Taking Care of Loved Ones
What Every Woman Should Know
A Woman’s Role Still Includes Caregiving
Although much has changed about our expectations of women’s work these days, in most families, there’s one role women can still be counted on to play: caregiver to the ill, old and dying. When a loved one needs care, it’s the women in the family we most often turn to.
That’s true whether it’s a sick child home from school with the sniffles or an elderly and infirm parent who needs long-term care. And because women still outlive their husbands the majority of time, the burden of caring for a spouse in failing health most often falls on a wife’s shoulders.
A recent Penn State Study underscores the fact that a woman’s touch is a part of the caregiving process, not only for spouses but for other kin as well. Toni Miles, MD, director of the Center for Special Populations and Health in Penn State’s College of Health and Human Development, reported that each year at least a million people deal with the death of an elderly spouse or patient. She found that in 75 percent of surveyed cases, the primary caregivers were either the wives, female significant others, or daughters of the dearly departed.
So, given that the odds greatly favor the chance that you, too, could one day be responsible for helping a loved one through a serious, possibly even terminal illness, what can you do to make the process more bearable -- emotionally, physically and financially -- for you and those you care for?
Making Sure Loved Ones Do Their Homework
Few decisions can bring greater anguish than trying to make a life-or-death decision on behalf of a loved one. We might think we know what they would want for themselves, but do we really?
A recent study published in the January 1997 issue of the Annals of Internal Medicine found that most of the elderly and the seriously ill surveyed were in favor of extraordinary means and painful treatments if it meant prolonging their lives, even if the quality of their lives declined. That conclusion contradicts the prevailing wisdom that most of us would rather have the plug pulled than be subject to feeding tubes, machine-aided respiration, and the like.
Since we’d probably rather not have to second guess our loved ones on matters as weighty as these, the best course of action is to encourage our elderly relatives to commit their wishes to writing, generally in the form of a living will. The living will allows the individual to describe when, where and how he or she wants to receive medical treatment and life saving intervention. A properly filled out living will can go along way toward easing your emotional burden should you have to step in on behalf of a loved one during a medical emergency.
Include a health care power of attorney
A living will is a good start, but it alone can’t give either the patient or the caregiver the clout necessary to see the patient’s wishes are carried out. That takes the legal authority granted by a health care power of attorney.
In a landmark study conducted by the American Medical Association in the mid-1990s, researchers found that a living will alone often gained the patient little control over his or her medical treatment. In almost half the cases, the study found, a patient’s stated desires against resuscitation or extraordinary intervention were ignored, and the patient received those treatments anyway. Those patients who did have their directions followed often had to wait weeks first. The study found that on average, a physician waited from 22 to 73 days to write orders complying with the patients’ requests. Of that number, 48 percent of the orders were written two days before the patients died.
That’s why it’s imperative for the patient, as well as the patient’s family, to have a trusted loved one empowered to speak for the patient with full legal authority. A health care power of authority does just that.
Don’t Stop with Health Care Matters: Look to the Financial Side
Of course, a loved one too ill or injured to make decisions about his or her own medical treatment is too ill to make financial decisions as well. That’s why part of your loved one’s emergency planning should include provisions for managing his financial matters as well.
Useless as long as the loved one is in good health and of sound mind, a durable power of attorney lets a chosen individual sign a patient’s name in financial matters when the patient is no longer mentally competent (even if only temporarily). In legal terms, you become the patient’s attorney-in-fact, even though you may not be an attorney at all, and can sign checks, authorize transactions and similarly help manage your loved one’s financial matters.
Another alternative is the living trust, a more comprehensive estate planning tool that has other advantages as well. When a loved one falls ill, you, as Successor Trustee, can step in and begin managing his affairs for him, according to the trust’s instructions. Should the loved one die, the living trust includes instructions for how his assets should be distributed to beneficiaries, all without the interference, delays, publicity and expense of probate court.
Be Cautions about Joint Tenancy
Yet another option that some consider -- but perhaps should think twice about -- is joint tenancy. Under joint tenancy, your loved one would add your name to the title of an asset, such as a bank account or home, as her joint tenant with rights of survivorship. As joint tenants, you each have full ownership of the asset and complete authority over its control. If ill health befalls one joint tenant, the other can step in immediately, without court intervention, to manage the asset as needed. If one of the joint tenants dies, the other assumes full ownership immediately.
