Resources for General Information and Assistance
Your state or local department on aging: Look for “aging” or “human services” in your local government blue pages of the phone book for the number. Specific resources to ask for include State Health Insurance Assistance Programs, and in many states Aging and Disability Resource Centers (ADRCs).
The Administration on Aging's national Eldercare Locator provides information including where to find specific services and supports in your community. Contact: 1-800-677-1116, weekdays 9:00 a.m. to 8:00 p.m. (ET) or contact the Eldercare Locator website.
Women’s Health/Health and Human Services (HHS) provides a range of information from caregiving to end of life and advance directives.
Resources to Assist with Caregiving
Administration on Aging (AoA)/Elders and Caregivers
The Caregiver Resource Room is where families, caregivers, and professionals can find information about The National Family Caregiver Support Program, including: where you can turn for support and assistance, and finding services for caregivers. In addition, another AoA resource is the Elder Care Locator.
Family Caregiver Alliance
The Family Caregiver Alliance (FCA) operates the National Center on Caregiving (NCC). The FCA provides a central source of information and technical assistance on caregiving and long-term-care for policy makers, health and service providers, media, program developers, funders and families. Their website, www.caregiver.org, contains a wealth of resources for caregivers and providers, including fact sheets, research and policy studies.
Family Caregiving 101
This website, developed by the Family Caregiver Alliance and the National Alliance for Caregiving, provides information and resources for family caregivers.
NIA Booklet on Long Distance Caregivers - The National Institute on Aging (NIA) has released So Far Away: Twenty Questions for Long Distance Caregivers. This booklet focuses on some of the most important concerns caregivers have about providing long distance care. The booklet is free and may be ordered by calling 1-800-222-2225 or going to http://www.nia.nih.gov/HealthInformation.
National Alliance for Caregivng
The National Alliance for Caregiving (NAC) is a coalition of national organizations focusing on issues related to and in support of family caregivers. NAC conducts research, policy analysis, program development and public awareness about caregiving. Their website, www.caregiving.org, provides publications and information including a link to the Caregiving 101 website and surveys on the status of caregiving.
National Family Caregivers Association
The National Family Caregivers Association (NFCA) focuses on public awareness, and caregiver education and support, especially as it relates to helping family caregivers work effectively with healthcare providers. Resources on the site include ways to link and support family caregivers through the stories project and a caregiver bulletin board.
Resources for Healthy Aging
Centers for Disease Control and Prevention (CDC)
This government site provides a wide range of information and resources on health and prevention for all ages and groups. Each specific topic, for example aging, physical activity and exercise, and staying healthy, includes news on related reports, conferences, listservs, statistics, and additional resources. The “aging” topic includes a Healthy Aging for Older Adults web page.
Center for Healthy Aging
This National Council on Aging site provides information on a range of health issues and identifies state and local programs that provide health promotion and disease prevention for older adults. These programs include AoA funded Evidenced-Based Disease Prevention Programs.
Center for Nutrition Policy and Promotion
The US Department of Agriculture (USDA) Center for Nutrition Policy and Promotion (CNPP) works to improve the health and well-being of Americans by developing and promoting dietary guidance that links scientific research to the nutrition needs of consumers.
National Center for Complimentary and Alternative Medicine
The National Center for Complementary and Alternative Medicine (NCCAM) is the Federal Government's lead agency for scientific research on complementary and alternative medicine within the National Institutes of Health (NIH). The Center conducts research, trains researchers, and provides a clearinghouse for information on treatments and therapies.
National Institute on Health: Health Information and Exercise Guide
This government site provides an Exercise Guide and links to additional publications and resources on health and wellness. The Guide provides advice on nutrition, balanced diets, and explains the benefits of exercise and physical activity, including how to get started and how to check your progress.
Resources to Assist with Financial Planning
The Federal Citizen Information Center section on ‘Money’ provides a range of information, fact sheets and resources on money and planning issues including banking, financial security, insurance, and retirement planning.
The My Money.Gov website provides information and resources that include social security benefit information, retirement planning strategies, and guidelines and questions to ask about trusts, IRA and other financial options.
The National Association of Insurance Commissioners' (NAIC) provides shoppers guides for different types of insurance, including long-term care insurance to help individuals understand and compare policies - (NAIC) Shopper's Guide to Long-Term Care Insurance.
Your State Insurance Department will have information about long-term care insurance in your area. They also often offer a shoppers' guide to long-term care insurance. Contact: http://www.consumeraction.gov/insurance.shtml to find your State’s Insurance Department.
Women’s Institute for Secure Retirement (WISER). This website offers a variety of information and consumer publications to help women understand the complex issues in areas such as Social Security, pay equity, pensions, savings and investments, home-ownership, long-term care and disability insurance.
Resources to Assist with Housing Planning
AARP
www.aarp.org/money/revmort
This AARP site provides information on reverse mortgages including a quide to compare reverse mortgage products.
Administration on Aging (AoA)
http://www.aoa.gov/eldfam/Housing/Housing.aspx
This AoA site provides information and resources on housing including assistive technology, remodeling and housing with services.
A Guide to Making Housing Decisions: Housing Options for Older Adults
http://www.eldercare.gov/Eldercare/Public/resources/fact_sheets/pdfs/Housing%20Options%20booklet.doc
This booklet provides an overview of housing options – from home ownership to rental and housing with services – and the related benefits, challenges, and legal issues to consider.
Alliance for Technology
http://www.ataccess.org/default.html
This site provides a range of information and resources on assistive devices and technology including community resources and vendors.
Fair Housing Accessibility First
http://www.fairhousingfirst.org/information/design.html
This Housing and Urban Development (HUD) website provides a wide range of information on modifications and accessibility including issues related to individuals in rental housing.
National Association of Home Builders (NAHB)
www.nahb.org/directory.aspx?sectionD=686&directoryID=188
This site provides a web-based directory you can search to find remodelers or contractors who specialize in modifying homes to make them safer and more comfortable.
National Resource Center on Supportive Housing and Home Modification
http://www.usc.edu/dept/gero/nrcshhm/directory/il.htm
This site provides information and local and state resources related to housing modifications and financing for modifications.
Rebuilding Together
http://www.rebuildingtogether.org/
This national nonprofit volunteer organization focuses on the home repair and improvement needs of lower income homeowners and includes a search tool to identify local assistance.
U.S. Department of Housing and Urban Development (HUD)
http://www.hud.gov/groups/seniors.cfm
This government website provides information on housing including buying, owning, renting, home modifications, reverse mortgages, and legal issues.
Resources to Assist with Advance Care Planning
Agency for Healthcare Research and Quality (AHRQ) provides research on preferences for care at end of life that can help guide decision making for end of life care.
