Category Archives: Elder Law

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Medicare to pay for end-of-life care counseling

Effective January 1, 2016, Medicare plans to pay doctors to speak to patients about their end-of-life care. The doctors will provide counseling and discuss options that range from care that’s more focused on comfort than extending life to doing whatever is possible to resuscitate a dying patient. Some doctors are already having conversations about this topic with their patients but are not billing for it.

Medicare payment will ensure that more doctors will have these conversations which many feel are critical to high-quality care.

The Institute of Medicine issued a report last year which found that few people make their wishes known so many deaths “are filled with breathing machines, feeding tubes, powerful drugs and other treatments that fail to extend life and make its final chapter more painful and unpleasant.” The report, “Dying in America” is free as a PDF or can be paid for and ordered as a bound volume.

While most people have given thought to how they would like to die, many have found it difficult to communicate those views and choices to family and loved ones and, in many cases, family and loved ones have their own perceptions and views about death that can influence discussions about dying. Most people envision their own death as a peaceful and an ideally rapid transition. However, with the exception of accidents or trauma or of a few illnesses that almost invariably result in death weeks or months after diagnosis, death usually comes at the end of a chronic illness or the frailty accompanying old age. Even though death is very much part of the cycle of life, thinking and talking about one’s own death usually remains in the background, at least until its prospect become more probable or imminent.

Thru the new Medicare offering doctors will be able to discuss with their patients how they would like to die, and to encourage them to put their wishes on paper and share those wishes with their family.

The “Aid in Dying” movement – is it a good idea?

According to an article that appeared a few days ago in the New York Times, there is a new movement in the United States called “Aid in Dying”. It’s supporters try to avoid calling it what it really is – assisted suicide – but, whatever they call it, it’s gaining traction.

Until 2008, assisted suicide was legal in just one state: Oregon. Today, it’s legal in five states: Montana, Oregon, Washington, Vermont and New Mexico. Supporters of the right for a terminally ill patient to choose aid in dying are supporting “death with dignity” bills in Connecticut and other states.

Lawsuits in New Mexico and Montana related to this topic have resulted in a differentiation between aid in dying, which is now legal, and assisted suicide, which is still considered a crime in both of those states.

Church groups have weighed in on the topic and claim that aid in dying is morally wrong. However, more and more people are asking for the right to die on their own terms according to Barbara Coombs Lee, president of Compassion & Choices.

In May 2013, a Gallup Poll was conducted. It asked whether doctors should be allowed to “end the patient’s life by some painless means” when patients and their families want it. 70% said yes. However, when asked whether doctors should be allowed to help a dying patient “commit suicide”, only 51% said they should. It’s clear that the exact wording is critically important in assessing how people really feel about the issue and on what is actually legal.

What do you think? Should aid in dying be made legal in your state?

To learn more about other topics related to death, go to www.diesmart.com.

What is the most important part of estate planning?

When you do your estate planning, you probably think the most important part of this planning is your Living Will or your Last Will and Testament. They are very important but they are not the most important thing.

I recently read an article by Julie Garber on about.com and she said the most important part is to select the right person to do each of the jobs your estate plan will require.” After thinking about it, I agree.

When selecting a person to be your healthcare agent or guardian for your minor children or personal representative, be sure that this is a person who has your best interests at heart. Also, verify that this person has the time as well as the skills to perform the needed tasks. And, finally, select someone who you think can make wise decisions.

If you have name someone who declines to accept this position, and the backup person you’ve named also declines, a judge will make all of the decisions for you and your family or will find someone who is willing to do so; this person may not be someone you would have chosen and may not do things the way you would have wanted them done.

Think about it carefully and choose wisely.

For more information about estate planning, go to www.diesmart.com.

Bad mistake made by heiress Huguette Clark

Huguette Clark was an heiress who died in 2011 at age 104. She left behind a $300 million estate. The bulk of the money was inherited from her father, a copper tycoon in Montana. She owned a 23-acre estate near Santa Barbara valued at $100 million, a $24 million house in Connecticut and a $100 million coop on Fifth Ave. in New York. She was a painter and a collector of rare French and Japanese dolls. She had no children, no close relatives and only limited contact with any of her distant relations.

She spent the last 20 years of her life living at Beth Israel Medical Center as a recluse, closer to her doctors and nurses than any family.

When she died, the only people who attended her burial were funeral home employees.

What did she do wrong? She left behind two wills, written just six weeks apart.

The first one left $5 million to her nurses and the balance of the estate to her distant relatives, even though 14 of the 19 involved said that they had never even met Huguette.

The second will left nothing to the relatives. It specifically said” I intentionally make no provision…for any members of my family…having had minimal contact with them over the years.” Instead, charities are the largest beneficiaries, receiving over 80% of the estate. Also named was her registered nurse, Hadassah Peri, who would receive $15.3 million after taxes, and a goddaughter who would get $7.9 million. Lesser beneficiaries included Beth Israel Medical Center, her attorney, her personal assistant, her accountant, property managers and one of her doctors.

In addition to what she was given in the will, her registered nurse received more than $31 million in gifts before Clark died and the estate administrator is asking that the $31 million be returned to the estate.

Family members are claiming that the second will was written under duress when she was mentally ill and incompetent and the victim of fraud by her nurse, attorney and accountant.

Negotiations have been going on for a few years, with 60 attorneys involved in the case. However, the chance of a settlement is not certain and a jury trial is scheduled to begin in Surrogate’s Court in Manhattan on September 17th.

Huguette Clark should have had better legal counsel when she decided what to do with her sizeable estate. She should have prepared a trust, including directions on who had the right to make decisions on her behalf when she was unable to do so. And she probably should have destroyed the first will.

It will be interesting to see what the probate court decides if a settled hasn’t been reached prior to September 17th.

For more information about Hugette Clark and her reclusive life, look for a book being released on September 10th titled “Empty Mansions: The Mysterious Life of Huguette Clark and the Spending of a Great American Fortune.”

To learn more about how to plan for the end of your life, go to www.diesmart.com.

DNR order – should your pet have one?

Do you know what a DNR (do not resuscitate) order is? It is a medical document that alerts doctors and other medical and rescue personnel about whether you want them to do anything they can to revive you if your heart stops.

I have been in the local hospital a few times for various medical procedures and am used to the questions that the staff asks before admitting you. And I have a DNR (do not resuscitate) document that I keep on file there. If my heart stops and reviving me will negatively impact my quality of life, I want my loved ones to let me go.

Information for and against human DNRs is readily available on the web and in books; anyone you ask will have an opinion.

However, for pets it’s a different story. Last week I had to take my dog, Suzi, to the veterinary hospital for a minor medical procedure and was given several forms to sign. One of them caught me totally off guard. I was asked to sign either a DNR or an “administer CPR” form for her. I had never thought about a DNR in relation to my dog and didn’t know what to do. I had no idea about how easily a dog’s heart stops beating during surgery and how quickly it’s quality of life will be impacted after that stoppage.

The vet told me that asking for a pet DNR is becoming common practice for many animal hospitals but would give me no recommendation on which form to sign.

When I got home, I got on the web and tried to research a pet DNR to see what the recommended practice is. I could find very little helpful information. I called friends with pets and they had no idea what to do either.

Luckily, the procedure went smoothly and Suzi was fine. But what if there is a next time? What should I do then?

We at Die Smart would love to hear from you with your opinions on this subject. To write a comment or to find out more about end of life planning, including human DNRs, go to www.diesmart.com.