The Law Office of Philip M. Flanigan, P.C.The Law Office of Philip M. Flanigan, P.C.2024-02-25T00:08:26Zhttps://www.pmflaw.com/feed/atom/WordPress/wp-content/uploads/sites/1303063/2022/08/cropped-pmf-fav-icon-32x32.pngOn Behalf of The Law Office of Philip M. Flanigan, P.C.https://www.pmflaw.com/?p=2552622024-02-25T00:08:26Z2024-02-25T00:08:26ZMedicare coverage has troubling limits
Although Medicare coverage theoretically exists for the protection and comfort of older adults, there are some glaring limitations to the support that it provides. Particularly when someone needs long-term care as they age, they may discover that Medicare is inadequate.
Medicare can offer some coverage for long-term care. An older adult who has been in the hospital for at least three days can expect Medicare to cover 100% of the costs for their first 20 days of skilled nursing care. They can then receive partial coverage for days 21-100. After 100 days, Medicare does not pay for additional nursing home or skilled nursing care.
Someone who requires an extended period of skilled nursing support or a long-term stay in a nursing home may need to apply for Medi-Cal, the California Medicaid program. Medi-Cal does provide long-term care benefits whereas Medicare does not. However, it also has many strict requirements for eligibility that Medicare does not.
The adult children of older adults worried about their long-term care needs may want to encourage their parents to revisit their estate plans. People may need to change how they hold property, move assets into trusts and otherwise diminish their personal holdings so that they can qualify for Medi-Cal benefits without a penalty. Otherwise, last-minute transfers could trigger penalties that leave someone personally responsible for care costs that they do not have the resources to cover.
Although it can be difficult to talk to aging parents about their finances, it is better to address issues proactively as opposed to waiting until someone needs support that they cannot access. Learning about Medicare, Medi-Cal and long-term care may benefit those worried about the comfort of their parents as they age.]]>On Behalf of The Law Office of Philip M. Flanigan, P.C.https://www.pmflaw.com/?p=2552432023-11-24T23:09:41Z2023-11-24T23:09:41Ztheir children), especially if the amount is substantial.
However, inheriting a large amount of money can actually be a double-edged sword. On one hand, it opens up opportunities for financial security and growth. On the other hand, a sudden influx of wealth can be a bit overwhelming to a lot of people – and they can easily mishandle the situation.
What are the most common financial mistakes?
When people inherit a lot of money and they aren’t adequate prepared to handle it, they tend to make some similar mistakes:
Impulsive spending: Extravagant purchases can easily get out of hand, especially if someone has lived a fairly frugal or modest existence before out of necessity. The wealth may end up funding a temporary lifestyle that isn’t sustainable.
Excessive generosity: Most people dream about having enough money to give their loved ones a boost when they need it – but that idealism can quickly lead to an empty wallet. Sometimes, people who inherit a lot of money can even be easily guilted into giving their friends and family large sums of cash simply because they feel like they haven’t really “earned” all that wealth.
Poor financial planning: Money grows only when it is tied to clear goals, so people with wealth know that they need good financial guidance, including an understanding of any tax considerations. When people don’t seek out the experts they need to help them make decisions, that can lead to bad investments, unexpected tax liabilities and financial disaster.
What can you do to help your beneficiaries and heirs avoid these kinds of problems? Start by letting them know what sort of inheritance they can expect and discuss your concerns. You may want to introduce them to your own financial planner and consider fail-safes, like establishing a trust to maintain some control over the money even after you’re gone. Seeking experienced legal guidance can help you address these kinds of problems in advance.]]>On Behalf of The Law Office of Philip M. Flanigan, P.C.https://www.pmflaw.com/?p=2552362023-08-03T22:01:20Z2023-09-26T08:58:47ZProbate Avoidance
One of the primary advantages of trusts is their ability to avoid probate. Probate is the legal process through which a deceased person's will is validated before distributing assets. It can be a lengthy and costly process, subject to court supervision and public scrutiny.
