INSIGHTS

End-of-Life Planning

Two of Tandem’s long-time clients found themselves at the end of their lives in a nursing home that they didn’t like and that didn’t meet their needs. Unfortunately, they had not planned for this eventuality nor confronted difficult end-of-life decisions.

It was a situation that could have been avoided with better pre-planning. That’s why Tandem has compiled this guide. We want to ensure that clients have the information and support they need to make the best decisions for themselves and their families.

End-of-life planning is an important way to ease the burden on your friends or family and make your medical and financial wishes known for your final days. Being thoroughly prepared and having important documents in a single place can give you peace of mind, ensure your wishes are honored, and help your friends or family at a difficult time.

This guide will walk you through the important steps you need to take to plan easily and thoroughly.

C. Angus Schaal, CFP®

Senior Managing Director

Estate Planning

Preparing an Estate Plan

Creating an estate plan is necessary for the sake of your family or friends. Consider the items below as you prepare to write your will.

Before Seeing an Attorney

  • Make a list of everyone that you would like to remember in your will.
  •  Make a list of all of your material assets.
  •  After subtracting your debts, match the names with the assets or consider giving a portion of your total estate to each individual.
  •  Consider establishing a trust if your estate is large enough. Consult with your attorney about this.
  •  Ask your chosen estate administrator (sometimes called executor/executrix) if he or she is willing to serve.
  •  Consult with the people you select as guardians of your children (where minors and other
    dependents are involved).

Bequests in Your Will Can Take Several Forms

  •  Before your meeting, consider how you would like to distribute your bequests. Options include:
  •  An outright monetary bequest.
  •  A percentage of an estate.
  •  A specific asset, such as personal or real property.
  •  A testamentary trust created in a will.
  •  A contingent beneficiary.

After Making Your Will

  • Make sure someone knows where your will is located, to include both physical and digital copies.
  • Review your will from time to time with your legal advisor. Laws, assets, and personal interests often change over time.

End-Of-Life Documentation

Power of Attorney (POA)

When healthcare is involved, Powers of Attorney can be referred to as Healthcare POAs. A healthcare POA (or Healthcare Proxy) is an important legal document that provides authorization for someone to act on your behalf in medical situations where you are unable to do so for yourself. There are also financial POAs, which allow you to appoint someone to manage your finances and property for you.

Do Not Resuscitate (DNR)

A DNR order is a document that states the patient’s wish not to be resuscitated if that need arises.

Physician’s Orders for Life-Sustaining Treatment (POLST)

A POLST is a better way to address the complex issues that can arise when extreme medical intervention is needed. Instead of simply addressing the desire to be resuscitated in a medical emergency, a POLST also addresses the use of CPR, the level of care desired, the use of feeding
tubes, etc. In addition, POLSTs are fairly standardized across the United States, though each state still has individual differences.

Advanced Directives/Living Wills

These are end-of-life documents that work hand in hand with POAs to communicate wishes and preferences regarding healthcare and end-of-life procedures (use of ventilators, feeding tubes, etc.). These documents can be a helpful guide to the appointed healthcare agent who has been named in the POA.

Why an Estate Attorney?

An estate planning attorney drafts legal documents that allow you to direct where your assets should go upon death or incapacity. The attorney should look carefully at your unique financial situation, explain the estate planning process, and help you make the best choices for you and
your descendants and beneficiaries. Tandem strongly encourages using an estate attorney. An estate attorney can draft Powers of Attorney, Do Not Resuscitate documents, and Physician’s Orders for Life Sustaining Treatments, and help set up a revocable living trust to avoid the probate process after your death if appropriate.

Finding an Estate Planning Attorney

Start with qualifications. Many counties and states have lawyers’ associations and councils to which an established attorney may belong. For example, check for membership in the American College of Trust and Estate Counsel.

Ask for recommendations. Referrals from family or friends can be an excellent way to start your search.

Look into the firm’s and the attorney’s backgrounds. Research each firm’s and attorney’s background. Also, check their websites for information about firm size, experience, and specializations.

