45 Secrets Your Surgeon Won't Tell You | The Healthy

 

As the COVID-19 pandemic continues to ravage the country, doctors across the nation are joining lawyers in urging Americans to create the proper estate planning documents, so medical providers can better coordinate their care should they become hospitalized with the virus.

The most critical planning tools for this purpose are medical power of attorney and a living will, advance healthcare directives that work together to help describe your wishes for medical treatment and end-of-life care in the event you’re unable to express your desires. In light of COVID-19, even those who have already created these documents should revisit them to ensure they are up-to-date.

 

While all adults over age 18 should put these documents in place as soon as possible, if you are over age 60 or have a chronic underlying health condition, the need is particularly urgent.

 

Advance directives
Medical power of attorney is an advance directive that allows you to name a person, known as your “agent,” to make healthcare decisions for you if you’re incapacitated and unable to make those decisions yourself. For example, if you are hospitalized with COVID-19 and need to be placed in a medically induced coma, this person would have the legal authority to advise doctors about your subsequent medical care.

 

If you become incapacitated without medical power of attorney, physicians may be forced to ask the court to appoint a legal guardian to be your decision maker. The person given this responsibility could be someone you’d never want having power over such life or death decisions—and that’s why having medical powers of attorney is so important.

 

While medical powers of attorney names who can make health-care decisions in the event of your incapacity, a living will explains how your care should be handled, particularly at the end of life. For example, if you should become seriously ill and unable to manage your own treatment, a living will can guide your agent to make these medical decisions on your behalf.

These decisions could include if and when you want life support removed, whether you would want hydration and nutrition, and even what kind of food you want and who can visit you. To ensure your medical treatment is handled in exactly the way you want and prevent your family from undergoing needless stress and conflict during an already trying time, it’s vital that you document such wishes in a living will.

 

Keep your directives updated
Even if you’ve already created advanced directives, now is the perfect time to review the documents to ensure they still match your wishes and circumstances. For instance, is the agent named in your medical power of attorney still the individual you’d want making these decisions? Do you have alternate agents named in case your primary choice is unable to serve? Has your health changed in ways that might affect your living will’s instructions? Are your values and wishes regarding end-of-life still the same?

Coronavirus considerations
What’s more, whether you are creating new documents or updating your old ones, you should keep COVID-19 in mind. The highly contagious and life-threatening nature of the coronavirus is something medical providers have never dealt with before, and it has strained our nation’s healthcare system to the breaking point.

You don’t want anything slowing down your treatment options if you contract COVID-19. Because COVID-19 is so contagious, family members of those who’ve contracted the virus are often not allowed to accompany them to the hospital. This means your agent likely won’t be there in person to make your treatment decisions. Ensure your agent has access to a copy of your directives and be sure to take a copy with you, along with contact info for your agent, if you must go to the hospital for treatment.

 

Don’t do it yourself

While you’ll find a wide selection of generic, advance-directive documents online, you shouldn’t trust these do-it-yourself forms to adequately address such critical decisions. This is especially true during the ongoing pandemic, when doctors are constantly tasked with making highly difficult and uncertain decisions for patients suffering from this deadly new virus.

 

When it comes to your medical treatment and end-of-life care, you have unique needs and wishes that just can’t be anticipated by fill-in-the-blank documents. To ensure your directives are specifically tailored to suit your unique situation, you must work with experienced planning professionals to create—or at the very least, review—your medical power of attorney and living will.

 

 

With the risks still posed by COVID-19, we all need to face the possibility that we could get sick, even if we take great care of ourselves through good nutrition, sleep, and exercise. And even if you don’t need to be hospitalized, if you do experience symptoms and test positive, you might have to stay quarantined for enough time that you’d lose income. These risks highlight the need for everyone, regardless of their age or current state of health, to have some form of disability insurance coverage.

You might think you don’t need disability insurance, especially if you’re young and in good health. Hopefully, you’re right. Unfortunately, though, becoming disabled can happen to anyone at any time. This isn’t specific to coronavirus either; it has always been true.

The sad fact is that, according to the US government’s statistics, one in four 20-year-olds become disabled before reaching retirement age. That makes it even more important that you consider how to protect yourself with insurance.

And this is especially important: you must get the actual insurance before something happens. If you’re already sick, you can’t buy disability insurance to make up for lost income.

So now is the time to prepare. Here’s some information to get you started.

