not MM Related: End of Life Planning

formerlyGDaisy09 · October 2015

So this is mostly not MM related, and is a little bit of a PSA. H and I attended an information session yesterday on setting-up advanced directives and assigning a medical proxy. As a public health/health policy professional this has been something that I knew H and I should do for a long time, it just never made it to the top of the to-do list.

Like setting up a will in your 20's or 30's, this is something that we won't likely have to use, but in the event of something terrible, our families and friends will be much better off with this document in place. Unlike setting up a will, you do not need a lawyer to set-up your advanced directive or assign a medical proxy. It seems each state has slightly different requirements, but you should be able to find a form to download to make your wishes known and assign whomever it is you wish to make decisions for you in the event that you're not capable of speaking for yourself. For the most part you're answering the question "If I'm in a terrible accident that leaves me in a state where I do not know who I am, or who any of the people around me are, and there is little chance I will recover, what do I (or don't I) want to be done?" It takes the burden off your friends and family from having to make that choice.

H and I both have our forms to fill out, once we've had appropriate discussions with the people we wish to be our medical proxies. we'll then make copies and make sure our immediate families and doctors have copies, make sure it gets scanned into our EMR, and fill out wallet cards stating we have an advanced directive and providing the contact information for our Proxies. I'm planning to ask my sister to be my proxie, I do not feel that H or my mother would be able to rationally think through decisions, or be able to keep their emotions out of the way when fulfilling my wishes. H has not yet decided who he would like to be his proxy.

Since we're all planners on this board I'm wondering if anyone has these set-up? If not, have you thought about it?

brij2006 · October 2015

We do have them set up, but it was rolled into our will.

ETA: My aunt is an ER doctor, so she is my medical proxy.

hoffse · October 2015

H and I haven't set these up yet, but we have talked about it. I have done a lot of these for clients, so I have an Alabama form on our system I can access easily.

I have no siblings so I would likely ask a close friend. A lot of people choose their spouse, but that only makes sense if you spend a lot of time apart (ie: one spouse travels, one stays home). H and I spend a lot of time together, especially while driving, so if one of us was incapacitated from an accident or something there's a high chance the other would be too.

I agree that parents are usually a poor choice for proxies.

We won't do wills until we're ready to have children. H and I don't need a will yet because virtually every asset we have is either jointly owned or has a POD beneficiary designation. We'll probably do medical directives when we're ready to do wills.

dragonstarjk · October 2015

I'm pretty much the same as @hoffse. This is something I want to get done; I actually learned a lot about these in one of my college courses, and I had to create a medical directive for one of our assignments. Maybe I'll add this to our 2016 goals.

We don't have a huge need for wills either.

Working in the banking industry, it is incredibly sad how many people haven't made plans for beneficiaries, signers on accounts, POAs, or whatever steps they need to take to make sure things are taken care of in an emergency. I imagine those of you in the legal field see a lot of the same issues. This can leave a terrible burden on family and friends when trying to figure out what a person would want.

cbee817 · October 2015

Ours are set up with our wills. We've discussed it and have always believed quality of life far outweighs quantity. My mother is my proxy (she's a pharmacist with the bulk of her career in hospitals.. not retail). I'm an only child and was raised by her alone so I feel like if DH was able to sit in on the decision (meaning he wasn't affected by whatever happened to me), he would also know what to do. We've discussed that you can't keep someone around if they're not really there.. it's just a body, the person is gone. My aunt recently passed away from a stroke (very unexpected- she was 56 and very healthy) and we talked a lot about it when it happened and when she passed (5 days later). They both know my wishes and I have faith that they would keep their word. DH's mother is his proxy and he's told her what to do as well.

hoffse · October 2015

dragonstarjk said:

I'm pretty much the same as @hoffse. This is something I want to get done; I actually learned a lot about these in one of my college courses, and I had to create a medical directive for one of our assignments. Maybe I'll add this to our 2016 goals.
We don't have a huge need for wills either.
Working in the banking industry, it is incredibly sad how many people haven't made plans for beneficiaries, signers on accounts, POAs, or whatever steps they need to take to make sure things are taken care of in an emergency. I imagine those of you in the legal field see a lot of the same issues. This can leave a terrible burden on family and friends when trying to figure out what a person would want.

