Health Care Power of Attorney: Specific or General

Health Care Power of Attorney: Specific or General

 

You have the right to decide what kind of medical treatment you want to receive from doctors and health-care providers. If you can speak up at the time, you can express your wishes yourself. But if you become incapable because you’re ill or injured, you need to plan in advance. Designate a person whom you trust to speak for you. You do this by creating what’s known as an “advance directive” or health care power of attorney.

You also have a choice about the kind of document you prefer. You can ask for a short document that simply conveys general authority on your agent to make health-care decisions for you – or you can opt for a longer document that details the specific powers you give to your agent.

For both versions, we offer a checklist to assist you in discussing your wishes with your agent beforehand.

 

The General Version

This version is short, clear, and easy to understand. It states, generally, that you have given your agent the authority to speak for you. Your agent knows your wishes, because you have discussed those wishes with him or her beforehand.

 

The Specific Version

This version goes into detail about what you would like your agent to do for you. For example, it includes the request that providers and your agent consult with you if possible. If not possible, it includes a list of procedures that you authorize your agent to decide on your behalf. Included are decisions about what kind of residential facility you want to be placed in, that an agent can visit you and bar others from visiting if appropriate, can advocate for pain relief, can consent to psychiatric treatment, can decide about anatomical gifts and organ donation, and the document provides procedural details about enforcement.

You will be covered with either version. The choice is yours.

 

Living Will

You may also want a separate Living Will for end-of-life decisions. This document becomes effective when you can no longer care for yourself, walk, talk, recognize loved ones, or are in the final stage of an incurable illness. At that point, you can decline expensive, high-intensity care that likely would not improve quality of life.

Choosing Your Agent

The person you choose to be your health-care agent must be someone you can depend on to have good communication skills, remain calm in difficult situations, and deal flexibly with complexity that might arise in reconciling your wishes with available medical options. Choose that person carefully.

 

Health Care Preferences Checklist

We can offer you a checklist, to help you discuss your wishes with your agent. This is not an easy conversation. It’s hard to contemplate a time when our health has declined or we suffer injury or accident. It is also challenging to try to imagine various scenarios involving situations that can be complicated by numerous medical contingencies.

Still, your agent needs to know what you would want in a variety of situations. These include whether to decline or accept life support and mechanical interventions, when you would opt for or decline surgery, and your preferences about blood transfusions, medication, and religious observance.

For certain states, the checklist also contains a signature line that proves you have discussed your wishes as to feeding and hydration tubes. Otherwise, if your agent doesn’t know what you would decide, the law in some states would take away from your agent the right to decide about those kinds of measures.

 

Don’t hide your documents!

When it comes time to use your documents but they can’t be found, or if your agent or family don’t understand them or ignore them, you will have spent your time, effort, and money in vain. Make sure your documents are readily available. Give a copy of them to your agent and ask your doctors to include them in your medical records.

You will have done your best to see that your values and health-care choices will be honored.  Let us know if you have any questions concerning this or any other matter.  Simply call us at 1.800.660.7564 or email us at info@covertlaw.com.

Beneficiary Designations: Pitfalls You May Not Know About

Beneficiary Designations: Pitfalls You May Not Know About

 

You might think that leaving your property to your heirs would be simple enough. You make a will or a trust, you do a transfer-on-death deed for your real estate, you put your kids on your bank account, you designate beneficiaries for your life insurance and retirement accounts, and you’re done.

If only things were that simple. The result you wanted can be seriously foiled, if all the above elements are not carefully coordinated. 

After you consider the following, we hope you’ll agree that it’s best to consult a qualified attorney. That’s the person you need to help you construct an estate plan that will do what you want it to do.

A pitfall: Conflict between deeds and wills or trusts

If your will or trust conflicts with a deed for real property, the law will resolve the conflict for you by following the deed, not the will or trust. This can produce unintended results. 

