Incapacity Planning

An article in USA Today focuses on a news release by the Kaiser Foundation about former First Lady Barbara Bush’s decision to seek comfort care prior to her death on April 17, 2018. The article applauds Mrs. Bush’s courage in bringing attention to the matter of the level of care sought by those who are terminally ill. Barbara Bush, age 92, had been battling congestive heart failure and chronic obstructive pulmonary disease for years prior her death.

Ellen Goodman, co-founder of the Conversation Project, which encourages families to have a discussion about end-of-life health care decisions, was supportive of Mrs. Bush’s actions. She stated that “It sounds like this forthright, outspoken woman has made her wishes known and the family is standing by her.” Dr. Joanne Lynn, who worked with Barbara Bush years ago at the Washington Home fro Chronically Ill Patients and who is now a Director at the Altarum Institute, said “it makes perfectly good sense at her age, with her failing health , that she would say at some point, ‘Life’s been good, and while you always want more, it’s enough.”

Advance Health Care Directive

The lawyers at estate planning and elder law firm, Dennis M. Sandoval, a Professional Law Corporation, recommend that everyone have an Advance Health Care Directive and HIPAA Pre-Authorization Form as part of his or her estate plan. An Advance Health Care Directive, sometime known as a Health Care Power of Attorney, allows you to designate who will make health care and personal care decisions for you in the event you are unable to do so for yourself. These type of decisions can include whether to seek care giving in the home or in an assisted living facility, whether to seek aggressive medical treatment or palliative care, whether to continue on life support if you are terminally ill and no longer getting any enjoyment out of life, whether to authorize organ donation, and whether you will be cremated or buried. Sometimes, such as the case of Terri Shiavo, there is tremendous conflict among the family members with regard to hard to medical decisions such as seeking hospice and palliative care, and removing life support. An Advance Health Care Directive makes your wishes known and appoints the person you entrust to carry out those wishes eve when there is controversy among the family members.

HIPAA Pre-Authorization Form

The Health Insurance Privacy and Accountability Act (HIPAA) is a federal law that protects a person’s private health care information and provides for fines and even criminal prosecution for violation. While the intent of the act is laudable, it has caused some doctors; hospitals, and laboratories to hesitate about sharing the health care information of a chronically or terminally ill individual with his or her health care agent or other family members. A HIPAA Pre-Authorization Form waives your protections under the HIPAA laws, so that you can designate the persons you wish to be able to speak with your health care professionals without fear of violating the law. It is an extremely important document to assure that your agent can have an open discussion with your attending physicians and other health care providers about your state of health and possible courses of action available to you.

POLST

The POLST (Physician’s Order on Life Sustaining Treatment) is a form that you should obtain and discuss with your attending physician to assure that your health care wishes regarding end-of-life treatment are documented and carried out by the health care professionals who are providing care for you. The POLST is not an alternative to an Advance Health Care Directive. Rather, it is an order from your doctor that documents your wishes and should support what you have expressed in your Advance Health Care Directive.  It contains a DNR (Do Not Resusitate) order, should that be your desire. It designates the level of care you desire, from comfort care to full treatment. It expresses whether or not you want artificially administered nutrition (feeding tube). The POLST form is supposed to accompany you wherever you go, so if you are transferred from a hospital to a skilled nursing facility, the form should be sent with your other health care information so the new facility is informed of your wishes. Please discuss with your doctor whether your health condition warrants completing a POLST, and if it does, make sure your doctor or other trained health care provider takes the time to explain and discuss these issues with you.

Riverside Elder Law Attorney Offers More Information on Incapacity Planning and End-of-Life Decision Making

Visit our website for more information about estate planning for the chronically ill. You can schedule an appointment with one of the elder law attorneys at our Riverside law firm, by calling us at 951-888-1460 or requesting an appointment at the bottom of this webpage.

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Dennis Sandoval

Dennis Sandoval is the only attorney in California who has certifications in the three areas of estate planning, elder law and taxation. In 2014, the National Academy of Elder Law Attorneys (NAELA) designated Dennis as a Fellow, an award given to less than 100 elder law attorneys across the United States. He received his Certified Estate Planning, Trust and Probate Law Specialist designation from the California Bar Board of Legal Specialization in 1998 and his Certified Taxation Law Specialist designation in 2000 from the same organization. He is a Certified Elder Law Attorney (CELA), a designation he proudly received in 2004 after meeting all the requirements established by the National Elder Law Foundation (NELF) and the American Bar Association. Dennis has also holds the designation as an Accredited Estate Planner® (AEP) from the National Association of Estate Planners and Councils.

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