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Elder Care: What estate planning really looks like
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Elder Care: What estate planning really looks like

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As a car crash victim lies unconscious in a hospital bed, a group of strangers who make up the hospital’s ethics committee meets to decide this patient’s future. The committee will decide what life-saving measures will be taken for this patient.

The committee members know nothing about this unconscious person’s ideas about quality of life. A medical decision may deprive the patient of the ability to travel, play the piano or go golfing with lifelong friends. The committee has no way of knowing how important those activities are for the patient.

The members of the committee do not know about the true impact of the medical treatment decisions, because the patient made no plans for this common situation.

Down the hall in the same hospital, a severe stroke has rendered a patient unable to communicate. The patient is having trouble chewing and swallowing, and the future ability of the patient to organize thoughts and perform basic daily functions is in question.

This patient had downloaded a health care advance directive from the internet and named a family member to make critical medical decisions in this moment. But the patient and family member never discussed the patient’s wishes, priorities or religious beliefs in the event that prolonging life would be balanced against quality of life. The family member is thinking about this monumental responsibility for the first time at the foot of the hospital bed.

Not only is the family member worried about making a decision that the patient would not have wanted, but the family member has another troubling realization. If the patient survives and leaves the hospital, the family member wonders how the family will afford to provide the ongoing care that will certainly be necessary.

After a year in which the news constantly focused on certain health care decisions, some may wonder whether it’s necessary to recognize National Health Care Decisions Day on April 16. People have consciously made health care decisions every day that range from wearing a mask and avoiding crowds to getting a vaccine.

The organizers of National Health Care Decisions Day chose April 16 deliberately to follow Tax Day. They were mindful of Benjamin Franklin’s observation that nothing in life is certain except death and taxes.

Truly recognizing the importance of planning for declining health means shifting from the masks and vaccines that make up the trees to see the forest of interconnected caregiving, legal and financial decisions. It means thinking through the impact of health crises on children who have jobs and families of their own.

Simply declaring that you will never go to an assisted living residence or nursing home is not planning. Real planning involves decisions about how your bills will get paid, how real estate will be handled, how you will pay for care provided in your home to maintain independence, and how your spouse will afford to live and receive care in the event of your declining health.

Previous generations had fewer of these decisions to make. Amazing advances in medical science and technology have extended life expectancies, but they have also made it necessary to envision how we will navigate longer lives. Heart disease may be more preventable and treatable, but now we face an explosion in dementia diagnoses.

The good news is that there is an abundance of free education available about these health care planning issues. At Keystone Elder Law P.C., our holistic planning philosophy is reflected in the makeup of our team, which includes a registered nurse, a medical billing specialist and attorneys trained to navigate the maze of estate planning strategies and public health benefits. In the coming weeks, we will be teaming up with financial advisers, insurance professionals and a range of health care providers to conduct free seminars to explore the many ways that people can make holistic plans for themselves and their families.

We hope that you will contact us or find information on our website and social media pages about these seminars. In the meantime, here are some concrete examples of planning issues to consider.

Advance health care directives: Legally enforceable documents allow people to ensure that their wishes for medical treatment will be honored in the event that they can no longer communicate. Each person has the right to decide when medical treatment should shift from a goal of prolonging life to providing comfort. When a person makes these decisions in advance, no family member will bear the burden of guilt or worry about whether treatment was provided in accordance with the patient’s wishes.

Pre-planning for a funeral and burial: Just as advance health care directives relieve family members of the burden of decision-making, planning for cremation or burial in advance will spare a family already stressed by their loved one’s declining health from having to determine how their loved one wanted to be laid to rest. Funeral directors and certain financial and insurance professionals can advise families about the ways to make these plans.

Public benefits planning: Most people are not aware that the cost of long-term care is almost $11,000 a month and is not covered by Medicare or related health insurance. Public health data show that 70% of people age 65 and older will need some type of long-term care. That extraordinary cost will quickly deplete the savings of most families in Central Pennsylvania.

The Medicaid program, however, provides a safety net to pay for skilled nursing care. At Keystone Elder Law, we guide people through proactive planning to ensure Medicaid eligibility. People commonly express concerns about losing their house or ask about transferring property to children to meet the Medicaid program’s strict financial eligibility criteria. These can be complicated issues and answers often depend on the person’s foundational estate planning documents.

Powers of attorney, trusts and wills: How long has it been since you examined your last will and testament? If your spouse receives public benefits to pay for long-term care, then your spouse is under strict financial guidelines. If you were to pass away, does your will leave all of your money and property to your spouse? If the answer is yes, your spouse will lose those benefits and your savings will be spent on long-term care, leaving nothing for your children.

Trusts, both the kind created during your life and the kind that are built into wills, can be very effective tools to protect your life savings from the costs of long-term care. While you are looking at your estate planning documents, examine your financial power of attorney and see what it says about gifting, which would enable someone to work with your money to achieve Medicaid eligibility for you in the event of a health crisis.

Take a moment on April 16, National Health Care Decisions Day, to contemplate the wisdom of Benjamin Franklin’s observation. Death and taxes are inevitable. Consider whether you think about the consequences of declining health as often as you think about your taxes.

Learn more about the article’s author, and other community education opportunities, at www.keystoneelderlaw.com. Check out the book, “Long Term Care Guide: Essential Tools for Solving the Elder Care Puzzle,” at the Whistlestop Bookshop or Amazon, and see Keystone’s free directory of services for older adults at www.mypeaceguide.com. Keystone Elder Law has offices in Mechanicsburg and Carlisle. Call 717-697-3223 for a free telephone consultation.

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