Peninsula Daily News Column 12-29-11 "Planning, living key for long-term care"

            It’s Christmas Day, and try as I may to ignore it for the purposes of a column, I can’t seem to evade that simple, irrevocable fact.

            It’s Christmas Day, and depending on who you are, where you are, who is or isn’t there with you and what you believe about the 25^th day of December, it may be a wonderful day, a horrible day, a meaningful day, a great TV day, a terrible TV day, a loud, busy day, a lonely, dreary day, an emotional day or just another day – But there’s no escaping the fact that it is Christmas Day.

            So, near as I can tell, here’s the one thing that every, single one of us, regardless of today’s circumstances, can agree upon: We aren’t dead. I know this to be true because every applicable marketing study and poll reveals that very few dead people read this column.

            So what? Well, it’s Christmas Day! So what?? No, try “NOW what?”

            Right: Now what? What now? What next? The end of the world, in another form or in another place or in another way, depending upon which talking head has captured our imaginations. All bad. All crises. The end of freedom, the end of capitalism, the end of everything we’ve ever known. Crime, viciousness, brutality.

            Greed.

            All around us, all the time, 24/7: What was wrong, what is wrong, what will be wrong – Fear motivates! Us vs. them! – And you know who’s right, right? Sure: Us!

            Us. We. And “we” are all having Christmas Day.

            And every single one of us feels very…small. Powerless. Inconsequential. There’s no way that any of us can possibly solve all the world’s horrible problems, so we just agree with whomever seems less harmful and call it “us.” Or just ignore it all, in the name of “mental health” – I get that.

            And we hope. We hope for something better, something saner, something more civilized. We hope for a time when people take care of one another and share the burdens. We hope for a society in which people encounter people as “people,” not political, philosophical or religious partisans – People. People can be good and decent people, and still disagree. Bigotry, in the name of being correct, is still bigotry.

            We hope that people we are supposed to be able to believe will just tell us the truth. We hope that we will be able to vote for someone instead of against someone. We hope that common sense will become a common commodity and we hope that aging really will be an achievement, and not an affliction.

            We hope that people will still hold doors open for other people. We hope that people will say “please” and “thank-you” – And mean it.

            We hope that people will share when they can, take when they need to and be able to remember which is which.

            We hope for fewer raised voices and blood pressures and we hope for gentleness.

            We hope for privacy as we hope for “community,” and we hope more for health care than we do for health insurance.

            We hope for dignity, personal responsibility and self-determination – And we wonder how many laws we really need.

            And we wonder when we’ll remember that we are our brothers’ keepers.

            We hope that people will stop doing bad things for good reasons and good things for bad reasons.

            We hope that we can take care of ourselves and take care of the caretakers. We hope that longevity won’t be a curse and we hope that the good don’t die young.

            We wonder if our leaders will ever figure out that the planet isn’t getting any bigger and we hope that the babies will be fed. And clothed.

            And loved.

            We hope for patience, civility and courtesy, while we hope for honesty.

            And we hope that “we” get so big that we totally consume “them!”

            We hope for love, in all its many colors.

            We hope, because it’s Christmas Day.

                

Peninsula Daily News Column 12-18-11 "Make life-sustaining treatment clear"

            Here we are on December 18^th, squarely in the middle of Phase III of the 2011 “Holiday Season” (well, I start counting at Halloween)!

            If you’ve just been dropped-off by the Mother Ship, allow me to point out that you have exactly seven days left until December 25^th, but I acknowledge that many of us are probably still suffering from a post-Medicare “open enrollment” hangover, so take two aspirin and call somebody else in the morning.

            Now, if “open enrollment” didn’t successfully put you in the holiday spirit, let’s pick up (as threatened) where we left off last week, which was talking about happy little documents called “advance directives.” These are the pieces of paper that tell doctors and other healthcare professionals what you do-or-don’t want done, if you can’t tell them yourself.

            There is a specific document called a “POLST” form, which stands for “Physician Orders for Life-Sustaining Treatment,” and this is one of the few times that you really do want to remember what an acronym stands for. Here’s why:

            Let’s say that I have an advanced, life-limiting illness (probably induced by “open enrollment”) and I’m at home (it could be “wherever,” but let’s say home) and something medically bad happens. Somebody calls 911 and the EMT’s (the “Good Guys”) come rushing in to save me. That’s their job, which is why they’re the “Good Guys.”

            Now, being the totally-on-top-of-it person that I am, I’ve diligently prepared an advance directive that spells out what I do-and-don’t want, and since this “medically bad thing” is preventing me from speaking for myself, everybody in the house is relying on the advance directive to tell the EMT’s what to do or not do, right?

            Wrong. EMT’s are required by law to do EVERYTHING THEY CAN to keep me going, and they will, which is why they’re the “Good Guys,” but it’s not what I wanted! How could I have prevented this??

            POLST. Remember that the first two letters stand for “Physician Orders?” That’s what allows the EMT’s to respect whatever it is that I did-or-didn’t want; in other words, it lets them off the proverbial legal hook.

            You might have seen these POLST forms around – They’re bright, electric green! – One piece of paper, front and back. These things are NOT for everybody and they are NOT a substitute for an advanced directive. Here’s why:

            POLST forms are designed for folks who have an “advanced, life-limiting illness;” in other words, you have a condition (or conditions) that could rise up and seriously whack you all of a sudden, potentially sending you on to the Promised Land. If you have some arthritis, maybe a little high blood pressure, maybe a controlled bit of this-and/or-that, POLST is not your thing – But, if you have something seriously serious, it might be.