The American Bar Association provides a tool kit that offers information to help clarify decision-making before a health crisis occurs and resources for legal help in each state including legal services funded through the Older Americans Act: http://www.abanet.org/aging/resources/statemap.shtml. Specific contact for the Consumer’s Tool Kit for Health Care Advance Planning can be found at: http://www.abanet.org/aging/toolkit/home.html.
National Association of Attorneys General (NAAG) are charged with protecting constituents in matters affecting the public interest, including consumer protection of those who are dying. The NAAG End-of-Life Health Care Project includes information on a range of end of life issues.
National Hospice and Palliative Care Association’s Caring Connections website, supported by funding from Robert Wood Johnson Foundation, provides general information on Advance Directives and state specific forms that can be downloaded.
Sunday, April 26, 2009
Tuesday, April 14, 2009
April 14, 2009
Dear Families and Friends:
This morning I was interviewed on 790 KGMI Radio regarding the House and Senate budget proposals for 2009-2011. I appreciated the opportunity to share my concerns about the impact of proposed House and Senate nursing home budget cuts. As you are likely aware, each budget takes over $90 million from the care of nursing home Medicaid residents from throughout the state.
As a provider with over 21 years of operating experience, I take seriously my advocacy responsibilities on behalf of our residents and employees, and I was pleased to have the opportunity to share my concerns with the listeners of KGMI.
The Legislature is down to 12 days before they are scheduled to adjourn. Budget proposals are being negotiated now. This is a critical time for our legislators to hear from their constituents regarding the implications of these cuts. If you haven’t had a chance to do so, I would ask that you contact Senator Dale Brandland, Representative Kelli Linville and Representative Doug Ericksen and ask them to eliminate nursing home budget cuts. Just call the Legislative Hotline, 1-800-562-6000, and leave a message for each.
Your voice truly matters in this discussion.
We will continue to monitor budget negotiations and will keep you informed as the Legislature works to pass the 2009—2011 operating budget. If you’d like additional information, please check out www.helpwashingtonseniors.org.
If you have questions, or if we can provide additional information about how you can help us protect our residents, please don’t hesitate to call.
Sincerely,
Tonja A. Myers
Administrator
Dear Families and Friends:
This morning I was interviewed on 790 KGMI Radio regarding the House and Senate budget proposals for 2009-2011. I appreciated the opportunity to share my concerns about the impact of proposed House and Senate nursing home budget cuts. As you are likely aware, each budget takes over $90 million from the care of nursing home Medicaid residents from throughout the state.
As a provider with over 21 years of operating experience, I take seriously my advocacy responsibilities on behalf of our residents and employees, and I was pleased to have the opportunity to share my concerns with the listeners of KGMI.
The Legislature is down to 12 days before they are scheduled to adjourn. Budget proposals are being negotiated now. This is a critical time for our legislators to hear from their constituents regarding the implications of these cuts. If you haven’t had a chance to do so, I would ask that you contact Senator Dale Brandland, Representative Kelli Linville and Representative Doug Ericksen and ask them to eliminate nursing home budget cuts. Just call the Legislative Hotline, 1-800-562-6000, and leave a message for each.
Your voice truly matters in this discussion.
We will continue to monitor budget negotiations and will keep you informed as the Legislature works to pass the 2009—2011 operating budget. If you’d like additional information, please check out www.helpwashingtonseniors.org.
If you have questions, or if we can provide additional information about how you can help us protect our residents, please don’t hesitate to call.
Sincerely,
Tonja A. Myers
Administrator
Sunday, April 12, 2009
Planning for long-term care
Planning for long-term care is a difficult task. It involves understanding and making decisions about services and options that are unfamiliar to many of us. These include services and supports, housing and financing options, and legal issues.
Personal Planning Steps
Assess Your Risk of Needing Long-Term Care Services
While you can never know for certain if you will need long-term care, assessing your risk factors can help you understand if you are at a higher or lower risk. Begin by talking with your doctor about whether you might be at increased risk based on your medical and family history or lifestyle choices. You will gain a better understanding of your risks, and your doctor may be able to help you decrease your risk.
Investigate Opportunities to Help Maintain Your Health and Independence
Many people fail to make the connection between healthy behaviors today and their impact on later life, but the science of aging indicates that chronic disease and disability are not always inevitable. Studies by the National Institute of Aging indicate that healthy eating, physical activity, mental stimulation, not smoking, active social engagement, moderate use of alcohol, maintaining a safe environment, social support, and regular health care are important in maintaining health and independence. Even if you haven’t been active in the past, it’s not too late to start.
Talk with Your Family about Caregiving
It is estimated that individuals turning 65 today could need up to 3 years of long-term care services, with almost 2 years of that care provided at home. Currently most care provided in the home is by an unpaid family member or other caregiver. You should talk to your family (spouse, adult children, siblings) or friends who would want to, or be able to, care for you if you became ill or disabled for a long time. Or, you might already be a caregiver for someone else. In either case, it is important for you and your family to understand how caregiving activities can affect you and your family, and what resources and supports are available.
Think about Where You Want to Receive Care
If you were to need care for an extended period of time, and were not able to stay at home, where would you want to receive care? If you need more information on long-term care services, review the list of services and providers in Understanding LTC. One way to find out what services are in your community is by contacting the Administration on Aging's Eldercare Locator.
Financial Planning Steps
Review Your Current Insurance Coverage
Do you know if your current health care insurance would pay if you needed to be in a nursing home or needed care at home for an extended illness? Unless you have purchased a specific long-term care insurance policy, your existing medical coverage, Medicare, Medicare supplement, or HMO will provide little if any coverage for long-term care. Review the policies you have with your insurance advisor or benefits counselor to learn what is covered and what is not.
Decide if You Can or Want to Pay for Long-Term Care Privately
If you don't have coverage for long-term care or prefer to pay out of your own resources, do you know if you would be able to cover all the costs from your retirement income and savings? Think about the financial resources you have and how you feel about using them to pay for long-term care. This could include various sources of income (for example, Social Security, pension, interest income, dividends from investments, payments from an IRA or 401 (k)), as well as cash, savings, stocks and bonds, and your home.
Investigate Future Insurance or Benefits You Expect or May Qualify for in Retirement
It is important to know and understand what your future benefits will cover, if you are not yet retired. If you only have Medicare, even with a Medicare supplemental plan, most of your long-term care services may not be covered. If you have limited resources, now or in the future, Medicaid may pay for your services. More information on Medicare, Medicaid and other public programs can be found in the Paying for Long-Term Care section of this website. You can also go to the Centers for Medicare and Medicaid Services [offsite] web site for more information on Medicare and Medicaid.