Request a consultation. Some, but not all, lawyers offer initial consultations to help clients get to know them. Some offer a free consultation for a set amount of time, such as the first hour, and begin charging after that. Find out what each attorney’s policy is before the first meeting. Some attorneys don’t offer free consultations, so don’t let that be a deciding factor when scheduling meetings.

Prepare for the first meeting. Prepare a list of questions you would like to ask prospective attorneys, such as the following:

  • What services do you offer?
  • How long have you been practicing?
  •  What is your rate (hourly vs. fixed rate)?

Understand fees. Fees for drafting an estate plan can vary. Some attorneys charge a flat fee, while others bill by the hour. Flat fees typically include everything required to prepare the estate planning documents. Hourly rates can vary significantly depending on several factors, such as the size of the firm.

Look for specializations. Depending on your circumstances, you may benefit from an estate planning attorney with additional expertise. For example, many attorneys specialize in Medicaid, estate taxes, or elder care. Likewise, if your case requires legal work in more than one jurisdiction or state, be sure to consider attorneys who are licensed to practice in all those places.

Continuous Care

Planning Ahead

The decision to go into a continuous care home is rarely an easy one and often arises suddenly, but there are things you can do to make the transition a little easier.

Choose the right facility in advance

Be proactive and tour several facilities in advance. We have included additional information and resources below to help you start your search. It’s important to talk to other people you know who found facilities in the past, like friends and hospital workers. Finally, there are private consultants available to hire to help guide you through decision-making. Ideally, you should tour facilities in advance and make a list of the ones you prefer to give to your family or friends.

Consider financial benefits and resource planning

In some circumstances, an individual may qualify for benefits to help pay for their care. Those benefits will help with the mounting costs of a nursing home. Be sure to consult with an experienced elder care  attorney before giving up on the prospect of additional benefits. In any case, it is important to match your assets with the cost of care. Tandem is here to help.

Know exactly what you’re signing

Oftentimes, when someone is entering a continuous care facility, it is at the height of a stressful situation. You may need help quickly, but before that can happen, you’re handed a huge packet of administrative information to review and sign. Don’t rush through signing anything. If you have questions, consult with an elder care attorney. While many attorneys practice estate planning and similar areas, elder care attorneys focus their practice specifically on legal issues that impact the senior population. Not all estate attorneys are
elder care attorneys. If you need help with issues beyond estate planning, such as health and long-term care planning, public benefits, surrogate decision-making, and legal capacity, you may want to consult an elder care attorney.

Make sure basic legal documents are in place

Once your family member or friend moves into a facility, it is best if they legally designate helpers to make decisions if the time comes that they can no longer make their own. As outlined previously, a power of attorney is an important legal document that authorizes someone to represent or act on your behalf. They will need two different power of attorney documents: one for medical decisions and another for financial decisions.

In addition to powers of attorney, you want to make sure there is a will in place, along with other estate planning documents depending on your situation. These documents can include trusts and end-of-life documents like a POLST, as discussed above.

Freeze credit

Chances are, if someone is entering a care facility, then they won’t be purchasing anything with credit. Sadly, there is great potential for financial elder abuse to occur when someone is in a facility, so it is easier to freeze the person’s credit to protect them. Contact each of the three credit bureaus individually to freeze the person’s credit.

Choosing Continuous Care

Choosing a place to live for long-term care is a big decision. It can be hard to know where to start. Here are some steps you can take to help find the right place for yourself or another.

Consider the person’s needs and wishes

What services are needed now and might be necessary in the future? For example, an older adult may need assistance with everyday activities, physical therapy, nursing care, hospice care, or a
special unit for people with memory problems or dementia. If you are unsure, ask a healthcare provider which services may be most helpful.

What features are important to the person? For example, they may care about meals, social and recreational activities, a religious connection, or staying close to family and friends.

Talk to friends, family, and others in your area

Ask about their experiences with specific continuous care facilities. Were they happy with the care? Healthcare providers, social workers, religious groups, and support groups in your community may also be able to suggest quality places.