            Also, a POLST form doesn’t necessarily do or say everything you might want (or not want), so it makes perfect sense to have BOTH an advanced directive AND a POLST.

            Are you “required” to have a POLST form? Of course not, it’s completely up to you, and if you want the Good Guys to rush in and perform all of their miracles, good for you! – In fact, the various sections of the POLST specifically allow you to say, “I want the full boat!”

            The form itself addresses issues like yes-or-no to CPR, extent of medical interventions, antibiotics, medically assisted nutrition, and a field for whatever else. The smart thing would be to get your hands on one of these and read through it, to see if it fits for you. They’re easy to find – Most clinics, facilities and certainly hospitals have them around. You can also go to www.wsma.org/patient_resources/polst which happens to be the Washington State Medical Association’s web site for some great info. More questions? Good! Talk to your doc or healthcare pro.

            So, let’s say I did a POLST form, and conscientiously provided copies to my doc and hospital, but I’m mostly at home – What should I do with this electric green eyesore? Well, you want it to be conspicuous, right? Remember the scenario: Something medically bad has happened and the EMT’s come charging in! They’re not likely to stroll casually through the house attempting to detect where I might have hidden the POLST form – They’re going to ACT! So, put it on the refrigerator or the bedroom door, in-or-on the medicine cabinet, on the bedside table – I’ve seen folks tack it to the wall right above the bed! Make it easy, and make it conspicuous!

            Now, I know what you’re thinking, because I know what the next question always is because I know what my next question would be: If I do all these forms correctly and give them to everybody who ought to have them and put them in all the right places blah blah, can I count on everything going the way I want everything to go?

            Look: I’ve heard and read horror stories, just like you have, about when these things didn’t work or some offspring defied them by screaming, “LIABILITY!” or whatever else. What you haven’t heard are the hundreds and thousands of times that they did work, and people’s wishes were respectfully respected, and I speak from experience – But if you want an iron-clad guarantee that everything will go perfectly no matter what, then I suggest that you signal the Mother Ship, because you are on the wrong planet.

            This is about – This whole “Boomer Primer” thing is about – Increasing the odds; Making it more likely that things will go the way you hope they will go. Here’s the only thing I can “guarantee” today: Tomorrow there will be six days until December 25^th .

            Everything else is a crap-shoot.

Peninsula Daily News Column 12-8-11 "Advance directives kick in near end"

            So, how did Part D “open enrollment” go? Mostly OK? Good! Are you just fed up with thinking about it?

            Me, too, so here we go, back to the “Boomer Primer” – If you don’t know what this is all about, please ask somebody else, because the rest of us are trying desperately to move on.

            And what we’re trying desperately to move on through is the paperwork part of this whole “aging thing,” so hang in there because this won’t go on forever (rather like “open enrollment”).

            OK, wills and probate and community property agreements and durable powers of attorney (which beat-the-heck out of guardianships) – What NOW?? Now, advance directives.

            “Advance directives” is an umbrella term; if you’ve heard other terms, like “living wills,” “healthcare directives” or “directives to physicians,” we’re talking about the same things. What these come down to is a document that tells your doctors, or other folks providing your healthcare, when you want them to stop life-sustaining treatment and let you die – I’m sorry, but that’s the truth of it.

            Now, are you “required” to have one of these? No. If you want ALL the “heroic measures,” right down to the bitter end (which is an absolutely fine thing to want!), then don’t do anything and go cruise catalogues for fruitcakes; however, some folks feel rather strongly about when to say, “Enough is enough” – If that sounds like you to you, stay with me.

            An advance directive can only take effect in two situations: (1) you’re terminally ill and will die soon, so life-sustaining procedures will only prolong the process, or (2) you’re in a permanent, unconscious condition (you may have heard the phrase, “permanent vegetative state” – Same thing). “Life-sustaining procedures” could include things like CPR or the use of a respirator or any number of other procedures. They do NOT include procedures to ease pain! – So, you’re going to get those, either way.

            Now, remember this: These things only kick-in if you can’t speak for yourself! – If you can, healthcare pros are going to go with what YOU say, regardless of what’s in any pretty piece of paper, OK? You call the shots, as long as you can call the shots.

            A healthcare power of attorney (familiar phrase?) allows someone you designate to make medical treatment decisions for you, if you can’t, and it doesn’t just have to apply to “life-sustaining procedures” – It can apply to any medical decisions. An advance directive can be combined with a healthcare power of attorney in one document.

            So, what would happen is that the person you designate in the healthcare POA could make decisions that might not have been considered when you were making out your advance directive, guided BY your advance directive, get it?

            Are there forms out there, so you could do one of these yourself? Yes. You know by now that my bias is to work through an elder law attorney (and, again, all these documents can often be included into a “package deal”), because they know the right questions to ask so that we think things through and the documents actually say whatever it is we want, but you can do them on your own, if you’re pretty darned sure that they say what you want them to say.

            To be valid, an advance directive has to be dated and signed in the presence of two witnesses, who also have to sign. These two witnesses CAN’T be: (a) related to you, by blood or marriage; (b) entitled to inherit, if you move on; (c) people you owe money to; (d) your attending doctor or the doctor’s employee, or (e) an employee of a healthcare facility where you are a patient – All of which make pretty good sense, when you think about them.

            It does not have to be notarized.

