Regardless of your parent's health or financial state, there are four documents which he/she should sign right away.
- An up-to-date will
- A durable power of attorney
- A health care proxy
- A living will
These papers are not expensive to execute and they will guard your family against sometimes lengthy legal proceedings and potentially bitter arguments. This information should serve as a guideline; your family should work with a lawyer who is knowledgeable about the laws in your parent's state and experienced in issues concerning the elderly.
The Advance Health Care Directive
California law provides individuals the ability to insure that their health care wishes are known and considered if they become unable to make these decisions themselves. According to the California Medical Association (CMA), the Advance Health Care Directive is now the legally recognized format for a living will in California. It replaces the Natural Death Act Declaration. The Advance Health Care Directive allows you to do more than the traditional living will, which only states your desire not to receive life-sustaining treatment if you are terminally ill or permanently unconscious. An Advance Health Care Directive allows you to state your wishes about refusing or accepting life-sustaining treatment in any situation. Unlike a living will, an Advance Health Care Directive also can be used to state your desires about your health care in any situation in which you are unable to make your own decisions, not just when you are in a coma or are terminally ill. In addition, an Advance Health Care Directive allows you to appoint someone you trust to speak for you when you are incapacitated. Even though you do not have to appoint a health care agent, the California Medical Association (CMA) recommends that you do so. Then there will be someone you trust to actively participate in the decisions surrounding your health care. You do not need a separate living will or a durable power of attorney if you have already stated your wishes about life-sustaining treatment in an Advance Health Care Directive. ~Bear in mind that this is for people living in California. The laws differ state to stateThe Advance Health Care Directive form in the California Medical Association's Advance Health Care Directive kit includes an optional living will statement that you can select if it reflects your desires.
The California Medical Association (415) 541-0900 publishes an Advance Health Care Directive Kit which includes an Advance Health Care Directive form and wallet cards as well as the following information which answers the questions commonly asked about Advance Directives. To order CMA's new Advance Health Care Directive, you can order it on-line at:
http://www.cmanet.org/bookstore/product.cfm?catid=12&productid=154
You do not need a lawyer to assist you in completing an Advance Health Care Directive form (such as the form supplied in the CMA kit). The only exception applies to individuals who have been involuntarily committed to a mental health facility who wish to appoint their conservator as their agent.
Some useful elder/dependent care definitions:
Advance directive: Most advance directives are written by older or seriously ill patients. However, they can be useful in case of an accident or serious illness. If you already have a signed advance directive, your wishes are more likely to be followed. An advance directive tells your doctor what kind of care you would like to have if you become unable to make medical decisions. The law now says that at the time you are admitted to the hospital, the hospital staff must tell you about advance directives.
Advance directives can take many forms. Laws about advance directives vary from state to state. You should be aware of the guidelines of your state laws regarding the scope and technical requirements that apply to advance directives.
A good advance directive describes the kind of treatment you would want to receive for different levels of illness. For example, the directives would describe what kind of care you would want if you have a critical illness, a terminal illness or permanent unconsciousness. Advance directives usually tell your doctor that you don't want certain kinds of treatment when you are this ill. However, they can also say that you want a certain treatment, no matter how ill you are.
Durable power of attorney for health care: Is like a living will, but it becomes active any time you are unconscious or unable to make medical decisions. In a DPA, you select a family member or friend who will be your medical decision-maker if you become unconscious or unable to make medical decisions. A DPA is generally more useful than a living will. If you don't have another person you trust to make these decisions for you, the DPA may not be right for you. Living wills and DPAs are legal in most states. Even if they aren't officially recognized by the law in your state, they can still guide your loved ones and doctor if you are unable to make decisions about your medical care. Ask your doctor, lawyer or state representative about the law in your state.
Health care proxy: This form covers a wider range of situations than a living will and it appoints a health-care agent, or proxy, who can make medical decisions on a person's behalf, interpret written instructions and respond to changing health and medical needs. Is often needed in addition to the durable power of attorney form to make health care decisions.
Living will: Living wills are one type of advance directive. They only come into effect when you are terminally ill. Being terminally ill generally means that you have less than six months to live. In a living will, you can describe the kind of treatment you want in a certain situations. A living will doesn't let you select someone to make decisions for you. Similar to directive to physician (this is more specific). It's different in some of the things it covers, broader in scope. This form states a person's wishes in the event that she is close to death and unable to make decisions about her medical care. Talks about organ donation.