By using a trust, your estate can bypass probate entirely, ensuring a faster, more efficient transfer of assets to your intended beneficiaries. This not only saves time and money but also maintains privacy, as trust documents are not public records like probated wills.
Flexibility
Another important aspect of trusts is their flexibility and customization options. Trusts can be tailored to meet the specific needs and goals of the grantor. For example, if the grantor has minor children or beneficiaries who are not yet responsible enough to handle their inheritances, a trust can be created to provide for their financial wellbeing until they reach a certain age or milestone. This allows the grantor to exercise control over how and when the assets are distributed, ensuring their loved ones are taken care of in the best possible way.
Asset Protection
Trusts are also valuable tools for protecting assets from creditors and lawsuits. By transferring assets to an irrevocable trust, the grantor effectively removes them from their personal ownership, making them less susceptible to potential legal claims or judgments. This can be particularly advantageous for people in high-risk professions or with substantial wealth. Additionally, trusts can safeguard assets in situations where the grantor becomes incapacitated, ensuring that a designated trustee manages their affairs and finances according to their wishes.
Philanthropic Legacy
Charitable giving is another area where trusts are especially helpful. If philanthropy is an essential aspect of your estate planning, you can establish a charitable trust to support your chosen causes. Through a charitable trust, you can donate assets while retaining income from those assets during your lifetime. This allows you to support charitable organizations and potentially receive certain tax benefits, all while ensuring that your philanthropic legacy endures.
Estate Taxes
Trusts can also be instrumental in minimizing estate taxes. Through various types of trusts, such as irrevocable life insurance trusts or generation-skipping trusts, you can reduce your overall estate tax liability. By leveraging the tax advantages provided by trusts, it becomes possible to preserve more wealth for future generations and secure a more meaningful legacy.
Adding a Trust to Your Estate Plan
By incorporating a trust, or trusts, into your estate plan, you can expedite the distribution of assets, maintain privacy, and provide greater control and flexibility over how your assets are managed. A trust can also offer asset protection, facilitate charitable giving, and help minimize estate taxes.
An experienced estate planning attorney or elder law attorney can help you navigate the intricacies of trusts and ensure that your estate plan aligns with your goals and aspirations. Contact our estate planning and elder law firm at (559) 435-0455 today to learn how we can help you establish a trust to meet your estate planning needs. We look forward to the opportunity to work with you.
This article offers a summary of aspects of estate planning law. It is not legal advice and does not create an attorney-client relationship. For legal advice, you should contact an attorney.]]>On Behalf of The Law Office of Philip M. Flanigan, P.C.https://www.pmflaw.com/?p=2552352023-08-03T21:58:41Z2023-09-19T08:53:45ZWhat Can Happen, and What Can You Do?
If you lose Medicaid coverage, you may be responsible for paying the full cost of your long-term care services. This situation can be financially challenging, as long-term care expenses can be significant. Finding an alternative payment source is an immediate concern, even if you plan to reenroll for Medicaid coverage. The application process takes some time to complete.
Tap Into Existing Resources
For the short term, you may need to seek family help. If you previously did Medicaid planning, you may tap into personal savings or sell assets. If you qualify, you may need to explore other government programs providing financial assistance for long-term care, such as veterans benefits. Medicare policies traditionally don’t cover long-term care, but they do cover some skilled nursing home care in specific situations for a limited time.
Negotiate with the Care Facility
If you can't cover the full cost of your long-term care, you may need to negotiate with the care facility, nursing home, or in-home services to find a solution. Some facilities may be willing to work out payment plans to avoid resident churn or make other arrangements to help you continue care. It's in your best interest to seek the counsel of a disability or elder law attorney specializing in long-term care to negotiate a solution.
Care Facility Discharge
When a short-term fix isn’t available, or negotiations to alter payment obligations fail, the loss of Medicaid coverage may result in discharge from the facility or denied in-home or community-based care services. However, a facility is legally obligated to provide notice before discharging a resident. During this time, the facility and your elder law attorney can work with you or your family to arrange a safe and suitable transition to another living arrangement.