            OK, let’s say you’ve done this thing and you have the piece of paper – Now what? Keep one for yourself, give one to your doctor (and talk it over with him or her, so we know that we’re all thinking the same thing) and copies to anybody else that might need it, like the facility you live in or the hospital you’re in-and-out of or whomever.

            Now, let’s overstate the obvious, because it, often, isn’t obvious: What I hope you did was to talk this over with your family (think, “kids!”) before you went out and made pretty paper, because if they don’t know about it, don’t “get it” or (WORSE!) won’t go along with it, this is not going to go well. Forgive the cliché, but everyone needs to be on the same page of this pretty paper!

            Can you change your mind about this stuff? Sure! You can change your mind about any of this stuff, anytime! If you want to “cancel” an advance directive, all you have to do is (a) destroy it (or tell someone else to do it, in your presence); (b) write out a “cancellation” (no “form” needed, then sign and date it, or (c) just say so, to your doctor (or whomever). Period.

            BUT! If you’ve strewn copies of this thing hither-and-yon, remember to backtrack and let everybody in on what you’re doing, and please let me repeat myself repeat myself: These things ONLY take effect if you can’t speak for yourself! If you can, none of this means anything to anybody!

            I go on and on about these, because they are very important to a lot of people, but please don’t take all this as a “hint” that I think that you “should” do this. I don’t. I think you SHOULD think about it, then make any decision you care to make, which is the point of this whole “Boomer Primer” thing, anyway.

            I’d hoped to get into a specialized type of document called a POLST (“Physician Orders for Life-Sustaining Treatment”) form today, but I’m running out of newspaper (again), so we’ll bump that to next week, then we’ll be done with all this cheery, pre-holiday paperwork

            OK, now take a few minutes to think about what you want to do next about all of this stuff, then make a note to actually do whatever that is, including nothing; then, go cruise catalogues for fruitcakes.

            Then, order a pizza.  

Peninsula Daily News Column 12-1-11 "Get guardianship while you can"

            Welcome to the first day of December! You have exactly six days left in 2011’s “open enrollment” for Medicare’s Part D and Advantage Plans, so just get it done and enjoy the holidays, for a change.

            But today is Thursday and it’s time to move on…Well, “back;” specifically, back to our old friend, the “Boomer Primer.” You remember what we’re doing here, right? The idea is to present a list of “things to think about,” then (hopefully) do something about, so we can take on this “aging thing” with a respectable degree of competence.

            The last time we were here, I went on about durable powers of attorney (DPOA’s) and threatened you with “guardianships,” but before I make good on that threat, one more word about DPOA’s; well, actually, a hint for those of us who are all about the details.

            Generally speaking, DPOA’s allow the “agent” (the person who has been granted the legal authority to do stuff on behalf of another person who can’t do it for themselves) to move money around: Write checks, pay bills, etc. There is a nuance that comes up with Social Security: While most sources of income (e.g. retirement pensions, whatever) accept a legitimate DPOA, as do banks, Social Security doesn’t. They want you to fill out another whole set of paperwork to become a “representative payee” – It isn’t insurmountable; it’s just another thing to do at a time when you probably have more than ENOUGH things to do.

            Here’s the work-around: Have the Social Security check deposited directly into your person’s checking account (which most of us do, anyway) – Once the money is in the account, you, as the agent with your DPOA, can access it to pay the bills that need to be paid. Click.

            OK, guardianships. Harken back: Remember the part about how a person has to be able to grant “informed consent” (in other words, they know what they’re doing) to execute a power of attorney or a DPOA? Good; so, what happens when a person didn’t get a DPOA, and now they’ve become incapacitated? An all-too-familiar example for a lot of us is the decline into Alzheimer’s (or any form of dementia) – Now what? Somebody has to make the decisions and pay the bills and and and…

            Right, so you’re left with having to petition Superior Court for a guardianship. A guardian is a person appointed by the court to manage the affairs of another because of a “…demonstrated inability to adequately manage property or financial affairs…” or “…adequately provide for nutrition, health, housing or physical safety.”

            Anyone can file a petition for guardianship over another, and the one doing the petitioning does NOT have to become the guardian. The court then has to decide (a) whether the person is, in fact, incapacitated, then (b) appoint a guardian.

            Here’s what happens after the petition is filed:

1. Notice of the petition is given to the person identified in the petition;
2. The court appoints a “guardian ad litem” to make an investigation and report to the court about whether the person really needs a guardian, to what extent, who it ought to be, etc;
3. The guardian ad litem must get a statement from a doctor or psychologist, and;
4. A hearing – In court! – Must be held.

In my experience, guardians ad litem are sharp, and they care. They also have temporary authority to make decisions if there is something that needs to be addressed right now; also, while the court is not required to follow the recommendations of the guardian ad litem, it usually does.

What if the person in question objects to having a guardian? Well, it’s rather rare, for obvious reasons, but I’ve seen it happen, and it isn’t pretty. That person has a right to be represented by their own attorney at the hearing.

What if the person isn’t totally “out of it,” but still needs help? Good question. The court can appoint a “limited guardian,” who makes some of the decisions (e.g. just financial) while the person makes the rest (e.g. healthcare). The court decides how this will go, so you often hear talk about a “guardianship of the estate” or a “guardianship of the person,” but a limited guardian ship could have pieces of both.

The “good news” about guardianships is that the court supervises how all this actually goes; for instance, a guardian of the estate has to file an inventory with the court and an annual accounting of what-got-done-with-what (NOTE: I’ve seen, and you’ve probably heard, of ugly situations where the “greedy son” is filing for a guardianship to get his sweaty palms on Mom’s money. The courts, and guardians ad litem, are VERY smart about…stuff like that).

