Living Wills, Health Proxies: Vital Documents for Everyone Tips for Chronic Illness and RVers By: Martin M. Shenkman, CPA, MBA, PFS, AEP, JD.

Living Wills, Health Living Wills, Health Proxies: Vital Documents Proxies: Vital Documents

for Everyonefor Everyone Tips for Chronic Illness and RV’ersTips for Chronic Illness and RV’ersBy: Martin M. Shenkman, CPA, MBA, PFS, AEP, JD

CaveatsCaveatsCaveatsCaveats

Nothing in these slides or any accompanying presentation is to be considered tax, legal, investment or other professional advice. The information is merely provided for educational purposes and no action should be taken without the individual consulting his or her own tax, estate, legal, financial, investment, insurance and other advisers.

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Overview of Living Wills, Overview of Living Wills, Health Care Proxies and Health Care Proxies and HIPAA ReleasesHIPAA Releases Definitions and basic planningDefinitions and basic planning

Designate a Person to Make Designate a Person to Make Health Care Decisions and Health Care Decisions and Access Medical RecordsAccess Medical Records

Agent Agent (successors)(successors)

Powers Powers (religion)(religion)

Signature Signature (State law)(State law)

Move Move (state; facility)(state; facility)

What is a Health Care What is a Health Care Proxy?Proxy? A legal document in which you A legal document in which you

authorize someone to make authorize someone to make health care decisions for you if health care decisions for you if you are not able to do soyou are not able to do so

It can address a broad range of It can address a broad range of related issues: burial, last rights, related issues: burial, last rights, hospice care and morehospice care and more

It is not only about “pulling the It is not only about “pulling the plug”plug”

Step 4: Step 4: Communicating Your Communicating Your Health Care WishesHealth Care Wishes

What is a Living Will?What is a Living Will?

A living will is a legal document in A living will is a legal document in which you make statements as to your which you make statements as to your health care wisheshealth care wishes

Not binding in all states but can be an Not binding in all states but can be an important tool to communicate your important tool to communicate your wishes to your agent and loved oneswishes to your agent and loved ones

Address religious and other personal Address religious and other personal health care and end of life decisionshealth care and end of life decisions

What do you want for palliative care, What do you want for palliative care, hospice, companion care and other hospice, companion care and other decisionsdecisions

Step 4: Authorize Access Step 4: Authorize Access to Your Private Health to Your Private Health InformationInformation

What is a HIPAA What is a HIPAA Release?Release? A legal document in which you authorize a A legal document in which you authorize a

person, called your HIPAA Representative, to person, called your HIPAA Representative, to have access to certain medical information have access to certain medical information (your PHI or Private Health Information)(your PHI or Private Health Information)

This can be a help when you want someone to This can be a help when you want someone to monitor your care and interact with medical monitor your care and interact with medical personal but you are not at a point where you personal but you are not at a point where you have to turn over medical decision making have to turn over medical decision making authorityauthority

This can be very important for someone living This can be very important for someone living with a chronic illness that might have an with a chronic illness that might have an attack or unexpected hospitalization and wish attack or unexpected hospitalization and wish help but not to abrogate decision making help but not to abrogate decision making (COPD, MS, Crohn’s) (COPD, MS, Crohn’s)

Who Should you Name as Who Should you Name as Agent for Medical Agent for Medical Matters? Matters? Usually you would name the same person as Usually you would name the same person as

Agent in your living will, health proxy and HIPAA Agent in your living will, health proxy and HIPAA release, but not alwaysrelease, but not always

Does the person have the emotional temperament Does the person have the emotional temperament to deal with the potentially tough decisionsto deal with the potentially tough decisions

If you have an existing health condition does the If you have an existing health condition does the person understand how it affects youperson understand how it affects you

Is the person’s religious perspective similar to Is the person’s religious perspective similar to yoursyours

Will the person you name interact well with other Will the person you name interact well with other loved onesloved ones

