ADVANCED CARE DIRECTIVES: Are they Necessary?
Most of us don’t like to think about the possibility of something harmful happening to us or a loved one. Because of this, we rarely think about how to protect ourselves and our loved ones if the worst were to happen. However, just as it is important to buy home insurance to protect your home and auto insurance to protect your vehicle, every individual should have an advanced care directive to protect themselves if they were no longer able to make decisions for their health care, end of life, living arrangements, and various other personal matters.
The basic definition of an advanced care directive is a legal document or group of legal documents in which a person puts in writing what their wishes are for their health if they no longer have capacity to make these decisions for themselves. Advanced care directives are often comprised of a living will and a health care proxy. Everyone who is above the age of 18 should have one.
There are several key items you should include in your advanced care directive. While these can be drafted without legal help, this is a legally binding document as soon as it is signed in front of the required witnesses and it is essential you seek the advice of a legal professional when creating a directive. The most important instructions to include are which life support treatments you want, or do not want. You can provide directions on if you want all life support treatments, no life support treatments, or you may choose individual support treatments such as blood transfusions or dialysis.
Another facet every healthcare directive should contain is who you choose to be your health care proxy – here in Florida we call this a “Health Care Surrogate.” This person will be responsible for making medical decisions on your behalf in the event you are unable to. This person should be someone who you are close to and can trust. You should also decide if you want a do not resuscitate order, which states that if your heart stops or you are no longer breathing, you want every effort or no effort made to revive you. Depending on your personal preferences, you should also include whether you would like to become a registered organ donor.
IMPORTANT INFORMATION TO KEEP IN MIND
Advanced directives are not congruent throughout the United States and laws may vary from state to state. This can often be confusing because one state’s directive may not work in another stat. To ensure your wishes are carried out, you should complete advanced care directives for all states where you spend a significant amount of time.
Emergency medical technicians are legally obligated to do whatever is necessary to stabilize a person and transfer them to a hospital. Therefore, they simply cannot honor your advanced care directive. Your directive will be implemented when a medical professional evaluates your condition and the underlying conditions.
Advanced care directives have no expiration timeline - the original will remain in effect unless you make changes to it. If you create a new directive in the same state, the previous one will be invalidated. However, it is important to notify the agent named in both the old and new document.
If your wishes do change, it is important to keep your advanced care directive up to date. If you choose to make changes, it is recommended that you create an entirely new document.
We have all of our Clients sign 3 separate health care documents: 1) Health Care Surrogate Designation (this is the document where you name a person(s) to make medical decisions for you if you cannot make them for yourself); 2) Living Will (this is the document where you state your intentions as to how you want to be taken care of in the event you are mentally incapacitated AND are either a) in a terminal condition, or b) in an end-stage condition of a disease, or c) in a persistent vegetative state); and 3) HIPAA Authorization (this is the document where you name people to act as your “personal representative” to obtain medical information about you).
Advanced care directives are extremely important because they give you a voice when you may not be able to speak on your behalf. If you have questions about anything you’ve read or would like to meet with a legal professional to discuss how you could benefit from an advanced care directive, please do not hesitate to contact our office.
5 Things to Include in an Estate Plan
Estate planning is important for people of all ages, but as we age, the need for planning becomes even more critical. Many people avoid estate planning, because they do not want to think about the end of life, failing health or disability. Others believe that an estate plan is only for rich people. However, an estate plan is helpful for the senior adult and their families regardless of overall wealth.
The estate is all the property owned both individually and jointly, including bank accounts, real estate, jewelry, etc., and what is owed. Without an estate plan, it is very difficult to carry out a person’s wishes and can bring on a long, drawn out probate that can be very expensive for the family. If an estate plan is in place, it can provide peace of mind for the senior adult and their family, as well as protection for the wishes of the senior.
Below are some basic guidelines for what should be included in an estate plan.
1. Will. A will provides for an executor of the estate, who will take care of managing the estate, paying debts, and distributing property as specified. The distribution of assets can be outlined in the will. This can be as broad or detailed as a person wishes. In a will, beneficiaries and guardians for minor children should be assigned. It may not seem necessary to discuss minor children when discussing seniors and estate planning, but with the rise of grandparents raising grandchildren, this may indeed be an important part of the will. A senior adult can spell out, in the will, how they want their funeral and burial to be carried out as well.
2. Living Will. A living will outlines a senior’s wishes for end of life medical care. It can include, in as much detail as the senior wishes, what medical treatments the senior would or would not like to have in specific situations. A living will takes the stress of making those decisions off of family members and helps to keep peace in families during times that can be difficult and emotional.
3. Healthcare Power of Attorney. A healthcare power of attorney is also a key part of an estate plan. This legal document provides for someone to legally make healthcare decisions for a senior adult. A durable power of attorney will remain in effect for the senior if the senior becomes unable to make decisions.
4. Financial Power of Attorney. A financial power of attorney names an agent who has the power to act in the place of the senior adult for matters relating to finances. The durable financial power of attorney stays in effect if the senior adult becomes unable to handle their affairs. By having a financial power of attorney in place, the stress and expense of a guardianship can be avoided, and the senior has the final say in who will make decisions relating to finances.