Find Out What Other Resources Can Help Cover Long-Term Care Expenses
Most people currently don't have coverage or do not have enough private funds to pay for all their long-term care needs, particularly if service needs are extensive or last a long time. There are an increasing number of private payment options available for this purpose. Two of the more common options are long-term care insurance and reverse mortgages. Review private financing options carefully to ensure that you understand all the details, eligibility requirements, and costs.
Housing Considerations and Planning Steps
Decisions about housing are often based on finances and personal choices such as neighborhood location or a retirement destination. But, there are numerous things to consider related to housing and potential long-term care needs as you age. The following sections summarize some of the major issues and considerations related to housing and long-term care planning.
Staying in Your Home or Moving to a New Independent Living Situation
If you are like most people and plan to stay in your own home for as long as possible, some important things to consider include the condition of your home, the accessibility of your home if you become less independent, the types of modifications you could make to your home, affordability of future maintenance and needed modifications, and the availability of services in the area.
If you decide to move, an important consideration is whether your new home has universal design features that can accommodate your needs if you become less independent. This could be a house all on one level, or an accessible condominium or apartment. A retirement community or senior housing complex that provides independent living units with support services such as transportation or house keeping are other options. Some issues to consider before making a decision to move include the value and equity you have in your home, whether this is a short term or long term move, the advantages of buying versus renting, and the related tax and legal issues.
Home Modifications
Home modifications can make your home safer and allow you to stay there longer. Modifications can range from lever style door and sink handles, grab bars in the bathroom, and improved lighting, to handrails, wider doorways for wheel chair access, stairway chair lifts, and adding a bathroom and/or bedroom on the first floor of a multi-story home to accommodate someone unable to climb stairs. You might also consider creating a separate apartment for a relative or renter in exchange for assistance when you need it. If you are not a home owner, you may have a right to some modifications, but you may need to negotiate with your landlord on types and costs.
Modifications can be costly, but those that meet universal design standards, such as wider doorways and walk-in, curbless showers, may add value to your home. If you have enough equity in your home, you can use it to help finance modifications, or other costs. There are also some state and local programs that provide low interest loans or grants for home modifications.
Assistive Devices
Assistive devices are tools, products or equipment that help you perform tasks and activities, as independently as possible, in your home and community. Some of the simplest are adapted kitchen and grooming tools that are easier to hold, or a “reacher” that grabs objects you can’t reach. Others may help you communicate, or move around. Mobility assistive devices include walkers, wheel chairs, and mopeds. Communication devices range from voice amplification and recognition tools to cueing and memory aids, and software such as word prediction programs.
In-home and Community Support Services
The availability of in-home and community supports can help you stay in your home longer. These include public transportation – or someone to drive you to do shopping or to go to appointments, help with housing and yard chores, or with personal care, even temporarily.
Moving to Housing with Services
At some point, you may decide to move into housing with services, often referred to as facility-based services. Many of these, for example assisted living and board and care homes, are group living settings that offer housing plus personal care and support services, but not the level of medical care provided in a nursing home. A Continuing Care Retirement Community (CCRC) is another type of housing with services that provides a range of housing options on one campus - independent units, assisted living, and nursing facilities. Generally, CCRCs have an initial entrance fee and require you to be independent when you first enter. Nursing Facilities are the most service intensive and include skilled nursing and therapies as needed. Planning considerations for any of these housing with services options include how much they cost, what you can afford, the range and quality of the services provided, what type of insurance or public programs reimburse these services, eligibility requirements, and how close you will be to family and friends.
Legal and Advance Care Planning Steps
What is Advance Care Planning?
Advance care planning is the process of discussing, determining and executing treatment directives - such as a Living Will, and appointing a health care proxy decision maker for care in the event that a person is not able to make medical decisions for him or herself. Advance Care planning can make a critical difference in your life, and the lives of the ones who care about you, either in emergency situations or when facing end-of-life care situations.
To be most effective, advance care planning needs to be a comprehensive, ongoing process that includes your family and friends, your proxy, and your providers. Planning should reflect your personal values and beliefs, and be adaptable if circumstances change.
Advance Care Planning Considerations:
Communication is the single most important first step in advance care planning. It is critical to consider what you want while you have time to think through the options clearly, and then to discuss your options and preferences with your family and others. While advance care planning may be difficult and emotionally charged, communicating your wishes ahead of time decreases the chance of future conflict and takes the burden off your family.
Several issues should be carefully considered for advance care planning.
Values and beliefs. Personal concerns, values, spiritual beliefs or views about what makes life worth living are important issues to consider when developing an advance care plan.
Preferences. Most people have ideas about the ways they wish to face death and/or disability, but may be uncomfortable discussing them. Sometimes sharing your own ideas, if you are helping someone, or reviewing the situations of other family or friends who have been in relevant situations can help.
Health care proxy: Decide who you will appoint as your health care proxy (surrogate or agent) decision-maker. Appointing a proxy is a very important decision. The person you choose as your proxy needs to be able to make decisions based on understanding and respecting your values and beliefs about care. Select someone who you believe will understand and be able to carry out your wishes even if they include denying life-sustaining treatments.
Help with Planning. Many different kinds of professionals can assist you in creating advance directives that help ensure that your wishes will be respected. Lawyers, social workers and members of the clergy are obvious examples. Some counselors and social workers – especially those who work for hospice services – are uniquely qualified to offer guidance at all stages of the advance care planning process.
What types of Planning Documents do I need?
Advance Directive – Living Will and Medical Powers of Attorney
Advance Directive is a general term used to describe two types of documents – living wills and medical powers of attorney. These planning documents allow you to convey the type of care you want if you cannot speak for yourself including the extent to which you want life-sustaining medical treatments, and who should make those decisions if you cannot. Advance directives are not only focused on what treatments you don’t want, they also should include all of the treatments you do want.
Living wills (sometimes called medical directives) are written instructions for care in the event that you are not able to make medical decisions for yourself. Currently, 47 states and the District of Columbia have laws authorizing living wills. State law, however, can vary on signing requirements and other aspects of a living will, so it is important to check on your state’s requirements when completing a living will.
Medical Power of Attorney (sometimes called a health care or durable power of attorney) is a document that appoints a particular person as a health care proxy or health care agent to make health care decisions for you if you are unable to do so yourself (not just during a terminal illness). A health care proxy is your substitute decision-maker. All 50 states and the District of Columbia have laws recognizing health care powers of attorney. Some specify the types of decisions that health care proxies can make.
Do Not Resuscitate (DNR) is a physician’s order that is written in a person’s medical record indicating that health care providers should not attempt life-saving measures such as cardiopulmonary resuscitation (CPR) in the event of a cardiac arrest (commonly known as a heart attack) or respiratory arrest. A request for a DNR can be included in your planning documents, or communicated directly to your physician. Also, most health care facilities have a Do Not Resuscitate order policy and forms that a hospital professional can help you with if you choose this option after being admitted to a hospital.