Name only one person at a timeName only one person at a time

What Authority Should What Authority Should You Give Your Medical You Give Your Medical Agents?Agents? Interact with medical professionalsInteract with medical professionals Make medical decisions if you cannot Make medical decisions if you cannot

that are consistent with your wishesthat are consistent with your wishes Hire companion and other careHire companion and other care Make hospice and related Make hospice and related

arrangementsarrangements Purchase a burial plot or make other Purchase a burial plot or make other

funeral and related arrangementsfuneral and related arrangements

What Authority Might What Authority Might You NOT Give Your You NOT Give Your Medical Agents?Medical Agents? To make decisions if you are To make decisions if you are

capable of doing socapable of doing so Violate your wishes as set forth in Violate your wishes as set forth in

your documentsyour documents

Merely Signing a Legal Merely Signing a Legal Form Alone is Never Form Alone is Never Enough ?Enough ? Your agent must know what is Your agent must know what is

expected and have a real expected and have a real understanding of your wishesunderstanding of your wishes

Key information must be accessible – Key information must be accessible – health insurance details, names and health insurance details, names and contact information on medical contact information on medical providers and moreproviders and more

A copy of your legal documents should A copy of your legal documents should be made a part of your patient recordsbe made a part of your patient records

RV’er Tips for Living WillsRV’er Tips for Living Wills

Which state law should apply to your health proxyWhich state law should apply to your health proxy Where should you sign your living will and health Where should you sign your living will and health

proxyproxy Consider taking a thumb drive with PDFs of your Consider taking a thumb drive with PDFs of your

health proxy, living will and HIPAA release and health proxy, living will and HIPAA release and medical recordsmedical records

Can you use a format that is more likely to be Can you use a format that is more likely to be accepted in other states (e.g., 2 witnesses and a accepted in other states (e.g., 2 witnesses and a notary)notary)

Living Wills and Your Living Wills and Your Other Legal Other Legal DocumentsDocuments Keeping the confusing names of Keeping the confusing names of

legal documents clearlegal documents clear

Overview of Estate Planning Overview of Estate Planning Documents and How they Relate to Documents and How they Relate to Your Health ProxyYour Health Proxy

Overview of Estate Planning Overview of Estate Planning Documents and How they Relate to Documents and How they Relate to Your Health ProxyYour Health Proxy

Power of AttorneyPower of Attorney• Agent to handle financesAgent to handle finances

• Springing vs. not – may Springing vs. not – may involve medical involve medical considerationsconsiderations

• Special provisions to include Special provisions to include – e.g. having your agent pay – e.g. having your agent pay for your health proxies for your health proxies medical decisionsmedical decisions

Living WillsLiving Wills• State your health care wishesState your health care wishes

• Address specific health Address specific health issuesissues

• Religious issuesReligious issues

•Health Proxies/HIPAA Releases

•Agent to make medical decisions based on living will

•Selecting agent

• What powers to include•Revocable Living Trusts

• Unique importance to those with health issues

• Boilerplate forms rarely address nuances needed for chronic illness

• Relationship to other documents

Medical Documents – Medical Documents – Making it Practical For Making it Practical For Your Agents to ActYour Agents to Act You need more than just a legal You need more than just a legal

formform

Organize Information So Organize Information So Your Agent Can ActYour Agent Can Act

Agent (names, numbers)Agent (names, numbers) Physicians (names, numbersPhysicians (names, numbers

specialty)specialty) Insurance infoInsurance info Selected health infoSelected health info

Organizing Emergency Info Organizing Emergency Info #1#1

People forget and panic. Don’t put off People forget and panic. Don’t put off creating an emergency listcreating an emergency list

Type up a list on your computer so you Type up a list on your computer so you can update itcan update it

Disseminate the list to key people, ask Disseminate the list to key people, ask for their help and tell them what they for their help and tell them what they might need to do to helpmight need to do to help

Your estate planning attorney should Your estate planning attorney should have a copy of each document in their have a copy of each document in their filefile

Organizing Emergency Info Organizing Emergency Info #2#2

Organize the list by category Organize the list by category (e.g., (e.g., general physicians, specialists, religious general physicians, specialists, religious advisers, family/loved ones)advisers, family/loved ones)

Give only the key facts someone will Give only the key facts someone will need to act in an emergency need to act in an emergency (name (name and contact info, medical institution, and contact info, medical institution, insurance company and policy info, insurance company and policy info, office/home and cell number, email, etc.)office/home and cell number, email, etc.)

