I presented early in January to a chapter of the State Retirees Association of Michigan–Lansing Chapter. (The materials I handed out can be found elsewhere on our site–like here: lhttp://SERAPresentationltcfinal )
One of the folks in attendance faced an issue that crops up more often than you might think. The issue? Who will help me when I need it. We were not talking about nursing home help or help in a hospital.
Rather we were talking “agents.” Those people who might help during a period when we are alive but not really able to help ourselves much.
Most attorneys suggest creation of a durable power of attorney to help with financial issues, contracts, bill paying, banking and property management. When your durable power of attorney document is drawn up, you are the principal. The person you entrust to help out is your agent.
A medical power of attorney is also advisable. In Michigan we have a particular name for these medical power of attorney documents–we also refer to them as a patient advocate form. So you name, effectively, a medical agent/patient advocate and possibly a successor as well.
Most naturally we urge selection of, and people tend to choose, those who know them, and in whom they can put a good deal of trust. That’s smart. Often this is family–but even then, if we are frank, we know some family members are better at such jobs, honors or duties, than others.
Back to the SERA member. She was very close to 90 years old, and had outlived most of those to whom she’d turn, and one other relative was darn close to her age and in worse physical health.
Sometimes other people come to us, and while they still have children only in their 30’s or 40’s, those children may have problems of their own–finding themselves in a messy divorce, or almost broke and near bankrupt, etc. Those folks also have a difficult time thinking of someone to name as an agent.
And more often than in the past, more clients come to us who have long been single, with no spouse nor children.
How do you find an agent under such circumstances? There is no one simple answer, but three routes come to mind:
a) explore your extended family tree—Is there a niece or even great niece or nephew who could help? Have you talked to them, and if so, do they share your values, are they up to the task?
b) go deeper into your friendship network, even make new friends (this isn’t a Dale Carnegie class, but you might be surprised what reaching out might do)—Do you belong to Rotary or a bowling club or hunting group? Would you ever be able to invite someone to discuss such an idea to dinner at your house? I am hearing more of intentional arrangements as well–a sort of adopted friend/family thing–where other single folks, maybe your age or younger, say in effect “Hey, I’ll help you out, if that time should ever come–and if you’re in a position to help me out, should the time come, you can do the same for me.” This often involves selecting a few people, of course, who talk the idea through.
c) consider professional assistance–In Michigan, a patient advocate cannot be paid for their services–talking with a doctor, considering alternative treatments, and so on. If they run into out-of-pocket costs, that can be reimbursed. So patient advocacy is something for which even a professional would make little or nothing. But if you have an agent under a durable power of attorney act on your behalf, and IF you have it in the document, an agent could charge a reasonable fee for doing the running around, making contracts, paying bills, and such other work as an agent might do. And if you have a trust and name a trustee (perhaps a bank, or an attorney or an accountant) they too can charge a reasonable fee to take care of your affairs.
This is not a “one size fits all” decision. Still, it is worth thinking about and worth discussing, before the need hits.
A recent article going a bit deeper, and perhaps with a slightly different direction, popped up in the ABA Bifocal Journal and can be found here: https://www.americanbar.org/groups/law_aging/publications/bifocal/vol–39/issue-3–february-2018-/agingsolo.html
And as always, if you need to chew on this, or related ideas, we are here to help.
From Left to Right: Brad, Tyler, Richard, Helen, Jadranko
At the law firm of Bradley Vauter & Associates, P.C. we also call ourselves “the place for good counsel.” We want to be the place you turn to in order to get information or advice or help when you need it–and we want folks to think about seeing us sooner rather than later. An hour of our time in advance of a major transaction, BEFORE you sign on the dotted line or BEFORE a deadline looms in something important, can often actually save you money or costly trouble in the long run. It’s always smart to think through the possible IMPACT of an action, or contract or response BEFORE you get locked in, we believe. Let us be your counselors and advisers soon–we still have office hours between now and the New Year. And God willing, we will be around in 2018 to help you in our many practice areas. Call us at 517 853-8015 to set up an appointment soon. In the meantime, from all of us–Merry Christmas, Happy Holidays, and Happy New Year to you and yours!