Call and visit different facilities

Once you’ve identified a few possibilities, get in touch with each place on your list. It’s a good idea to visit several facilities in person. Make plans to meet with the director, nursing director, or other key staff members. Take a copy of the Medicare Nursing Home Checklist (link in Resources section) to fill out during each visit. For example, look for:

  • Medicare and Medicaid certification
  •  State licensing
  •  Accessibility for people with disabilities
  • Residents who look appropriately dressed and well cared for
  • Warm and respectful interaction between staff and residents
  • A clean, fresh-smelling, comfortable, and well-maintained facility

Make a second visit without calling in advance. Try another day of the week or time of day so you will meet different staff members and have an opportunity to attend different activities. Also, stop by at mealtime and sample the food.
Ask questions during your visits
Don’t be afraid to ask questions. Ask about anything that is important or concerning. Here are a few ideas for questions to ask the staff:

  • How many care providers are there per resident? What kind of training do they have? How many of them are trained to provide medical care if needed?
  • How long have the director and heads of nursing, food, and social services departments worked at the facility? How often do key staff members turn over?
  • Is there a waiting list?
  • Is there a doctor who checks on residents on a regular basis? How often?
  • What activities are planned for residents during the week and on weekends? Can you attend activities yourself to see what they’re like?
  • Is there a safe place for residents to go outside? How do residents get to medical appointments? Is transportation to other locations available?
  • If you need it, does the facility have a special unit for people with Alzheimer’s disease or other special needs? If so, what kinds of services does it provide?
  • Is there information on state regulations for how care is provided? For example, what happens  when there is an infectious disease outbreak requiring quarantine?

Find out about costs and contracts

Each facility is different, so get detailed information about costs and which services are included. Find out if Medicare, Medicaid, or long-term care insurance will pay for any of the costs. The facility may have a financial office that can help you determine what assistance is available.
As noted above, once you select a facility, read the contract carefully. Make sure all the agreements are clear and ask questions about anything you don’t understand. Read over the contract again before signing it and consider consulting an elder care attorney.

Long-Term Care Insurance
Long-term care insurance covers care not generally covered by health insurance, Medicare, or Medicaid. Long-term care insurance can be used to pay for a portion of continuous care. It can also help defray the costs of other care services such as home care, respite care, adult day care, and hospice care. You will find a guide to purchasing this kind of insurance in the list of resources at the end of this document. Please consult with Tandem before you make a purchase to determine whether it’s appropriate for your situation.

Funeral Planning

Planning ahead for your funeral is a thoughtful, forward-thinking gift for your family or friends. With your wishes in hand, others can confidently make decisions about your final tribute and never wonder if they did the right thing. Use the list below to help ensure that you don’t miss any details as you put your wishes in writing.

Choose your final resting place: burial, cremation, green burial (eco-friendly), anatomical donation (ending in cremation)

Choose the type of gathering, service, or memorial you’d like to have. For example, do you want a private or public gathering? Do you want the casket open or closed? Memorial service (takes place after burial or cremation) or a religious or non-religious service?

Choose options to personalize the event:

  • Speakers such as a clergy member or family or friends
  • Pallbearers, eulogists, and attendees
  • Prayers, poems, or other readings
  • Music
  • Memorial video
  • Memorial, monument, or virtual memorials, such as a grave marker, headstone, video tribute, or online memorial website
  • Memorial contributions to charity or other organizations

Choose a method of payment. If you want to prearrange your funeral, you can opt for funeral insurance through a funeral home which sometimes offers a guarantee of their current prices. Other options include a funeral trust or pay-on-death account. Consider speaking to a funeral director now about making advanced payments. This can take a burden off others and lock in the price for your arrangements.

Caring for Others

We don’t always get the opportunity to have a say in everything that happens in our lives because of accidents, unforeseen events, or health challenges that may arise. One of the most important conversations you can have with your family or friends is to share preferences for medical care in the event you or they are not able to communicate wishes. An open and honest conversation with those close to you about end-of-life choices is important for both of you.