Guardians aren’t God, and there are things that they can’t do, at least not without the court’s OK; the most notable is that a guardian can’t put someone somewhere they don’t want to be, like in a nursing home, but here’s the reality: If the person in question is truly “incapacitated” to a significant degree, they probably aren’t going to object because they don’t know where they are, so the absence of “no” defaults to “yes.”

I don’t mean that crack to be disrespectful, but those of us who have walked the “caregiver walk” know darned-good-and-well what’s true, and while that person still deserves dignity, respect and (in most cases) love, what’s true is what’s true.

Is this everything that anyone could possibly need to know about guardianship? Of course not! – But it’ll get you in the ballpark, and if you find you or yours in this unhappy circumstance, find an attorney you can trust, which takes us back to the point of this whole “Boomer Primer” thing:

If everything I’ve just described sounds fun to you (or for the people you purport to love), feel free to do absolutely nothing; if it doesn’t, think seriously about having a DPOA prepared when you’re sitting with that elder law attorney, having your will drawn up. Remember, you can only do it before you need it, because by the time you need it, you can’t do it.

Informed consent.

Peninsula Daily News 11-24-11 "More on (durable) powers of attorney"

            Yes, I do know that today is Thanksgiving Day – Happy Thanksgiving!

            I also know that the whole world is writing about it, and undoubtedly more poignantly than I, so I’ve decided to ignore it. Read this later in the day and think of it as “leftovers.”

Last week I went on about powers of attorney (POA’s) and durable powers of attorney DPOA’s), and was going to move seamlessly, if not stealthily, into guardianships, but a number of you have e-mailed with some disturbingly intelligent questions, so let’s do those first.

            Can a POA or DPOA be revoked? You bet, anytime. All you have to do is give written notice of same to the “agent” (the person who you originally designated to make decisions) and to anyone who is relying on that DPOA like, say, a bank. IF you filed the DPOA with a County, file the revocation in the same place. By the way, guardianships can be revoked, too.

            Contrary to popular opinion, a POA/DPOA does NOT give the agent the right to do anything and everything; for instance, they cannot put you someplace that you don’t want to be (think, “nursing home” – Of course, you have to be willing to say “No!”). A separate court order is usually required for an amputation, shock therapy and certain mental health treatments that restrict a person’s freedom of movement; also, an agent can’t vote on your supposed behalf nor can she/he make or alter your will.

            Does a POA/DPOA have to be notarized? Sometimes, most notably if the agent is likely to have to sell, transfer, encumber or in any way mess around with real estate; otherwise generally not – HOWEVER, it might be smart, on general principles: It makes everything more “official,” so might help to smooth the way for your agent to do what has to be done, say, with a bank.

            Can I give a grant a POA/DPOA to more than one person at a time? Well, yeah – It’s certainly smart to name a “backup” in case Choice #1 goes down – But the real question had to do with a situation in which Mr.-&-Mrs. didn’t want to appear to be showing “favoritism” between a son and a daughter.

            Can you do that? Yes, you can, but please be…darn sure you want to! If ever there was a situation ripe for conflict, disagreements and resurrecting old wounds from grade school, this is it! And if they do manage to “compromise,” will that compromise be what you’d want? Remember, making decisions as close as humanly possible to the decisions that you’d make for yourself is the point of this whole thing! But, can you do it? Yes.

            Now, think about that, in a general sense: You’re granting someone the legal right and ability to, in most cases, make a lot of important decisions AND move money around AND likely make decisions about what healthcare you might get under what circumstances and tra la – This is IMPORTANT! And, again, the idea is to appoint someone who will likely respect your own values and wishes and someone YOU CAN TRUST!

            I’m reminded of the gal I sat with several years ago, having this very conversation. We got to the part about which of her several children might be the choice as her agent, and she was thinking out loud when she said, “Well, Benny really is such a good boy, when he’s not in jail or doing those nasty drugs…” It made my head hurt. We talked for quite a bit longer.

            Speaking of “trust,” generally speaking, there is no court supervision of a POA/DPOA, while there is under a guardianship, so we’re a little more “vulnerable” to stupid, greedy or vengeful agents. Oh, sure, courts can be requested to decide this-or-that or order this-or-that or change this-or-that, but that rarely happens so, again, be as sure as you can that your agent actually like you.

            And, again, do you have to have an attorney do a POA/DPOA? No, you don’t – I wish you would, but no.

            Certain DPOA’s are written in such a way that they only kick-in in the event of an event, e.g. two physicians certify that you’re incapable of calling your own shots (or one physician, or whomever or whatever), so think about that. I often get calls that start with, “I have a DPOA for…”, and my first question is always, “Has it kicked-in?” Until it has, it’s just a piece of paper.

            Well, so much for getting to guardianships today, but I don’t suppose they’re going anywhere, so we’ll try again next week. At the risk of overstating the painfully obvious, keep in mind that I am NOT an attorney – I’m a social worker – And in some sectors, even that can be successfully argued.

Peninsula Daily News Column 11-17-11 "Power of attorney a must with aging"

            Today we’re finally getting back to the “Boomer Primer?” Remember the “Boomer Primer?” That’s the thing we were doing before the juggernaut of Part D/Advantage Plan “open enrollment” rolled over us (and continues to roll through December 7), then there were other unscheduled interruptions under the general heading of “Real Life,” blah blah – Anyway, here we are.

