Thursday, March 22, 2018

Who Will Take Care of You?

By Carrie Vittitoe 

No one likes to think that one day he may need nursing home care or be unable to make his own financial or medical decisions. Thinking about these topics can be especially confusing if you don’t have children or nearby relatives. Whom do you trust to care for you as you become a much older adult? What choices would you make for your life, and how do you ensure that your wishes are followed?

Sabine Stovall, a wealth and estate planner and owner of The Wealth Planning Company, says the first step in planning for older age is to understand what assets you have. “Most of us underestimate the value of what we have,” she says. It is important to sit down periodically to look at your assets, both large and small, and decide how you would like those assets to be used.

Parents often want to ensure that any assets they have be protected as a legacy for their children, but it is important to consider how your assets can be used for your own protection and quality of life in much older age, especially if staying in your own home is a priority.

For some single, childless individuals, the plan is to go into a nursing home, use up their assets, and then apply for Medicaid, and that is certainly one option. However, attorney Eileen Walsh of Elder Law of Louisville, says protecting one’s assets can mean that other care options open up. Protecting one’s assets could mean being able to hire an in-home care provider and avoid a nursing home for a number of years or indefinitely. If a nursing home is the next step, protected assets such as a 401K or IRA savings can pay for a geriatric care manager to visit you in the nursing home twice a month to review care, or it could mean having a private room supplement.

Eileen strongly advises people to at least look into long-term care insurance. Some people think that long-term care insurance only pays for nursing home care, but, she says, “it can be helpful for staying at home. No policy sold now should be limited to nursing home care but should cover care wherever you are.”

In planning for advanced age, especially as it concerns assisted care, Eileen says veterans and/or their surviving spouses are a special population that should get information about the VA’s Aid and Attendance pension benefit. “It can bring cash to them when they need care,” she says.

For some older adults, planning may involve moving out of their long-time homes and into a home that allows them greater access to doctors and shopping without the need for a vehicle. Another plan might involve moving in with a friend and sharing expenses. It is critical to envision how you want your advanced senior years to be and what support network you are able to access or create.

Once you’ve tabulated your assets and considered your vision for much older age, the next step is to have documents drawn up. When it comes to an individual’s protection, Eileen says, “Power of attorney is a critically important document.” It is a document that gives another person the power to act on your wishes when you are unable to do so, and it is only valid during one’s lifetime. She says individuals can draw up separate medical and financial powers of attorney if they wish.

Some people worry that assigning power of attorney gives someone else total control over their lives, but Sabine says it is possible to draw up a document that gives another person power of attorney only as a result of a triggering event. Losing your sight, being unable to speak or walk can be triggering events. “Power of attorney is your individual power to give under the conditions that you set forth,” she says.

For someone without children or close living relatives, it might be a difficult choice to determine whom they would grant power of attorney. Eileen is a board member of Elder Serve/Guardia Care (the entities merged in July 2016) and says it offers a program whereby the nonprofit itself can be named as power of attorney for those without suitable family members. “I see it as a very positive presence in the community,” she says.

There are other important documents that older adults should have in planning for advanced age, but these differ in that they go into effect at the very end of life or after death. A living will, for example, is a legal instrument in which an individual communicates her wishes if unable to make her own end-of-life medical decisions, such as whether to be resuscitated or whether to be given a feeding tube. In this document, a person can select a health-care surrogate, who is granted responsibility for acting on one’s wishes as described in the Living Will.

The Last Will and Testament document “communicates where you want to be buried and under what conditions and where you want your stuff to go and under what conditions,” Sabine says. For individuals without children or close living relatives, it may make sense for an attorney to be the executor of the estate.

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