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.
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