When we help clients with “estate planning’ we also discuss planning for events while they are still living. Many of us have ideas about what to do with our legacy or estate, once we are dead. We might have family or friends or charities in mind–people or organizations who would take after our death because of provisions in our will or trust, or even because we have simply named the person or organization as a beneficiary after our death on an account at a bank or credit union or IRA.
But what would happen if we became quite disabled before we died? Is there a way we can sort of “take control” even though we are disabled? Some advocates say yes, if you work hard at it. But even more folks say, the time to “take control” is before you lose control–in other words, line up your choices and make some decisions AND PUT THEM IN WRITING, before you ever become severely disabled.
Have you thought about naming someone/something who could help with your financial and business affairs (sometimes this might even include a financial institution if your holdings are large or sophisticated) while you are living?
How about your medical affairs? Who have you picked to speak for you, should you be so disabled that doctors don’t think you understand what is going on, and medical treatment decisions (starting or switching or stopping treatments, for instance) are needed? In Michigan parents DO NOT automatically get to speak for their young adult children such as the 19-year-old still in college or trade school, nor–a surprise to many–is a spouse legally allowed to decide for a spouse without documents in place or a court order.
The law in Michigan, through Michigan’s statutes, gives a preference for these issues to next-of-kin BUT that preference arises when we haven’t made the decision in advance, and put it in writing. Without a bit of planning and work court involvement might be needed–a hassle and expense in a time of crisis or mourning that you can usually avoid by getting documents set up ahead of time.
For the times when we might be alive but not able to handle our own affairs, the usual documents needed are a durable power of attorney (the business and financial affairs of life) and a medical power of attorney/designation of patient advocate (medical decision making when we are alive but incompetent). Sometimes a trust can help as well–in the financial/business arena.
When we are dead, the most common document to come in handy is a will (or a trust, or both) and one can also have a personal property distribution list, and a funeral representative named if you so desire.
As a recent article in the New York Times indicates, we should not always assume that “next-of-kin” are the natural choice after all–estrangement among family members is not uncommon. And even among families who have been keenly supportive of one another, not all our relatives are equally able to step into our shoes while we are living, nor be smart choices to wrap up our affairs once we die.
Our firm takes the time to talk through some of these issues with you for better planning and to help create documents that will be helpful and not merely perfunctory. We have created a sort of estate and life planning questionnaire that we can send to folks before they meet with us, so that our meetings then are productive and informative, and in order that we can eventually create a tailored estate plan at a still reasonable cost. Give us a call soon if you’d like to create or update your life and estate planning.
As to the New York Times article, you can find it here: https://mobile.nytimes.com/…/debunking-myths-about-estrange…
Those who accept Medicare as payment–meaning almost every hospital, almost every nursing home and most doctors and rehab specialists in the country–sometimes worry about being audited. Their records can be checked a year or so after they have billed for services, and been paid, for services. It might make an administrative person with such providers anxious–what if they have to pay back something to Medicare, after all?
Audits are smart and help reduce error and fraud. But if providers over-react and become too cautious because of audits those who use Medicare can suffer. This is so because for a long time an informal and improper metric has been used by providers, and the metric puts Medicare users at a real disadvantage.
Watch out for these old terms, still used at times now: “failure to improve” or “plateau.” Those terms have been used informally for a long time. You might hear it even now when you are trying to see about services for a loved one who has Medicare coverage. Coverage denials based on that alone are improper and unfair.
Those on Medicare who want more therapy or services, in hopes of maintaining some small part of their health or abilities, or better levels of care that might let them return home, have been often told by facilities or providers that Medicare wouldn’t help reimburse or pay for such services. Scary stuff, as many seniors would find it tough to pay for much in the way of such services themselves for more than a few weeks.
Medicare does not provide unlimited coverage, as we know. But be prepared to challenge some denials of care coverage if it seems proper. Remember, the “failure to improve” or the “he/she’s reached a plateau” is not the right metric. Actually under the regulation and law, maintaining a patient’s current condition or preventing or slowing a patient’s further decline or deterioration is a sufficient reason to obtain services.
Feel free to gently push back against providers if you are given this line, or call an elder law firm like ours to review the situation.
Rather than writing a full dissertation though, I suggest folks check this website–a feisty group sued (the case is Jimmo v Siebelius) to get clarification of this issue to help the aged and disabled, and here is their question and answer page about the issue: http://www.medicareadvocacy.org/jimmo-v-sebelius-the-improvement-standard-case-faqs/