Yup. We see it when people's worst sides come out and they start fighting with each other. You would be amazed how long people will fight over a relatively trivial amount of money. One of my very first projects involved an estate where a couple of heirs were fighting over $12K. They fought over it for two years, they took each other to court, and we billed them way more than that in legal fees. It was so dumb.

It also could have been completely avoided if the will had been written more clearly.

jessica490 · October 2015

We set up wills about 2 years ago and this was something that was included into it.

vlagrl29 · October 2015

we set up wills when DD was 14 months old. Is this like having a person in charge if you were unable to make medical decisions on your own health? we need to do that.

short+sassy · October 2015

Yeah...this is all something I really need to get figured out. I'll set up a prime directive when I set up my will, so I'll probably just do all of that with an attorney. I hate the thought of going to an attorney, though. I suspect it will be pretty pricey, even though my will should be a fairly basic one.

(Thinking out loud)...I probably wouldn't even set one up at all because I just want everything to go to my H anyway. But then, what if we die together? Or I die first and he dies within just few years later. Suddenly the house I bought before we married and is just in my name, goes to his daughters...who I've never even met! Hell no on that. Plus the duplex I just bought is under an LLC where I am the only signer/owner. I'd want my H to have easy access to take over that LLC upon my death.

Crap. I didn't even think of some of this stuff until right now. I guess I do need to bite the bullet and get my affairs in order with an attorney. I know it's silly, but I feel intimidated. I've never needed to see an attorney for anything before (other than a property closing).

formerlyGDaisy09 · October 2015

vlagrl29 said:

we set up wills when DD was 14 months old. Is this like having a person in charge if you were unable to make medical decisions on your own health? we need to do that.

Yes, it's similar to having a durable power of attorney for financial decisions...but this is the person designated to speak for you in a medical situation where you can't speak for yourself. And this is getting your wishes in writing, which can be as simple as; if there is no chance of recovery, pull the plug; or do everything possible, do not pull plug under any circumstances. but it can as complex as putting timelines on things (you want everything possible done for 30, 60, 90 days, then if there is still no chance of recovery you'd like the plug pulled, or that you're ok with supplemental hydration and nutrtition, but you're not OK with a ventilator if it's not a temporary measure).

And designating people, you can designate a primary decision maker (for me this will be my sister, if she agrees) and a list of people who are to be consulted (I like this idea, so for me this will include H, my parents, and my brother), my sister is still the decision maker, but the rest of my family is to be part of the conversation.

Some states have laws with an automatic hierarchy of who is the proxy if no advanced directive in place, so in that case you wouldn't get left in a position where your family is fighting over who is in charge, but whoever the state designates might not be who you want.

From what we got last night, the paper work is really not that difficult to complete (It was like a 3-4 page packet for our state), but it's more taking the time to have the conversations with people and decide what it is you want that is more difficult.

Advanced directives are also something that can be changed anytime, and as often as you'd like...so just because you put something in writing now, doesn't mean you can't change your mind later.

short+sassy · October 2015

Oh! Additional question about medical proxies. Is it important that the person I choose as my medical proxy would actually be able to show up personally at the hospital?

After seeing the other posts, I would like to choose my H, but with my sister as an alternate if H and I are both in bad shape. But she lives halfway across the country. If I'm in an accident and there are immediate medical decisions that need to be made, she would not be there to make them. Or is my written medical directive enough until she gets there? Or maybe she wouldn't want to even come at all just to see me like a vegetable. We're friendly, but not close.

formerlyGDaisy09 · October 2015

short+sassy said:

Oh! Additional question about medical proxies. Is it important that the person I choose as my medical proxy would actually be able to show up personally at the hospital?
After seeing the other posts, I would like to choose my H, but with my sister as an alternate if H and I are both in bad shape. But she lives halfway across the country. If I'm in an accident and there are immediate medical decisions that need to be made, she would not be there to make them. Or is my written medical directive enough until she gets there? Or maybe she wouldn't want to even come at all just to see me like a vegetable. We're friendly, but not close.