Disenrollment Numbers
The number of Medicaid cutoffs for previously existing beneficiaries has surpassed one million, with the expectation to increase between 14 to 18 million. So far, Medicaid-dependent facilities, nursing homes, and at-home and community-based services are not widely affected. Still, the law of large numbers indicates disenrollment can significantly impact some beneficiaries requiring long-term care.
Many Medicaid beneficiaries who have been released due to procedural issues or technicalities anticipate being reenrolled. However, according to Medicaid, states have up to “twelve months to return to normal eligibility and enrollment operations.” The permitted time frame creates havoc for many Americans who rely on Medicaid benefits. However, it’s catastrophic for beneficiaries receiving Medicaid for long-term care as costs in a facility may range from about $4,000 - $8,000 per month, depending on the location.
If You or a Loved One Are in Long-Term Care
Understand that the unwinding of Medicaid continuous enrollment happens by state. Some long-term care beneficiaries may be unaware that continuous enrollment has stopped. Beneficiaries or their loved ones may neglect to return Medicaid paperwork or omit required documents consistent with current Medicaid qualifiers.
Some long-term care providers raise concerns that staff shortages in state agencies that handle reenrollment will create delays in processing required patient paperwork. The twelve-month grace period Medicaid provides to the states creates a slow reenrollment process that affects providers who continue to care for residents without reimbursement.
Consult a Disability or Elder Law Attorney
If you have been cut off from Medicaid and need to reenroll, an attorney can guide you through the general steps to ensure your benefits begin again as soon as possible. Your lawyer can help you confirm the reason for the discontinuation of benefits. It may be a failure to provide required documentation since the end of continuous enrollment or changes in eligibility requirements.
Once you understand why it has happened, your attorney can gather the necessary documentation for the reenrollment process. Documents may include:
Proof of income
Identification documents
Proof of residency
Social Security number
Other documents your state’s Medicaid office requests
Your disability or elder law attorney can ensure all relevant financial documents and medical records are included to support your application. They may contact the state’s Medicaid office and advise them that you have been receiving long-term care benefits in an effort to flag your application for expedited processing.
Because short-term loss of benefits can make maintaining residency in a long-term care facility difficult, your attorney can strategize a short-term solution that addresses your unique situation.
Appeals and Advocacy
If your Medicaid reenrollment application is denied or you face challenges during the reenrollment process, an elder law or disability attorney specializing in long-term care can help you through the appeals process. They can gather additional information, advocate on your behalf, and represent you in administrative hearings or appeals.
If you are in long-term care and lose Medicaid benefits, specific consequences will depend on individual circumstances and your state’s regulations. Pay close attention to your Medicaid status. Disenrollment may continue to affect long-term care beneficiaries for some time due to the end of the requirement in FFCRA legislation requiring continuous enrollment.
Consult with one of our experienced elder law or disability attorneys specializing in Medicaid and long-term care issues. They understand the laws and regulations and help you reenroll in Medicaid, securing the necessary coverage to continue your long-term care benefits. Please contact our office today at (559) 435-0455 and schedule a free consultation to discuss your legal matters. We look forward to the opportunity to work with you.]]>On Behalf of The Law Office of Philip M. Flanigan, P.C.https://www.pmflaw.com/?p=2552332023-08-03T21:53:43Z2023-09-12T08:51:50ZExamples of People with Disabilities and Special Needs
While disability and special needs are not mutually exclusive, it can be confusing to explain the situation on a benefits application. Some examples may include:
A person with autism spectrum disorder (ASD) may have a disability that makes communicating and interacting with others difficult. They may also have special needs in the form of behavioral interventions or educational support.
A person with Down syndrome may have a disability that affects their physical and cognitive development. They may also have special needs like medical care, education support, and social services to navigate daily life.
A person with a visual impairment may have a disability that makes it difficult to see. They may also have special needs requiring adaptive technology, mobility assistance, and accessible transportation.
