Category: Advance Health Care Directive

Alzheimer’s Patient Spoon-Fed Because Directive Wasn’t Specific

In 40 years, Bill Harris built up a lifetime of memories with his wife, Nora, but since she was diagnosed with early onset of Alzheimer’s seven years ago, things have changed.

“She doesn't really make words sometimes,” said Harris in an article on KGW.com entitled “Man says state ignoring wife's wishes in advance directive.” 11-07-16

For Harris, this tough situation got even more difficult with the decision of a southern Oregon judge this summer. The judge, in effect, “condemned her to ride out Alzheimer’s to the bitter end,” said Harris. He says it’s exactly what she didn’t want.

When Nora was told of her diagnosis, she completed an advance directive to be certain that her illness wouldn’t be prolonged. She believed when it wasn’t mechanically possible to eat by herself then she wanted to let nature take its course. However, now she’s stopped eating by herself and is being spoon-fed at a nursing home because, according to the judge’s ruling, her advance directive wasn't specific enough.

Still, the advance directive forms usually only cover getting fed through a tube, creating a conflict between two laws. An advance directive allows you to elect what happens if you become incapacitated, but the state law is there to make sure that care facilities do their job.

Advanced directives should be as specific as possible.

“What they did was basically sentence her to have to experience the full gamut of Alzheimer's,” said Harris. He said he also wishes the judge would have ruled in the spirit of the law and not the letter.

The advance directive law has limitations, but the legislature could amend the law so someone can make decisions on a loved one's behalf. However, now the best option is to be as specific as possible when filling out an advance directive.

Reference: KGW.com (Sept. 19, 2016) “Man says state ignoring wife's wishes in advance directive”

Make Certain Your College-Bound Kid Has Packed a Health Care Power of Attorney

You thought you purchased just about everything for your child for college, but don’t forget one more important item: a health care power of attorney or health proxy.

When a child turns 18, parents don’t have much authority under federal law to remotely access medical records or make decision. With the medical privacy law HIPAA, you 10-28-16need to have your child’s written permission.

CBS News’ recent article, “Don't send your child to college without this,” suggests a health care proxy. It’s a pretty simple legal document that gives you the authority to make medical decisions and access their records if they’re disabled. Talk about a critical back-to-school item!

A health care power of attorney is critically important when a child has a health emergency at college.

A HIPAA authorization allows you access to your child’s medical records, which are protected by the Health Insurance Portability and Accountability Act (HIPAA). Your child is an adult, so you can’t call the health center at college and get his or her detailed health information without an authorization.

The health care proxy is more complicated. The one signing it is giving another the authority to make medical decisions for them if they become incapacitated. An agent for health decisions is appointed with the proxy. The proxy covers a broad range of powers, and parents or other trusted individuals who are agents are allowed to speak with doctors, approve tests and examine medical records.

Prior to getting these forms, you should have a serious conversation with your college student on why the documents are important. The proxy talks about some unpleasant decision making—like specifying what treatment or care a person on life support wants and stipulating organ donation and other post-mortem issues. Some of the more detailed proxies have a questionnaire that runs through end-of-life or advanced “health care directive” decisions. As a parent, this is tough language to read, and these are difficult issues to discuss. Nonetheless, they provoke some serious thinking about quality of life in the event of a health emergency.

It’s important to know what the documents can and can’t do: they don’t ensure quality care, and you’ll still need to consult with doctors. Be sure you fully comprehend what these documents mean and how you can modify them.

Speak with your estate planning lawyer and appoint trusted family members or friends to make decisions if you or your spouse/partner can’t. You should also, at the same time, review your own estate plan. If you don’t have a will, powers of attorney or living trust, find out which documents are appropriate for your situation.

Reference: CBS News (September 9, 2016) “Don't send your child to college without this”

Saving the Home with Long-Term Health Care Demands

The largest asset most people have is their family home. If a senior is in a situation where his or her long-term care insurance is exhausted and the other assets are used to pay for care, how does one protect the home from being taken?

Long-term care insurance is important; however, it’s also critical to review and revise your financial and estate plans regularly as your situation changes, according to NJ 101.5’s article “Medicaid and protecting your home.” 10-27-16

Speak with an experienced estate planning or elder care attorney to plan for your individual circumstances. You should also have your will, general power of attorney, advance health care directive or other estate planning documents reviewed or drafted.

As far as how Medicaid works, it has both income and asset limitations that require a recipient to become impoverished to qualify. For Medicaid eligibility, your primary residence is exempt provided you or your spouse live in the house or intend to return to the house to reside. That said, Medicaid will have an automatic lien on any interest in a residence in your name equal to the amount of Medicaid funds you receive. The program will execute on that lien when the home sells or upon death—unless the recipient’s spouse remains an owner of the residence.

To keep people from giving away their property to qualify for Medicaid, there’s a penalty for the transfer within five years of applying for Medicaid. The penalty is calculated by dividing the value of the assets transferred by the state’s Medicaid average monthly cost of a nursing home. The penalty period starts only after an individual enters a nursing home and would otherwise be eligible for Medicaid, not at the time of the transfer. During that time, Medicaid won’t pay for the nursing home. Private funds have to be used.

There are exceptions for undue hardship but these are rare. One exception is for the transfer of a residence to a child who has lived in the home for at least two years before the applicant enters a care facility and who during that period provided the applicant with care and services that enabled that person to live at home. In that situation, the transfer of the house to the child doesn’t result in a penalty. The house won’t be subject to a Medicaid lien.

Similarly, gifts and sales that are less than fair market value within five years of applying for Medicaid are subject to a penalty. But before a transfer is made, there are also income tax considerations which may significantly impact both the transferee and the applicant. If there is no mortgage, another option is a reverse mortgage, which lets you withdraw the equity in the property with the loan being paid back at death or once the property is permanently vacated.

Medicaid is a complex and constantly changing area, so talk with an experienced elder law or Medicaid planning attorney who is current on all the rules that may impact your decisions.

Reference: NJ 101.5 (September 12, 2016) “Medicaid and protecting your home”