Power of attorney, living wills & end of life

End-of-life issues can be extremely complex, and many people avoid making decisions about how such issues will be handled because it can be an uncomfortable and difficult subject to address. However, it is crucial that you do spend time thinking about how you want your final days to play out, both for your own personal comfort and for the well-being of your loved ones. At the very least, strongly consider making a living will and determining who you want to grant a durable power of attorney for healthcare decisions.

The Living Will

living will is a document that sets forth what to do, and what not to do, if you are incapacitated and unable to make those decisions. This could be because you are in a coma, suffered a debilitating injury, or because you have become seriously mentally incapacitated. Here are some of the most basic considerations to account for in your living will:

  • Life-Prolonging Medical Care: Your living will should state whether you want to receive life-prolonging treatments at the end of your life. Typical treatments include blood transfusions, respirators, dialysis, drug treatment and surgery.
  • Do Not Resuscitate (DNR) Directives: In conjunction with directives about whether you want to receive life-prolonging medical care, most living wills will state whether or not you want to be resuscitated (CPR) at the end of your life. It is advisable to let your doctor and local hospital know about your DNR decisions and, if you do not want paramedics to try to resuscitate you, to wear a Medic Alert bracelet, anklet or necklace with those instructions.
  • Life-Prolonging Food and Water: Often, if someone is comatose or seriously injured, they will only be able to survive through the external administration of food and water. When such treatment is stopped, the patient will die naturally of dehydration and medical professionals will typically apply medication to make such a passing comfortable. You should specify whether you want to receive food and water, under what conditions and timelines you would like to receive such treatment and when to stop it.
  • Pain Management: Even if you decide you want to let death occur naturally, without intervening care, it does not mean you have to die with pain. Now commonly called comfort care or palliative care, the goal of such care is to emphasize qualify of life and dignity by keeping the patient comfortable and free of pain until they pass. Specify in your living will if you want doctors to emphasize pain management at the end of your life.

Need a Living Will or Durable Power of Attorney? An Estate Planning Attorney Can Help

Imagine suffering from a massive stroke, resulting in the inability to move your body or even speak, and thus unable to convey your wishes to doctors or other caretakers. That is what living wills and powers of attorney are meant to remedy. But it’s important to get ahead of the curve while you’re healthy and lucid. Learn more about your health care and end-of-life legal options by speaking with an estate planning attorney near you today.

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Choosing a healthcare proxy

Choosing a healthcare proxy helps to ensure you receive the care you want at the end of life. Your healthcare proxy, or agent, should be someone you trust, a family member or close friend. Your agent makes medical decisions for you when you no longer can. You can ask your proxy to make all your healthcare decisions or only certain ones. Your proxy can also decide how your wishes apply as your condition changes. Appointing a proxy ensures that providers follow your wishes.

Everyone over age 18 should have a healthcare proxy. Situations that may require a proxy:

  • You are in a coma from an accident or illness.
  • You are terminally ill and not expected to recover.
  • You have Alzheimer’s or another form of dementia.
  • You are under general anesthesia, when something unexpected occurs.
  • You are in a persistent vegetative state.

Appointing the right person to be your healthcare proxy can be difficult. Here are some steps to guide you:

Clarify your values and beliefs.

Consider what’s important to you. What contributes to the quality of life you want? How do you want to spend your final years, weeks or days? What activities are essential to having a quality life? What role does your faith play in making these decisions?

Frame your medical wishes around these values and priorities. Determine which treatments you are willing to accept. Figure out which treatments you would never want. How much medical care are you willing to have to stay alive? What kind of medical risks are you willing to take? When would you want to shift from treatment to comfort care?

Have an honest conversation.

Talk to family members and friends about what you want. During those conversations, look for someone who is most likely to represent your wishes.

Once you choose a proxy, continue to share your wishes, thoughts and opinions with that person. It’s impossible to predict every scenario that may present itself. But explaining your views will give your agent the information to make decisions on your behalf.

Discuss your wishes with providers.

It’s important to share your wishes with your providers, particularly your primary care provider. This information will enable them to care for you in a manner that is consistent with your wishes. You should also let them know you have a healthcare proxy.

Once you have a healthcare proxy, complete the New York Health Care Proxy form. Instructions are available in several languages:

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What you should know about strokes

Even though strokes are the leading cause of preventable deaths, very few people know much about them. So, the American Stroke Association has published a list of things you didn’t know about strokes for its 20th anniversary. Here are the top 10.

