Damomma, also known as Elizabeth Soutter and the woman who helped design my website, has a beautifully touching post on caring for a loved one at the end of life.

“We’re going to turn you on your side,” I said into her good ear, “and in a minute you’ll be all warm and fresh.”  I put my arms on her naked shoulders, lifted when the aid said lift.  My grandmother cried out.  I turned her into my chest,  wondering whether my presence was making it better or cosmically worse.

That was when she inhaled.  Deep against me, nuzzling, just like my babies did.  And it occurred to me that I was probably the first woman to hold her like that in about eighty years.  I rested my cheek against her head, stroked her hair.

As you can see, it’s a good idea to have some tissues handy before you go read the whole story. And return to her blog often, because she’s just as likely to have you laughing out load.

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The New York Times has a new article on Estate Planning as a Family Conversation.

Families that speak freely about estate planning can sometimes address awkward situations that might arise, like the choice of the executor — who is in charge of distributing assets after someone dies — or succession plans for a family business or the leaving of assets in trust….

How families handle delicate issues depends both on the particular circumstances and the personalities involved. Sometimes it is best to have a series of talks, rather than covering everything all at once, Mr. Collier said. Or parents may talk to each child separately, rather than addressing them as a group. Afterward, he says, parents should ask, “What do you think?” Adult children “may have great ideas and opinions,” he said.

I wish the article had focused more on talking about planning for incapacity and who will make health care decisions while you are alive, or handle your property if you are unable, but any kind of conversation about estate planning is better than none at all.

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And, since Spring is on its way and outdoor exercise becomes a little more pleasant, here’s a great reminder about the importance of exercise in healthy aging.

“I’m 86 and have walked every day of my life. The public needs to wake up and move.”

“I’m 83 going on 84 years! I find that daily aerobics and walking are fine. But these regimens neglect the rest of the body, and I find the older you get the more attention they need.”

Regular exercise is the only well-established fountain of youth, and it’s free. What, I’d like to know, will persuade the majority of Americans who remain sedentary to get off their duffs and give their bodies the workout they deserve? My hope is that every new testimonial to the value of exercise will win a few more converts until everyone is doing it.

Hmm, I’m 37 and I don’t walk every day.  I have sneakers, two legs that work and no excuses.  Maybe today is the perfect day to start my walking regimen. After all it is March 4th, what better time to March Forth!

]]> http://www.hamilllawoffice.com/estate-planning/linklove1/feed/ 0 http://www.hamilllawoffice.com/for-caregivers/trash-or-treasures/ http://www.hamilllawoffice.com/for-caregivers/trash-or-treasures/#comments Wed, 03 Mar 2010 18:18:41 +0000 admin http://www.hamilllawoffice.com/?p=465

I went to an antique appraisal event over the weekend. The fees went to charity, so I figured it would be a fun way to find out some more information about some family “heirlooms.” During the rather long wait, people were talking to each other and sharing information about their treasures.  It got me thinking about what we keep and why.

I try to abide by the William Morris quote to “have nothing in your homes that you do not know to be useful and believe to be beautiful,” but there were some people there who had been holding on to things that they did not find beautiful at all, but kept because someone had told them they were worth something.  Most of them left feeling free to finally throw out the piece of junk that they never liked anyway.

There was another person who had a lovely item that he’d kept in a box in his basement for decades. He said that before he had it, his parents had kept it in a box in their basement.  It turned out to be worth over $10,000.00. As he left, he said he was going to keep it in the box in his basement to preserve it.  It seemed strange to me to keep such a lovely thing under wraps. Why not sell it and put the $10,000.00 in a box in your basement? Or display it and get enjoyment out of it.  And, of course, my estate planning brain kicked in and I wondered if he would re-do his will to include this item.

Many people, like me, found out that they did not have any hidden treasures in their homes, but would continue to display and treasure their items because they found them beautiful and derived pleasure from their existence.  That’s when things are truly priceless.

What are you holding on to because you think maybe it’s worth something? If you found out that an item you didn’t like was worth money, would you feel differently about it?  If you found out that an item was worth a significant amount of money, would you reconsider how you would pass it down?

Wheelchairs 101: In this practical class learn how to disassemble and fold up a client’s wheelchair and wrangle it into the trunk of their car. Final exam will take place outside, in the rain.

