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Long Term Care Planning: 7 Tools for Success – Part 1 of 2

Getting older is hard.  I don’t just mean the physical aches and pains and other issues that tend to get worse with age.  Getting older can also be very expensive.  There are a number of complex legal and financial issues that arise as you get older and need more care.  When you find yourself working through those issues, any misstep in long term care planning could be very costly.  We have worked with a lot of people in a lot of different situations, and there are certain patterns we see over and over again.  People who have the right tools in place have better outcomes.  The people who are missing those tools can be in a really bad position. 

In this article and next week’s article, I am going to tell you about the tools you need to have in your tool belt for long term care planning, so that you can have the best possible outcomes along your journey.  As we are going through these tools, I am going to tell you a story about Bob and Cheryl.  They are a pretty typical middle-class couple.  Bob is 77 and his wife Cheryl is 70.  They have two supportive adult children, Jason and Eric, who are both there for them, and a number of grandchildren they love dearly.

Tool #1:  Good People in Your Life

Bob’s family members are important.  More important than anything else, if you want to succeed in long term care planning, you need to have good people in your life.  People who are in your corner, who notice when you need help, and who are willing and able to do the right thing for you.  These are the people who are willing to act as caregivers as you age, who can help you stay in your home as long as possible, and who can act on your behalf to make sure you get the care you need if your needs progress beyond what they can handle.  Cherish those people.  Nurture those relationships.  Let them know how important they are to you.  You do not want to go without them.  For long-term care purposes, though, it is not enough just to have good people around you.  You also need to arm those people with the tools they will need to act on your behalf and make sure you get the care you need.

Tool #2:  Health Care Power of Attorney

Bob is out working in the garden one day when he collapses.  Cheryl looks up from washing dishes.  She sees through the window that Bob is motionless on the ground.  Cheryl calls 911 and gets him to a hospital.  Bob has had a stroke. He is in no condition to talk to the doctor.  So what happens?  It depends on whether Bob has Tool #2, a Health Care Power of Attorney.  If he did not have a Health Care Power of Attorney, the doctor might not be comfortable allowing Cheryl to speak for Bob and make his medical decisions.  Cheryl might not be able to authorize or refuse procedures, even if she knows Bob’s values, beliefs, and wishes.  Precious time could be ticking away, and Bob’s prognosis could be rapidly declining, while the doctor has no guidance and no one to authorize or refuse treatment. 

That is where a Health Care Power of Attorney comes into play.   A Health Care Power of Attorney identifies the people the doctor can talk to during a crisis to make medical decisions.  Luckily Bob went to Keystone Elder Law several years before and set up a Health Care Power of Attorney.  That document gives the doctor permission to talk to Cheryl, Jason, and Eric.  Not only can the doctor talk to Cheryl, but the boys can also take shifts looking out for Bob so Cheryl can get some rest.  The Health Care Power of Attorney also includes an advance directive.  Bob has thought through the hard medical decisions and provided guidance on his wishes.  That way his family can feel confident about the right decisions to make for him. 

Tool #3:  Financial Power of Attorney

Bob’s stroke was pretty severe, and he didn’t fully recover mentally.  Over the next several months, he has increasing memory problems and shows signs of dementia.  He has “sundowning” syndrome, which means his symptoms increase in the afternoon and evening.  Cheryl is worried he will wander off and get into a dangerous situation.  The strain of being up all hours of the night trying to keep Bob safe gets to be too much for her.  Cheryl needs help.  She considers moving him into a memory care community, but she needs to be able to pay for it.  Bob had always managed their finances.  Most of their savings is in his name only. 

So now what happens?  You might think Cheryl has authority to authorize Bob’s admission and access his bank accounts just by being his spouse. But in Pennsylvania, a spouse does not automatically have that authority. The Health Care Power of Attorney might allow Cheryl to authorize his admission, but some facilities require a Financial Power of Attorney as well.  Payment for Memory Care is usually out of pocket, so Cheryl needs access to Bob’s accounts to pay for his care.  This is where a Financial Power of Attorney comes into play.  Luckily Bob also set up a Financial Power of Attorney at Keystone Elder Law, which allows Cheryl to act on his behalf regarding financial matters.  It also names back-up agents, so Jason can take over if Cheryl’s health declines, and Eric could take over if something were to happen to Jason.  It also contains provisions that allow Bob’s agents to do Medicaid planning, should they need to, and it turns out they do.

See Part II to continue this illustration of long term care planning.

By Kelly M. Walsh Appleyard, Attorney