End of Life Concerns
Although we all understand that the end of life is inevitable, it is a topic that many people feel uncomfortable thinking about or discussing. The type and timing of decisions surrounding end of life issues varies based on an individual’s personality, age, health status, cultural influences, access to medical care and professional resources, family dynamics, religious beliefs, and a host of other factors. Some individuals may be given a time frame for the expected end of life, such as when receiving a diagnosis of cancer; others will have no idea.
There are some steps that can be taken by adults of any age to ensure that autonomy will be respected whenever the end of life occurs. Most people would agree that they would not want strangers making decisions for them during this critical time. In order to prevent this situation from occurring, legal documents addressing decision making for both health related issues and legal/financial concerns should be drafted. These documents are called Powers of Attorney. In addition, a document called an Advance Care Directive (or Living Will) can specify the type of treatment you desire if you should be in an end stage terminal medical condition or permanently unconscious, and unable to voice your preferences at that time. For additional information about these documents, click here.
Another type of document used to communicate an individual’s preferences for end of life care is called POLST (Pennsylvania Orders for Life Sustaining Treatment). This form is a medical form that must be completed by the individual and his physician. The POLST form is appropriate for individuals who are experiencing chronic progressive illness and/or frailty, or those who may die or lose decision-making ability within the next year. POLST is a bright pink form that is standardized across the entire state, and specifies medical orders for treatment such as cardiopulmonary resuscitation, artificially administered hydration/nutrition, antibiotics, and mechanical ventilation. It is different from, and is not meant to replace, an Advance Care Directive or Health Care Power of Attorney. These types of documents work best when a Health Care Power of Attorney Agent has been designated to assist in decision-making when the individual is unable to speak for himself. An individual should ALWAYS discuss his wishes related to medical treatment with his Power of Attorney Agent, so that the agent has an accurate understanding of and can act in accordance with the wishes of the individual.
Whether or not treatment wishes are clear, when a loved one’s end of life is near, families often wrestle with conflicting emotions and lack of knowledge about the process of continuing or withdrawing treatment. Keystone Elder Law has a Care Coordinator on staff who has training and experience with these types of issues, and can help advocate for the client and guide and support family members during this difficult time. Assistance with understanding what to expect, communicating with care providers, initiation of hospice services, and the process of estate administration are just some of the services Keystone Elder Law can provide to help families handle essential tasks while they are experiencing the grieving process.
For additional information or questions, give us a call at 717-697-3223.
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A Power of Attorney can be used to give another person the right to sell a car, home, or other property in the place of the maker of the Power of Attorney. A Power of Attorney might be used to allow another person to sign a contract for the maker of the Power of Attorney (the person who makes a power of attorney is called the “principal”). It can be used to give another person the authority to make health care decisions, do financial transactions, or sign legal documents that the principal cannot do for one reason or another. With few exceptions, Powers of Attorney can give others the right to do any legal acts that the makers of the Powers of Attorney could do them themselves. A General Power of Attorney gives the “power of attorney Agent” or simply “Agent” (the legal name of the person who is authorized to act for the principal) very broad powers to do almost every legal act that the principal can do. When Elder Law Attorneys draft general Powers of Attorney, they still list the types of things the Agent can do but these powers are very broad. People often do general Powers of Attorney to plan ahead for the day when they may not be able to take care of things themselves. By doing the General Power of Attorney, they designate someone who can do these things for them.
Normal Powers of Attorney terminate if and when the principal becomes incompetent. Yet many people do Powers of Attorney for the sole purpose of designating someone else to act for them if they cannot act for themselves. It is precisely when persons can no longer do for themselves that a Power of Attorney is most valuable. To remedy this inconsistency, the law created a Durable Power of Attorney that remains effective even if a person becomes incompetent. The only thing that distinguishes a Durable Power of Attorney from a regular Power of Attorney is special wording that states that the power survives the principal’s incapacity. Even a Durable Power of Attorney, however, may be terminated under certain circumstances if court proceedings are filed. Most Powers of Attorney done today are durable.
Yes. At the time the Power of Attorney is signed, the principal must be capable of understanding the document. Although a Power of Attorney is still valid if and when a person becomes incompetent, the principal must understand what he or she is signing at the moment of execution. That means a person can be suffering from dementia or Alzheimer’s Disease or be otherwise incompetent sometimes but as long as they have a lucid moment and are competent at the moment they sign the Power of Attorney, it is valid even if they do not remember signing it at a later date. At the time it is signed, the principal must know what the Power of Attorney does, whom they are giving the Power of Attorney to, and what property may be affected by the Power of Attorney.
Any competent person eighteen years of age and older can serve as an agent. Certain financial institutions can also serve. There is no course of education that agent must complete or any test that Agent must pass. Because a Power of Attorney is such a potentially powerful document, agents should be chosen for reliability and trustworthiness. In the wrong hands, a Power of Attorney can be a license to steal. It can be a big responsibility to serve as an agent.
For Medicaid
Medicare is health insurance and covers medical services such as physician appointments, therapy, blood tests, x rays, medical procedures and hospitalization. Medicare will sometime pay for rehabilitation in a long-term care facility for a period of 20 to 100 days, but not longer. In long-term care, Medicaid covers the cost of ongoing support services for daily functioning, such as room and board in a nursing home.
Medicaid is a federal program that is overseen by the Center for Medicare and Medicaid Services (CMS). In Pennsylvania, Medicaid is called Medical Assistance and is administered by the Department of Human Services (DHS).
In Pennsylvania, Medicaid funds are not available to pay for assisted living or personal care.
For Medicaid to pay for care in a nursing home, an individual recipient must be determined to need a nursing home level of care by a physician and the local Office of Aging. An individual whose income is not greater than three times the poverty level may keep up to $8,000 of total resources, but may otherwise keep only $2,400. The cash value of life insurance counts as a resource, but one car and a residential home does not count as a resource.
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Empowering Clients with Holistic Planning at
Keystone Elder Law
At Keystone Elder Law, we believe that the physical, social, legal, and financial considerations of our clients all intertwine. We utilize an interdisciplinary approach to evaluate each area, which allows for the creation of a plan that addresses the concerns of the individual as a whole as well as the family. To this end, our model of practice includes a Care Coordinator (usually a nurse or social worker), whose expertise complements our team of attorneys.
When the road of life is smooth, decisions about legal and financial matters are easy to push aside for “a rainy day.” Planning ahead, however, will allow for more options as you view the map of where you’ve been and where you want to go. Don’t let a crisis limit your choices or derail your plans.
(717) 697-3223