Hospital Hygiene: For those emergency estate plan signings at the hospital with immune-compromised client learn how to scrub-up, gown-up and conduct a signing while wearing latex gloves in between medical exams.  Extra credit project: flagging down busy hospital staff to serve as witnesses.

Interior Design for Attorneys: Learn how to design and decorate your office so that it is easily accessible by folks in wheelchairs, walkers or people walking 3 across (one on each arm).  Design a childproof office with some quiet things to keep the child visitor amused.  Final exam scavenger hunt to find the following items: reading glasses, lap desk, fat pens, and an extra lamp.

Other things I wish they had taught us, but that aren’t so easy to learn in school: how to deal with client’s deaths, which come often in an elder law practice; how to feel comfortable walking into a nursing home, rehabilitation hospital or the bedroom of a client who cannot get out of bed but needs to see their attorney; what to do when someone cries in your office or lashes out at you in their grief, and how to gently suggest to someone that maybe the best solution to their problem doesn’t involve the legal system.  These I just learn as I go along, and am honored when I get the chance to do so.

I’ve had a few clients at Linden Ponds and was pleased to see them doing such focused, good work.

Click here for the Patriot Ledger article.

No matter which parent is in my office, they are inevitably going to ask me “Does it even matter if I choose a guardian? Won’t her other parent get custody anyway?”  In most situations, yes, the other parent will be the natural guardian of the child.  However, I still advise my clients to select a guardian and at least one alternate to serve in the event that both parents pass away.

There are a couple of reasons for this.  One is, you never know what will happen.  Your former spouse could predecease you and you want to be sure you’ve nominated someone.  You could predecease your former spouse, but in the event that he or she passes away while your child is still a minor and there is no other document nominating a potential guardian, yours would be used by the court to determine what the parent’s intent was for their child.

Additionally, if you and your former spouse can agree on guardians to serve if neither parent is around, you can both make provisions to name that person, which again provides valuable guidance to the court.

“It doesn’t matter anyway” is an easy excuse to use to put off making a plan, but doesn’t your child deserve better than that?

I am acutely tempted to answer, “Of course not — my father would not want heroic measures.” But I hesitate because I know it might not be true. In the past, he has wanted everything possible done. This night is different, but I do not know if his answer would be different.

I look at my father. It is hard to tell if he is conscious. No one else is looking at my father. Everyone is watching me closely.

Finally, I say out loud the only thing I know to be true. “In the past, my father has asked that everything possible be done.”

Then I bend over my father and ask him in a clear, strong voice: “Daddy, do you want to be intubated again? Squeeze my hand if you want to be intubated.” I wait, but he does not squeeze. Instead, he surprises us all by nodding his head. He is weak, but the nod is unmistakable.

In the story, the nurses seem annoyed that they chose this invasive procedure.

What the doctor and nurses do not know, what I hesitate to admit even to myself, is that I almost gave them the answer they wanted: the reasonable one. But I would have been terribly wrong.

My father never really recovered. He could never again breathe without a respirator, he never left the hospital bed, and he eventually needed dialysis and a feeding tube. Six months later he died of heart failure.

I suppose my father’s decision was a mistake. But it was his mistake to make, not mine. My role was to support my father, no matter what, and to tell the truth, no matter how hard.

This is why when I talk to my clients about their health care proxy, I stress that it is not just enough to appoint someone to make those health care decisions, you must talk to them about the decisions you want them to make. You have to actually have the conversations about end of life care, intubation, feeding tubes and all those things that make most people uncomfortable. You also have to make sure that you are appointing someone who is capable of communicating your wishes during a medical crisis.

A lot of my clients use the Five Wishes Living Will to help them with these decisions. Other choose a living will designed by their church, still others write their own.  The important thing is that you do it, and then talk about it with those people to whom you are giving the authority to communicate those decisions.  And then trust that they will convey your wishes, not theirs.

When we last left our not-so-secret agent, she had been to the post office and had visited her client at the rehab hospital and was just finishing up lunch at an Indian Restaurant in Harvard Square….

2:00 p.m.  Location: The Bank

I had a check to deposit for the client, needed to be added to the client’s account as his power of attorney, and needed routing number information from the bank in order to start having his pension and social security checks directly deposited into his account.