  1. There are three different types of strokes: Ischemic, Hemorrhagic, and TIA (Transient Ischemic Attack). Ischemic occurs as a result of an obstruction within a blood vessel supplying blood to the brain. It accounts for 87 percent of all stroke cases. Hemorrhagic occurs when a weakened blood vessel ruptures. Two types of weakened blood vessels usually cause hemorrhagic stroke: aneurysms and arteriovenous malformations(AVMs). But the most common cause of hemorrhagic stroke is uncontrolled hypertension (high blood pressure). TIA is caused by a temporary clot. Often called a “mini stroke”, these warning strokes should be taken very seriously.
  2. During a stroke, nearly 120 million brain cells die every hour. Compared with the normal rate of cell loss in brain aging, the brain ages 3.6 years each hour without treatment. The sooner the patient gets medical care, the better their chances of recovery.
  3. About 66 percent of the time, someone other than the patient makes the decision to seek treatment – recognizing the warning signs and sudden symptoms of stroke to receive treatment fast, could help save a life.
  4. F.A.S.T. is an acronym used to teach the most common warning signs and sudden symptoms of stroke. F.A.S.T. stands for (F) face drooping, (A) arm weakness, (S) speech difficulty, (T) time to call 9-1-1. Less than half of the population is aware of the signs.
  5. Stroke symptoms can also include sudden numbness, sudden trouble seeing in one or both eyes, sudden severe headache with no known cause and sudden trouble walk
  6. Calling 9-1-1 and arriving at the hospital in an ambulance is the fastest way to get treated quickly during a stroke emergency. Driving to the hospital is a common mistake people make, that can result in longer wait times before the patient receives medical care.
  7. Patients who have an ischemic stroke, may have a treatment window for mechanical clot removal within six hours to up to 24 hours in certain patients with clots in large vessels.
  8. Alteplase (also known as tPA) is a drug used to dissolve a blood clot that causes stroke. Stroke patients who arrive at a hospital within 90 minutes of symptom onset and qualify to receive tPA are almost 3 times more likely to recover with little or no disability.
  9.  Nearly half of all adults in the U.S. (an estimated 103 million) have high blood pressure.
  10.  High blood pressure is the most common controllable cause of stroke. Recent guidelines redefined high blood pressure as a reading of 130/80 mm Hg or higher. A normal reading would be any blood pressure below 120/80 mm Hg and above 90/60 mm Hg in an adult.

To read more about strokes please visit National Stroke Association

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Nursing homes dosing patients with anti-psychotic drugs

According to a Human Rights Watch report, nursing homes are doping tens of thousands residents with anti-psychotic drugs that don’t have diagnoses that require them. Not only that they are doing it without the patients’ consent.

In the report called, “They Want Docile,” the group claims 179,000 residents of long-term nursing homes across the country are given anti-psychotic drugs each week that are not appropriate for their condition. They claim the drugs are used for their sedating side effects, which make patients with dementia and Alzheimer’s disease easier to manage.

Hannah Flamm, an NYU law school fellow at Human Rights Watch told the Guardian, “People with dementia are often sedated to make life easier for overworked nursing home staff, and the government does little to protect vulnerable residents from such abuse.”

The report is based on publicly available data and visits  to 109 nursing facilities from October 2016 to March 2017 in California, Florida, Illinois, Kansas, New York and Texas. They also interviewed 323 people living in nursing homes, nursing facility staff and long-term care and disability experts.

An attorney for AARP, Kelly Bagby, which has been involved in several court cases challenging nursing home medication practices, told Fox News  “given the dire consequences” of antipsychotics, the number of elderly people with dementia taking the drugs “should be zero.”

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Medicaid & nursing homes

Under Medicaid laws, if you transfer certain assets five years before you apply for Medicaid, Your access to Medicaid can be delayed, the length of the delay depending on the amount of the transfer.

While federal tax laws allow you to transfer up to $14,000 a year without having to pay a gift tax, Medicaid still treats that as a transfer an it can delay your benefits. Any transfer you make will be looked at no matter what the amount or reason. Even if you give money for an anniversary, birthday or a charity could count for a penalty.

If, all of a sudden you become Diamond Jim Brady an start spending money that will prompt the State to look into what you are spending it on.

While most transfers are penalized, there are some that are exempt and when you go into a nursing home these won’t count against you.

You can transfer these assets to the following people and not have to worry about the waiting period.

  • your spouse
  • a child who is blind or permanently disabled
  • a trust for the sole benefit of anyone under age 65 who is permanently disabled

Also, you can transfer your home to the above people as well as the following:

  • a child who is under age 21
  • a child who has lived in your home for at least two years prior to your moving to a nursing home and who provided you with care that allowed you to stay at home during that time
  • a sibling who already has an equity interest in the house and who lived there for at least a year before you moved to a nursing home

For more info Medicaid’s transfer rules, click here.


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