From what I heard last night, and know from the medical ethics courses I took, I don't believe it is necessary that the proxy be available in person, just that the medical staff be able to reach them.

You do want to be careful about alternates, and making sure they're both on the same page with your wishes, some ethical issues would come up if say something happened to you, your H was unreachable at first, so your alternate was contacted, and then your H and your sister disagree on things. It's very important that whoever you choose understands that they are speaking for you (not for what they want for you), and that you've had ongoing conversations about what you would want.

This is also why you want some basics in your written directive...it could even be something like; everything is to be done until my medical proxy is reached.

Many hospitals have staff that is trained to help people set-up their advanced directives.

formerlyGDaisy09 · October 2015

And one of the other important things, for those that already have advanced directives in place, is to make sure that your medical providers have copies, and that you've gotten it attached to any electronic medical records you have.

For those who travel, I've heard it recommended you travel with a copy of your advanced directive...but a wallet card with your medical proxy's information might suffice, if your medical proxy has a copy of your advanced directive, or knows where they can find one (your PCP or your eMR)

hoffse · October 2015

short+sassy said:

Yeah...this is all something I really need to get figured out. I'll set up a prime directive when I set up my will, so I'll probably just do all of that with an attorney. I hate the thought of going to an attorney, though. I suspect it will be pretty pricey, even though my will should be a fairly basic one.
(Thinking out loud)...I probably wouldn't even set one up at all because I just want everything to go to my H anyway. But then, what if we die together? Or I die first and he dies within just few years later. Suddenly the house I bought before we married and is just in my name, goes to his daughters...who I've never even met! Hell no on that. Plus the duplex I just bought is under an LLC where I am the only signer/owner. I'd want my H to have easy access to take over that LLC upon my death.
Crap. I didn't even think of some of this stuff until right now. I guess I do need to bite the bullet and get my affairs in order with an attorney. I know it's silly, but I feel intimidated. I've never needed to see an attorney for anything before (other than a property closing).

Most of us don't bite, I promise

If you have an LLC that holds assets, you definitely need to get that squared away. I don't know how Louisiana treats LLCs when a sole member dies. It's the only state with its roots in French civil law. The other 49 states are based on British common law. I personally try to form everything in Delaware so I only have to remember one set of rules

I would guess that basic estate planning will run you under $1,000. It can go higher than that if there are complicated tax issues to be addressed. A lawyer who wants to keep your business should be very happy to outline everything that needs to happen before they start billing you.

short+sassy · October 2015

formerlyGDaisy09 said:

short+sassy said:

Oh! Additional question about medical proxies. Is it important that the person I choose as my medical proxy would actually be able to show up personally at the hospital?
After seeing the other posts, I would like to choose my H, but with my sister as an alternate if H and I are both in bad shape. But she lives halfway across the country. If I'm in an accident and there are immediate medical decisions that need to be made, she would not be there to make them. Or is my written medical directive enough until she gets there? Or maybe she wouldn't want to even come at all just to see me like a vegetable. We're friendly, but not close.

From what I heard last night, and know from the medical ethics courses I took, I don't believe it is necessary that the proxy be available in person, just that the medical staff be able to reach them.

You do want to be careful about alternates, and making sure they're both on the same page with your wishes, some ethical issues would come up if say something happened to you, your H was unreachable at first, so your alternate was contacted, and then your H and your sister disagree on things. It's very important that whoever you choose understands that they are speaking for you (not for what they want for you), and that you've had ongoing conversations about what you would want.

This is also why you want some basics in your written directive...it could even be something like; everything is to be done until my medical proxy is reached.

Many hospitals have staff that is trained to help people set-up their advanced directives.

Thanks! That is great advice and exactly what I would want. I really wouldn't want my sister to be my alternate unless it was something like my H and I were both in a bad car accident and he wasn't physically/mentally able to act as my proxy. Not just that they couldn't get in touch with him for a couple hours.

blondie42107 · October 2015

short+sassy said:
Oh! Additional question about medical proxies. Is it important that the person I choose as my medical proxy would actually be able to show up personally at the hospital?
After seeing the other posts, I would like to choose my H, but with my sister as an alternate if H and I are both in bad shape. But she lives halfway across the country. If I'm in an accident and there are immediate medical decisions that need to be made, she would not be there to make them. Or is my written medical directive enough until she gets there? Or maybe she wouldn't want to even come at all just to see me like a vegetable. We're friendly, but not close.

