With Special Steps for Those Living With Chronic Illness By: Martin M. Shenkman, CPA, MBA, PFS, AEP, JD.

With Special Steps for With Special Steps for Those Living With Chronic Those Living With Chronic

IllnessIllnessBy: Martin M. Shenkman, CPA, MBA, PFS, AEP, JD

Introduction to the 12 Introduction to the 12 StepsSteps Every person is unique – it has to be Every person is unique – it has to be youryour

plan and address plan and address youryour challenges challenges Reflect your personal wishes and Reflect your personal wishes and

circumstancescircumstances Create a strong foundation of documents, Create a strong foundation of documents,

steps and a plan to build uponsteps and a plan to build upon

Action Step: 12 Steps Action Step: 12 Steps Begin by Informing Your Begin by Informing Your AdvisorsAdvisors Chronic illness affects every aspect of estate Chronic illness affects every aspect of estate

and related planning – don’t use “standard” and related planning – don’t use “standard” documents or planning stepsdocuments or planning steps

You must explain your circumstances to all of You must explain your circumstances to all of your advisers or they will not be able to your advisers or they will not be able to guide youguide you

Larry’s storyLarry’s story Those not touched by chronic illness don’t Those not touched by chronic illness don’t

understand the symptoms (96% are understand the symptoms (96% are invisible), disease course, variability between invisible), disease course, variability between diseases and among those affected by a diseases and among those affected by a particular diseaseparticular disease

Step 1: Organize Emergency Step 1: Organize Emergency Information and Your Information and Your AdvisorsAdvisors

Contact People Contact People (names, (names, numbers)numbers)

Financial Information Financial Information (account information)(account information)

Passwords and Security Passwords and Security CodesCodes

Documents Documents (Estate planning (Estate planning documents, legal documents, and more)documents, legal documents, and more)

Budget and PlanBudget and Plan

Action Steps: Emergency Info Action Steps: Emergency Info #1#1

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

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

Each professional adviser should Each professional adviser should have the list in their filehave the list in their file

Action Steps: Emergency Info Action Steps: Emergency Info #2#2

Organize the list by category Organize the list by category (e.g., (e.g., banking, religious adviser, professional banking, religious adviser, professional advisers, family, neighbors)advisers, family, neighbors)

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 (person (person name, institution, insurance, office/home name, institution, insurance, office/home and cell number, email, etc.)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.)

Step 2: Designate a Person to Step 2: Designate a Person to Handle Financial and Legal Handle Financial and Legal IssuesIssues

AgentAgent (Successors)(Successors)

CompensationCompensation Begin dateBegin date (Trigger)(Trigger)

PowersPowers (Authority)(Authority)

DurabilityDurability (Disability)(Disability)

Action Steps: Power of Action Steps: Power of AttorneyAttorney

Choose a trusted agent and several successorsChoose a trusted agent and several successors Hire a lawyer to draft powers that work for your Hire a lawyer to draft powers that work for your

disease course and financial situationdisease course and financial situation Discuss modifications to standard forms: Discuss modifications to standard forms:

– Limited power for short term hospitalizations and Limited power for short term hospitalizations and broad power for permanent disability)broad power for permanent disability)

– CompensationCompensation– Definition of disabilityDefinition of disability

Sign several originals, distribute them, organize Sign several originals, distribute them, organize and simplify assets so an agent can act easily and simplify assets so an agent can act easily and safelyand safely

Create a monitor relationshipCreate a monitor relationship

Step 3: Designate a Person to Step 3: Designate a Person to Make Health Care Decisions Make Health Care Decisions and Access Medical Recordsand Access Medical Records

Agent Agent (successors)(successors)

Powers Powers (religion)(religion)

Signature Signature (State law)(State law)

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

Action Steps: Health Care Action Steps: Health Care ProxyProxy

Choose an agent and several Choose an agent and several successors who understand your successors who understand your health situation and wisheshealth situation and wishes

Hire a lawyer to draft a health proxy Hire a lawyer to draft a health proxy that accomplishes your personal goalsthat accomplishes your personal goals

Sign several originals, distribute them, Sign several originals, distribute them, be sure one is included in your medical be sure one is included in your medical chartchart

Discuss your decisions with family, Discuss your decisions with family, friends and agentsfriends and agents

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

Action Steps: Living WillAction Steps: Living Will

Review and consider personal wishes that Review and consider personal wishes that should be reflected, e.g. religious should be reflected, e.g. religious observances, care instructionsobservances, care instructions

Hire a lawyer to draft a living will that Hire a lawyer to draft a living will that communicates your personal decisionscommunicates your personal decisions

Discuss modifications to forms: Organ Discuss modifications to forms: Organ donations – e.g., CNS to foster MS research; donations – e.g., CNS to foster MS research; Experimental or non-traditional treatment; Experimental or non-traditional treatment; Pain reliefPain relief

Sign several originals, distribute them, be Sign several originals, distribute them, be sure one is included in your medical chartsure one is included in your medical chart

Discuss your decisions with family, friends Discuss your decisions with family, friends and agentsand agents

Step 5: Protect Your Minor Step 5: Protect Your Minor Child With an Emergency Child With an Emergency Child Medical FormChild Medical Form Disclose child’s care informationDisclose child’s care information