5. Trust. Setting up a trust can be beneficial for the distribution of specific assets or pieces of property. The benefit of a trust is that it does not go through probate, as compared to a will. Property is still distributed at the death of the trustmaker, but it is done without the need of a court. This also allows for privacy of the trustmaker, where with a will and a probate, all of the deceased person’s assets and the the terms of their will is made public.
Having an estate plan is necessary if you or your senior loved one wishes to have a say in what happens in the end of life and with assets after death. Consulting and planning with an elder law attorney will help to ensure that all options are explored and the best possible solution is utilized. The elder law attorney can walk you through all of the necessary parts of the estate plan, provide explanation, and prepare the paperwork. Elder law attorneys will help take the guesswork out of estate planning.
If you have any questions about something you have read or would like additional information, please feel free to contact us.
Alzheimer’s 101 – Understanding the Basics
What is Alzheimer’s Disease?
Alzheimer’s disease is defined as an irreversible, progressive mental deterioration that can occur in middle or old age. It is the most common form of dementia.
What causes Alzheimer’s Disease?
Alzheimer’s disease is caused by a generalized deterioration of the brain. The disease is caused by a combination of factors, including genetic, lifestyle, and environmental factors. There are a variety of factors that put people at risk for Alzheimer’s disease. Age and genetics are risk factors. As people age or if there is a family history of Alzheimer’s, there is a greater risk of the onset of Alzheimer’s disease. People with Down Syndrome or mild cognitive impairment have a greater chance of having Alzheimer’s as they age. If a person has experienced past head trauma, this puts them at risk for Alzheimer’s.
The risk of Alzheimer’s is also related to lifestyle and heart health. Those with poor heart health and an unhealthy lifestyle put themselves at greater risk for the disease.
Finally, women are more likely to be diagnosed with Alzheimer’s than men. Some causes and risk factors of Alzheimer’s disease are impossible to change or control, but lifestyle and heart health are things that can be controlled.
What are the symptoms of Alzheimer’s Disease?
Alzheimer’s disease, in general, destroys memory and thinking skills. In the late stages, a person with Alzheimer’s is unable to carry out even the simplest tasks. A person who is experiencing the onset of Alzheimer’s will experience mild symptoms, which may include increasing forgetfulness or mild confusion. As the disease progresses, the memory loss increases, especially recent memories. The progressive nature of the disease causes memory to continue to deteriorate throughout the rest of the person’s life. The ability to think and reason are impaired until even performing familiar tasks can become impossible.
A person with Alzheimer’s disease often experiences changes in behavior. They may do things out of their character for them prior to the disease. Common changes in behavior include aggressive behavior, agitation and irritability. Alzheimer’s disease symptoms can include depression, mood swings, and difficulty sleeping. The deterioration of the brain causes a person to change in ways that are difficult and trying for all involved.
How is Alzheimer’s Disease diagnosed?
Alzheimer’s disease is complicated and getting to a diagnosis is a long process. If a person or their family suspects the onset of Alzheimer’s disease, it is important to understand that there will be many steps and visits with doctors to determine if in fact it is Alzheimer’s. There is no single test. The first step for the doctor will be to get a comprehensive medical history. The doctor can use this history to determine if the patient has risk factors for Alzheimer’s disease. The next step is to complete testing on mental status and mood of the patient. Beyond this there will be physical and neurological examinations. If the doctor suspects Alzheimer’s, the tests will continue with blood tests and brain imaging. The goal is to rule out other causes to be sure that Alzheimer’s disease is the correct diagnosis.
What treatment options are available?
Alzheimer’s disease has no cure. Treatment options are meant to delay or slow the progression of the disease. Medication is one treatment option. The medicines are used to treat the cognitive symptoms. As the disease progresses, symptoms continue to worsen. Medication is unable to stop the damage that Alzheimer’s disease causes to brain cells, it can help stabilize the patient or slow the progression for some time.
Behavioral symptoms can be treated with some medication as well, but there are other ways to address these symptoms. The first thing is to know and be aware of triggers. By knowing triggers, there are a variety of coping strategies that can be used. Some of these include avoiding confrontation, making sure the Alzheimer’s patient gets adequate rest, monitoring comfort, and creating a calm environment. Many are now looking at herbal remedies, dietary supplements, and “medical” foods as possible treatments to enhance memory. There is no conclusive evidence that these things work.
Alzheimer’s disease is complicated. The causes and symptoms vary from one person to the next as does the progression of the disease. Being educated about the disease and care options is the key to helping a loved one with Alzheimer’s disease. Doctors, therapists, and elder law attorneys can guide families through the difficult process of caring for a loved one with Alzheimer’s.
If you have any questions about something you have read or would like additional information, please feel free to contact us.