Steps to Insure that Your Advance Care Planning is Carried Out
Complete a living will and a medical power of attorney. If possible, you should consult with a lawyer or other professional regarding specific state laws or regulations related to these planning documents.
Insure that your family and other important people in your life understand what your wishes are, and what is included in these documents. It is particularly important to discuss your decisions with the individual who will be your health care proxy to be sure he/she is comfortable with that role, and can be available to carry out your wishes.
Keep your planning documents easily accessible and in multiple places. Consider carrying a wallet card with you. Give copies to family members, friends, your physician, and/or your lawyer if appropriate. It is critical that your health care proxy has a copy, or can access a copy quickly, if there is an unexpected emergency.
Review your plans periodically to be sure that you are still satisfied with your decisions, and your health proxy is still able and willing to be responsible for carrying out your plans.
Personal Planning Steps
Assess Your Risk of Needing Long-Term Care Services
While you can never know for certain if you will need long-term care, assessing your risk factors can help you understand if you are at a higher or lower risk. Begin by talking with your doctor about whether you might be at increased risk based on your medical and family history or lifestyle choices. You will gain a better understanding of your risks, and your doctor may be able to help you decrease your risk.
Investigate Opportunities to Help Maintain Your Health and Independence
Many people fail to make the connection between healthy behaviors today and their impact on later life, but the science of aging indicates that chronic disease and disability are not always inevitable. Studies by the National Institute of Aging indicate that healthy eating, physical activity, mental stimulation, not smoking, active social engagement, moderate use of alcohol, maintaining a safe environment, social support, and regular health care are important in maintaining health and independence. Even if you haven’t been active in the past, it’s not too late to start.
Talk with Your Family about Caregiving
It is estimated that individuals turning 65 today could need up to 3 years of long-term care services, with almost 2 years of that care provided at home. Currently most care provided in the home is by an unpaid family member or other caregiver. You should talk to your family (spouse, adult children, siblings) or friends who would want to, or be able to, care for you if you became ill or disabled for a long time. Or, you might already be a caregiver for someone else. In either case, it is important for you and your family to understand how caregiving activities can affect you and your family, and what resources and supports are available.
Think about Where You Want to Receive Care
If you were to need care for an extended period of time, and were not able to stay at home, where would you want to receive care? If you need more information on long-term care services, review the list of services and providers in Understanding LTC. One way to find out what services are in your community is by contacting the Administration on Aging's Eldercare Locator.
Financial Planning Steps
Review Your Current Insurance Coverage
Do you know if your current health care insurance would pay if you needed to be in a nursing home or needed care at home for an extended illness? Unless you have purchased a specific long-term care insurance policy, your existing medical coverage, Medicare, Medicare supplement, or HMO will provide little if any coverage for long-term care. Review the policies you have with your insurance advisor or benefits counselor to learn what is covered and what is not.
Decide if You Can or Want to Pay for Long-Term Care Privately
If you don't have coverage for long-term care or prefer to pay out of your own resources, do you know if you would be able to cover all the costs from your retirement income and savings? Think about the financial resources you have and how you feel about using them to pay for long-term care. This could include various sources of income (for example, Social Security, pension, interest income, dividends from investments, payments from an IRA or 401 (k)), as well as cash, savings, stocks and bonds, and your home.
Investigate Future Insurance or Benefits You Expect or May Qualify for in Retirement
It is important to know and understand what your future benefits will cover, if you are not yet retired. If you only have Medicare, even with a Medicare supplemental plan, most of your long-term care services may not be covered. If you have limited resources, now or in the future, Medicaid may pay for your services. More information on Medicare, Medicaid and other public programs can be found in the Paying for Long-Term Care section of this website. You can also go to the Centers for Medicare and Medicaid Services [offsite] web site for more information on Medicare and Medicaid.
Find Out What Other Resources Can Help Cover Long-Term Care Expenses
Most people currently don't have coverage or do not have enough private funds to pay for all their long-term care needs, particularly if service needs are extensive or last a long time. There are an increasing number of private payment options available for this purpose. Two of the more common options are long-term care insurance and reverse mortgages. Review private financing options carefully to ensure that you understand all the details, eligibility requirements, and costs.
Housing Considerations and Planning Steps
Decisions about housing are often based on finances and personal choices such as neighborhood location or a retirement destination. But, there are numerous things to consider related to housing and potential long-term care needs as you age. The following sections summarize some of the major issues and considerations related to housing and long-term care planning.
Staying in Your Home or Moving to a New Independent Living Situation
If you are like most people and plan to stay in your own home for as long as possible, some important things to consider include the condition of your home, the accessibility of your home if you become less independent, the types of modifications you could make to your home, affordability of future maintenance and needed modifications, and the availability of services in the area.
If you decide to move, an important consideration is whether your new home has universal design features that can accommodate your needs if you become less independent. This could be a house all on one level, or an accessible condominium or apartment. A retirement community or senior housing complex that provides independent living units with support services such as transportation or house keeping are other options. Some issues to consider before making a decision to move include the value and equity you have in your home, whether this is a short term or long term move, the advantages of buying versus renting, and the related tax and legal issues.
Home Modifications
Home modifications can make your home safer and allow you to stay there longer. Modifications can range from lever style door and sink handles, grab bars in the bathroom, and improved lighting, to handrails, wider doorways for wheel chair access, stairway chair lifts, and adding a bathroom and/or bedroom on the first floor of a multi-story home to accommodate someone unable to climb stairs. You might also consider creating a separate apartment for a relative or renter in exchange for assistance when you need it. If you are not a home owner, you may have a right to some modifications, but you may need to negotiate with your landlord on types and costs.
Modifications can be costly, but those that meet universal design standards, such as wider doorways and walk-in, curbless showers, may add value to your home. If you have enough equity in your home, you can use it to help finance modifications, or other costs. There are also some state and local programs that provide low interest loans or grants for home modifications.
Assistive Devices
Assistive devices are tools, products or equipment that help you perform tasks and activities, as independently as possible, in your home and community. Some of the simplest are adapted kitchen and grooming tools that are easier to hold, or a “reacher” that grabs objects you can’t reach. Others may help you communicate, or move around. Mobility assistive devices include walkers, wheel chairs, and mopeds. Communication devices range from voice amplification and recognition tools to cueing and memory aids, and software such as word prediction programs.
In-home and Community Support Services
The availability of in-home and community supports can help you stay in your home longer. These include public transportation – or someone to drive you to do shopping or to go to appointments, help with housing and yard chores, or with personal care, even temporarily.
