In Case of Emergency, Medical Decisions Can’t Wait

ER- Henry Ford Hospital, Detroit. June 2017.

“A man’s mind will very gradually refuse to make itself up until it is driven and compelled by emergency.” -Anthony Trollope

After returning from a much needed, weeklong, pure leisurely vacation, the last place I expected to visit was the emergency room. The only time I had ever been to the ER was just over four years ago, when I lost my father. A young woman, on the verge of 30, with no serious medical history and an active mother to a very energetic 4 year old sounds like the picture of good health. Yet, this description did not shield me from medical emergency, as I found myself being treated in the ER for chest pains. Needless to say, medical emergencies are not reserved for the sick, disabled, and aged, as commonly believed, although the need can increase in each of those categories. However, this begs the question, in case of emergency, are your medical decisions in order?

Before answering that question, we must first understand what advanced directives are and the differences amongst them. An advance directive is a written document in which you specify the type of medical care you want or who you want to make decisions for you, should you lose the ability to make decisions for yourself. In Michigan, there are three types: a durable power of attorney for healthcare, living will, and do-not-resuscitate order.

A durable power of attorney for healthcare authorizes an individual to act on a patient’s behalf in regards to care, custody, and medical treatment when the patient receiving such services is unable to make decisions for him or herself. This is commonly referred to as a patient advocate, which is the individual granted the power to act on behalf of the patient. A living will is a document that instructs physicians and others to withhold or withdraw life-sustaining procedures and equipment in the face of certain death, such as terminal illness. The living will provides useful guidance to family, friends, physicians, and hospitals, but its legal effect in Michigan is uncertain. Finally, a do-not-resuscitate order (DNR), is a document directing that no resuscitation will be initiated if a patient’s heart stops beating and he or she stops breathing outside of a hospital. In order to execute this document, the individual must be a person who is at least age 18 and of sound mind, or a patient advocate of an individual who is at least age 18.

Now, returning to the question of whether your medical decisions are in order, they likely are not, as according to a January 2014 study by the American Journal of Preventive Medicine, only 26.3% of U.S. adults had an advanced directive. Notably,  the most common reason for not having an advanced directive was lack of awareness. While patient advocate services are available at many hospitals, based on the study, the majority of adults are unaware of their availability or of what they are. Additionally, executing a patient advocate designation at the hospital can lead to quick, on the spot thinking, rather than taking the time to fully consider what is best for you and whom is best to make those choices for you.

Therefore, when deciding what choices are best in regards to your medical care, consider the following questions: whom can you trust to carry out decisions on your behalf in the event of your disability or incapacity? Is this person a responsible and dependable individual? Will this individual be willing to accept? Think about who you can trust to carry out your wishes, talk it to such individuals, and close family and friends, so that your decisions are known. Decide what method is best for you, and disclose the location of pertinent documents, which you can even register free through Gift of Life Michigan.

Furthermore, should you find yourself unable to make your own medical decisions, instead of planning ahead, would you rather leave the choice to your family with no plan, setting the stage for disagreement and argument? Your family, who is already grieving at your condition, will be left with the burden of deciding how to treat you further, or whether to even continue treatment at all. It is a monumental decision, and can bring about stress and ruin relationships in the family. However, with a medical directive, you can lessen the burden, and be prepared in case of emergency.

“No one can confidently say that he will still be living tomorrow.” -Euripides. No matter the situation, it is always best to plan ahead. Contact TMP Law to secure your plan in place today.

 

Life Ends at 20: Preparing for the Worst Case Scenario

Family Life. Cincinnati, 2017.

“No one can confidently say that he will still be living tomorrow.” -Euripides

Although the youth are regarded as the leaders of tomorrow, death comes at any age, meaning it is as near to the young as it is to the old. Often, the field of estate planning is viewed as an area of practice reserved to elderly clients. However, while older clients have lived longer lives to accumulate more assets, have more family, and therefore protect a potentially larger estate than a younger individual, young people potentially have just as much to lose.

The millenial generation, credited as individuals aged 18-35, along with baby boomers, make up the largest segment of the US population. As this group of people moves further into adulthood and constitute larger segments of the working population, they accumulate personal responsibilities such as marriage, parenthood, homeownership, and household financial decisions.

Additionally,  many millenials and other younger individuals (35-50) often find themselves caught in the sandwich generation– caring for their elderly family members, including parents and grandparents, along with minor children. Therefore, in spite of accumulation of property or liquid assets, family obligations loom large, begging the question, what would happen in the event of their deaths, or, are they prepared for the worst case scenario?

According to research, likely not. A recent Gallup poll revealed that only 44% of Americans reported having a will, but just 14% of Americans under 30 reported having a will, and only 35% aged 30-49 reported the same. Further, life insurance is a tool that can be used to create an estate and pay a death benefit to named beneficiaries. Yet, according to a 2015 Insurance Barometer Study, 43% of Americans do not own a policy, with a whopping 70% of individuals under 25 reporting that they did not own a policy. To put a face to these numbers and demonstrate the fragility of youth, I offer an example from my own family: my cousin, who was murdered at age 23, leaving behind a minor daughter under age 5.

So in light of such responsibility, what can you do to prepare for the time when you will not be around to shoulder the load? This is where estate planning not only comes in handy, but becomes a young person’s best defense against the uncertain and unexpected.

