DYING: A Book of Comfort
Companion website about dying, bereavement, loss, grief — and aging with spirit
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Practical Matters• Documents you need to protect your own and your survivors' rights • Other documents and information you should have available in an easy-to-find place: • Helpful Links DOCUMENTS YOU NEED TO PROTECT YOUR OWN AND YOUR SURVIVORS' RIGHTS
These documents are not just for old or sick people. The big court cases about sustaining the lives of people in a coma have been about young women in their twenties. So think about these issues! DOCUMENTS GOVERNING YOUR MEDICAL AND HEALTH CARE: An advance directive (an advance medical directive or an advance health care directive) a document stating what medical care you want if you are unable to speak for yourself. Laws vary from state to state, so you should prepare these documents under the guidance of a local attorney. There are two main kinds of advance directive: a living will and a health care proxy (or durable health care power of attorney). Of these the second is probably most important. · A LIVING WILL, a legal document in which you spell out the kind of medical and health care and life-sustaining treatments you want or don't want when you can no longer care for yourself. (Should they shut off the ventilator when all hope seems lost, or should they do everything possible to save you, including tube feeding you as long as possible, no matter the cost? Under what circumstances would you want chemotherapy, blood transfusions, exploratory surgery, amputation, etc. Under what circumstances are you willing to donate your organs?) For more information, go to the U.S. Living Will Registry (link provided). For a contrarian view, read Charlotte Allen's piece (link below). You do not name another person to make medical decisions for you in a living will. For that you need to prepare a health care proxy or durable health care power of attorney. (Don't confuse living wills with living trusts, described under legal and financial documents.) · A HEALTH CARE PROXY (or DURABLE HEALTH CARE POWER OF ATTORNEY), a legal document in which you name someone (besides the doctor and/or hospital) to be your advocate and make decisions about your health care should you become incapacitated. It is probably a good idea to have one of these even if you don't expect to die soon, because if you are involved in an accident and aren't in a position to make decisions, you want a person you choose to be able to make them for you. Don't choose someone kind and gentle; choose someone smart and able to speak strongly to authorities. You can have both — a health care proxy naming a person to make the decisions and a living will to help guide that person in making the decisions. It is also important to discuss the feelings, beliefs, and reasoning behind your preferences while you are in a position to do so, as what you say may be more morally and emotionally persuasive than what you provide in writing. · You may decide at some point to have a do not resuscitate (DNR) order — another type of advance directive — a request not to have cardiopulmonary resuscitation (CPR) if your heart stops or if you stop breathing. If not given such instructions, hospital staff will try to help any patient whose heart has stopped or who has stopped breathing. If you (or your health care proxy) tell your doctor you don't want to be resuscitated, your doctor will put a DNR order in your medical chart. LEGAL AND FINANCIAL DOCUMENTS: Your last will and testament, which is legally binding, details how you want to distribute your earthly goods — your valuables, what you want your survivors to have. You should also prepare: A durable financial power of attorney, appointing someone to make financial decisions on your behalf until your death (should you become unable to do so). You might want to explore the possibilities of a living trust, which gives a designated person (a trustee) authority to hold, manage, and distribute property for you while you are alive and to distribute it when you die. For this and the other legal and financial arrangements, you need sound advice from an expert. PERSONAL WISHES AND LEGACY DOCUMENTS: · A letter of intent (which is not legally binding) can spell out the things that would make you happy should you experience a disabling health event, so that you can't care for yourself and might not be able to express yourself. (Kristie Miller's letter of intent is a great example.) · An ethical will (a legacy letter, a life letter — I haven't seen an ideal name for this kind of document) tells your survivors what you want them to know. This, too, is not legally binding. This document (or videotape or audiotape) conveys expressions of love, blessings, and regret; it conveys treasured personal and family stories and life lessons; it articulates what you value and want to be remembered for, what you want your children and grandchildren never to forget. You may convey what you want your survivors to know in print, on an audio or video recording, as a one-page letter, as collection of messages, a story, a memoir, genealogical records, a family history, a series of recorded interviews — the possibilities are endless. These needn't be fancy or ambitious, but they can be, and you can arrange for someone to help you through a writer's organization or the Association of Personal Historians, among other organizations. The Financial Planning Association reports from survey results that these "non-financial leave-behinds" are ten times more important to most people than their parents' financial legacy. Also, find the time to document your medical history and the medical histories of all the family members that you can document. This information may be as important three generations down the line as it is now. At some point we'll find it easy to leave behind a sample of DNA, too. And don't forget to gather and pass along favorite family recipes. Food is such an important part of our legacy of memories. [Go Top] Other documents and information you should have available in an easy-to-find place: Names, addresses, phone numbers, birth dates, and social security numbers of everyone named in your will and other documents, and everyone important in your life, for your executors and guardians of minor children.