            The idea of the Boomer Primer (designed primarily for…You guessed it! Boomers!) is to provide a list of “Things to Think About,” assuming that you (whoever “you” are) are in your early-to-mid ‘60’s, or rapidly closing in on same, and would like to have some idea of what tomorrow might look like, before it’s tomorrow.

            You are not required to do “this” or do “that,” or to agree with “this” or “that” – You are required to think about these things, as a part of the whole “aging thing,” then decide whatever you decide to decide, because surprises can easily turn into shocks.

            OK, the last chapter of the Primer pre-Part D (which actually was a chapter unto itself, but let’s not get distracted by thinking that the whole is equal to the sum of its parts), was about “wills” and “probate,” because nothing goes very well in America without the legal paper, so you thought to yourself (pre-Part D), “OK, so, if I do that right, I’m done with making paper, right?”

            Wrong. Here’s why: Most of us aren’t overly enthusiastic about the prospect of dying, but in the privacy of our own homes, will generally concede that it’s highly likely that we will; the fact is, that what most of us hope for is something sudden and definitive, meaning I’m living and living and living and suddenly…BOOM! It’s over! Bye.

            The reason we hope for a sudden BOOM is because what most of us fear the most is that “gray area” between what we call “life” and what we assume “death” to be, unfortunately referred to as “disability.” In my world, people are much more afraid of nursing homes than they are of morgues, for exactly that reason: We want to be able to live our lives on, more or less, our own terms, than go out with a “bang” (or, in this case, a BOOM).

            Many of us do – And will. Many of us won’t, and you know that as well as I do, so then what?? Well, presuming the worst case where we won’t be able to call our own shots (which also doesn’t happen to everybody), someone else is going to have to, so how does that actually happen? Good question. Listen:

            A “power of attorney” (POA) is a legal document in which I give someone else the authority to act on my behalf – Buy things, sell things, collect money, spend money, manage a business, whatever. A POA can be written to take effect right now, or at some future date, like between January 1 and March 31 of 2030, when I’m water-skiing the canals of Venice – You get it. A POA is predicated on the legal assumption that I know what I’m doing (“informed consent”) and it ends when I die, so it is NOT a substitute for a will (Nice try, though).

            A POA also “goes away” when I become mentally incapacitated, because I no longer have the ability to grant “informed consent,” get it? However, a POA can be written in such a way that it is to remain in effect in the event of mental incapacity OR only kicks-in in the event of mental capacity. These are called “Durable Powers of Attorneys” (DPOA’s), probably because they “endure,” huh? Close enough.

            I like these – A lot. Here’s why: Remember that a POA can only be granted when I’m capable of giving informed consent? Now, let’s say I have a massive stroke or, more statistically likely, start slipping away into Alzheimer’s (or whatever) and I haven’t prepared a DPOA – Can I do one now? No, because I lack “mental capacity;” in other words, I can only do it before I need it because, when I need it, I can no longer do it. And what does that sound like?

            Right! Planning! So, when would be a smart time to have a DPOA drawn up? Right! When I’m already sitting with my attorney talking about my will (Note: you can often get a “package deal” from a smart attorney when you get a will, a DPOA, an Advance Directive and, often, a Community Property agreement). I know what you’re thinking: Do I have to pay an attorney to do this?

            No. There is no legal requirement that a POA/DPOA be prepared or reviewed by a lawyer, and there are generic forms out there that are perfectly legal. Do I think that’s a good idea? No, because smart elder law attorneys know the right questions to ask that will make us think, and avoid a future “Oops!” – “Oops” being the 2^nd scariest word in the entire Primer. Do I think a generic, self-executed DPOA is better than nothing? Almost always, and here’s why:

            Let’s say that I actually like my family, but enough to have prepared a DPOA; then let’s say that something bad happens to me, to where I can no longer make my own decisions or manage my own affairs, can my family make all the necessary decisions and do all the legal stuff? Nope, so they’re going to have to petition for a guardianship, which is expensive, time-consuming and generally extremely annoying (and we’ll talk about those next week) – Because they have no other choice.

            A little bit of quick Q & A, because I’m running out of newspaper:

1. Can a POA/DPOA be used to make healthcare decisions? Yes;
2. Can I still make my own decisions if I’ve already given a DPOA? Sure, if you can;
3. Can I cancel my DPOA? Absolutely. Or change who’s making the decisions? You bet;
4. Is this everything I need to know? NO!

Talk to an elder law attorney, or at least go to www.washingtonlawhelp.org and click on the “60+” button to read up on these things (Hint: You’ll also find some generic forms, if you’re just bound-and-determined to go that way).

Here’s what’s worth remembering: I can only get it when I don’t need it because, when I need it, I can’t get it.

           

           

Peninsula Daily News column, 11-10-11 "Energy assistance for low-income folks"

            It’s beginning to get cold. That has to with La Nina or El Nino or La Bamba or J-Lo or something like that, but the fact is that it’s beginning to get cold.

            If you have plenty of money as it’s beginning to get cold, God-love-ya and please go back to thinking about becoming a TAX-AIDE volunteer; if you don’t have a lot of money as it’s beginning to get cold, or you know someone who is in that unenviable situation, please stay with me.