Joint tenancy looks like a solution, at least on the surface, but it brings with it significant disadvantages for your loved one. For instance:
• Adding your name as joint tenant to a major asset, such as a home, could trigger costly gift taxes or estate taxes for your loved one.
• If you become a joint tenant on a loved one’s checking account, you’ll have to keep scrupulous records showing that you spent none of the funds for your own purposes and only on behalf of your loved one. Otherwise, gift taxes may be incurred.
• If you have debts -- such as judgments from lawsuits, bad debts, tax liens, etc. -- creditors can now seize your loved one’s entire asset for which you are a joint tenant to satisfy their claim against you.
• If your loved one dies, you’ll become sole owner of the asset, which might become a source of family friction if your loved one had other heirs to whom she wished a portion of her estate to be distributed. If you take it upon yourself to share the wealth with the rest of your family, you could incur gift taxes or estate taxes!
Thinking Ahead to the Final Passage
That brings us to an even bigger planning issue: the need for your loved one to plan for how her wealth will be distributed to loved ones after she passes on. The larger her estate (including all her worldly possessions, such as real property, bank accounts, life insurance, retirement funds, investments, etc.), the greater her need for professional planning and options to help minimize estate settlement costs, such as probate fees and estate taxes. In those cases, the best course of action is to urge your loved one to seek out the guidance of an estate planning attorney.
If your loved one’s estate is very small, and her plans for distribution are straightforward, then a simple will may be all she needs. The important point is to encourage her to put her wishes down in writing, to avoid family squabbles and potentially costly legal battles in the future.
Planning Checklist
Here’s a quick list of tips to help you and your loved one ensure that a medical emergency is handled as painlessly as possible . . . emotionally, physically and financially. Make sure your loved one:
• Keeps an updated list of the location of important documents (living will, health care power of attorney, estate plan, final instructions, etc.) and make sure you know where to find the list.
• Keeps a current list handy of her financial institutions and her professional advisors, with addresses and phone numbers.
• Distributes copies of her living will to all her medical caregivers, as well as to her family members.
• Talks over her wishes for critical care and extraordinary intervention with her medical caregivers to ensure they fully understand her intent.
• Discusses with family members just what type of medical treatment she wants in an emergency, to minimize disagreements in a time of crisis.
• Shares with family members her wishes for the distribution of her personal effects and valuables, as well as her desires for her funeral arrangements.
Helping to Convince a Loved One to Plan
Discussing the possibility of infirmity or death is a touchy subject in the best of times. So, don’t be surprised if a loved one balks at the notion that he or she may one day become dependent on others for help.
One way to help motivate a loved one is to talk about what happens if there is no advanced planning. Whenever a loved one fails to plan in advance, the odds increase greatly that he or she will be subject to an often humiliating public legal proceeding called a living probate. Also known as a guardianship or conservatorship proceeding, this court hearing will bring before a probate judge all the personal facts of your loved one’s present circumstances. Does he soil himself uncontrollably? That fact may become court record. Does she think the hall tree is her beloved sister Ruthie? The judge may need those details, too.
You need only remind your loved one of the well publicized case of Groucho Marx to drum home the fact that conservatorship proceedings can expose us at our most vulnerable to public scrutiny and derision.
Even worse, however, is the fact that the probate judge will have full authority to appoint whomever he sees fit to not only serve as your loved one’s caregiver in health care matters, but also to oversee your loved one’s financial affairs. Because probate judges have complete discretion, they can choose whomever they want, and often appoint professionals for the role: individuals who will charge your loved one for their services. Enduring a living probate is not only a public humiliation, with lots of delays and added expenses that must be paid out of your loved one’s assets, it also offers absolutely no guarantees that the person your loved one would have chosen, given the chance, will end up being the actual person in charge.
Finally, death probate will also be required if your loved one has made no provision for passing on his estate after death. Just like living probate, death probate can be time consuming, expensive, public and unpleasant for the family members left behind. And without any instructions from your loved one, the probate judge will decide who gets what from your loved one’s legacy.
These possibilities can be enough to persuade even the most reluctant elder to take action.
|