Senior Adults and Identity Theft – How to Protect Against It
Senior adults can be more susceptible to identity theft than others. Identity theft is a crime that is on the rise. It involves a criminal stealing personal identifying information to create a new identity or to steal money from the victim. Senior adults are targeted for a few reasons. One reason is that they often have more money saved after a lifetime of working than younger people. Another factor is that personal information for elderly adults often passes through more hands, especially those in hospitals and nursing homes. Senior adults can be more trusting of people and often do not pick up on warning signs. Finally, aging adults are far less likely to report identity theft crimes. They fear that their independence might be taken away by their loved ones. It is important for senior adults and their caregivers to know how to protect themselves against identity theft.
The rapid growth of technology has given identity thieves many new outlets for preying on seniors. Many thieves use email to present themselves as a reputable group or company. In the emails, they request personal information. Seniors give their information and the thief has what they need to steal from them. Identity thieves also use phone calls to gain personal information from elderly adults. They may pose as representatives from companies or the government, and ask for personal information. Unsuspecting seniors, then give them personal information. Social media is another place that identity thieves comb to find the personal information of senior adults. To protect their identity, seniors should never give any personal information through unsecured sources, such as email or over the phone. Seniors should avoid sharing personal information on social media. Even information like the exact date of birth can allow identity thieves to obtain information to steal from an unsuspecting adult.
Papers, including mail, are an excellent way for thieves to get personal information. Keep tabs on all important documents and store them safely in a file cabinet that locks or a safe. If a senior adult is in the hospital or travelling, it is important to stop mail delivery or arrange for daily pick up. Monitoring credit and bank accounts on a regular basis also helps to protect the identity of senior adults. Shred old paperwork, mail, and receipts instead of just throwing them away and be careful when throwing away receipts in places like hotels.
The starting point for for seniors to be protected from identity theft is to be informed. Seniors and their loved ones should educate themselves and their loved ones on common scams that identity thieves use. Another way to protect identity is through a monitoring service. For a small fee, companies can monitor online accounts and a person’s social security number to help prevent identity theft.
There are also a variety of legal planning tools to help protect seniors and their loved ones from identity theft. The way assets are titled can play a large part in whether those assets can be stolen. Planning with trusts can also provide a layer of protection against identity theft and fraud. A thorough legal plan combined with knowledge and awareness is the best defense.
If you have any questions or would like additional information, please feel free to contact us.
What the New Tax Bill Means for You
Congress passed the Tax Cuts and Jobs Act in December of 2017 which is aimed at cutting taxes for corporations and all Americans. While the bulk of the legislation went into effect January 2018, most taxpayers will not see much of a difference in their taxes until 2019, when they file their 2018 taxes. However, there are several important changes seniors need to be aware of now that could affect not only their tax bill, but other items such as their health care premiums. Legislation as complicated as a new tax code can be difficult to dissect, and certainly requires the help of a tax professional. Please feel free to contact our office with any questions you may have while reading through the points below:
Before explaining the changes, let’s examine several facets important to seniors that will remain the same. The new tax bill keeps the extra standard deduction for those 65 and older, which is $1,250 for individuals, $1,550 for heads of households, and $2,500 for couples who are both age 65 or older. Also, the new plan keeps the popular medical expense deduction. This deduction is for people with incomes below $75,000 which allows them to deduct medical expenses that exceed 7.5 percent of their income for the 2017 and 2018 tax year. In 2019, this will increase to bills that exceed 10 percent of their income. Further, the new plan does not affect the way Social Security or investment income is taxed.
Perhaps the most talked about change in the new tax plan is the repeal of the individual mandate contained in the Affordable Care Act. According to the bipartisan Congressional Budget Office (CBO), by 2027, this will increase the number of Americans without health insurance by 13 million. The CBO also states that because there will be a smaller pool of insured, it expects insurance premiums in the individual market to increase by 10 percent over the next 10 years. Citizens age 50 to 64 can expect a premium increase of up to $1,500 in 2019.
The tax bill slashes taxes across the board, contributing to a loss of $1.5 trillion in revenue to the government over the next decade. This deficit would trigger cuts to “pay-as-you-go” programs such as Medicare and Medicaid. Medicare is expected to have its budget slashed by $25 billion in 2018.
Other notable provisions that will affect senior taxpayers include the new tax brackets which range from 10 percent for the lowest earners to 37 percent for those with the highest incomes. Taxpayers can deduct state and local taxes, which may include income, sales, and property taxes. The state and local tax deductions are capped at $10,000. Alimony payments will no longer be deductible. Anyone who inherits an estate can now exempt $10 million compared to the previous $5.6 million. The charitable giving deduction will increase under the new plan until this provision expires in 2026. The mortgage interest deduction is also being updated. Now, the deduction on mortgage interest is capped to loans of $750,000 for new home purchases and interest accrued on home equity loans is no longer deductible.
Under the new Tax Cuts and Jobs Act, the majority of seniors may see their tax bills decrease. However, it is still prudent that seniors be aware of the changes that may affect them such as their health care premiums or deductions on medical expenses. If you would like to meet with a professional who will be able to assess your personal situation and provide you with guidance on how this will affect you, please don’t hesitate to give our office a call.