Suppose Mary wanted to divide her property equally between her two children, John and Jane. She recorded a beneficiary deed for John so he could inherit the house. She wrote a will leaving money to her daughter Jane that was roughly the same value as the house.

Subsequently, however, Mary forgot about John’s deed. She made another will that split everything equally between John and Jane. 

On Mary’s death, John ended up getting significantly more than Jane. The portion of the second will including the house would be invalidated, because the earlier deed would supplant the will. So John got the house through the deed, plus half the money through the will. Jane got half the money only. That was not what Mary intended and the unfairness damaged John’s and Jane’s relationship.

A similar pitfall: Conflict between beneficiary designations and wills or trusts

Financial accounts can transfer automatically to people of your choice, avoiding probate, if you designate beneficiaries by means of “transfer on death” (TOD) through your broker. But you must not depend on your will to change TOD designations. The beneficiary designations establish a contract between the holder of the account and you. When you pass, the holder is legally obligated to transfer your account to the beneficiaries you designate, regardless what your will says. The designations, like deeds, supplant wills.

So if you have named your spouse as a beneficiary of, say, a retirement account, and then you get divorced and forget to change the beneficiary designation, your ex-spouse – and neither your new spouse nor your children nor anybody else – will receive the account proceeds when you die, regardless what your will says.

Underage beneficiaries and guardianship proceedings

Suppose your financial advisor calls to alert you that you have not designated beneficiaries on your accounts and that if you don’t do so, your estate will have to go through probate when you pass. By making TOD designations, your beneficiary would simply present a death certificate and the assets would transfer to him or her without the need to go to court. That sounds good. So you follow your advisor’s suggestion and designate your beneficiaries.

In the meantime, your lawyer drafts a good will for you. This will, as good wills should, contains a subtrust providing for underage beneficiaries. Your lawyer, echoing your financial advisor, explains that the subtrust is intended to avoid the necessity of court proceedings.

Your efforts to avoid court will be defeated, however, if you choose an underage beneficiary to receive your financial account through TOD. Guardianship proceedings would still be necessary to administer the money until the beneficiary came of age.

It would have been better to route the gift to the underage beneficiary through a will or trust and not through TOD designation. If wills or trusts are properly drafted, they contain provisions to administer the underage beneficiary’s inheritance privately and thereby avoid the court guardianship proceedings.

Another pitfall: Disabled beneficiaries and government benefits

The pitfall here is similar to the one above. If your beneficiary is disabled and gets a TOD (or any other kind of) inheritance, the inherited money could jeopardize the beneficiary’s entitlement to government benefits. Most benefits programs are “means-tested.” To be eligible, recipients must own practically nothing. If your beneficiary were suddenly to inherit, he or she would lose benefits and end up having to pay for care until the inheritance was spent. That could involve a lot of money!

Rather, like for underage beneficiaries, the disabled beneficiary’s inheritance should be routed through a will or “supplemental needs trust” (SNT) that imposes restrictions on spending. With those restrictions in place, the benefits would keep coming, and the inheritance assets could be used to pay for “extras” that benefits don’t cover. These extras might include payment of real estate taxes, upkeep of a residence, or vacations or a flat-screen television. The inherited money would be managed by a trusted person and the disabled beneficiary would still continue to receive the crucially important benefits.

Bank accounts and disabled or underage beneficiaries

The pitfall is the same as above. If you have designated underage or disabled beneficiaries by making your accounts “payable on death” (POD), court proceedings will be necessary in the case of the underage beneficiary, or the inheritance could jeopardize or eliminate the disabled beneficiary’s government benefits.

“Spendthrift” beneficiaries

The problem is likewise similar here. If your beneficiary has a gambling habit or drug addiction, or if he or she needs bankruptcy protection from creditors, and if he or she inherits without trust protections, the inheritance could be lost to the beneficiary’s detriment.

Joint tenancy of real property

It may be tempting to avoid probate by putting real estate in your beneficiaries’ names as joint tenants. But if multiple people own real estate jointly, all must agree on what is to be done with the land and all should contribute equally to property maintenance expenses. This can create disputes. A better solution might be to subject the property to probate, to dispose of it in orderly court proceedings. 

