Just before his brain surgery, Dad showed me where he kept all of his and Mom’s legal and financial documents: living wills, durable powers of attorney for finances and healthcare, wills, financial records, checkbook, credit cards, copies of bills, receipts, etc.
Then he took me for a tour of the city to show me where their primary bank was located, their attorney’s office, the bank where they had their safe deposit box, the bank that was the trustee for their living trusts, the banks where they had purchased CDs, and the offices of their stockbroker. And, he calmly informed me that my sisters and I were his and Mom’s co-powers of attorney and successor trustees to his and Mom’s living trusts.
Putting your affairs in order is not about death. It’s about making sure things get done your way and the right way. It is one of the most important financial and lifestyle decisions of your life. “6 Essential Estate Planning Steps For You And Your Parents,” Forbes.com, June 25, 2015
Looking back, it was as though he had a premonition that he wouldn’t come out of the hospital alive even though outwardly he seemed quite confident. Unfortunately, he was right. He passed away from a massive stroke in the hospital 5 days after his surgery.
Everything he showed me a few weeks earlier then made sense. Because of Mom’s various medical conditions, I took over as her primary care manager shortly after Dad’s funeral. Thank God he showed me where all of his and Mom’s advance planning papers were, and that we had time to discuss their decisions before he passed away. Otherwise, I wouldn’t have had a clue as to where to start.
How about you and your parent? If something tragic should happen to either of you, are you prepared — even if the emergency turns out to be only temporary? What kind of medical care would you want if you were too ill or hurt to express your wishes?
Advance directives are legal documents that allow you to spell out your decisions about end-of-life care ahead of time. They give you a way to tell your wishes to family, friends, and health care professionals and to avoid confusion later on.
Don’t wait for someone’s premonition. Instead of putting it off any longer, you and your aging parent should have these basic documents in place:
- Living Will
- Durable Power of Attorney for Health Care (Health Care Proxy)
- Durable Power of Attorney for Finances
A living will is not the same as a will. A will tells people how you want your assets and other belongings to be distributed among your heirs.
On the other hand, a living will is an advance directive that tells which medical treatments you want if you are dying or permanently unconscious. You can accept or refuse medical care. You might want to include instructions on:
- The use of dialysis and breathing machines
- If you want to be resuscitated if your breathing or heartbeat stops
- Tube feeding
- Organ or tissue donation
Durable Power of Attorney for Health Care (Health Care Proxy)
A durable power of attorney for health care is a another advance directive that names your health care proxy. Your proxy is someone you trust to make health decisions for you if you are unable to do so.
Durable Power of Attorney for Finances
A Power of Attorney (POA) for Finances is a legal document that is used to delegate legal authority to another person. The person who signs (executes) a POA is called the Principal. The POA gives legal authority to another person (called an Agent or Attorney-in-Fact) to make property, financial and other legal decisions for the Principal. A Principal can give an Agent broad legal authority or very limited authority. It is frequently used to help in the event of a Principal’s illness or disability. Unless otherwise specified, the POA applies only to assets owned directly by the Principal, not to any assets transferred into a trust by the Principal.
A simple Durable Power of Attorney enables the Agent to act for the Principal even after the Principal is not mentally competent or physically able to make decisions. A simple Durable POA may be used immediately by the Agent, and is effective until it is revoked by the Principal, or until the Principal’s death. [This is the type my father and mother had prepared for my sisters and me.]
A Springing Durable Power of Attorney becomes effective at a future time. That is, it becomes effective upon the happening of a specific event chosen by the Principal, and spelled out in the POA. The springing event is usually the determination that the Principal is no longer competent to handle his or her affairs. The Springing POA will frequently provide that the determination of non-competency will be made by the Principal’s physician (or by the Principal’s physician and another qualified physician). A Springing POA remains in effect until the Principal’s death, or until revoked by a court.
Supplemental Medical Orders involved with Advance Care Planning
POLST (Physician Order for Life-Sustaining Treatment)
A POLST order is called different things in different states (e.g., MOLST, MOST, POST). Regardless of the term, a POLST Form is a medical order for the specific medical treatments you want during a medical emergency. A POLST form turns treatment wishes outlined in a living will into medical orders. Only individuals with a serious illness or advanced frailty near the end-of-life should have this form.
DNR (Do Not Resuscitate)
A DNR order tells medical staff in a hospital or nursing facility that no attempts should be made to restart breathing or restart the heart if it stops. Even though a living will might say CPR is not wanted, it is helpful to have a DNR order as part of your medical file if you go to a hospital. Posting a DNR next to your bed might avoid confusion in an emergency situation. Without a DNR order, medical staff will make every effort to restore the normal rhythm of your heart.
DNI (Do Not Intubate)
A similar document is called a DNI order. A DNI tells medical staff in a hospital or nursing facility that you do not want to be put on a breathing machine.
AND (Allow Natural Death)
An AND order is an alternative to the more traditional DNR order. An AND order is used to ensure that only comfort measures, designed to provide excellent control of pain or other symptoms, are taken. This includes withholding or discontinuing resuscitation, artificial feedings, fluids, and other treatments that prolong the dying process without adding to your parent’s quality of life. Allowing a natural death means not interfering with the natural dying process. It also means that every effort will be made to have your parent’s time of death be calm and peaceful, with you and your parent surrounded by as many family and friends as you and your parent wish.
DNH (Do Not Hospitalize)
Hospitalizing nursing home patients with advanced dementia is often more harmful than treating them in the nursing home. A DNH order is appropriate for a patient whose goals are focused on comfort and maximizing quality of life without returning to the hospital.
How can you or your parent write an advance directive?
- Use a form provided by your doctor.
- Write your wishes down by yourself.
- Call your health department or state department on aging to get a form.
- Use a computer software package for legal documents.
- Work with a lawyer who specializes in elder law.
Advance directives and living wills do not have to be complicated legal documents.