advanced directive, unless you happen to live in New York, because it recently became the first state to allow this option as NPR reports in "'Aggressive' Advance Directive Permits Halting Food and Water In Sever Dementia."

People in New York will now have two options. They can direct that they continue to be given food and water, if it appears that they accept and enjoy it. They can also direct that they not be given food and water at all. It is hoped that the new directive will allow people suffering from advanced dementia to pass away more quickly, if that is what they choose in advance.

If this law works well in New York, it could become available in other states. It is still a good idea to get advanced medical directives, even if this particular option is not available in your state of residence.

For more information about estate planning in Orlando, FL (and throughout the rest of Central Florida), visit our estate planning website and be sure to subscribe to our complimentary estate planning e-newsletter while you are there.

Reference: NPR (March 29, 2018) "'Aggressive' Advance Directive Permits Halting Food and Water In Sever Dementia."

A Second Marriage Thanks to Alzheimer's

People who suffer from Alzheimer's disease do not suddenly forget everything. Instead their memories fade over time leading to some unique situations, as the story of one couple in New Zealand illustrates.

Alzheimer's works in ways that cannot be predicted. What memories will disappear and when they will disappear can often seem random.

Michael Joyce of New Zealand suffers from Alzheimer's disease. He had been married to his wife for 38 years and eventually the disease progressed enough that he forgot he was married. In most cases, this would be a cause of deep pain for Joyce's wife.

It is not easy for family members when patients forget something that important. In this case, Joyce remembered that he still loved his wife and he asked her to marry him for what he thought was the first time.

The couple held a second ceremony as the Washington Post reported in "Husband with Alzheimer's forgot he was married to his wife of 38 years. He proposed, and they married again."

While this story ends on a heartwarming note, there is an important lesson here about how Alzheimer's disease works. People who get the disease cannot know what memories they will lose and when they will lose them, so they cannot afford to wait to make plans for dealing with the disease. Otherwise, they may forget something important before they fully plan.

People need to go to an estate planning attorney before that happens. That way they can make sure they have planned for their estates and their end-of-life care through powers of attorney and advanced medical directives.

For more information about estate planning in Orlando, FL (and throughout the rest of Central Florida), visit our estate planning website and be sure to subscribe to our complimentary estate planning e-newsletter while you are there.

Reference: Washington Post (Jan. 2018) "Husband with Alzheimer's forgot he was married to his wife of 38 years. He proposed, and they married again."

Easing The Way Toward Time to Go

When an elderly person is extremely ill and unlikely to survive, it is time for doctors and family to discuss how long the patient should be kept alive. It is not an easy conversation for anyone involved.

In recent years, medical science has made tremendous advances. People can now be kept alive far longer than they ever could at any other time in history.

While that is generally good, it does have some drawbacks.

Many of the people that medical science can keep alive today have no chance of ever making a full recovery and returning to a normal life. Instead, keeping them alive means keeping them on life support in a hospital, often in great pain, indefinitely.

Recently, an anonymous doctor wrote about how difficult it can be in these situations to talk to patients about whether it is time to go.

The article appeared in The Guardian with the title "My patient is 93 and has pneumonia. It's time to talk about her death."

Most of the time, the uncomfortable conversations mentioned in the article can be avoided by doing some advance planning.

Advance medical directives, including living wills and health care powers of attorney, make it possible for people to give directions regarding when doctors should no longer keep them alive and who should make any medical decisions, if there are any to make.

With advance medical directives, you can make decisions now while you are still able and avoid the pain of having others make them later.

Most estate planning attorneys offer advance medical directives as a matter of course in estate planning. Talk to one today.

For more information about estate planning in Orlando, FL (and throughout the rest of Central Florida), visit our estate planning website and be sure to subscribe to our complimentary estate planning e-newsletter while you are there.

Reference: The Guardian (July 6, 2017) "My patient is 93 and has pneumonia. It's time to talk about her death."

Ensure Your Living Will Does What You Wish

Living wills are a useful tool to let medical professionals know what types of treatment they should give you when you are incapacitated and unable to express your wishes. To make them work there are a few things that you need to do.

Part of planning your estate is planning for your end of life care. If you are ill and incapacitated, then it is important to have plans in place regarding how you should be treated and who should manage your affairs. Not making such plans now can risks chaos and legal struggles later that can drain your eventual estate of assets.

One of the key components to planning your end of life care is an advanced medical directive, commonly called a living will. This document lets you state in advance what treatments medical professionals should give in the event you are incapacitated with a terminal illness or injury and have no chance of recovery.

However, these important instructions are too often ineffective as Wealth Management discusses in "What Advisors Need to Know about Living Wills."

For your living will to be effective when you need it there are a few things you should consider. First, it is a good idea to be as specific as possible in the document. Detail exactly what treatments you do and do not want to authorize in advance.

You also need to let other people know you have a living will. If you stick it in a desk drawer without telling anyone, then no one will know to give it to medical professionals at the appropriate time.

Finally, every state has its own laws concerning living wills. In some states you must use official forms. In every state, even if official forms are not required, specific language must be included in a valid living will document.

For all of these reasons and more, make sure your living will is drawn up by your estate planning attorney without delay.

For more information about estate planning in Orlando, FL (and throughout the rest of Central Florida), visit our estate planning website and be sure to subscribe to our complimentary estate planning e-newsletter while you are there.

Reference: Wealth Management (Sept. 27, 2016) "What Advisors Need to Know about Living Wills."

Unhappy Retirees

A recent study revealed that more Americans than ever are unhappy or dissatisfied in retirement. If you are one of them, getting your affairs in order might help your security and satisfaction.