Moving to Housing with Services
At some point, you may decide to move into housing with services, often referred to as facility-based services. Many of these, for example assisted living and board and care homes, are group living settings that offer housing plus personal care and support services, but not the level of medical care provided in a nursing home. A Continuing Care Retirement Community (CCRC) is another type of housing with services that provides a range of housing options on one campus - independent units, assisted living, and nursing facilities. Generally, CCRCs have an initial entrance fee and require you to be independent when you first enter. Nursing Facilities are the most service intensive and include skilled nursing and therapies as needed. Planning considerations for any of these housing with services options include how much they cost, what you can afford, the range and quality of the services provided, what type of insurance or public programs reimburse these services, eligibility requirements, and how close you will be to family and friends.
Legal and Advance Care Planning Steps
What is Advance Care Planning?
Advance care planning is the process of discussing, determining and executing treatment directives - such as a Living Will, and appointing a health care proxy decision maker for care in the event that a person is not able to make medical decisions for him or herself. Advance Care planning can make a critical difference in your life, and the lives of the ones who care about you, either in emergency situations or when facing end-of-life care situations.
To be most effective, advance care planning needs to be a comprehensive, ongoing process that includes your family and friends, your proxy, and your providers. Planning should reflect your personal values and beliefs, and be adaptable if circumstances change.
Advance Care Planning Considerations:
Communication is the single most important first step in advance care planning. It is critical to consider what you want while you have time to think through the options clearly, and then to discuss your options and preferences with your family and others. While advance care planning may be difficult and emotionally charged, communicating your wishes ahead of time decreases the chance of future conflict and takes the burden off your family.
Several issues should be carefully considered for advance care planning.
Values and beliefs. Personal concerns, values, spiritual beliefs or views about what makes life worth living are important issues to consider when developing an advance care plan.
Preferences. Most people have ideas about the ways they wish to face death and/or disability, but may be uncomfortable discussing them. Sometimes sharing your own ideas, if you are helping someone, or reviewing the situations of other family or friends who have been in relevant situations can help.
Health care proxy: Decide who you will appoint as your health care proxy (surrogate or agent) decision-maker. Appointing a proxy is a very important decision. The person you choose as your proxy needs to be able to make decisions based on understanding and respecting your values and beliefs about care. Select someone who you believe will understand and be able to carry out your wishes even if they include denying life-sustaining treatments.
Help with Planning. Many different kinds of professionals can assist you in creating advance directives that help ensure that your wishes will be respected. Lawyers, social workers and members of the clergy are obvious examples. Some counselors and social workers – especially those who work for hospice services – are uniquely qualified to offer guidance at all stages of the advance care planning process.
What types of Planning Documents do I need?
Advance Directive – Living Will and Medical Powers of Attorney
Advance Directive is a general term used to describe two types of documents – living wills and medical powers of attorney. These planning documents allow you to convey the type of care you want if you cannot speak for yourself including the extent to which you want life-sustaining medical treatments, and who should make those decisions if you cannot. Advance directives are not only focused on what treatments you don’t want, they also should include all of the treatments you do want.
Living wills (sometimes called medical directives) are written instructions for care in the event that you are not able to make medical decisions for yourself. Currently, 47 states and the District of Columbia have laws authorizing living wills. State law, however, can vary on signing requirements and other aspects of a living will, so it is important to check on your state’s requirements when completing a living will.
Medical Power of Attorney (sometimes called a health care or durable power of attorney) is a document that appoints a particular person as a health care proxy or health care agent to make health care decisions for you if you are unable to do so yourself (not just during a terminal illness). A health care proxy is your substitute decision-maker. All 50 states and the District of Columbia have laws recognizing health care powers of attorney. Some specify the types of decisions that health care proxies can make.
Do Not Resuscitate (DNR) is a physician’s order that is written in a person’s medical record indicating that health care providers should not attempt life-saving measures such as cardiopulmonary resuscitation (CPR) in the event of a cardiac arrest (commonly known as a heart attack) or respiratory arrest. A request for a DNR can be included in your planning documents, or communicated directly to your physician. Also, most health care facilities have a Do Not Resuscitate order policy and forms that a hospital professional can help you with if you choose this option after being admitted to a hospital.
Steps to Insure that Your Advance Care Planning is Carried Out
Complete a living will and a medical power of attorney. If possible, you should consult with a lawyer or other professional regarding specific state laws or regulations related to these planning documents.
Insure that your family and other important people in your life understand what your wishes are, and what is included in these documents. It is particularly important to discuss your decisions with the individual who will be your health care proxy to be sure he/she is comfortable with that role, and can be available to carry out your wishes.
Keep your planning documents easily accessible and in multiple places. Consider carrying a wallet card with you. Give copies to family members, friends, your physician, and/or your lawyer if appropriate. It is critical that your health care proxy has a copy, or can access a copy quickly, if there is an unexpected emergency.
Review your plans periodically to be sure that you are still satisfied with your decisions, and your health proxy is still able and willing to be responsible for carrying out your plans.
Sunday, April 5, 2009
The importance of planning
Planning for long-term care is a difficult task. It involves understanding and making decisions about services and options that are unfamiliar to many of us. These include services and supports, housing and financing options, and legal issues.
Personal Planning Steps
Assess Your Risk of Needing Long-Term Care Services
While you can never know for certain if you will need long-term care, assessing your risk factors can help you understand if you are at a higher or lower risk. Begin by talking with your doctor about whether you might be at increased risk based on your medical and family history or lifestyle choices. You will gain a better understanding of your risks, and your doctor may be able to help you decrease your risk. You should also review other risk factors, such as gender, listed in the Understanding LTC section of this website.
Investigate Opportunities to Help Maintain Your Health and Independence
Many people fail to make the connection between healthy behaviors today and their impact on later life, but the science of aging indicates that chronic disease and disability are not always inevitable. Studies by the National Institute of Aging indicate that healthy eating, physical activity, mental stimulation, not smoking, active social engagement, moderate use of alcohol, maintaining a safe environment, social support, and regular health care are important in maintaining health and independence.
Even if you haven’t been active in the past, it’s not too late to start. You can begin by reviewing the information on healthy lifestyles and programs in the Resources section of this website.
Talk with Your Family about Caregiving
It is estimated that individuals turning 65 today could need up to 3 years of long-term care services, with almost 2 years of that care provided at home. Currently most care provided in the home is by an unpaid family member or other caregiver. You should talk to your family (spouse, adult children, siblings) or friends who would want to, or be able to, care for you if you became ill or disabled for a long time. Or, you might already be a caregiver for someone else. In either case, it is important for you and your family to understand how caregiving activities can affect you and your family, and what resources and supports are available.
Think about Where You Want to Receive Care
If you were to need care for an extended period of time, and were not able to stay at home, where would you want to receive care? If you need more information on long-term care services, review the list of services and providers in Understanding LTC. One way to find out what services are in your community is by contacting the Administration on Aging's Eldercare Locator.
