Patti's Blog - Advocate for Elders, People with Disabilities and Their Families

Help for Planning End-of-Life Care

Excerpt from: New York Times (click for full article)

 

Dr. Rebecca Sudore, a geriatrician at the University of California, San Francisco, has spent several years developing Prepare, and in that time, “the tide in advance care planning has been moving away from forms and toward discussions,” she told me. Her site reflects that shift.

Dr. Sudore and several colleagues have thought a lot about those forms, called advance directives, and they have pinpointed why they don’t work as well as you’d hope. To take one problem, people find it hard to come up with answers to hypothetical situations (“Do you want a feeding tube?”) that might be years away.

And people often choose a health care proxy — someone to make medical decisions for them if they are incapacitated — and then neglect to tell anyone, or even ask that person if she will accept the responsibility.

Advance directives typically focus on end-of-life care, but “most people make a lot of medical decisions about serious diseases and treatments over the course of their lives,” Dr. Sudore pointed out. “They’re not only end-of-life decisions.”

$66M Kinkade estate dispute secretly settled

Excerpt from: The Oakland Press (click for full article)

 

Thomas Kinkade's widow and girlfriend have reached a settlement after a dispute over the late artist's $66 million estate, their attorneys said Wednesday.

The San Jose Mercury News reports (http://bit.ly/Wq5kti ) that counsel for Nanette Kinkade and his girlfriend Amy Pinto announced the settlement but wouldn't provide further details, leaving it unclear who will inherit Kinkade's San Francisco Bay area mansion and his warehouse of paintings.

In a statement, they said the women kept Kinkade's message of "love, spirituality and optimism" in their amicable resolution.

The dispute went public after the 54-year-old artist died April 6 from an accidental overdose of alcohol and prescription tranquilizers.

Elder Law: New Year's resolutions

Excerpt from: The Sentinel (click for full article)

 

The first day of 2013 is the perfect time to look forward with a sense of hope and optimism. Certainly, from a legal point of view, New Year’s resolutions are largely irrelevant.

A contract requires participation by two or more parties. We are each cursed and blessed that a resolution, which is essentially a promise with oneself, is not legally enforceable.

New Year’s resolutions can be easier to talk about than to fulfill. It has been said that “a New Year’s resolution is something that goes in one year and out the other.” For an optimist, the arrival of Jan. 1 can be a watershed time to get started.

Just because the resolutions suggested in this column are easier to fulfill than losing weight or quitting smoking, it doesn’t make them less important.

Seniors, baby boomers and caregivers can act to reduce stress and take control of their lives. This article includes 10 resolutions to consider.

Better, if Not Cheaper, Care

Excerpt from: The New York Times (click for full article)

 

IT is conventional wisdom that end-of-life care is an increasingly huge proportion of health care spending. I’ve often heard it said that people spend more on health care in the year before they die than they do in the entire rest of their lives. If we don’t address these costs, the story goes, we can never control health care inflation.

Wrong. Here are the real numbers. The roughly 6 percent of Medicare patients who die each year do make up a large proportion of Medicare costs: 27 to 30 percent. But this figure has not changed significantly in decades. And the total number of Americans, not just older people, who die every year — less than 1 percent of the population — account for much less of total health care spending, just 10 to 12 percent.

The more important issue is that just because we spend a lot on end-of-life care does not mean we can save a lot. We do know that costs for dying patients vary widely among hospitals, which suggests that we can do better. And yet no one can reliably say what specific changes would significantly lower costs. There is no body of well-conducted research studies that has proved how to save 5, 10, much less 20 percent.

Ten Myths About the Dying Process

Excerpt from: Maryland Elder Law (click for full article)

 

When people don’t understand the wisdom of the body, they will make decisions based on fear, lack of information or misinformation. This can lead to devastating physical, emotional and financial consequences for the patient and family as they seek futile or even harmful end of life care. Knowing and honoring the body’s changes will lead to the best possible choices and care for our loved ones.

As a healthcare professional working directly with those facing a terminal illness, I believe it is our work to excavate and correct the myths and misconceptions that may drive treatment decisions, including understanding their prior experience or knowledge of death.

The following is a list of what I have seen as the most common myths about the dying process.

Dying is painful

If people don’t eat they should get a feeding tube or they will starve to death

Not drinking leads to painful dehydration

If I don’t make use of every possible technology available, or if I tell the doctor to stop using machines to keep my loved ones alive, I am essentially killing them.