What Qualifies You for Benefits (And What Doesn’t)
Let’s get clear on one thing that applies to the coronavirus pandemic: only medical quarantine qualifies you for disability benefits. That means only medical self-quarantine related to COVID-19, which is verified by a doctor, will qualify you. Socially quarantining to decrease your chance of contracting the virus in the first place won’t qualify you for your disability insurance benefits. Disability insurance also won’t cover you if you lose income or health insurance because your employer has closed or laid you off.

Also, disability insurance is not the same as health insurance. Though your failed health is the reason you’d get access to your disability insurance in the first place, disability insurance will not cover your medical bills. Disability benefits are basically to help you pay housing and food costs. But in a time when you’re dealing with disability, it’s good to have those bills covered while you are focused on healing and self-care.

There are two different types of disability insurance and knowing the difference will help you save a lot of time.

Short-Term Disability Insurance
Short-term disability insurance normally lasts around 3–6 months, sometimes up to a year or two. It covers about 60–70% of whatever your salary is. The premiums you pay are often higher than long term coverage, ranging from 1–3% of your annual income. So for someone making $50k a year, it would range between $60 to $125 every month. The percentage depends on what kind of health risks the insurance company determines you have. If you smoke, for instance, the premium will probably be higher, just like with many health insurance policies. If you have a risky job, such as dealing with heavy machinery, premiums will likely be higher as well. A major upside, though, is that payouts usually happen within two weeks, which can be a huge relief in an emergency.

Financial expert Dave Ramsey points out that, because of the higher premiums and shorter span of coverage time, you might want to consider building up a solid emergency fund with 3–6 months of expenses instead. You can consider that personal short-term disability coverage that you don’t have to pay premiums on. But if you’re living paycheck-to-paycheck and can’t foresee saving that much (like 80% of American workers, according to CNBC), and your employer doesn’t offer short-term disability insurance, it is something you may want to consider buying yourself.

Long-Term Disability Insurance
This is the type of insurance that is most important to get, no matter what. This is the type that will last through a long recovery or treatment period. Look for a “non-cancellable insurance policy”, which will keep the insurance company from being able to cancel your policy if you have any health changes.

Long-term disability insurance may pay you benefits for a few years or until your disability ends. Most policies cover 40–60% of your salary, but ones that pay up to 70% do exist, and you should try to find one. These policies also cost 1–3% of your yearly income, but they tend to be on the lower side than short-term. A major difference between the two forms of insurance is that it can take up to 6 months to see a payout. This means that it’s not the best option for covering costs if you have to go into medical quarantine for COVID-19.

We recommend that, even if you decide to pass on short-term disability in favor of emergency fund savings (or if your employee already covers it), you should definitely consider a long-term policy to protect your earnings. Remember, though, it will only pay a percentage of the income you’d be taking in otherwise. Make sure you also have health insurance and as much savings as you can get to protect yourself as well.

Dedicated to empowering your family, building your wealth and defining your legacy,

As you already know, the COVID-19 pandemic means there’s no more “business as usual”. So don’t just hope you can survive until things return to normal. Strategize, now, on how you can take what control is in your sphere of influence. Once you have attended to your (and your parents’) immediate needs, it will be time to consider more long-term plans.

In this time of stress and chaos, your parents may be resistant to talking about estate planning. It may feel too pessimistic to plan for the worst amid a scary situation. However, that’s exactly why it’s important right now to do so. Plus, since hopefully you are staying inside, you may have the time to dedicate to getting these tasks taken care of.

Here are actions you can, and should, take to ensure you and your family are fully protected legally.

Update Your Health Care Documents

Above all, you first need to ensure that both you and your parents have your health care documents in order. This will be an invaluable reference point for those who are assisting you, whether they be friends, family, or medical professionals.

There are three important and distinct documents you should have in place: Your advanced directive, HIPAA waiver, and living will. They are separate documents but all work together. Think of them like the legs of a stool. If just one is missing or defective, the stool will fall – with you in it!

Your advanced directive identifies and gives legal authority to whom you would like to make your medical decisions if you are unable to do so yourself. Many people think spouses automatically have this legal authority and therefore don’t need this type of document for each other. That is a mistaken belief which can cost married couples substantial time, money, and anguish when a medical emergency arises.

A HIPAA waiver is important because even though your advanced directive gives authority to someone of your choosing to make medical decisions for you, privacy laws will prevent your doctor from sharing your medical information with that person. I see a lot of advanced directives which include a HIPAA section, but this is not legally sound and often fails. For starters, the privacy laws mandate the HIPAA waiver be written in a certain font style and size. Trust me on this. You want your HIPAA waiver to be a standalone document.