Financial Planning Steps
Review Your Current Insurance Coverage
Do you know if your current health care insurance would pay if you needed to be in a nursing home or needed care at home for an extended illness? Unless you have purchased a specific long-term care insurance policy, your existing medical coverage, Medicare, Medicare supplement, or HMO will provide little if any coverage for long-term care. Review the policies you have with your insurance advisor or benefits counselor to learn what is covered and what is not.
Decide if You Can or Want to Pay for Long-Term Care Privately
If you don't have coverage for long-term care or prefer to pay out of your own resources, do you know if you would be able to cover all the costs from your retirement income and savings? Think about the financial resources you have and how you feel about using them to pay for long-term care. This could include various sources of income (for example, Social Security, pension, interest income, dividends from investments, payments from an IRA or 401 (k)), as well as cash, savings, stocks and bonds, and your home.
Investigate Future Insurance or Benefits You Expect or May Qualify for in Retirement
It is important to know and understand what your future benefits will cover, if you are not yet retired. If you only have Medicare, even with a Medicare supplemental plan, most of your long-term care services may not be covered. If you have limited resources, now or in the future, Medicaid may pay for your services.
Find Out What Other Resources Can Help Cover Long-Term Care Expenses
Most people currently don't have coverage or do not have enough private funds to pay for all their long-term care needs, particularly if service needs are extensive or last a long time. There are an increasing number of private payment options available for this purpose. Two of the more common options are long-term care insurance and reverse mortgages. Review private financing options carefully to ensure that you understand all the details, eligibility requirements, and costs. Read about the range of private long-term care financing options in the Paying for Long-Term Care section of this web site.
Housing Considerations and Planning Steps
Decisions about housing are often based on finances and personal choices such as neighborhood location or a retirement destination. But, there are numerous things to consider related to housing and potential long-term care needs as you age. The following sections summarize some of the major issues and considerations related to housing and long-term care planning. The "Housing Planning Resources" section of this site has more information and contacts related to each of these housing planning issues.
Staying in Your Home or Moving to a New Independent Living Situation
If you are like most people and plan to stay in your own home for as long as possible, some important things to consider include the condition of your home, the accessibility of your home if you become less independent, the types of modifications you could make to your home, affordability of future maintenance and needed modifications, and the availability of services in the area.
If you decide to move, an important consideration is whether your new home has universal design features that can accommodate your needs if you become less independent. This could be a house all on one level, or an accessible condominium or apartment. A retirement community or senior housing complex that provides independent living units with support services such as transportation or house keeping are other options. Some issues to consider before making a decision to move include the value and equity you have in your home, whether this is a short term or long term move, the advantages of buying versus renting, and the related tax and legal issues.
Home Modifications
Home modifications can make your home safer and allow you to stay there longer. Modifications can range from lever style door and sink handles, grab bars in the bathroom, and improved lighting, to handrails, wider doorways for wheel chair access, stairway chair lifts, and adding a bathroom and/or bedroom on the first floor of a multi-story home to accommodate someone unable to climb stairs. You might also consider creating a separate apartment for a relative or renter in exchange for assistance when you need it. If you are not a home owner, you may have a right to some modifications, but you may need to negotiate with your landlord on types and costs.
Modifications can be costly, but those that meet universal design standards, such as wider doorways and walk-in, curbless showers, may add value to your home. If you have enough equity in your home, you can use it to help finance modifications, or other costs. Ways to use home equity are described in the Paying for LTC: Reverse Mortgage section of this website. There are also some state and local programs that provide low interest loans or grants for home modifications.
Assistive Devices
Assistive devices are tools, products or equipment that help you perform tasks and activities, as independently as possible, in your home and community. Some of the simplest are adapted kitchen and grooming tools that are easier to hold, or a “reacher” that grabs objects you can’t reach. Others may help you communicate, or move around. Mobility assistive devices include walkers, wheel chairs, and mopeds. Communication devices range from voice amplification and recognition tools to cueing and memory aids, and software such as word prediction programs.
In-home and Community Support Services
The availability of in-home and community supports can help you stay in your home longer. These include public transportation – or someone to drive you to do shopping or to go to appointments, help with housing and yard chores, or with personal care, even temporarily. The “ Understanding Long-Term Care: Home and Community Based Services ” section of this website describes the types of services to look for in your community.
Moving to Housing with Services
At some point, you may decide to move into housing with services, often referred to as facility-based services. Many of these, for example assisted living and board and care homes, are group living settings that offer housing plus personal care and support services, but not the level of medical care provided in a nursing home. A Continuing Care Retirement Community (CCRC) is another type of housing with services that provides a range of housing options on one campus - independent units, assisted living, and nursing facilities. Generally, CCRCs have an initial entrance fee and require you to be independent when you first enter. Nursing Facilities are the most service intensive and include skilled nursing and therapies as needed.
Planning considerations for any of these housing with services options include how much they cost, what you can afford, the range and quality of the services provided, what type of insurance or public programs reimburse these services, eligibility requirements, and how close you will be to family and friends.
Legal and Advance Care Planning Steps
What is Advance Care Planning?
Advance care planning is the process of discussing, determining and executing treatment directives - such as a Living Will, and appointing a health care proxy decision maker for care in the event that a person is not able to make medical decisions for him or herself. Advance Care planning can make a critical difference in your life, and the lives of the ones who care about you, either in emergency situations or when facing end-of-life care situations.
To be most effective, advance care planning needs to be a comprehensive, ongoing process that includes your family and friends, your proxy, and your providers. Planning should reflect your personal values and beliefs, and be adaptable if circumstances change.
Advance Care Planning Considerations:
Communication is the single most important first step in advance care planning. It is critical to consider what you want while you have time to think through the options clearly, and then to discuss your options and preferences with your family and others. While advance care planning may be difficult and emotionally charged, communicating your wishes ahead of time decreases the chance of future conflict and takes the burden off your family.
Several issues should be carefully considered for advance care planning.
Values and beliefs. Personal concerns, values, spiritual beliefs or views about what makes life worth living are important issues to consider when developing an advance care plan.
Preferences. Most people have ideas about the ways they wish to face death and/or disability, but may be uncomfortable discussing them. Sometimes sharing your own ideas, if you are helping someone, or reviewing the situations of other family or friends who have been in relevant situations can help.
Health care proxy: Decide who you will appoint as your health care proxy (surrogate or agent) decision-maker. Appointing a proxy is a very important decision. The person you choose as your proxy needs to be able to make decisions based on understanding and respecting your values and beliefs about care. Select someone who you believe will understand and be able to carry out your wishes even if they include denying life-sustaining treatments.
Help with Planning. Many different kinds of professionals can assist you in creating advance directives that help ensure that your wishes will be respected. Lawyers, social workers and members of the clergy are obvious examples. Some counselors and social workers – especially those who work for hospice services – are uniquely qualified to offer guidance at all stages of the advance care planning process.