Differences in Applying for SSA Disability and Special Needs Benefits
Applying for SSA disability and special needs benefits is different in several ways. The first is the purpose of the application. SSA disability applications determine eligibility for financial benefits, while special needs applications determine eligibility for education and other support services.
SSA disability benefits are contingent on the ability to engage in substantial gainful activity (SGA), while special needs determinations consider an individual’s needs.
The Social Security Administration (SSA) has a process to make disability determinations, while a school district or other organization generally determines special needs requirements. Many children with special needs become developmentally disabled adults. An SSA disability application will require medical documentation supporting the disability claim, while special needs applications may require medical documentation, education records, and psychological evaluations. An SSA disability application may take months or years to complete and receive, while a special needs process can typically conclude within a few weeks or months.
SSA and Special Needs Determinations
SSA disability determination is a process that identifies if an individual is disabled enough to qualify for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) benefits. The SSA uses a strict definition of disability that bases a person’s ability to engage in SGA. A person must have a medical condition that prevents them from doing any work they have done in the past or any other kind of work that exists in the national economy to receive formal disability status. SSI benefits are low-income based.
Special needs determination is a process by which a school district (or other organization) determines a child has special needs requiring special education or related services. The definition of special needs varies by state but typically includes children with physical or mental disabilities, learning disabilities, or other conditions affecting their learning ability.
Ultimately the main difference is the purpose of the benefit. SSA disability determinations create eligibility for financial benefits, while special needs determinations determine eligibility for education services.
A Disability Attorney Can Help With Disability and Special Needs
A disability attorney can help you define your loved one’s situation regarding special needs and disability benefits, choosing the correct qualifying benefits. They can help navigate the complex application process and represent you in court if the claim is denied.
Application processes differ, and age plays a significant role in applying for benefits. SSDI is not particularly relevant to a minor who has never been employed. However, SSI can be relevant for low-income children who are either disabled, special needs, or both.
Working adults who qualify for the SSDI earned benefit program will ensure the best application outcome with the help of a disability attorney. Most applications are denied on the first submission, and appeals and reviews take precious time when financial benefits are most needed. Many disability attorneys work on a contingency basis so that initial benefits payments will cover the cost of legal representation.
Understanding the terms special needs and disability and their associated services or benefits through government programs is complex. Criteria and qualifications differ based on needs, medical and psychological evaluations, and age. Our disability attorneys can provide the required oversight and actions to access the best service and benefits possible.
We hope you found this article helpful. Please contact our office today at (559) 435-0455 and schedule a free consultation to discuss your legal matters. We look forward to the opportunity to work with you.]]>On Behalf of The Law Office of Philip M. Flanigan, P.C.https://www.pmflaw.com/?p=2552272023-08-03T21:50:55Z2023-09-05T08:47:58ZCommon Legal Concerns in Probate Court
Some common problems leading to probate litigations include:
Will contests – The validity of a will can be challenged. Interested parties may dispute the will’s authenticity, allege undue influence or fraud, or argue that the person who made the will (testator) lacked the mental capacity to create a valid will.
Estate administration disputes – Disagreements may arise among beneficiaries, executors, or administrators regarding the management and distribution of estate assets. These disagreements can include allegations of mismanagement or conflicts over the interpretation of the will or trust provisions.
Claims against the estate – Creditors or individuals who believe they have a rightful claim to the deceased person’s assets may file claims against the estate. Claims can include outstanding debts, unresolved contracts, or disputed property ownership.
Guardianship or conservatorship disputes – If there are disputes over the appointment of a guardian for a minor or an incapacitated adult or concerns about the actions of an appointed guardian or conservator, it can result in probate litigation.
Breach of fiduciary duty – Executors, administrators, trustees, and other fiduciaries are legally obligated to act in the best interests of the estate and its beneficiaries. Allegations of misconduct, self-dealing, or failure to fulfill these obligations may lead to litigation.
Document interpretation – Disputes may arise over the interpretation of a will, trust, or other estate planning documents. These conflicts can involve disagreements about the intended meaning of certain provisions, the scope of powers granted to trustees or executors, or the distribution of assets among beneficiaries.