            There is a program that can help folks without a lot of money as it gets cold, and it’s called LIHEAP (pronounced “LieHeep,” and it stands for “Low Income Home Energy Assistance Program,” but I can’t imagine why you’d care). What it does is help you pay for your home heating costs – Interested? Good! Here we go:

            LIHEAP, which is available in both Clallam and Jefferson counties, can provide anywhere from $25 to $1,000 toward those costs, depending upon your income, etc, so let’s start there. Let’s say that you’re Mom, Dad and two kids – Your monthly income has to be at or below $2,328; for a couple, $1,532 or if you’re just you, $1,134 – There’s a scale that runs up to a household of nine, but you get the drift.

            By the way, if you live in Jefferson County and are a customer of Puget Sound Energy Company, PSE has their own “Energy Help Fund.” To get in the ballpark for that, for a family of four, income at or below $2,794; for a couple, $1,839 and for just you, $1,361. And FYI: The PSE Help Fund opens in Jefferson County again after the LIHEAP money is gone, so there’ll be more help available down the way – The two programs do NOT run concurrently. OK so far? Good – Hang in there.

            The “season” for LIHEAP began ten days ago, on November 1^st. It’s run by Olympic Community Action Programs (OlyCAP) for both counties. Here’s what you do: Get on a computer and go to http://www.olycap.org/ and click on the thermostat, then go from there. No computer or don’t get it or whatever (maybe because it’s getting cold and you’re shivering)? OK, in the Port Townsend area, call 385-2571; in Forks, call 374-6193 on a Monday and in Port Angeles/Sequim, call 452-4726 between 1:00-4:00 p.m. on Tuesday or between 9:00 a.m. and 12:00 p.m. on Thursdays.  

            Depending upon how the funding goes, OlyCAP will open a January calendar for appointments in December, so if at first you don’t succeed…

            TIME OUT: Some of us are familiar with LIHEAP because it’s gotten cold before and we haven’t had a lot of money before. In the past, we had to mail in stuff, which then sat in a huge pile because a lot of folks without a lot of money were getting cold, then nothing happened for LONG time, because the pile was so big, so the utility companies became unpleasant and turned things off and things got worse and colder and…BUT! OlyCAP, to their credit, has figured that out, so those days are gone; now, it’s sit-down-with-a-person, 1:1 appointment, so things get done when they need to get done.

            Obviously, there could be another problem: How do I get to a 1:1 appointment with a person if I’m “home bound?” Good question. Here’s OlyCAP’s good answer: Beginning December 1^st, they’ll come to you, if need be, if you are an Elder, a person with a disability or a family with children under the age of six; down the road, they’ll be locating themselves strategically hither-and-yon around the Peninsula, to make the seemingly impossible, doable.

            Good for them.

            Now, not for the faint of heart, here’s how things go in my head: “OK, it’s cold and I don’t have a lot of money, and it looks like I might qualify for these things. I’ve actually managed to get an appointment that I can actually make and I’ve actually figured out a way to get there; so, I walk in, sit down and find out that I don’t have some magic piece of paper, so I’m…unhappy!” Right. Not good. Here’s what you actually need to have:

            Bring proof of income for anyone in the household who’s 18 or better, or if that anyone is still in high school, bring a school ID. If you’re a member of a Tribe, bring a letter from the Tribe saying that your application for Tribal LIHEAP is denied. Bring ID for everyone in the household! – Driver’s license or photo ID or passport or birth certificate.

            Bring a current utility bill that has the account #, with your name and address on it. If you’re renting and heat is included in the rent, bring a copy of the rental agreement or lease. If you’re primary heat source isn’t electric (or in Jeffco with PSE, natural gas), you’re going to have to provide some kind of proof of residency.

            Now, go back to the part about going to http://www.olycap.org/ and clicking on the thermostat: There’s a form there that you can print or look at that spells out everything I just said, in a bit more detail, OK?

            Can I absolutely guarantee that everything will go perfectly? No. Can I promise you that OlyCAP will have enough money to help everybody that needs help? Of course not. Can I assure you that you’ll be able to get an appointment exactly when you need or want it? Not on this planet, but here’s what I can assure you of:

            These are good folks who are honestly trying to help, and if you’re cold and without a lot of money, it’s worth a shot. Doing nothing won’t make it any warmer.

Peninsula Daily News column, 11-3-2011 "Tax-Aide volunteers face classes, test"

            HEADS UP!

            I’m hearing that more-than-a-few folks are getting disenrollment letters from their Medicare Part D plans – Kind of out-of-nowhere; now, there could be any number of reasons why that unhappy circumstance could befall you, but here’s one: It appears to the Plan that you have two or more addresses!

            Look: If you change (or add) an address after you enroll in a Part D plan that appears to be out of that plan’s service area, they are required to disenroll you. One thing that happens a lot is that the kid in Nevada is helping Dad sort this stuff out, so she’s having all the Part D mail forwarded to her. The plan gets wind of this and says to itself (because Part D plan talk to themselves), “Oops! That’s out of our service area!” – And BOOM! Dad is Part D history.

            Now, can you do what I’ve just described above? Sure, but let the plan in on your little secret, because once you get one of those disenrollment letters, your coverage has lapsed UNTIL you get it straightened out, and who needs that?!

            In fact, couldn’t you just live without the hassle of this whole Part D “thing??” The detail and the paperwork and the everlasting grief of trying to keep everything straight…Let’s face it: It has all the appeal of root canals or opening the packaging of just about any commercial product (like arthritis medicine) that requires three strong men and the jaws-of-life or doing anything in a crawlspace or preparing tax returns or…

            Tax returns?? Well, I don’t enjoy it, do you? You do?? Or, you could? Maybe? Really?? Then, you are who we’re looking for, because it’s the time of the season to recruit weirdoes like you for TAX-AIDE!