What types of Planning Documents do I need?
Advance Directive – Living Will and Medical Powers of Attorney
Advance Directive is a general term used to describe two types of documents – living wills and medical powers of attorney. These planning documents allow you to convey the type of care you want if you cannot speak for yourself including the extent to which you want life-sustaining medical treatments, and who should make those decisions if you cannot. Advance directives are not only focused on what treatments you don’t want, they also should include all of the treatments you do want.
Living wills (sometimes called medical directives) are written instructions for care in the event that you are not able to make medical decisions for yourself. Currently, 47 states and the District of Columbia have laws authorizing living wills. State law, however, can vary on signing requirements and other aspects of a living will, so it is important to check on your state’s requirements when completing a living will.
Medical Power of Attorney (sometimes called a health care or durable power of attorney) is a document that appoints a particular person as a health care proxy or health care agent to make health care decisions for you if you are unable to do so yourself (not just during a terminal illness). A health care proxy is your substitute decision-maker. All 50 states and the District of Columbia have laws recognizing health care powers of attorney. Some specify the types of decisions that health care proxies can make.
Do Not Resuscitate (DNR) is a physician’s order that is written in a person’s medical record indicating that health care providers should not attempt life-saving measures such as cardiopulmonary resuscitation (CPR) in the event of a cardiac arrest (commonly known as a heart attack) or respiratory arrest. A request for a DNR can be included in your planning documents, or communicated directly to your physician. Also, most health care facilities have a Do Not Resuscitate order policy and forms that a hospital professional can help you with if you choose this option after being admitted to a hospital.
Steps to Insure that Your Advance Care Planning is Carried Out
Complete a living will and a medical power of attorney. If possible, you should consult with a lawyer or other professional regarding specific state laws or regulations related to these planning documents.
Insure that your family and other important people in your life understand what your wishes are, and what is included in these documents. It is particularly important to discuss your decisions with the individual who will be your health care proxy to be sure he/she is comfortable with that role, and can be available to carry out your wishes.
Keep your planning documents easily accessible and in multiple places. Consider carrying a wallet card with you. Give copies to family members, friends, your physician, and/or your lawyer if appropriate. It is critical that your health care proxy has a copy, or can access a copy quickly, if there is an unexpected emergency.
Review your plans periodically to be sure that you are still satisfied with your decisions, and your health proxy is still able and willing to be responsible for carrying out your plans.
Personal Planning Steps
Assess Your Risk of Needing Long-Term Care Services
While you can never know for certain if you will need long-term care, assessing your risk factors can help you understand if you are at a higher or lower risk. Begin by talking with your doctor about whether you might be at increased risk based on your medical and family history or lifestyle choices. You will gain a better understanding of your risks, and your doctor may be able to help you decrease your risk. You should also review other risk factors, such as gender, listed in the Understanding LTC section of this website.
Investigate Opportunities to Help Maintain Your Health and Independence
Many people fail to make the connection between healthy behaviors today and their impact on later life, but the science of aging indicates that chronic disease and disability are not always inevitable. Studies by the National Institute of Aging indicate that healthy eating, physical activity, mental stimulation, not smoking, active social engagement, moderate use of alcohol, maintaining a safe environment, social support, and regular health care are important in maintaining health and independence.
Even if you haven’t been active in the past, it’s not too late to start. You can begin by reviewing the information on healthy lifestyles and programs in the Resources section of this website.
Talk with Your Family about Caregiving
It is estimated that individuals turning 65 today could need up to 3 years of long-term care services, with almost 2 years of that care provided at home. Currently most care provided in the home is by an unpaid family member or other caregiver. You should talk to your family (spouse, adult children, siblings) or friends who would want to, or be able to, care for you if you became ill or disabled for a long time. Or, you might already be a caregiver for someone else. In either case, it is important for you and your family to understand how caregiving activities can affect you and your family, and what resources and supports are available.
Think about Where You Want to Receive Care
If you were to need care for an extended period of time, and were not able to stay at home, where would you want to receive care? If you need more information on long-term care services, review the list of services and providers in Understanding LTC. One way to find out what services are in your community is by contacting the Administration on Aging's Eldercare Locator.
Financial Planning Steps
Review Your Current Insurance Coverage
Do you know if your current health care insurance would pay if you needed to be in a nursing home or needed care at home for an extended illness? Unless you have purchased a specific long-term care insurance policy, your existing medical coverage, Medicare, Medicare supplement, or HMO will provide little if any coverage for long-term care. Review the policies you have with your insurance advisor or benefits counselor to learn what is covered and what is not.
Decide if You Can or Want to Pay for Long-Term Care Privately
If you don't have coverage for long-term care or prefer to pay out of your own resources, do you know if you would be able to cover all the costs from your retirement income and savings? Think about the financial resources you have and how you feel about using them to pay for long-term care. This could include various sources of income (for example, Social Security, pension, interest income, dividends from investments, payments from an IRA or 401 (k)), as well as cash, savings, stocks and bonds, and your home.
Investigate Future Insurance or Benefits You Expect or May Qualify for in Retirement
It is important to know and understand what your future benefits will cover, if you are not yet retired. If you only have Medicare, even with a Medicare supplemental plan, most of your long-term care services may not be covered. If you have limited resources, now or in the future, Medicaid may pay for your services.
Find Out What Other Resources Can Help Cover Long-Term Care Expenses
Most people currently don't have coverage or do not have enough private funds to pay for all their long-term care needs, particularly if service needs are extensive or last a long time. There are an increasing number of private payment options available for this purpose. Two of the more common options are long-term care insurance and reverse mortgages. Review private financing options carefully to ensure that you understand all the details, eligibility requirements, and costs. Read about the range of private long-term care financing options in the Paying for Long-Term Care section of this web site.
Housing Considerations and Planning Steps
Decisions about housing are often based on finances and personal choices such as neighborhood location or a retirement destination. But, there are numerous things to consider related to housing and potential long-term care needs as you age. The following sections summarize some of the major issues and considerations related to housing and long-term care planning. The "Housing Planning Resources" section of this site has more information and contacts related to each of these housing planning issues.
Staying in Your Home or Moving to a New Independent Living Situation
If you are like most people and plan to stay in your own home for as long as possible, some important things to consider include the condition of your home, the accessibility of your home if you become less independent, the types of modifications you could make to your home, affordability of future maintenance and needed modifications, and the availability of services in the area.
If you decide to move, an important consideration is whether your new home has universal design features that can accommodate your needs if you become less independent. This could be a house all on one level, or an accessible condominium or apartment. A retirement community or senior housing complex that provides independent living units with support services such as transportation or house keeping are other options. Some issues to consider before making a decision to move include the value and equity you have in your home, whether this is a short term or long term move, the advantages of buying versus renting, and the related tax and legal issues.