Do-not-resuscitate (DNR) (for everyone who handles the patient)
Unless given other instructions, hospital staff will try to help all patients whose hearts have stopped or who have stopped breathing. You can indicate with an advance directive form or by talking with your doctor that you don't want to have cardiopulmonary resuscitation (CPR) if your heart stops or if you stop breathing. In this case, a do-not-resuscitate (DNR) order is put in your medical chart by your doctor. DNR orders are accepted by doctors and hospitals in all states. Most patients who die in a hospital have had a DNR order written for them before they die. Patients who are not likely to benefit from CPR include people who have cancer that has spread, people whose kidneys don't work well, people who need a lot of help with daily activities, or people who have severe infections such as pneumonia that require hospitalization. If you already have one or more of these conditions, you should discuss your wishes about CPR with you doctor, either in the office or when you go to the hospital. It's best to do this early, before you are very sick and are considered unable to make your own decisions.
A legal, binding request in the form of a doctor's order. Some places do not accept a living will. It refers to decisions or orders not to initiate cardiopulmonary resuscitation (CPR) to attempt to revive a person who has experienced heart/respiratory failure. Can be initiated by the patient, the person who has been granted durable power of attorney, or the physician, if they have been given a directive by the patient. The directive to the physician (a broader description of what types of care) and DNR (a form that goes into the patient's chart) sometimes it's put in big letters on the front of the chart. They can be temporary or permanent and can be revoked at any time. Power of attorney dies with the patient.
Effective July 1, 2000, the Natural Death Act and the laws governing Durable Powers of Attorney for Health Care was replaced by the new Health Care Decisions Law (AB 891;Chapter 658). This new, greatly improved, law should improve the value and acceptance of advance directives.
http://www.leginfo.ca.gov/pub/99-00/bill/asm/ab_0851-900/ab_891_bill_19991010_chaptered.html
For further information on both the changes made by this new law as well as what will not change, order CMA ON-CALL document,
http://www.cmanet.org/bookstore/cmaoncall.cfm?templateinc=oncall3&article_id=480.0445
Driver Safety
A time will eventually come when your parent's driving ability is unsafe. Unfortunately, you can't rely on the state to monitor his driving because most states, reluctant to alienate a large population of elderly voters, refuse to retest or otherwise restrict older drivers. You need to act. It's a matter of your parent's safety as well as the safety of others. It truly is a matter of life and death.If you can't do it yourself, ask your parent's doctor to tell him that it's time to stop driving. It will be easier for your parent to hear and heed this, if it comes from a doctor or another professional. If you decide to take this on, brace yourself, because your parent is bound to be hurt and/or irate. Be sensitive to the issues this will bring up, both emotionally and practically, but remain firm in your resolve. Be ready with solutions to his travel problems- look into public and senior transportation programs, ask family and friends if they can provide some transportation.
If your parent still is unable to accept that he can no longer safely drive, you can make a report to the DMV Driver Safety Unit (805)488-0863. If you have your parent's driver license number, you can leave this number on the answering machine, along with your concerns, and they will contact your parent and require him to get re-tested for driving. If you do not have your parent's driver license number, leave your name and phone number and someone will get back to you to help find out this information. This report can be done at any time (not just at the time of license renewal) and it can be initiated by anyone. Most reports are called in by the parent's doctor, a family member, or even a neighbor; it can also be done anonymously. The State requires the DMV to act on these reports and they usually contact the parent within a few weeks after the report is made.
Long term care insurance
What is Long-Term care?
Long-term care is the extended care you may need due to a serious accident, chronic illness, or the frailties of old age. Long-term care helps one live as she or he is now; it may not help to improve or correct medical problems. Long-term care services may include help with activities of daily living (such as bathing, dressing, and eating), monitoring and support for cognitive impairments such as Alzheimer's disease, home health care, respite care, adult day care, nursing home care, and care in an assisted living facility. Long-term care may also include care management services, which will evaluate your needs and coordinate and monitor the delivery of long-term services. Long-term care is different from the rest of your health care, and typically not covered by health insurance plans or Medicare.
What are my chances of needing long-term care?
Many people will need long-term care at some point in their lives. Long-term care is not just for senior citizens. Of the 13 million Americans receiving long-term care today, 40% are working age adults 18 to 64. As you age, your risk increases. 60% of people age 65 and older can expect to need long-term care for some period of time.
