"Prepare the umbrella before it rains." - Malay Proverb
"Mom, what's wrong?"
She was unresponsive. Her head lolled, and her frail body was limp.
Most basic estate planning forms can be found online and printed out to be signed and notarized. Some are state-specific, so make sure to include state names in which you spend significant time in those online searches.
Keeping a list of medications on hand is a necessity as people age. Adult children and caregivers should be aware of what their parents are taking in case of an emergency. Bring the prescriptions and/or the list to doctor appointments or the emergency room.
Hospital stays aren’t always planned, but, even if they are, patients may need to make decisions about continuing health care. If the patient is not well enough to make decisions, having the proper paperwork on file will insure that the patient’s wishes for procedures and care are plain, and caregivers or children are not left with difficult decisions.
"Mom, please say something. What is wrong? Are you in pain?"
A trip to the emergency room revealed that she was experiencing atrial fibrillation, an erratic heartbeat. Her already-weak heart was struggling to pump, and she was barely able to stand. A few days in the hospital got her back on track, and she was released to a care facility.
One week later this writer was trying to stay calm as she repeated these questions, this time to her father. He was trying to respond but couldn't.
"My father is having a stroke. Someone needs to come right away," she told the 911 operator.
It can happen in an instant. Seconds can mark the difference between health and life-changing illness or death. There may or may not be warning signs, and even diet, exercise or medications can't prevent acts of fate. However, advance medical, legal and estate preparation can, first, ensure that one's wishes are put into effect and, second, can assist caregivers and heirs with weighty decisions and allow them to focus on issues at hand.
One of the first and easiest steps in this process should be updating medical disclosure forms allowing a doctor to discuss the patient's case with a designated caregiver or adult child. It should be someone in addition to the spouse in case both are incapacitated at the same time.
The next form to update or have on file is a "Do Not Resuscitate" (DNR) order. In case of an emergency or incapacitation, this form tells a medical team (or care facility) how far to go with life saving measures. A "full code" means that they will use any means possible to resuscitate the patient in the event of cardiac or pulmonary arrest. This includes CPR, breathing tubes and electric shock. A "DNR Comfort Care" will allow resuscitation via pharmaceuticals, oxygen or other measures, but stops short of CPR. The reason for this, especially with the elderly, is that CPR is taxing on the body and can cause fractures, broken ribs or internal organ damage. A "DNR" means exactly that: do not resuscitate, and allow the patient to expire.
Another recommended form, a living will, allows the patient to specify what treatment he or she desires or declines in order to maintain life. In the event that the individual is in a coma, has a terminal disease or is unable to coherently make decisions, the living will tells the doctors how to proceed with treatment - respirator, chemotherapy, transplant - or to stop life support mechanisms under specified conditions.
The final medical form that doctors, care facilities and estate planners recommend is the "Durable Health Care Power of Attorney." If the patient is unable to make medical treatment decisions, this POA designates someone that the patient trusts to determine the course of treatment that will be in line with the patient's wishes. As difficult as it may be, the individual who is planning needs to discuss his or her wishes with whoever will hold the POA in regard to invasive tests, organ transplants or other surgery, chemotherapy, feeding tubes, respirators, kidney dialysis, blood transfusions, pain medication and organ donation upon death.
All of these forms should be available through a hospital, doctor's office or care facility, but are state-specific, meaning that the forms may differ slightly from state to state. After filling them out (and signing with witnesses and a notary for the living will and health care POA) copies of the forms should be given to all doctors, a family member and the named POA. Experts also recommend keeping copies of the living will at home, in the car and in a suitcase for trips in case of an accident.
The other part of planning is financial. Initially, the simplest and most important document everyone should have is a "Last Will and Testament," or Will. The document can be hand written as long as it includes the writer's name, address, marital status, children's names, the writer's signature, dated, two witnesses' signatures, dated, and a statement declaring the writer's wishes as to belongings and assets. However, some courts do not recognize hand-written Wills, and it is also best to have any important legal document notarized. Standardized forms for simple Wills are readily available online. Using one of these would help ensure that the document is legally binding.
If someone dies without a Will, or "intestate," the state will take over the estate and determine how the assets are distributed according to the state's formula, without input from the family. The majority of the time, the Will and the assets and liabilities of the deceased will need to go through probate court. This can be a lengthy and expensive process.
Another common option for distribution is a trust, especially for more complicated estates. Reasons to set up trusts include bypassing probate court and reducing estate taxes. There are various types of trusts, such as revocable, which is accessible and changeable by the maker, and irrevocable, which is permanent and owns all of the assets which are placed into it. Cash, stocks, bonds, art, cars, certificates of deposit and other assets can be put in trust, depending, again, on how the trust is designed. While some simple trusts can be set up by the individual, an attorney is the safest way to make sure all of the legal bases are covered and that some elements will not have to be probated.
An estate planner or attorney offers the best advice regarding individual estates because circumstances, income sources and assets will differ for everyone.
In the event that a patient is unable to physically or mentally manage his affairs, a "Durable Power of Attorney" should be in place designating a trusted family member to take care of bills and the household during this time. This responsibility expires upon the death of the patient. The POA should name someone other than the spouse, particularly if both are elderly, because it is possible that neither would be able to make coherent decisions or that one pre-deceases the other.
The documents mentioned in this article are basic and apply to most people. In addition to these, as a caregiver, this writer found that it was helpful and necessary to have the following information about both parents immediately available: Social Security number; Medicare card or number; health insurance card or name and number; doctor and specialist contact information; current prescription list; complete health history with surgeries or hospital stays; family health history of diseases (diabetes, cancer, heart problems, etc.)
Attorney Daniel L. Frizzi Jr., of Frizzi Law Offices in Bellaire, says the "common thread" he sees when it comes to estate planning is procrastination.
"People should probably come in five to eight years before they actually do come in," he explains. "It's something that no one likes to think about, but if a plan or paperwork isn't in place, it can create problems in various situations. Planning aspects are not just for financial purposes, but for health care as well."
Frizzi's advice is to have a plan with all the necessary documentation ready as soon as possible while thinking "about the persons involved and your goals in respect to property matters."
"Procrastination affects all of us," he adds. "But think of your loved ones and those who may be caregivers later in your life. It's much easier for you to deal with potential situations before they happen."