Family disputes – Family dynamics can often lead to probate litigation, especially with strained relationships, blended families, or unequal distributions of assets. Sibling rivalry, disputes with former spouses, or disinheritance can result in legal challenges.
Individuals marrying multiple times without a prenuptial agreement are also likely to incite probate litigation upon their death. Life insurance trusts can be a valuable way to separate the interests of the decedent’s spouses and children.
Probate, Estate, and Trust Litigation Attorneys
If you anticipate probate litigation, an experienced estate administration attorney can provide guidance and explain your rights and options to prevent future problems. If you are involved in a dispute, a probate litigation attorney can help you navigate the legal system and resolve it. There are also attorneys who specialize in conflicts with trust administration and litigation.
It’s essential to consider your legal situation and an attorney’s experience, reputation, and track record when handling similar matters. It’s also crucial to feel comfortable working with them.
Early Steps in Probate Litigation
In probate litigation, your attorney plays a key role in representing your interests while navigating the legal process. All things begin with an initial lawyer consultation to discuss your case’s details, goals, and concerns. Your attorney will evaluate the strength of your claims or defenses and explain the legal process, potential outcomes, and available strategies to achieve your objectives. Most states have strict statutes of limitations, so the earlier you contact a probate litigation lawyer, the better.
Your attorney will then thoroughly research your case’s relevant laws, precedents, and regulations. They will analyze the facts and circumstances to develop a legal strategy tailored to your situation. All relevant documents will be gathered and reviewed, including wills, financial records, trusts, and other evidence relating to the dispute. Your attorney will then prepare and draft legal documents like complaints, petitions, answers, motions, and discovery requests.
Probate Court Processes
Probate litigation hearings and trials are usually held in the county probate court where the decedent died. The probate litigation attorney you select should be familiar with the county probate court where the case is being tried.
Your attorney will engage in the discovery process by gathering evidence, documents, and depositions from other parties. They will also respond to discovery requests from the opposing party. Each side will advocate for their client’s interests, work to reach a favorable settlement if possible, and advise on the merits of accepting or rejecting settlement offers.
Trial preparation and representation will occur if the settlement phase fails. Your lawyer will prepare you for trial, make legal arguments, examine and cross-examine witnesses, and present your case to the court. Throughout the process, your attorney will help you make informed decisions regarding the direction of your case.
Probate court can illicit high emotions and tense interactions that greatly disrupt family relationships and leave the estate open to creditor lawsuits as well.
Our estate administration and probate litigation attorneys help prevent estate-related contests through proper estate planning and significantly reduce the likelihood of probate litigation in the first place. Should you find yourself in need of an experienced litigator, we can represent you. Please contact our office today at (559) 435-0455 and schedule a free consultation to discuss your legal matters. We look forward to the opportunity to work with you.]]>On Behalf of The Law Office of Philip M. Flanigan, P.C.https://www.pmflaw.com/?p=2552242023-07-17T16:43:12Z2023-08-29T08:42:03Z
What is the child's long-term prognosis
What type of care is anticipated to meet their needs?
Are there any potential medical breakthroughs that could change their future?
What government programs will they be eligible for when they become an adult?
How will your estate plan change when your child can legally make some decisions on their own?
Involving Your Child in the Planning Process
It’s challenging for parents or guardians to set up the best plan possible for a child with special needs. Most state laws mandate that the parent or fiduciary in charge of a child with special needs must allow the child’s participation in the process as much as possible. This prompts more questions, such as:
Are they able to express their needs and wants regarding their care?
To what degree can they manage activities of daily living like eating, bathing, and dressing by themselves?
Is the child deemed capable being employed outside of the home in the future?
Can they ride a bus to work?
Is outside care, such as an assisted living facility, likely?
Is the family capable of providing income and assets for their future wellbeing?