List info needed for emergency List info needed for emergency action action (e.g., account number, policy (e.g., account number, policy number, etc.)number, etc.)

RV TIP: Organize Emergency RV TIP: Organize Emergency InformationInformation

Rv’ers, or anyone who travels extensively, Rv’ers, or anyone who travels extensively, should take extra precautions to make sure should take extra precautions to make sure information is available when neededinformation is available when needed

Carry an extra set of originals with youCarry an extra set of originals with you Consider a web based personal information Consider a web based personal information

“locker” and give a trusted person the info“locker” and give a trusted person the info Email updated emergency info list to key Email updated emergency info list to key

people whenever there are major changespeople whenever there are major changes

Medical Decision Medical Decision Making – Making – Communication is KeyCommunication is Key You need to discuss your planYou need to discuss your plan

Communicate with Communicate with Your Agent and Loved Your Agent and Loved OnesOnes Educate and inform your loved ones and agent Educate and inform your loved ones and agent

about your wishes, what they may need to do about your wishes, what they may need to do to help, where they’ll find info they needto help, where they’ll find info they need

Communication TipsCommunication Tips

Explain your health care concerns, family Explain your health care concerns, family issues, personal wishes, religious issues, personal wishes, religious considerations, and so forth to your agents considerations, and so forth to your agents and loved ones (don’t assume they know!) – and loved ones (don’t assume they know!) – tell all so they can help properlytell all so they can help properly

Discuss with family, friends or others Discuss with family, friends or others involved in your life what your wishes areinvolved in your life what your wishes are

Can those you expect to rely on really help? Can those you expect to rely on really help? Have alternativesHave alternatives

Express your wishes in face to face meetings Express your wishes in face to face meetings and then confirm key points in writingand then confirm key points in writing

Living Wills and Health Living Wills and Health Proxies – A Process not a Proxies – A Process not a Single ActSingle Act Don’t sign it and forget it!Don’t sign it and forget it!

Review, Revisit, ReviseReview, Revisit, Revise

Nothing remains staticNothing remains static– Family situationsFamily situations– Health Health – Comfort with AgentComfort with Agent– Where you liveWhere you live

Living Wills – What’s Living Wills – What’s Next?Next? Understanding medical decision Understanding medical decision

making is not enough – Take making is not enough – Take actionaction

Action Steps: Your Action Steps: Your Action PlanAction Plan√ √ Write it down or it won’t happenWrite it down or it won’t happen√ √ Set small goals – make decisions, hire Set small goals – make decisions, hire

a lawyer, gather information – even a lawyer, gather information – even devoting an hour a week or month will devoting an hour a week or month will get you thereget you there

√ √ Tell others – including advisersTell others – including advisers√ √ Get help and guidance to get started – Get help and guidance to get started –

an initial consultation with a physician an initial consultation with a physician or other health care adviser can jump or other health care adviser can jump start the entire processstart the entire process

Summary: Living Wills; Summary: Living Wills; Health Proxies and HIPAA Health Proxies and HIPAA ReleasesReleases Choose an appropriate agent and several Choose an appropriate agent and several

successorssuccessors Hire a lawyer to draft documents that work for Hire a lawyer to draft documents that work for

your personal medical, family and religious your personal medical, family and religious situationsituation

Discuss modifications to standard forms: Discuss modifications to standard forms: – Existing health issuesExisting health issues– Religious beliefs (or an indication that you don’t Religious beliefs (or an indication that you don’t

want religious restrictions)want religious restrictions) Sign then distribute originals and/or copiesSign then distribute originals and/or copies Update as your medical situation evolves or Update as your medical situation evolves or

feelings changefeelings change