Consider this:

  • 90% of people say that talking with their loved ones about end-of-life care is important. Yet, 27% have actually done so.
  • 80% of people say that if seriously ill, they would want to talk to their doctor about their wishes for medical treatment toward the end of their life. 7% report having had this conversation with their doctor.

Preparing for this conversation will help you have a more meaningful, productive discussion will ensure that last wishes are carried out in a way everyone can feel good about. You can start this process by thinking about what is most important to you in terms of quality of life, how you want to live at the end of your life, and any concerns you may have regarding what that might look like.

Below are five ways to help you get started in talking about priorities at the end of life.

  • Reflect on the death of someone you loved and have a conversation about this experience. How will yours be different? If you could change anything about that experience, what would that be?
  • If you or a someone else receives a new diagnosis, take time now with family, friends, and your doctor to talk about how life may look, including preferences and goals for how you want to live. A question may be, “Even though I’m okay right now, I’m worried that ____, and I want to be prepared.”
  • If you or someone else were recently hospitalized, it’s a good time to have a conversation. Consider this question: “I was thinking about what happened, and it made me realize____.”
  • Share this: “I just answered some questions about how I want the end of my life to be. I want you to see my answers. I’m also wondering what your answers would be.”
  • Ask the question, “I need to think about the future. Will you help me?”

Once you’ve started the conversation, work with your friends or family to create end-of-life documents, a funeral plan, and a plan for necessary care.

Tandem is here to help you through these difficult decisions and the issues and logistics that go with them. Please reach out to us at any time.

Resources

National Council on Aging
ncoa.org

NIH National Institute on Aging
nia.nih.gov

AARP Caregiving Resource Line
1-877-333-5885
There are many end-of-life planners available at bookstores or online. For example, “I’m Dead, Now What?” published by TH Guides Press.

Estate Planning Resources

The American College of Trust and Estate Counsel
actec.org

Super Lawyers
SuperLawyers.com

Justia
Justia.com

Nursing Care Resources

Eldercare Locator
Use eldercare.acl.gov or call 800-677-1116 for help finding care in your area.

LongTermCare.gov
Search LongTermCare.gov for information about housing options for older adults and finding local services.

Area Agency on Aging
Call your local Area Agency on Aging or department of human services from your state or local government.

Medicare
Use Medicare’s Care Compare tool to find and compare nursing homes and other health care facilities in your state or territory. Visit medicare.gov/care-compare.

Joint Commission Quality Check
Check the quality of nursing homes and other health care facilities with the Joint Commission’s Quality Check. Visit qualitycheck.org.

Medicare Nursing Home Checklist
medicare.gov/media/document/12130nursing-home-checklist508.pdf

Long-Term Care Guide
content.naic.org/sites/default/files/publication-ltc-lp-shoppers-guide-long-term.pdf

Caring for Others

The Conversation Project
theconversationproject.org/get-started

Hospice Foundation of America
https://hospicefoundation.org/

Disclosures:

Tandem Wealth Advisors LLC (“Tandem”) is an SEC-registered investment adviser. The information published herein is provided for informational purposes only and does not constitute an offer of investment advisory services. All information is subject to change without notice. Nothing contained herein constitutes financial, legal, tax, or other advice. No investment process is free of risk, and investors may lose all their investments. Past performance is not indicative of current or future performance and is not a guarantee. The opinions expressed in this document may not fit your risk and return preferences. The information provided is obtained from sources believed to be reliable, but we cannot attest to its accuracy. Past performance is not necessarily indicative of future returns. Certain information contained herein constitutes “forward-looking statements,” which can be identified by the use of forward-looking terminology such as “may,” “will,” “should,” “expect,” “anticipate,” “project,” “estimate,” “intend,” “continue,” or “believe,” or the negatives thereof or other variations or comparable terminology. Due to various risks and uncertainties, actual events, results, or actual performance may differ materially from those reflected or contemplated in such forward-looking statements. Nothing contained herein may be relied upon as a guarantee, promise, assurance, or a representation of future events or conditions. Additional copies of Tandem’s ADV Part 2A and/or Privacy Policy are available upon request by phone at 602-297-8600 or by email at [email protected].

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