Home Modifications
Home modifications can make your home safer and allow you to stay there longer. Modifications can range from lever style door and sink handles, grab bars in the bathroom, and improved lighting, to handrails, wider doorways for wheel chair access, stairway chair lifts, and adding a bathroom and/or bedroom on the first floor of a multi-story home to accommodate someone unable to climb stairs. You might also consider creating a separate apartment for a relative or renter in exchange for assistance when you need it. If you are not a home owner, you may have a right to some modifications, but you may need to negotiate with your landlord on types and costs.
Modifications can be costly, but those that meet universal design standards, such as wider doorways and walk-in, curbless showers, may add value to your home. If you have enough equity in your home, you can use it to help finance modifications, or other costs. Ways to use home equity are described in the Paying for LTC: Reverse Mortgage section of this website. There are also some state and local programs that provide low interest loans or grants for home modifications.
Assistive Devices
Assistive devices are tools, products or equipment that help you perform tasks and activities, as independently as possible, in your home and community. Some of the simplest are adapted kitchen and grooming tools that are easier to hold, or a “reacher” that grabs objects you can’t reach. Others may help you communicate, or move around. Mobility assistive devices include walkers, wheel chairs, and mopeds. Communication devices range from voice amplification and recognition tools to cueing and memory aids, and software such as word prediction programs.
In-home and Community Support Services
The availability of in-home and community supports can help you stay in your home longer. These include public transportation – or someone to drive you to do shopping or to go to appointments, help with housing and yard chores, or with personal care, even temporarily. The “ Understanding Long-Term Care: Home and Community Based Services ” section of this website describes the types of services to look for in your community.
Moving to Housing with Services
At some point, you may decide to move into housing with services, often referred to as facility-based services. Many of these, for example assisted living and board and care homes, are group living settings that offer housing plus personal care and support services, but not the level of medical care provided in a nursing home. A Continuing Care Retirement Community (CCRC) is another type of housing with services that provides a range of housing options on one campus - independent units, assisted living, and nursing facilities. Generally, CCRCs have an initial entrance fee and require you to be independent when you first enter. Nursing Facilities are the most service intensive and include skilled nursing and therapies as needed.
Planning considerations for any of these housing with services options include how much they cost, what you can afford, the range and quality of the services provided, what type of insurance or public programs reimburse these services, eligibility requirements, and how close you will be to family and friends.
Legal and Advance Care Planning Steps
What is Advance Care Planning?
Advance care planning is the process of discussing, determining and executing treatment directives - such as a Living Will, and appointing a health care proxy decision maker for care in the event that a person is not able to make medical decisions for him or herself. Advance Care planning can make a critical difference in your life, and the lives of the ones who care about you, either in emergency situations or when facing end-of-life care situations.
To be most effective, advance care planning needs to be a comprehensive, ongoing process that includes your family and friends, your proxy, and your providers. Planning should reflect your personal values and beliefs, and be adaptable if circumstances change.
Advance Care Planning Considerations:
Communication is the single most important first step in advance care planning. It is critical to consider what you want while you have time to think through the options clearly, and then to discuss your options and preferences with your family and others. While advance care planning may be difficult and emotionally charged, communicating your wishes ahead of time decreases the chance of future conflict and takes the burden off your family.
Several issues should be carefully considered for advance care planning.
Values and beliefs. Personal concerns, values, spiritual beliefs or views about what makes life worth living are important issues to consider when developing an advance care plan.
Preferences. Most people have ideas about the ways they wish to face death and/or disability, but may be uncomfortable discussing them. Sometimes sharing your own ideas, if you are helping someone, or reviewing the situations of other family or friends who have been in relevant situations can help.
Health care proxy: Decide who you will appoint as your health care proxy (surrogate or agent) decision-maker. Appointing a proxy is a very important decision. The person you choose as your proxy needs to be able to make decisions based on understanding and respecting your values and beliefs about care. Select someone who you believe will understand and be able to carry out your wishes even if they include denying life-sustaining treatments.
Help with Planning. Many different kinds of professionals can assist you in creating advance directives that help ensure that your wishes will be respected. Lawyers, social workers and members of the clergy are obvious examples. Some counselors and social workers – especially those who work for hospice services – are uniquely qualified to offer guidance at all stages of the advance care planning process.
What types of Planning Documents do I need?
Advance Directive – Living Will and Medical Powers of Attorney
Advance Directive is a general term used to describe two types of documents – living wills and medical powers of attorney. These planning documents allow you to convey the type of care you want if you cannot speak for yourself including the extent to which you want life-sustaining medical treatments, and who should make those decisions if you cannot. Advance directives are not only focused on what treatments you don’t want, they also should include all of the treatments you do want.
Living wills (sometimes called medical directives) are written instructions for care in the event that you are not able to make medical decisions for yourself. Currently, 47 states and the District of Columbia have laws authorizing living wills. State law, however, can vary on signing requirements and other aspects of a living will, so it is important to check on your state’s requirements when completing a living will.
Medical Power of Attorney (sometimes called a health care or durable power of attorney) is a document that appoints a particular person as a health care proxy or health care agent to make health care decisions for you if you are unable to do so yourself (not just during a terminal illness). A health care proxy is your substitute decision-maker. All 50 states and the District of Columbia have laws recognizing health care powers of attorney. Some specify the types of decisions that health care proxies can make.
Do Not Resuscitate (DNR) is a physician’s order that is written in a person’s medical record indicating that health care providers should not attempt life-saving measures such as cardiopulmonary resuscitation (CPR) in the event of a cardiac arrest (commonly known as a heart attack) or respiratory arrest. A request for a DNR can be included in your planning documents, or communicated directly to your physician. Also, most health care facilities have a Do Not Resuscitate order policy and forms that a hospital professional can help you with if you choose this option after being admitted to a hospital.
Steps to Insure that Your Advance Care Planning is Carried Out
Complete a living will and a medical power of attorney. If possible, you should consult with a lawyer or other professional regarding specific state laws or regulations related to these planning documents.
Insure that your family and other important people in your life understand what your wishes are, and what is included in these documents. It is particularly important to discuss your decisions with the individual who will be your health care proxy to be sure he/she is comfortable with that role, and can be available to carry out your wishes.
Keep your planning documents easily accessible and in multiple places. Consider carrying a wallet card with you. Give copies to family members, friends, your physician, and/or your lawyer if appropriate. It is critical that your health care proxy has a copy, or can access a copy quickly, if there is an unexpected emergency.
Review your plans periodically to be sure that you are still satisfied with your decisions, and your health proxy is still able and willing to be responsible for carrying out your plans.
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