I sat with the banker for about a half an hour.  She needed to see the original power of attorney, my driver’s license, and an addition piece of identification in order to add me to the account.  She checked to make sure that the power of attorney included banking powers but didn’t keep a copy of the document.  I had to sign some papers so that my signature is on file, and she helped with the deposit and routing number information.  We then reviewed the transactions that had taken place since the last bank statement so that I could take over the handling of my client’s account with a clear picture of his situation.

Without the power of attorney, she would not have been able to give me any information about his accounts or help me in any way.

3:00 p.m.  Location: My Office

After returning to my office, I set up my client’s bank account in a computer system (such as Quickbooks or Quicken) and paid the bills that had come in over the last week while he’d been in the hospital.  I made sure to sign the checks as “Client Name by Leanna Hamill as POA” and not just with my name or his name.  I then called my client to let him know that his bills had been paid.  He’d been concerned about not getting this done while he was sick.

4:00 p.m. Location: My Office

My urgent work for my client was done for the day, but I knew that in the future I’d need to talk to his benefits department, retirement fund account and health insurance company to get information from them.  I know that these companies need time for their legal departments to review the documents and then get the permissions entered into their system so I called each of these companies to let them know that I had been appointed as my client’s agent and that I wanted to send the appropriate document to them.  I’ll follow up next week to make sure that everything is in place for when I need it.

Being prepared isn’t just wise when you are planning, it’s an essential skill for a not-so-secret agent as well.

I hope you enjoyed the adventure of a not-so-secret agent. As you can see, it’s a big responsibility to give to someone but it’s also a vital thing to put in place.  Because my client appointed me to handle his finances and medical decisions when he is unable, he can concentrate on getting better and not worry about how his bills are going to get paid, whether his checks will be deposited, or who is making sure his medical bills will be covered by insurance.

Client profile (all details changed, obviously): 70 year old man with no immediate family. Had been living at home and recently fell. Due to complications he had been bouncing between the hospital, rehabilitation hospital and home and was back at the rehab hospital.  There was a case management meeting that morning and some other business for he and I to discuss.

10:00 a.m.  Location: my office. I was preparing my traveling bag since I knew I’d be out of the office most of the day.  Let’s take a look inside the bag:

1. Original health care proxy, power of attorney & HIPAA medical release form.
2. 2 copies of each of these documents.
3. Hand sanitizer. Clients (and other patients) at a hospital or rehab are always more susceptible to illness than other people, so I always make sure to carry hand sanitizer and we skip the handshakes.
4. Short sleeve shirt, which was on me, not in the bag. Nursing homes and rehabs often have the heat turned up higher than is comfortable for me in long sleeves, so I always make sure to wear short sleeves when visiting.
5. Business cards & pens.

11:00 a.m.  Location: Post Office.

Picked up client’s mail from his PO Box.  Filled out a temporary change of address card (signing it as agent under the power of attorney) to have his mail forwarded to my office since it looks like he’s going to be in the rehab hospital for at least a month.  The post office supervisor took the original and a copy of the power of attorney into the back room for about 15 minutes to review it.  Finally, she returned and gave me back the documents and said she’d process the address change.

12:00 p.m. Location: Rehab hospital.

I arrived at the rehab hospital and signed in. My client was in his room (with two roommates) and due to his condition we couldn’t go into an office or conference room.  We did our best to preserve privacy by pulling the curtain, but there were still a few people coming and going.  They were involved in their own business and my client said he felt comfortable going over his mail and bills.

We reviewed his mail, wrote out some checks to pay bills that had come in and talked about his health insurance benefits. His stay was currently being covered by Medicare, but we needed to know about his health insurance coverage.  I had faxed a copy of the HIPAA form to the insurance company earlier that day, so I called and requested that they mail me a copy of his benefit booklet.

The nursing manager, social worker, occupational therapist and physical therapist arrived for the care plan meeting.  They requested copies of the health care proxy and HIPAA release for my client’s file and so they could speak to me later if I called.  The nurse reviewed his medical condition and prognosis, the rehab therapists reviewed what had been going on with his rehabilitation and the social worker talked about his insurance benefits and their plan if it appeared that his benefits were running out.