            These are the “good guys,” remember? These are the folks who volunteer their time to help the rest of us get our taxes out the door – Correctly! They’re sponsored by the AARP Foundation and IRS, but you don’t have to like either one; you do have to like helping people who will like you back for helping them out of yet another externally imposed crisis.

            Here are all the ways that you will have to make yourself miserable in the name of helping people: First, you’ll have to attend two days of volunteer orientation classes, in Sequim, on December 7^th and 8^th; then, you’ll have to devote significant chunks of your December studying studying studying the IRS-provided materials and tax preparation software – Sound fun so far?

            THEN, you’ll have to attend “review classes, in Sequim, on January 4^th and 5^th, to go over all the stuff you taught yourself in December – Why? Well, because help isn’t help unless it helps, and if you haven’t learned how to help people with their taxes – Correctly! – That isn’t “help;” then, you’ll have to pass the IRS Test to prove it! (Hey, all TAX-AIDE volunteers have to pass that every year – Competence is mandatory!)

            Then, you’ll have to sign the IRS “standards of conduct” to insure that you’ll help folks in an ethical and confidential manner, and THEN you’ll be expected to work (unpaid) at least four hours per week, although most of these guys do a lot more than that, throughout the tax season! Have I talked you out of it yet?

            There are only a handful of reasons to do this:

1.     You’re a good and decent human being;

2.     You’ll learn a LOT about taxes and tax preparation, and…

3.     …you rather enjoy being bathed in the gratitude from those of us whom you’ve helped, and I am NOT kidding about that part!

The rest of us need you! And we appreciate you! You have no idea…

So, what do you do to include yourself in an unmitigated exercise in masochism? Well…

1.     If you want to volunteer in Jefferson County, contact David Self at dcself@olypen.com or 385-2617;

2.     If you’re in the West End, call Corinne Spicer at 374-6332 – A bilingual volunteer would be extraordinarily cool!

3.     In the Port Angeles area, holler at Hearst Coen at hj_coen@msn.com or 452-6541, or…

4.     …around Sequim, Gail Anundson at gail@anundson.org or 582-1295.

You’d be willing to help, but the actual tax preparation isn’t your thing? Good! Get in touch! There are other ways.

I have to laugh at myself: I unhesitatingly jump into the infinite nuances of Medicare or Medicaid or legalistic paperwork or whatever else, but run screaming from the room in the face of tax preparation! See? We NEED you!

And you might as well get used to hearing this right now: Thank you!

Peninsula Daily News column, 10-27-11 "It's time to fill caregivers' toolbox"

            It’s easy to be sarcastic about healthcare in America - It’s even easier to be sarcastic about health insurance! – In fact, it’s so easy that, sometimes, we can confuse those two things, so let’s start there:

            Health insurance is NOT healthcare. Healthcare keeps us going, and as healthy as we can, or are willing, to be, and we’re actually pretty darned good at it! We’re so good at it that a lot of us are living a whole lot longer than would have been imagined even a generation or two ago.

            So, the “good news” is that a lot of us are living a whole lot longer! The “bad news” is that, in the course of living longer, a number of us require “care” – You know, somebody (or somebodies) to help us get through the day. We call those folks, which most of us are, have been or will be, “caregivers,” but since “caregivers” almost never call themselves “caregivers,” here’s my standard definition: A “caregiver” is somebody who is taking care of somebody who needs to be taken care of, whether they like it or not.

            Does that sound at all like you to you? Then, WELCOME! – Because you’re “us.”

            And, yeah, there are a LOT of us.

            And if we don’t take care of us, what do you suppose happens to the folks that we’re taking care of? Right: Nothing good; so here’s our annual opportunity to take care of us.

            The 5^th annual “Building Your Caregiver Tool Box” will be held on Saturday, November 5^th, from 8:30 am to 3:00 pm, at the Peninsula College PUB (Pirate Union Building, and don’t panic: Costumes are NOT required!), 1502 East Lauridsen Blvd. in Port Angeles, free.

            We like free.

            The theme this year is “The Tsunami of Caregiving,” with the keynote address by Jamye Wisecup, the coordinator of the Clallam County Sheriff’s Emergency Management Division. There will be breakout sessions on “Map Your Neighborhood,” “Outages,” “Preparing for the ‘Little Emergencies’,” etc. as well as some other, more personal, options.

            There will also be a free lunch, snacks, beverages, vendor and informational tables, a lot of us “professional-types lurking about and a comedy (Yes, COMEDY! – If we don’t laugh at this stuff now and then, it’ll kill us!) presentation in the afternoon! – But here’s the best part: There will be a room full of people who are doing the same thing (more or less) that we’re doing, which means a room full of very smart, experienced and creative people.

            That’s what puts the “us” into the us.

            What do you do? Call 360-452-3221 (1-800-801-0070) to register, and do it RIGHT NOW! These conferences fill up fast, which ought to tell you something. Can you bring your “person” with you? No, and here’s why: If you bring your person, then you’ll be doing what you do all the time, which is giving care, which means that you’ll be all about them, and not about you, and this is about you.

            Us.

            Do this. Care enough about your person to care about you, and to remember that you aren’t alone.

            Us. See ya there.

            Now, change channels, OK? – Click. A number of the more loyal among you have heard me go on (and on!) about “Living Well with Chronic Conditions.” I know this to be true because a lot of you with chronic conditions have been through this 6-week, 2.5 hours/week workshop and have told me that it changed your life – For the BETTER! It works, and it’s free. We like free.