@short+sassy
Our local hospitals will communicate with the patient advocate via phone. So it's extremely important that your primary MD and your local hospital of choice have a copy of this document. If something happens outside of that area, the primary MD can forward that information to whatever hospital.

vlagrl29 · October 2015

so is it best to have the attorney that did our wills add this medical proxy to it or are there papers online that you fill out? I would want it to be legit in case something horrible happened.

vlagrl29 · October 2015

we currently have our wills in the safe deposit box at the bank and both sets of parents able to open it as a beneficiary.

formerlyGDaisy09 · October 2015

vlagrl29 said:

so is it best to have the attorney that did our wills add this medical proxy to it or are there papers online that you fill out? I would want it to be legit in case something horrible happened.

You would have to check with your state...but I think in most cases a lawyer is not necessary, I searched "My State Advanced Directive" the PDF came-up. Looks like my state requires that it also be signed by either; 2 witnesses, a notary public, or a justice of the peace.

this would not be something you would want to store in a safety deposit box, but rather make copies and distribute among those that might need it (keep track of who has it so if you decide to update it you can get them a new copy).

Sisugal · October 2015

All done.

Xstatic3333 · October 2015

This has really got me thinking. H and I are both only children, and I hate to give a friend this burden (especially since I'll already have to ask one to be our "take the kids" person). I trust my H and parents to follow my wishes, but H and I are always together and my parents are already in their late 60s. Ugh. I've definitely got some thinking to do!

formerlyGDaisy09 · October 2015

Xstatic3333 said:

This has really got me thinking. H and I are both only children, and I hate to give a friend this burden (especially since I'll already have to ask one to be our "take the kids" person). I trust my H and parents to follow my wishes, but H and I are always together and my parents are already in their late 60s. Ugh. I've definitely got some thinking to do!

That's the great thing about Advanced directives, you can change them as often as you want to. if you wanted to name your parents now, you could change your AD if their status changed.

Xstatic3333 · October 2015

formerlyGDaisy09 said:

Xstatic3333 said:

This has really got me thinking. H and I are both only children, and I hate to give a friend this burden (especially since I'll already have to ask one to be our "take the kids" person). I trust my H and parents to follow my wishes, but H and I are always together and my parents are already in their late 60s. Ugh. I've definitely got some thinking to do!

That's the great thing about Advanced directives, you can change them as often as you want to. if you wanted to name your parents now, you could change your AD if their status changed.

Good point! That's probably what I'll do then. H may even want to use them for himself. I figure once I am PG we will hire a lawyer to write up real wills, so perhaps we can just wrap this in.

MommyLiberty5013 · October 2015

We have a Living Will/Health Care Directive set up for our state. DH also found a form online that isn't a legal document, but it provides questions that a person can answer to help that person's family/spouse determine their wishes. We each filled one out and have it in tandem with our legal docs.
For example, it asks things like: Having my pain managed for me so much that I may lose my ability to think or speak clearly, is important to me. Scale of 1 to 10.
It's basically a gauge for others to know your wishes so they feel better about making decisions.

blondie42107 · October 2015

Check out (Google) Five Wishes. It meets the legal requirements in most states (40 some) but can be included with documents in other states where a different form is needed. Either way it's a great outline for thought and discussion.

Living wills are gray in my state, not always legally recognized. DPOA for health care and patient advocates are.

vlagrl29 · October 2015

MommyLiberty5013 said:

We have a Living Will/Health Care Directive set up for our state. DH also found a form online that isn't a legal document, but it provides questions that a person can answer to help that person's family/spouse determine their wishes. We each filled one out and have it in tandem with our legal docs.
For example, it asks things like: Having my pain managed for me so much that I may lose my ability to think or speak clearly, is important to me. Scale of 1 to 10.
It's basically a gauge for others to know your wishes so they feel better about making decisions.

Living Will! - that's the word I was thinking of. We need to do that.

not MM Related: End of Life Planning

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