Joint bank accounts

The intent to avoid probate here is similar to joint tenancy of land, but putting your bank account in your and your children’s names exposes the funds to risk that should be avoided. Once a person is named as a co-owner of a bank account, that person has immediate and unfettered access to the funds. The funds are thus exposed to misappropriation by the joint-tenant child, or they can go instead to the child’s creditors in bankruptcy, or to ex-spouses in divorce proceedings.

It would be better to create a power of attorney that allows a trusted agent access to bank-account funds for your benefit while you are alive. Then, for when you pass, you could name beneficiaries via a POD designation with the bank – but remember the warnings above regarding underage or disabled or spendthrift beneficiaries. Those beneficiaries’ access  to funds should be protected by a trust.

A lot of moving parts

Each of the estate-planning strategies above could work well in and of themselves, but, taken together, may have an adverse impact. Crafting a plan that combines and coordinates the various strategies requires expertise and care. That care is worth taking, to safeguard the wealth you have built up over the years. Don’t risk a result you don’t want. Call on us to design a plan that harmonizes all the moving parts, so the gears will work together and you will leave the legacy you intended.  Simply give us a call at 1.800.660.7564 or email us at info@covertlaw.com.

Challenging Health Care Bills

Challenging Health Care Bills

 

We owe immense gratitude to those who are caring for the sick, and to those who support those workers. At the same time, we should be skeptical of bills we may be presented for that care.

The struggle to contain health-care costs in this country is now a fixture in the national policy debate. Our health-care expense does not lead to good results. The United States spends more on health care as a share of the economy – nearly twice as other developed nations – yet has the lowest life expectancy and the highest rates for suicide, chronic disease, and obesity. See:

https://www.commonwealthfund.org/publications/issue-briefs/2020/jan/us-health-care-global-perspective-2019

If that expense has landed in the middle of your household budget, here are some home truths that may help you monitor what you’re being charged. In many cases, the bills are fair. But they may not be.

For example, in the case of coronavirus testing, many providers charge between zero and $200 – yet one Texas lab charged insurance companies as much as $2,315.

Or, a hospital may have charged you exorbitant fees for medication you could have obtained over the counter. A patient was billed $238 for eyedrops obtainable in a retail pharmacy for between $15 and $50. Sometimes the worst excesses are due to “surprise medical bills.” You can be treated in a hospital that is in your insurer’s network, but if the particular physician has rejected the insurer’s rates as too low, the physician will be treated as out-of-network, the costs can go through the roof, and your insurance company will refuse to pay

If you are willing to put in the time and effort, it may be that you can negotiate to have your bills reduced. If the charges are big enough, it may be worthwhile to embark on an effort to get them reconsidered.

Health care reporter Sarah Kliff, formerly of Vox and now with the New York Times, has written a primer on how to proceed. 

The steps she outlines are:

*     Obtain an itemized bill. The first bill you receive may give you no idea of what the charges are for.

*     It is common practice for emergency rooms to bill for simply walking in the door. Hospitals often use a point system depending on their assessment of the emergency, with higher fees for more complicated conditions. You may be able to challenge the assessment down to a lower grade.

*     You may be able to obtain a discount for paying promptly. Sarah Kliff advises persistence until you connect with a person who has authority to permit this.

For especially big bills, please call us at 1.800.660.7564 or email us at info@covertlaw.com. We can assist in advocating for you.

Family Caregiving During the Coronavirus

Family Caregiving During the Coronavirus

There are new challenges to meet for family systems with loved ones who are most vulnerable to the coronavirus yet still require caregiving. Family caregivers that use to aid their family directly, now find themselves learning how to be long-distance providers during this pandemic. US News reports that before the coronavirus, thirteen percent of Americans provided long-distance care. The new reality is that all family caregivers must employ protocols that maintain social distancing to protect their loved ones.