How much does long-term care cost?
Long-term care can be expensive. The cost depends on the
amount and type of care you need and where you get it. In 2000,
one year in a nursing home cost an average of $47,000 in California.
In addition to the care provided by loved ones, people can pay more
than $20,000 for care at home.
Who Pays for Long-Term Care?
Unless you have long-term care insurance, you will pay out of pocket for long-term care whether it is at home, in an assisted living facility, or in a nursing home. You can apply for assistance from Medi-Cal only after you have virtually exhausted all of your own assets paying for care.
Some features to look for in long term care insurance:
- Broad coverage- Be sure a long-term policy covers in-home care and "custodial care"- supervision and help with dressing, eating, bathing and other daily tasks- in addition to nursing care.
- Few restrictions- A policy should not have prerequisites for coverage, such as specifying that nursing home care be preceded by hospitalization. Coverage should be based on need, not "medical necessity"
- Adequate reimbursement-Most policies pay a fixed amount for each day of long-term care, and your parent pays the rest. Home care is usually covered at about half of the rate of nursing home care. Your parent will need to calculate how much he can afford to spend on future long-term care and then find a policy which will cover the rest.
- Inflation protection-A policy should allow for at least 5 percent inflation, compounded annually.This is more important for relatively young people (in their 60s or early 70s) who will not be needing long term care as soon as an older person.
- A reasonable waiting period- Any waiting period less than 20 days will make the policy too expensive. However, a waiting period of more than 100 days reduces the chance significantly that your parent will ever put the policy to use.
- A reasonable maximum- Policies that offer unlimited nursing home care are rare and expensive. Your parent should buy a policy with the highest maximum that she can comfortably afford.
- Waivers- A policy should include a waiver that frees your parent from paying premiums while he is receiving long-term care.
- Coverage for dementia- Check to make sure that the policy will cover Alzheimer's and other "organic diseases of the brain". Note: most policies will not cover mental illness, alcoholism, and drug addiction.
- Guaranteed renewals- A company should be allowed to cancel a policy only if the premiums are not paid, and under no other circumstances
- Fixed premiums-Because your parent is likely to be living on a fixed income, he should find a policy that has fixed premiums.
- Non forfeiture protection-This guarantees that the buyer will receive some value from the policy even if the policy is cancelled.
- A solid company- Check with the rating services listed below:
A.M. Best Company- (908) 439-2200
Fitch Investors Service, Inc. (212) 908-0800
Moody's Investor Service, Inc. (212)553-0377
Standard & Poor's Insurance Rating Services (212) 438-2400
Weiss Research, Inc. (800)289-9222
Resources for Long-Term Care Insurance Information & Publications
AARP (American Association of Retired Persons)
AARP members aged 50 to 79.11 months can obtain long-term care information
by calling: 1-866-345-5824, or by visiting their web site.
www.aarp.org
California Department of Aging
Provides a packet of materials, telephone counseling, and face-to-face
counseling throughout the state.
Medicare enrollees, call toll-free:
1-800-434-0222, 9:00 a.m. - 3:00 p.m., PT.
If you are not enrolled in Medicare, call toll-free:
1-800-510-2020 to be automatically transferred to a senior services
office in the county from which you are calling.
http://www.aging.ca.gov/
California Department of Insurance
This department is responsible for enforcing laws and regulations governing all types of insurance, as well a providing the public with information about insurance.
300 Capitol Mall, #1500
Sacramento, CA 85814
(800) 927-4357
(916) 445-5544
National Association of Insurance Commissioners
(NAIC)
The NAIC offers a booklet called "A Shopper's Guide to Long-Term
Care Insurance." For a copy (the first copy is free), write to:
NAIC
2301 McGee Street, Suite 800
Kansas City, MO 64108
Or visit their web site: www.naic.org
CalPERS (California Public Employees' Retirement system)
is offering another opportunity for UC employees and annuitants to sign up for its long-term care program. The new application period begins on April 1 and runs through June 30, 2002.
The CalPERS Long-Term Care Program provides quality coverage that is more affordable than before. All premiums are age related. The younger you are, the less a plan costs. You may request a free application kit on the Internet http://www.calpers.ca.gov/index.jsp?bc=/member/ltc/home.xml
Or by calling 1-800-338-2244
Buying Long-Term Care
Insurance
Consumer guide to assist seniors and their families in buying a
long-term care policy, avoiding fraud and switching plans.