If they are allowed to stay in bed or sleep as much as they want, they are giving up and will die sooner.

People should be conscious until the moment of death. If they are increasingly tired or confused, they are being over-medicated.

Narcotic pain medications will cause loss of control or even hasten death

It’s too late to say good-bye if they are in a coma

Dying ends in a final struggle

If I’m not there when my loved ones die, I failed them.

On the Way to Hospice, Surprising Hurdles

Excerpt from: The New York Times (click for full article)

 

I’ve often wondered why more families don’t call hospice when a loved one has a terminal disease — and why people who do call wait so long, often until death is just days away.

Even though more than 40 percent of American deaths now involve hospice care, many families still are trying to shoulder the burden on their own rather than turning to a proven source of help and knowledge. I’ve surmised that the reason is families’ or patients’ unwillingness to acknowledge the prospect of death, or physicians’ inability to say the h-word and refer dying patients to hospice care.

But maybe there’s another reason. A study in the journal Health Affairs recently pointed out that hospices themselves may be turning away patients because of certain restrictive enrollment policies. It’s possible, too, that physicians who know of these policies aren’t referring patients whom the doctors fear wouldn’t qualify.

Americans Support Physician-Assisted Suicide For Terminally Ill

Excerpt from: NPR (click for full article)

 

The results from the latest NPR-Truven Health Analytics Health Poll show that most Americans favor physician-assisted suicide for people with less than six months to live.

Overall, 55 percent of respondents favored it, and 45 percent were opposed. Those proportions were unchanged from July 2011, when Truven asked the same questions.

Support for the idea varied by age and income.

Fifty-six percent of people 65 and older opposed physician-assisted suicide for the terminally ill; 44 percent supported it. Among people younger than 35, the results were reversed: 59 percent for and 41 percent against.

Finding and Choosing a Pooled Special Needs Trust

Excerpt from: NOLO: Law for All (click for full article)

 

Joining a pooled special needs trust might be a good option for your family if you don’t have much money to leave for your loved one, or if you don’t know a suitable person to name as trustee of your trust.  Learn more about how pooled trusts work and why you might want to join one in the article Pooled Special Needs Trusts onNolo.com. Here’s how to find and choose a quality pooled trust. 

Searching for a Pooled Trust

Pooled trusts must adhere to strict state rules, so to keep things manageable, most pooled trusts only take residents that reside in the same state. To find a special needs pooled trust in your state, try contacting one of these organizations:

• Academy of Special Needs Planners: www.specialneedsanswers.com
• The Arc: www.thearc.org
• The Center for Special Needs Trust Administration, Inc.: www.sntcenter.org
• The National PLAN Alliance: www.nationalplanalliance.org

If you find a pooled trust that you’re interested in, it’s time to ask some detailed questions about how the trust will provide for your loved one.

How to talk long-term care with relatives

Excerpt from: Orange County Register (click for full article)

 

If you have elderly parents or other relatives, you might not get to see them as often as you'd like. And so during these visits it's extra-important to watch for signs of dementia or other illnesses. "It's a good time to be observant and see how parents are functioning," says Deborah O'Connor, vice president of programs and education at the Alzheimer's Association of Orange County.

If there are any signs of Alzheimer's or other illnesses, it might be a good time to schedule a doctor's visit, so the relative can act as an advocate.

The holidays also might be a good time to begin discussing long-term care options with the rest of the family, as difficult as that might be.

Some Couples Might Need Separate Lawyers

Excerpt from: Wills, Trusts,& Estates Prof Blog (click for full article)

 

While a good number of couples will likely want to plan their estate plan together with only one lawyer, that might not be possible in some circumstances or a good idea in other circumstances. The following are a few situations where that might occur:

• If the clients have a blended family where the couple has children from a different marriage, then the both parents might want to obtain separate lawyers. To ensure that the children of each spouse receives the inheritance that their parent wanted them to receive, that parent might want to create an estate plan separate from the other spouse. In that case, the parent would need a separate lawyer.
• A client might also need a separate lawyer if the client is seeking a prenuptial agreement.
• There are also certain groups of people that might want to strongly consider obtaining separate lawyers because these people are not married or cannot get married, as in the case of LGBT couples. These couples need more attention because of their non-martial status.
• A person might also want to consider obtaining the services of a separate attorney if there is a dispute over the ownership of the assets of the couple.