Special Needs Planning Requires a Flexibility Estate Plan
Your estate plan might need updating in the future due to unforeseen changes in the abilities, requirements, and available government benefits of a child with special needs. Government assistance may not be necessary if you have sufficient assets that can be paid out in a discretionary trust throughout your child’s life at the direction of an appointed trustee.
However, if your child receives government benefits, a special needs trust is a good strategy to supplement their lifestyle. It’s crucial to have a special needs attorney properly draft a trust to ensure the child doesn’t become ineligible for their benefits if they receive lump sums of money or gifts intended to support them.
A Special Needs Trust Offers Options
Whether your child with special needs will be eligible for government benefits or not, an already established trust allows a named trustee to create a special needs trust if something happens to you. You can choose to fund the trust now or leave it empty until your death proceeds flow into the trust from your estate, another trust, or life insurance policy.
Special Needs Planning Mistakes
Some parents choose not to create a trust for their special needs child and completely disinherit them so that government benefits can solely support them. The absence of explicit financial support directives for a special needs child can have lasting negative effects on their financial and emotional wellbeing.
However, parents of children with special needs often try to overcompensate for their child's future rather than leave them with no family aid whatsoever. Establishing a framework of legal documents that define the future of your loved one with special needs will help ensure you take care of all their financial, medical, and personal needs for life.
We hope you found this article helpful. Please contact our office today at (559) 435-0455 and schedule a free consultation to discuss your legal matters. We look forward to the opportunity to work with you.]]>On Behalf of The Law Office of Philip M. Flanigan, P.C.https://www.pmflaw.com/?p=2552222023-07-17T16:41:18Z2023-08-22T08:38:30Zchanging attitudes towards working past age 65. Retirement doesn’t necessarily mean a senior is leaving the workforce.
Reason Seniors May Continue Working
Many US adults plan to continue working in retirement. Some will work out of necessity to earn more money because of increased longevity, health care costs, and reduced Social Security payouts, while others will leave their career and strike out in a different direction, often pursuing a lifelong dream or spending time and energy in volunteer work or philanthropy. Whatever the senior individual’s pursuit, it’s clear that new patterns have emerged in the past 10 years, and it has a profound budgetary effect on individual US states.
Seniors Prefer to Age in Place
Baby boomers want to age in place and are committed to staying vital, fit, and independent for as long as possible. They want to die in their own homes, not in a hospital or long-term care facility. An AARP survey of 2,826 US adults found that about 75% of people over 50 want to stay in their homes or communities for as long as possible.
The Impact on State Health Care Budgets
So why does this demographic and economic shift put a strain on so many state budgets? The answer is twofold; there is an increase in health care burdens while tax revenues decline since Americans tend to pay fewer taxes as they get older. This is due partially to senior retirement but also because seniors tend to spend less money than younger generations. This means more health services are needed, and fewer tax dollars are available to fund the programs.
Even the states that are best rated for aging, ranked by overall health, senior unemployment, life expectancy, and nursing home quality, are challenged because of health care costs. Rising health care costs have been taking a large portion of each state’s government budget and will most likely continue to do so.
Health care costs are also hitting baby boomers hard. There is a trend in people aged 50 to 65 having more incidence of disability, obesity, and diabetes, increasing their need for medical care and services. The average 65-year-old couple retiring in 2022 needs $315,000 to cover health care costs alone over the remainder of their lives. That is a 5% increase from the previous year, and with no substantive health care pricing reform on the policy horizon, that amount will continue to increase.
Have an Elder Law Attorney Speak with Your Financial Advisor
Now is the time to work with a legal and financial professional to work on a personal retirement plan that considers your future care needs. Our estate planning and elder law attorneys would be honored to work with you on this important planning step.
We hope you found this article helpful. Please contact our office today at (559) 435-0455 and schedule a free consultation to discuss your legal matters. We look forward to the opportunity to work with you.]]>On Behalf of The Law Office of Philip M. Flanigan, P.C.https://www.pmflaw.com/?p=2552402023-08-18T19:26:05Z2023-08-18T19:26:05Zestate planning. Some can be easily fixed, while others take additional steps to remedy.