Your living will is different from your last will and testament. While a last will deals with the decisions to be made after death, a living will pertains to decisions which are to be made while you are still alive. This is where you will provide guidance on when you would want to be placed on life support, removed from life support, whether you want to donate your organs, etc.

Even if you have already created your medical directives, I urge you to take out any existing documents now and review them. Have your circumstances changed? Do you have additions to make? Encourage your parents to do the same thing, and to communicate with you about what their documents say. If you are unsure whether your health care documents are in ship-shape, call us, and we’ll be happy to review them for you.

Ensure Your Estate Plan is Up to Date and In Order

Your healthcare documents are an important start, but you should also review (or create) powers of attorney, a last will, and perhaps even a living trust. Remember that it’s never an inappropriate time to plan. Getting this in order will provide you and your loved ones peace of mind. And we’re here to support you, virtually now, as well. We can take care of you, and your family, fully online. Call us, we’re here.

 Dedicated to empowering your family, building your wealth and defining your legacy,

I’m dealing with working from home, managing my business and my team remotely, operating in shifts with my wife to take care of my children during the day, homeschool them, all while keeping a nervous eye on our stockpile of toilet paper. But perhaps my biggest challenge is feeling like my parents and in-laws are taking COVID-19 as seriously as I wish they would.

As of March 25th, the number of confirmed cases of COVID-19 across the United States was 54,453 cases across the United States with 737 confirmed deaths from the virus. And these numbers are still rising exponentially. 

When we first became aware of the novel coronavirus, there were several TV pundits and other authority figures saying that the virus was just another version of the flu. But in other parts of the world, we’ve seen COVID-19 overwhelm healthcare systems in a way the flu virus just hasn’t.

It seems, though, that many people of the older generation may still not be taking this seriously. And hey, they are the most battle tested of all of us. They’ve seen it all and survived it all and aren’t generally the types to give in to panic and stress. 

That said, they are also among the most vulnerable to the effects of COVID-19. And even with the stay at home order in place, I still feel like my parents are taking too many unnecessary risks. Here’s how I’m trying to express my concerns to them:

  1. Listening to them and determining the worries they have.
    I want to know what they have heard, what they are frustrated about, and what they are skeptical about. Everyone is frustrated with lines at the grocery store, toilet paper hoarding, and the hysteria of the crowds around them. I’m sure my parents do not want to feel like they are one of “those people.” I know I don’t. So I’m just trying to assure them that taking some precautions, especially staying home, is completely reasonable and can be done in a non-panicked way. I’m also trying to support them to make alternative arrangements during this time so they don’t have to go out.
  2. Emphasizing the risk in practical terms.
    I’m sharing articles and news with them that state the facts, soberly, like this one. My parents are bright and already have a good understanding about how viruses spread in general and they already know the basics of how important it is for them to wash their hands. But I want to ensure that is at the top of mind for them every day right now.
  3. Showing them I’m taking it seriously.
    I’m not getting together with my parents unless absolutely necessary, and when I do, I’m wearing a mask and keeping my distance as much as possible. I also shared the video created by Max Brooks, son of legendary comedian Mel Brooks, with them. Max created a PSA to convince younger people to be cognizant of how they might spread the virus to people who are the most vulnerable to it. It presents the situation in a succinct, somewhat lighthearted way. 

If you’re experiencing something similar with your loved ones, I’d love to hear your thoughts. Together, we can get through this. Let’s make sure our parents come through this with us.

Be well and stay safe.

Dedicated to empowering your family, building your wealth and defining your legacy,

I’ve always believed “the buck stops here” regarding protecting and providing for my family, no matter what. They are my responsibility, period. One of the ways that feeling manifests itself in me is that I’ve always had a stockpile of supplies, food, and water to last my family for months if normal services and goods aren’t available for whatever reason. My wife’s continually given me a hard time about the corner of the garage dedicated toward that endeavor until this weekend when she abruptly asked, “do we have enough food and water to get us through a quarantine if that happens?” I smiled, smugly, and responded, “we’re good; we’ll be okay.”