First, identify your heirs at law- most commonly spouses and children, and second, identify your assets. Who would get what? Additionally, who would you choose to administer your estate, or in other words, follow your wishes and make distributions? Choose wisely. While family is usually the most common choice, you must consider whether the individuals named are equipped with the skills and temperament to follow your guidelines, protect your assets, and make wise legal and financial decisions.

Next, choose how your estate would be administered, traditionally through three means- by will, by trust, or by state law. Wills are the most common and popular, as well as the simplest means, but individuals with larger assets may want to consider a trust for privacy and tax purposes. Dying intestate- or without a will- means your estate will follow state law, which may not be harmful, but may fail to follow your intents. In this respect, it is more beneficial to use a will or trust to better reflect your wishes and choose the individuals you wish to include in your plan.

Most significantly, the biggest need for young people with young families is naming of a guardian for minor children. This is something that can only be done in a will or separate guardianship form. A trust can never name a guardian, nor can dying intestate. Additionally, a conservator can be named to make financial decisions for the support and maintenance of minor children, as they do not have the legal capacity to make such decisions for themselves.

Finally, research wisely and consider investing in a life insurance policy to protect beneficiaries in the event of death. It can be used as a useful and inexpensive tool, particularly for younger people with family obligations, as rates are based on age and health, which is most favorable for  younger individuals. Most importantly, life insurance will restore loss of income, giving your family financial protection to pay for continued costs and expenses.

In closing, these are a few basic ways to prepare for the worst case scenario, and while there are many resources available to learn more about this topic, it can be overwhelming and time consuming to go at it alone. Consulting with an estate planning attorney about the best options for your circumstances will save time and provide maximum value for minimal cost, while protecting your assets, family, and legacy. Life is precious. Enjoy every moment, and do not fail to plan for loved ones who will remain after your end.

 

 

Preserving History in Present and Future Times: Protecting Elders and the Aging Population

 

John F. Kennedy Exhibit. The John F. Kennedy Center for Performing Arts, Washington DC.

“History is a relentless master. It has no present, only the past rushing into the future.” 

As we celebrate President’s day in memorialization of the great leaders of this nation’s past, we reflect on this quote by former President John F. Kennedy and what I call the greatest teacher in life- history. With this in mind, there is perhaps no population group in our society that are greater students of history than our elders, who throughout the years have experienced life and encountered history in ways many of us hope to attain by reaching greater age.

Significantly, according to the Administration on Aging (AA), the United States is experiencing a dramatic increase of people who live to old age, creating challenges for Americans of all ages. Although elders are often synonymous with senior citizens aged 65 and over, with the growing aging population and baby boomers coming into retirement age, AA categorizes “preseniors” as those ages 55-64. Like senior citizens, preseniors often face the same issues that come along with aging as years continue.

Furthermore, as our population ages and transitions, we face unique obstacles in not only protecting the legacies left behind by our elders, but in protecting the lives of our elders themselves.  As we grow, our estate grows, our family grows, and our needs grow. We have more to lose and protect, including the key categories of asset protection, health protection, and income protection. Yet, with proper planning, we can “ensure” preservation of wealth and assets for the benefit of future generations, as well as personal protection for the well being of our beloved elders.

First, regarding asset protection, the more we age and earn, the more we acquire. But, we all know that we cannot take our possessions with us after death, so what happens to our prized valuables? This is where an estate plan becomes pivotal, whether it be instructions left in a simple will or a more complex but structured trust to distribute assets, which can also be tailor made to fit individual situations, such as a special needs trust. Regardless of the outcome, the key requirement in estate planning is capacity. One must know what they possess and the natural objects of their bound, usually close family members like spouses and children, or else the plan can be challenged or overruled due to lack of capacity. With memory illnesses like Dementia and Alzheimer’s often affecting older populations, testing for capacity can be quite a challenge, but it is nevertheless possible and necessary in constructing an adequate estate plan.

Second, as referenced, with the aging process, our health needs change, including our ability to care for ourselves physically and make decisions mentally. In planning for elder health requirements, government insurance programs such as Social Security, Medicare, and Medicaid play key roles in covering these needs. However, there are a variety of other options available to cover issues that are not so commonly tied to traditional health needs such as medical treatment and prescriptions. Often times, due to deteriorating physical and mental health conditions, in additional to medical care, seniors may require assistance in making common decisions and transactions. In these scenarios, guardianships and conservatorships  present attractive options, as guardians are appointed to meet personal care needs and conservators appointed to make informed decisions, most often regarding finances.

Third, speaking of finances, with advanced age comes the joy of retirement, but the loss of income. Social Security, once again, is a program to provide income during our golden ages, but the caveat is that it is a fixed income, which leaves little room for many expenditures for lower income seniors. Nevertheless, there are many useful options for managing income and retirement finances, including aforementioned conservators, as well as powers of attorney- written instruments that give another person the authority to make decisions on behalf of the person granting the power. Additionally, estate planning presents a multitude of options to best utilize retirement plans such as IRA’s and 401Ks.

Because our population is rapidly aging and retiring, the need to protect elders and preserve their legacies is paramount. Granted, though accounting for all needs may seems like a daunting task, it is nonetheless necessary for the well being of the older individual affected, as well as beloved family and friends. So today, as we reflect and honor the nation’s forefathers and greatest leaders, let us also hold our current elders in these highest regards by ensuring their personal protection and preserving their legacies for future generations to honor and celebrate.