            So, now: What if I gave you a chance to become a facilitator for “Living Well with Chronic Conditions?” Really! To get trained in how to conduct these workshops that change lives, for free! Well, here’s your chance.

            The training will run November 8, 9, 15 and 16 at the Port Angeles Senior Center (328 E. 7^th, but you probably knew that). You’d run these workshops in teams of two, so bringing a friend would be fun, and you don’t have to have any teaching experience.

            All you have to commit to is showing up for all four days of the training and facilitating a minimum of two, 6-week workshops per year. Do you know how much you’ll learn from this? Not to mention the karma!!! And if you don’t have a lot of fun doing it, you’re doing it wrong.

            What do you do? Call 1-866-582-1487 and sign-up, then show up.

            So, what was the theme of today’s column? Right: Good and decent people being good and decent people – Together – One person at a time, in spite of everything you hear in the news.

Peninsula Daily News column, 10-20-11 "On acronyms, open enrollment, Medicare"

            This is about Medicare – again.

            ‘Tis the time of the season for Medicare, because “open enrollment” for Part D and Advantage Plans began five days ago (October 15^th) and will run through December 7^th (a day that will probably live in infamy); regardless, here we are.

            So (again), if you’re not on Medicare, about to be and don’t know anyone who is, feel free to go check out what’s on tap for “live music” on the Peninsula – The rest of us have work to do and today that “work” might save a number of us a considerable amount of money.

            As threatened last week, today we’re going to venture into a land of acronyms generally referred to as “Medicare Savings Programs.” I’ll quote the acronyms and tell you what they stand for, because some of you will feel sufficiently neglected to warrant e-mailing me, demanding to know what they stand for; however, it is NOT important that you remember said acronyms, nor is it important that you remember what they stand for – It IS important that you pay enough attention to the numbers to see if they will do you or yours some good.

            Acronym #1 is QMB (pronounced “Quimby”), that stands for “Qualified Medicare Beneficiary.” If you qualify for it, it will pay for your Part A premium (if you have one), your Part B premium (I’m pretty sure that you have one of those) AND your Part A or B deductibles, copays or coinsurances. If you have an Advantage Plan, QMB will pay copays and coinsurances for medical and hospital care.

            Did you follow that? Did you see the part about it paying your Part B premium? So, without even trying, we’ve just saved you real close to $1,200! – Indeed, Quimby is our friend.

            You qualify for QMB if your income as a single person is at or below $908 per month and your “assets” are at or below $6,680. “Assets” means cash, bank accounts, stocks, bonds, real estate contracts, blah blah – Pretty much what you’d think it means. It does NOT mean your house, one car or your stuff; also, if you have up to $1,500 set aside in a specific account for burial costs, that isn’t counted, either.

            If you’re a couple, income at or below $1,226 per month, assets at or below $10,020.

            FYI, if you qualify for QMB, you AUTOMATICALLY qualify for the Part D “extra help” (“L.I.S./Low Income Subsidy” – I went on about this last week), so you’d have very low to $0 premium, $0 deductibles and very low copays and, probably, no donut hole.

            See? Quimby is our friend.

            Acronym #2 is SLMB (pronounced “Slimby”), that stands for “Specified Low-Income Medicare Beneficiary” (feel smarter?). If you qualify for this, it’ll pay your Part B premium only (again, do the math in your head – Real close to $1,200/year, right? Right!)  To get in the game, for a single person, income at $1,090 per month, assets the same: $6,680; for a couple, income at $1,471 per month, assets the same at $10, 020.

            Acronym # 3 is QI-1 (pronounced “QI-1”), which stands for “Qualified Individual” (I know, but I don’t make them up). QI-1 will pay for your Part B premium only. Income for a single person at or below $1,226 per month, assets the same at $6,680, and for a couple, income = $1,655 per month, assets the same at $10,020.

            I know what you’re thinking, and No: You did NOT misread something – YES, I just referenced two acronyms that both pay your Part B premium, with different income levels, so you’re thinking, “WHY???”

            Answer: I don’t know. I probably knew once, but I don’t know now; more importantly, I don’t care. I DO care that people without a lot of money get the help.

            Now, a handful of you are, for lack of a more pejorative term, “policy wonks,” so you’re thinking, “You can’t fool me, Harvey! ‘Medicare Savings Programs’ are a form of Medicaid, which means that ‘they’ will come after my estate!”

            First, I’m not in the business of “fooling” you – If I were, we’d call this “Fool Line,” and we don’t.

            Second, you’re right about these being a form of Medicaid; however, Medicare Savings Programs are NOT “recoverable” under Medicaid, so you have nothing to lose (Score one for my side!).

            So, what do you actually do? Well, you can come to any of the SHIBA clinics that I listed last week or you can call any of the numbers at the end of this column for help.

            You can go online to http://www.dshs.wa.gov/onlinecso/findservice.shtml or you can truck on down to the nearest DSHS office (You want the “CSO,” which stands for “Community Services Office”). FYI, it really isn’t all that tough to get signed-up, so just keep repeating to yourself, “$1,200, $1,200, $1,200…” but do it silently, so people don’t look at you oddly.

            And, Yes, Virginia, you should insert this in your “Boomer Primer.”

I know this stuff can glaze you over – Me, too; but the fact is that they can save us serious money in a time when pretty much any money is “serious,” so read this two or three times, then DO IT, because waiting or “thinking about it” won’t help you or anybody else.

$1,200, $1,200, $1,200…