For this reason, understanding the most common mistakes can be helpful for people embarking on this journey. Common mistakes people make, which you should avoid, include:
Thinking you are too young to plan your estate
You can create an estate plan if you have a checking or savings account and begin accumulating assets via a retirement account and investing.
Planning an estate is critical as soon as you are able. After that age, you may purchase homes, vehicles, and other assets you want to protect. Estate planning does just that.
Rushing to choose a personal representative
You should know your personal representative very carefully because this person will have access to everything that was yours.
You must trust them very well because, after all, you are, in some ways, handing over your life to them and trusting that they will respect and honor your wishes, as you have stated.
Forgetting to update your estate plan
Having an estate plan is not a one-time thing you do and leave inside a safe. Every time something material changes, whether having a child or adding assets to your name, you should update your estate plan and beneficiaries accordingly.
Not having a will and power of attorney
It is essential to have a will, a power of attorney and, if you choose to, a trust where you can put your assets. Many tools are available to protect yourself, your assets and your beneficiaries.
These tools are designed to help you and them. Ensuring you have all documentation needed to make swift transfers of assets can make a massive difference for your beneficiaries.
Not discussing taxes as they relate to estate planning with your attorney
Taxes and estate planning are very much intertwined and can work in concert in many ways. Ensure that you know what you can do to minimize tax liability while at the same time paying what the law requires you to pay.
While some of these may seem overwhelming, you will not have to worry about almost anything if you have proper counsel.
Making mistakes when planning your estate can cost you, which is why it is so essential to prevent that from happening by having the foresight to begin your estate planning now.]]>On Behalf of The Law Office of Philip M. Flanigan, P.C.https://www.pmflaw.com/?p=2552212023-07-17T16:38:03Z2023-08-15T08:36:32ZA Question of Quality of Life
With poor quality of life, many would choose to stop hand-feeding and hydration and allow the dying process to begin. However, long before that time arrives, you or your loved one has lost the capacity to make and express that decision. If you no longer have an effective way to be heard, institutions providing memory care are legally and morally obligated to continue hand-feeding and hydration until the bitter end.
A terrible characteristic of Alzheimer’s and other forms of dementia is that people may have lost all that made them who they once were, and yet, they remain physically healthy enough to continue, in that absent state, for many years.
Legal Documents to Communicate Your Wishes
Existing health care powers of attorney usually only address artificial nutrition and hydration, like feeding tubes and IV for end-of-life care. Until recently, the documents didn’t include hand-feeding. Despite your health care agent’s requests, caregivers would be required to continue cajoling, persuading, and insisting that you continue to be fed by hand. This process would rely on a primitive reflex in which touching the spoon to the corner of your mouth would result in an involuntary opening of the mouth. This could be misinterpreted as a desire to eat, and the sad situation could drag on and on without any way to intervene. In especially tragic cases, where the swallowing reflex has become diminished, you could aspirate food and fluid into your lungs, resulting in pneumonia.
Thanks to pioneering efforts by End of Life Washington and End of Life Choices in New York, a dementia directive emerged to supplement existing health care directives and to specifically address this issue. When a person has become unable to feed themselves, can no longer use the toilet, and can no longer move or speak or recognize loved ones, the person may have expressed, in a dementia-related illness, that hand-feeding be stopped – or that feeding be restricted only to foods that they demonstrably enjoy. The dementia document further requests that the person be kept comfortable and out of pain through careful medication and other measures to relieve any anxiety, agitation, or insomnia.
Expressing Your Wishes Before It’s Too Late
Especially when the dementia diagnosis is first made, and while you or a loved one still have the capacity to make and communicate health care decisions, this supplemental health care directive must be considered. Creating a video expressing your wishes for end-of-life care is also a very good idea. That way, when you’ve become a silent, immobile presence in bed, caregivers can see you as you used to be, expressing wishes while you were still able to communicate them.
Please contact our office today at (559) 435-0455 and how to create a legal document reflecting your or your loved one’s wishes. We look forward to the opportunity to work with you.]]>