When working people think about retirement, they normally look forward to it. After all, retirement is supposed to be the reward for years of long work. Once retired, retirees no longer have to pay attention to a work schedule. They can do what they want when they want to do it.

It sounds great, doesn't it? However, according to a recent study discussed by Trust Advisor in "More People Are Unhappy In Retirement Than Ever Before," not everyone is happy and satisfied in retirement. That is somewhat to be expected.

Life is complicated enough. No longer "having to work" is not a miracle cure that can make everyone happy. It seems today that a greater percentage of people are unhappy and dissatisfied in retirement than in previous decades.

The reason for the increase is not exactly known. It has been suggested that more retirees are financially insecure than in previous generations. Others say it might be the result of more people having unreasonable expectations about retirement or merely a generational shift as Baby Boomers retire in greater numbers.

While happiness can be very elusive, satisfaction can be less so. For most people there is a certain level of satisfaction in knowing their affairs are in order in case there is an emergency. Thus, getting advanced medical directives and a general durable power of attorney will help with retirees' satisfaction levels.

Getting a complete estate plan should help as well because there is also satisfaction in knowing that family will be taken care of should anything untoward happen to you.

I welcome you to join my estate planning practice's "happy family" of clients who have the piece of mind that a good plan can bring.  Please contact my office to schedule a consultation.

Reference: Trust Advisor (July 1, 2016) "More People Are Unhappy In Retirement Than Ever Before"

Japan Debating End of Life Rights

The right to refuse life-extending medical care is well-established in the U.S. Millions of Americans have living wills instructing doctors not to give them certain kinds of treatment. In Japan the idea is a novel one and being hotly debated.

In the United States when you prepare your estate plan, you will be asked if you also would like to get a living will. When you go into the hospital, you also might be asked if you want one.

Living wills allow us to direct doctors not to give medical care that would artificially prolong our lives when we have no hope of recovering. These documents have legal effect and doctors are not liable for following these directives.

Japanese attitudes have traditionally been different than ours. There it is normal for doctors to extend life as long as possible. There is no formal, legal way to order doctors not to.

However, under pressure from a struggling economy and an aging population, the Japanese attitude is beginning to change according to Japan Today in "'Living wills' spur debate on right to die with dignity in Japan."

People in Japan are starting to create their own living wills, but doctors do not have to follow them. In fact many doctors fear getting sued by upset family members if they do follow the living wills. This is sparking a national debate over the issue.

Those in favor of them say they allow people to die with dignity while the opposition fears allowing the living wills could be the first step towards euthanasia.

It will be interesting to see how the debate ends up in Japan.

In the meantime if you do not have a living will and you would like one, please schedule a visit to discuss this and other estate planning concerns.

Reference: Japan Today (March 8, 2016) "'Living wills' spur debate on right to die with dignity in Japan."

Steps and Help After A Terrifying Diagnosis

If you or a loved one is diagnosed with Alzheimer's disease, it is important to take immediate steps to ensure that end-of-life care is as comfortable as can be.

There is a common myth that people with Alzheimer's are completely incompetent and cannot be trusted to make their own decisions. It is not true as the early stages of the disease are relatively mild.

People who are diagnosed with the disease early enough can still make their own decisions. However, as the disease progresses most do eventually lose the ability to make their legal decisions as NorthJersey.com points out in "Planning becomes vital following Alzheimer's diagnosis."

The article suggests that people who receive an Alzheimer's diagnosis should get a durable power of attorney, a designation of health care surrogate (healthcare power of attorney) and a living will.

The powers of attorney will allow the person to appoint someone else to handle financial and medical affairs, respectively, when the Alzheimer's patient is no longer able to do so. The living will is used to give advanced directives about what type of treatments doctors should employ to keep the patient alive.

These are critical documents to have.

Getting them after an Alzheimer's diagnosis is solid advice. However, even better advice is not to wait until after receiving such a diagnosis. All three documents are part of general estate planning. There is no need to wait until you know you will need them to get them.

Plan ahead and get them now before an issue of competency is raised.  Please make an appointment to prepare, review or update those and other vital planning documents.  And remember, no matter how terrifying a diagnosis, we are here to help.

Reference: NorthJersey.com (Dec. 27, 2015) "Planning becomes vital following Alzheimer's diagnosis."

Will Boomers Outlive Their Good Health?

The baby boomer generation is on average expected to live a lot longer than previous generations, but that does not mean they are expected to be healthier than the elderly of those previous generations.

In 2030, when the last of the baby boomer generation will be fully eligible for Medicare, the average life expectancy of a 65 year old is projected to be 20.1 years.

A recent study suggests, however, that those elderly people who will live longer will do so in poorer overall health than the elderly people from previous generations. It appears, in part, this is because medical science has done such a great job of finding treatments for diseases that often kill people early, such as cardiovascular problems. As people will be living longer, however, they will get other diseases, such as cancer and Alzheimer's, in greater numbers.

The Bangor Daily News reported this story in "Baby Boomers are more likely to spend their last years in worse health than past generations."

This has important implications.

While an individual cannot know for certain whether he or she will be one of the people who live longer and suffer from disease, individuals can play it safe and plan ahead.

The wise baby boomer would plan as if he or she will live as an elderly person for a long time and will likely suffer health complications as a result. This means that baby boomers should get estate plans that include powers of attorney and advanced health care directives. That way should they get sick or become incapacitated in their elderly years their affairs will still be handled by people of their choosing.

We will also discuss strategies for paying for health care and other concerns at our estate planning check-up.  If you have not had a legal check-up in the last three years, schedule one today.

Reference: Bangor Daily News (Dec. 29, 2015) "Baby Boomers are more likely to spend their last years in worse health than past generations."