The best way to stay close from far away with ease is to employ technology in your parent’s home, making wellness checks, or using camera monitoring if they are particularly frail. Many homes are already fully alarmed with cameras and motion detectors inside and out. Sharing access codes will allow a family caregiver to visually check-in and ensure all is well. As access codes can be changed, a parent can know if the future permits, they can reassert their independence by simply changing their code. Camera systems are an incredibly valuable tool in the event you cannot reach your parent by phone.  

In the absence of cameras previously installed in the care recipient’s home, solutions such as Briocare or LifePod remotely address a senior’s quality of life. Both of these solutions meet the needs of self-care, independence, and safety while allowing access to you, the remote caregiver. Briocare employs Amazon’s virtual assistant technology (smart speaker) by overlaying their mobile application (app) with customized care subgroups like dementia care, diabetes care, hypertension care, and general wellness. 

Daily routines can be set, including medication reminders, family calls, emergency calls and alerts, medical device integration, and entertainment activities. Similarly, LifePod uses the capabilities of smart speakers for family caregivers to configure reminders and remotely check in with their loved ones. Telemedicine interactions with their physicians are also possible using a smart speaker. A remote appointment can provide much-needed assurance, prescription dosage changes, or determination that, despite the pandemic, medical intervention is required. Smart speaker voice-activated technology that is appropriately configured to meet your parent’s specific needs is a lifeline between remote family caregivers and their loved ones. 

Beyond organizing daily activities, medical needs, and monitoring the safety of your at-home senior, there are other essential needs to address like food and finances. Restaurant food delivery services are readily available in all but the most rural of locations to provide prepared meals to your senior’s doorstep. Restaurants must meet strict guidelines for food preparation and handling to ensure safety during the coronavirus. Meanwhile, at the grocery store, personal shopping assistants can gather all the food and pharmacy needs on your list for delivery to your parent’s home. 

Check with the local stores your parent prefers for instructions on how to get home delivery or check out Instacart, an online food shopping service provider, that in some areas can deliver groceries in as little as an hour. Fully one-third of family caregivers are now millennials who have a comfort level leveraging technology to simplify caregiving to their family. If you are a baby boomer and are unsure about using these online food services, enlist the help of your children or a trusted friend who is comfortable with technology. 

An Amazon Prime account can send packaged food goods and even connect a user to Whole Foods Market for fresh meat, fish, and produce shopping. Tips on how to save money and expeditiously choose and use food products are outlined on these sites. Read through the information provided on the website as a little planning goes a long way to purchasing efficiency and proper nutrition for your care recipient.

To ensure your parent’s finances are in good order, again turn to technology. During this pandemic, many older people are rightly experiencing a lot of fear as they are primary targets of the new scams associated with the coronavirus. Even if you have never checked on your parent’s finances before, now is an excellent time to have a look. Check for unusual activity in credit card balances or credit score data. Seniors tend to accumulate many and varied account types such as investment accounts, credit and debit card accounts, business entities, real estate, and more. If you feel out of your depth in overseeing their finances, implement some online financial services.

Individualized shared platforms like EverSafe and Onist monitor all types of financial accounts and provide simple tools that let you organize, analyze, and track your loved one’s finances all in one place. Each program is customizable to grant access to family members and even financial professionals if managing monies is not your expertise. Artificial intelligence tools are designed for oversite, identifying account anomalies like unusual withdrawals, missing deposits, changes in spending habits, and will provide suspicious activity alerts to your email, text, or phone. Look for platforms with highly secure 2048-bit encryption to ensure online security.

There are many practical considerations to address when caregiving remotely for your family loved one, but using technology can solve most of them quite easily. While nothing can replace human contact, the basics of care for your parent are within reach because of the digital age. 

We help families who are caring for aging parents. If you have questions or would like to discuss your family situation, please don’t hesitate to reach out by calling us at 1.800.660.7564 or by emailing us at info@covertlaw.com.  Stay safe.