Wednesday, September 23, 2009

Getting Your House in Order

As we age we start to think more and more about our later years, what we want, and don’t want and the what if’s. Part of those thoughts revolve around our medical wishes. We also think about our finances, will, living and care arrangements. What we don’t think about is getting our things in order before old age. The truth is it’s never too early to plan and prepare.

Two of the statements I hear most frequently from seniors are “I don’t want to go to a nursing home”, and “I don’t want to be put on machines.” Without the proper documents in place, your medical decisions may end up out of your hands.

This delicate subject seems to be difficult for many families to even bring up. Although we know there is a need to prepare, we tend to not want to think about someone in the family becoming terminally ill, tragically injured, or dying. Sometimes a diagnosis comes that leaves a family time to prepare, but many times there is an unexpected crisis, which can leave a family reeling to make decisions. Caring Connections has a great article to bring the subject up within the family and ease the process into this conversation.

Many people lack understanding or misunderstand Advanced Directives, DNR, Full Code, Living Will, Guardianship, and Power of Attorney. For the ease of understanding, here are the basic definitions. There are also financial Wills, and Trusts. These are detailed legal documents for your financial planning. Many companies offer free seminars to educate the public on this planning.

Advanced Directives-
A legal document also referred to as a medical directive, which documents an individual's preferences regarding the manner in which they would like to receive health care, in the event they can no longer communicate such wishes directly. Living Wills, Health Care Powers of Attorney and Health Care Proxy are examples. Here is a website that has Advanced Directive forms by state, since this document can vary by state.

DNR- Stands for Do Not Resuscitate, meaning you do not want CPR performed if your heart stops. This ONLY relates to CPR, and not continuing medical treatment. This is also a legal document signed by a physician and witnesses. You can obtain a Michigan DNR form at Check with your primary physician if this form is legal in your state.

Full Code- This is referring to having CPR done if your heart stops. Again, this does not refer to continuing medical treatment. You do not need any type of documentation to receive CPR. CPR is emergency protocol in all states unless there is a DNR order signed and available.

Living Will-
This is another term for Advanced Directives. It is a legal document that describes individuals' wishes and preferences about lifesaving medical treatments should they not be able to communicate their wishes directly.

Guardianship- A legal procedure that grants an individual guardian status over another individual who can no longer make decisions for him or herself. This impacts the subject's rights and as such is usually used as a last approach. This typically happens when an individual has not prepared for Power of Attorney, and is debilitated to the point they can no longer make decisions. There are situations where a family member will apply for Guardianship if a parent has lost the ability to make decisions, or when an individual has no family, and through some type of crisis, will be appointed a Guardian through the courts list of Guardians. The individual has to be certified by a physician, they are no longer to make informed and appropriate decisions, and there will be a court hearing to either grant or deny guardianship.

Power of Attorney-
There are 2 types of POA’s. One is over financial matters; the other is over healthcare decisions. These are legal documents in which you grant permission to a specific individual or individuals to make decisions on your behalf. These type of document’s give the person you appoint full control of decisions, unless you include a will or trust in financial matters, or an Advanced Directive in the event of healthcare matters.

Although an attorney is not necessary to prepare POA’s, I highly recommend an attorney or estate planner in the case of a financial power of attorney. The American Bar Association has detailed information about planning your estate and healthcare matters. University of Michigan Health System has a Medical Power of Attorney form available. You should make an appointment with your primary physician to discuss your medical wishes, as well as your Medical POA.

All of these planning documents are able to be changed, and/or revoked as long as you are of sound mind. Never let anyone pressure you to grant them POA, or make any other decisions you are not comfortable with. I have seen care providers, and family members pressure seniors into signing documents that are not in the best interest of them, to take advantage of their finances. You will want to appoint someone that understands your wishes and loves you enough to make sure those wishes take place as much as possible. Consult an attorney if you need advice, or feel uncomfortable if someone approaches you to sign documents you are unsure of.

Proper planning cannot be done soon enough, and will eliminate the stress involved in snap decisions.

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