Action Steps: Protecting Action Steps: Protecting ChildrenChildren

Review all aspects of protecting your Review all aspects of protecting your children with your adviserschildren with your advisers

Trustees under a revocable trust while Trustees under a revocable trust while you are alive and disabled and trustees you are alive and disabled and trustees and guardians under your will to provide and guardians under your will to provide carecare

Financial planning – 529 plans, resourcesFinancial planning – 529 plans, resources Personal letter of instructionPersonal letter of instruction Directions in your power of attorneyDirections in your power of attorney

Step 6: Sign a WillStep 6: Sign a Will

Action Steps: Sign a WillAction Steps: Sign a Will

Wills are important but if you’re facing Wills are important but if you’re facing a progressive chronic illness it is only a progressive chronic illness it is only one step of many and perhaps not the one step of many and perhaps not the most important stepmost important step

Include personal letters of instructionInclude personal letters of instruction Consider trusts for minor childrenConsider trusts for minor children Include a donation to charities that Include a donation to charities that

have helped you – even modest have helped you – even modest donations send an important “thank donations send an important “thank you”you”

Step 7: Create a Step 7: Create a Revocable Living TrustRevocable Living Trust Establish a personalized (not boilerplate) Establish a personalized (not boilerplate)

living trustliving trust Transfer assets to a trust during your lifetimeTransfer assets to a trust during your lifetime Probate and intestacyProbate and intestacy Manage assets during disability or illnessManage assets during disability or illness

Action Steps: Revocable Living Action Steps: Revocable Living TrustTrust

See comments for “Wills” above and See comments for “Wills” above and coordinatecoordinate

Boilerplate Trusts designed to avoid Boilerplate Trusts designed to avoid probate won’t accomplish your goalsprobate won’t accomplish your goals

Focus of document should be Focus of document should be protecting you and communicating protecting you and communicating your wishes as your disease your wishes as your disease progressesprogresses

Tailor trustee replacement, disability Tailor trustee replacement, disability and other provisions to the nuances of and other provisions to the nuances of your anticipated disease courseyour anticipated disease course

Step 8: Be Sure Your Step 8: Be Sure Your Insurance Coverage is in Insurance Coverage is in OrderOrder Property and casualty insuranceProperty and casualty insurance Long term coverageLong term coverage Disability income replacementDisability income replacement Life insuranceLife insurance Liability Liability

Action Steps: Insurance Action Steps: Insurance CoverageCoverage

Don’t make assumptions – get every Don’t make assumptions – get every insurance coverage reviewed at least insurance coverage reviewed at least every 2 yearsevery 2 years

Evaluate options – Can you convert Evaluate options – Can you convert term life insurance to a permanent term life insurance to a permanent policy? Can you sell life insurance in policy? Can you sell life insurance in the secondary market to free up cash?the secondary market to free up cash?

Standard may not work – do you need Standard may not work – do you need a rider for home health workers or a rider for home health workers or home improvements?home improvements?

Step 9: File Beneficiary Step 9: File Beneficiary Designations and Designations and Confirm Title to AccountsConfirm Title to Accounts

Standard provisions are not always Standard provisions are not always adequateadequate

Coordinate with Revocable TrustCoordinate with Revocable Trust What powers should agent haveWhat powers should agent have Give copies to your advisersGive copies to your advisers Update when banks mergeUpdate when banks merge Revise when tax laws changeRevise when tax laws change

Action Steps: Beneficiary Action Steps: Beneficiary DesignationsDesignations

Consider all beneficiary designations: Consider all beneficiary designations: life insurance, pensions, IRAs, life insurance, pensions, IRAs, brokerage accounts and morebrokerage accounts and more

Obtain copies of the forms you filed Obtain copies of the forms you filed and blank forms to facilitate revisionand blank forms to facilitate revision

Have family members who name you Have family members who name you as beneficiary consider a trust for youas beneficiary consider a trust for you

Step 10: Give BackStep 10: Give Back Demonstrate important values to Demonstrate important values to

heirsheirs Thank those that have helpedThank those that have helped Inspire others to giveInspire others to give

Action Steps: To Give BackAction Steps: To Give Back

Make a donation (cash, stuff, insurance)Make a donation (cash, stuff, insurance) Include a bequest in your will – even Include a bequest in your will – even

small bequests can make a big small bequests can make a big statementstatement

Write a heartfelt letter of instruction to Write a heartfelt letter of instruction to heirs and thanks to those that have heirs and thanks to those that have helpedhelped

Inspire others to give that have the Inspire others to give that have the wherewithal to do sowherewithal to do so

Step 11: Step 11: CommunicateCommunicate Educate and inform your Educate and inform your

fiduciariesfiduciaries Preparation of beneficiariesPreparation of beneficiaries

Action Steps: CommunicateAction Steps: Communicate

Explain your finances, family, care, Explain your finances, family, care, disease, and so forth to your advisers – disease, and so forth to your advisers – 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 help you involved in your life what help you might needmight need

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

Express your wishes in face to face Express your wishes in face to face meetings and then confirm key points meetings and then confirm key points in writtingin writting

Step 12: Review, Step 12: Review, Revisit, ReviseRevisit, Revise

Nothing remains staticNothing remains static– Tax and property lawsTax and property laws– Family situationsFamily situations– Assets and net worthAssets and net worth– Health Health