It looks like he’ll be able to start some rehab on his legs, but will need to wait for clearance from his doctor after his visit next week before he can start walking again.  He’ll need someone to escort him to the hospital for his doctor’s visit so we arranged for a nursing assistant (CNA) to accompany him on his visit.

We finished up our visit, I signed out of the facility and headed to lunch.

Tune in tomorrow for the further adventures of the not-so-secret agent….

1.  Your attorney cannot make your decisions for you.  Your attorney can provide you with the information you need to help you make an informed decision. We can’t tell you which adult child to choose as your health care proxy, or who to appoint as guardian for your children. But we can tell you what those roles involve and help you work through the pros and cons of each choice.

2. Your attorney cannot fix your relationship with your sibling/parent/spouse/child/self. Your attorney can provide you with a referral to a good therapist. And not only will you be seeing the proper professional for your needs, you’ll most likely be paying a lot less than if you attempted to use your attorney as your therapist.

3. Your attorney cannot predict the future.  Your attorney can tell what the consequences are if certain things come to pass. A lot of times my meetings with clients go through the difference scenarios of “what if” – what if mom lives at home and we bring in help, what if dad needs a nursing home, what if I move in and take care of them, what if something happens to us both at the same time? We can never predict what will happen, but we can help educate our clients so they are prepared for what comes.

4. Your attorney cannot read your mind.  Your attorney can provide you with advice and guidance if you ask questions, and answer the questions your attorneys asks you.  Open communication with your attorney can help you get the most out of your relationship and feel the most prepared for what the future brings.

]]> http://www.hamilllawoffice.com/for-caregivers/what-an-attorney-can-and-cannot-do/feed/ 0 http://www.hamilllawoffice.com/parents-of-minor-children/divorce-who-handles-money/ http://www.hamilllawoffice.com/parents-of-minor-children/divorce-who-handles-money/#comments Wed, 13 Jan 2010 15:37:50 +0000 admin http://www.leannahamill.com/?p=321 If I am divorced and I pass away, does my child’s other parent automatically get any money I leave to my children?

This is a common question from my clients, and something that often holds people up from making a plan.  The simple answer is: not necessarily.  The more complete answer is below.

1. Check the Divorce Agreement. The first thing to do is check your divorce agreement or parenting plan. Often there will be instructions in there about any money you may be required to leave the other parent, in the form of life insurance or other provisions.  There may be a requirement that one or both parents fund a trust for the child.  If you aren’t sure what the terms mean, you should check with your divorce attorney and definitely bring the agreement to the meeting with the estate planning attorney.
2. DIY Estate Planning.   What I often see people doing is naming their minor child as the beneficiary of their life insurance policy or retirement accounts, as a form of do-it-yourself estate planning.  They mean well and figure that their child will be provided for with this money.  What they may not understand is that a minor child cannot inherit outright and a conservator will need to be appointed by the Court to handle the money until the child turns 18.  Most often, the surviving parent will be appointed the conservator and have full control over the money.  And the child will have full access to the funds the day they turn 18.  If either one of these things does not appeal to you, you need to go a step further.
   The other way that people often attempt to do their own estate planning is to name a sibling or parent as the beneficiary of these policies with an informal agreement to use the money to care for the child. This carries its own risks because the funds could be open to claims against the sibling by creditors, could get mixed into a sibling’s divorce, or could be at risk if a parent is on Medicaid or other public benefits.
3. Estate Planning On Your Terms. The best way to insure that your wishes are honored even after you have passed away is make a legal agreement with someone you trust to handle the funds for your child in the way you instruct them to and to set the ages at which your child will be able to access the funds themselves.  Your estate planning attorney can help you decide the best option in your situation and according to your budget – whether it’s a fully funded revocable trust, a testamentary trust or some other method.

The key is to not let your concerns hold you back from putting a plan in place.  Your attorney should walk you through all the options and answer all your questions before the documents are finalized.  Then you can rest assured that your child’s inheritance will be managed by the people of your choosing according to your instructions.

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Estate Planning, Probate and Trusts involve complex areas of law. Individual circumstances must be considered before any advice can be given.  The general information above is not to be construed as legal advice, which can only be given after consideration of the unique facts of each matter. Please seek the advice or counsel of your attorney, financial advisor or CPA as it may be appropriate.