Details about principal income and about your retirement savings accounts and other assets, including names, addresses, phone numbers, and social security numbers of principal beneficiaries. Details about your debts (especially to whom and how much). Include mortgages, loans, other debts. List of property you own, with values (include real estate, vehicles, jewelry, furniture, other assets) List of jointly owned property, and names of co-owners. Location of all vital and legal documents (including birth certificate, prenuptial agreements, marriage certificates, divorce decrees, military records, immigration documents, property deeds, recent tax returns, wills). A list of all financial assets and accounts, with bank ccount numbers and branch locations. A master list of all your accounts (savings, checking, credit card, stocks, bonds, other investments, insurance, frequent flier accounts, etc). List each institution, type of account (checking? savings? money market?), owner or policyholder (you? you and spouse?), account number, contact information for institution. A list of computer access codes and key passwords, or instructions on how to find them. Details on all forms of insurance (life, health, dwelling, car, etc.). A list of safe-deposit boxes, with an inventory of the contents. List all irreplaceable valuables (jewelry, heirlooms, photo negatives) and critical documents ( (marriage license, birth certificate, stocks and bonds) that are stored under lock and key and photocopy the documents for your home office files. ASSISTED LIVING AND END-OF-LIFE PLANNINGAssisted Living: All the Right Questions. What to know and what to ask when choosing an assisted-living facility. Julyssa Lopez (Washingtonian, 11-09) explains key questions to get info on: What care is provided? Is the facility well run? Can it handle emergencies? What if my health gets worse? What do I look for in a contract? Can I change the contract? Are there hidden fees? Can I get a refund? Can they kick me out?
Breaking the Silence (John Leland, NY Times, 3-18-08, on talking openly in the family about sharing the family's wealth in a way that helps, not hurts, the next generation)
Breaking the Silence: Helping Clients Discuss Estate Plans with Their Families (excerpt from white paper sponsored by GenSpring Family Offices). Written for wealth management professionals, but helpful to those wondering whether and how to pass their wealth on to the next generation.
Elder Care, a few books about
• The Elder Law Handbook: A Legal and Financial Survival Guide for Caregivers and Seniors • Elder Care: What to Look For, What to Look Out For!, by Thomas M. Cassidy (which includes, among other things, useful checklists) • Eldercare 911: The Caregiver's Complete Handbook for Making Decisions by Susan Beerman, Judith Rappaport-Musson • Eldercare for Dummies by Dr. Rachelle Zukerman • The Eldercare Handbook: Difficult Choices, Compassionate Solutions by Stella Henry and Ann Convery Help! Keith Olbermann on 'The Life Panel.' "Have that conversation." Keith Olbermann's statement about the conversation he had with his father, who was exhausted and terrified from multiple procedures and complications after having his colon removed. Conferring with the doctors and asking them to give him a rest from procedures was a "life panel," not a "death panel."
The Hidden Dangers in Living Wills, excerpt on PBS NOW site from Understanding Your Living Will: What You Need to Know Before a Medical Emergency by Ferdinando L. Mirarchi. Mirarchi explains that living wills may be misinterpreted as "Do Not Resuscitate" (DNR) orders or "Do Not Treat" orders. They also lack code status designations that medical personnel would readily understand. "Full Code Except Cardiac Arrest" will serve you better than "Do Not Resuscitate (DNR)," which should not be in your living will. You should also avoid putting "No Code" or "Do Not Intubate," "Chemical Code," or "Slow Code," in your living will. Read here online for why. Be very specific about what YOU want, or don't want, in your living will, but write one!
Jane Brody's Guide to the Great Beyond: A Practical Primer to Help You and Your Loved Ones Prepare Medically, Legally, and Emotionally for the End of Life -- a practical book, with explanations and to-do lists for everything from advance directives and why a living will is not enough to funeral plans, living with a bad prognosis and dealing with uncertainty, caregiving, hospice, communicating with doctors, assisted dying, organ donation, autopsy, and legacies.
Legal Guide for the Seriously Ill: Seven Key Steps to Get Your Affairs in Order, prepared by the American Bar Association Commission on Aging for the National Hospice and Palliative Care Organization. Step-by-step instructions on planning for health care expenses; managing health, money, property and personal decisions; planning for the care of dependents; knowing your rights as a patient; and getting your legal documents in order--with information on regulatory and legislative changes related to health care.
Long-term care insurance, advice and information about:
• ElderLaw Answers (What to Look for In a Long-Term Care Insurance Policy, When Should You Purchase Long-Term Care Insurance?, How Much Insurance Should You Purchase?, Which Spouse Should Get Coverage?,Long-Term Care Insurance and Medicaid Planning, Partnership Policies, The Tax Deductibility of Long-Term Care Insurance Premiums, The Taxation of Benefits, Consult With a Qualified Agent, Books on Long-Term Care Insurance) • National Clearinghouse for Long-Term Care Information U.S. Dept of Health & Human Services • ResearchLTC (get comparisons of top 10 insurers & policies: Allianz, Bankers Life & Casualty, Genworth Life, John Hancock, MassMutual, MetLife, Mutual of Omaha, New York Life, Prudential, State Farm) • The Coming Caregiver Crunch and Why This Gerontologist Owns Long Term Care Insurance by Ken Dychtwald, Huffington Post • Long-Term Care Insurance: The Essentials (free PDF from MetLife, an insurer) • J.K. Lasser's Choosing the Right Long-Term Care Insurance by Benjamin Lipson • Long-Term Care: Your Financial Planning Guide by Phyllis Shelton Organizing and dealing with things and information
• The Boomer Burden: Dealing with Your Parents' Lifetime Accumulation of Stuff by Julie Hall • Don't Toss My Memories in the Trash-A Step-by-Step Guide to Helping Seniors Downsize, Organize, and Move by Vickie Dellaquila • Get It Together: Organize Your Records So Your Family Won't Have To by Melanie Cullen and Shae Irving • If Something Happens to Me by Joseph R. Hearn and Niel Nielsen (a workbook to organize legal, financial, and insurance information) • The Senior Organizer: Personal, Medical, Legal, Financial by Debby S. Bitticks, Lynn Benson, and Dorothy Breininger |
The Beneficial Effects of Life Story and Legacy Writing by Pat McNees (Journal of Geriatric Care Management, Spring 2009)
Tess Vigeland interviews DJ, a 58-year-old woman from Durham, NC, who after many years with a chronic illness learns she has terminal cancer. At that point she realized she should make arrangements for her animal companions and her possessions…" those very difficult decisions we have to make in our lives about what to do with what remains after we leave." "When my mother died," she says, "we had to go through her things, and it was so hard, because every time I was getting rid of something I felt like I was giving away a piece of her. So what I'm doing, I'm giving away a lot of things already… "In truth, none of us knows how much time we have left. … Please do this. You owe it to your family; you owe it to the people who love you. When they lose you that trauma is so overwhelming, the last thing they need is to try to second guess what you wanted. Love them enough, love yourself enough, to do this for them. Face your fears about it and just do it. It's terribly scary, it's like the monster in the closet. But when you open the closet, the monster's not there. And it's going to happen to all of us. "  DYING, A Book of Comfort pageTracker._trackPageview(); } catch(err) {} |