But while much of the focus has been on how to prevent catching the Coronavirus, or what to stock up on to survive if the pandemic wallops the U.S. like it has elsewhere, little has been mentioned on how to best legally and financially prepare for such a scenario. We know from what’s happening abroad that national economies as well as individual families are taking big financial hits in lost wages, not to mention the medical nightmare many people find themselves in. While panic and overreaction do more harm than good, I’m a big believer that you should always have your eyes wide open and ensure your family is prepared for these kinds of possibilities.

Here are five important tips to help you best prepare for the legal and financial aspects of a local Coronavirus epidemic or quarantine:

  1. Make Sure Your Medical Power of Attorney Is Accessible. Completing your medical power of attorney where you formalized your wishes for your medical care was a great first step, but make sure it would be accessible if/when it’s needed. Make sure the person you appointed to make your medical decisions if you are seriously ill or incapacitated knows where you keep the document. Also, file a copy with your primary care physician so it’s available through that avenue well before it’s needed, thus avoiding delays or confusion. If you have minor children, make sure they have a medical power of attorney as well, something we include with every Child Protection Plan.
  • Nominate Temporary Guardians for Minor Children. Most estate plans will include a provision in a parent’s will nominating permanent guardians to raise their children if the parent passes away. However, few law firms offer a Nomination of Temporary Guardian form as well. Temporary guardians (AKA first responders) are 3-4 designated family members or friends who live within 20 minutes and have legal permission to care for your children in an emergency scenario (thus significantly limiting the chances that the State would have to step in). If you have not named temporary guardians for your children, you should contact your estate planning attorney right away.
  • Make Sure You Have Enough Life Insurance. In my role as an estate planner, it surprises me how many families are either uninsured or considerably underinsured. Having a lone life insurance policy through your employer is rarely enough to cover what your family would need if you were to pass away during your working years. Plus, sometimes there are limiting provisions in those work policies requiring the death be caused by an “accident” as opposed to an illness such as the Coronavirus. You need to know how much life insurance you have and the exact death scenarios your policy covers. If you are not 100% certain that your existing insurance policies would cover your family’s needs, you should arrange for your existing life insurance policies to be reviewed by a trusted life insurance professional. Ask me for a referral if you don’t already have a trusted advisor in your corner.
  • Have an Emergency Fund. A Coronavirus quarantine is likely to last 2-3 week, which is a significant amount of time to lose out on a paycheck or have your business shut down. Beyond that, a mass quarantine would certainly affect our overall economy, causing residual effects to your finances over time. Most people do not have more than $1,000 in emergency funds, according to financial expert Suze Orman. She recommends that families save at least eight-months’ worth of living expenses in non-retirement/accessible financial accounts to be sufficiently prepared for any unexpected life event. For business owners, you also need to have enough financial reserves for your business as well.
  • Make Sure Your Trust is Funded. Setting up an estate plan is a great first step to protecting your loved ones in an emergency, illness, or death, as it ensures that your loved ones would be financially, emotionally, and physically taken care of. However, too many people fail to properly transfer their assets to their trust. Your estate planning attorney should help you make sure that your bank accounts, brokerage accounts, business interests, life insurance policies, real properties, retirement accounts, and your other financial assets are all properly connected to your trust. Without completing this very important step, those assets left outside your trust are subject to probate proceedings.

While individually, none of us can control a Coronavirus epidemic or quarantine from happening here, we can certainly make sure our families are legally and financially prepared. Call your trusted advisor or start by scheduling a complimentary planning session with a member of our team if you are not yet prepared, or to have your existing estate plan reviewed to ensure it has you as prepared as you should be.

Dedicated to empowering your family, building your wealth and defining your legacy,

Queen-LatifahWe may not think about it often, but even celebrities take care of their aging parents. For example, actress, singer, and songwriter Queen Latifah plays an active role in caring for her mother, Rita Owens, who was diagnosed with heart failure more than 10 years ago.

Owens learned of her condition when she passed out at work one day. She moved from New Jersey to California to recover and be close to her daughter. There, Queen Latifah cared for her mom and acted as a coordinator for a network of healthcare providers, family, and friends.

After her recovery, Owens was able to return to her home in New Jersey. Now, the two are working with the American Heart Association to raise awareness of heart failure.

Queen Latifah’s story is far from unique, and can help you remember that if you are a caregiver of an elderly or sick parent, you are not alone. And there are resources available to support you.

AARP reports of a study that found more discontent in relationships between U.S. elderly parents and their adult caregivers than in five other countries. In the U.S., 20% of the relationships were rated as disharmonious. In the five other countries surveyed-England, Germany, Israel, Norway, and Spain-less than 10% were similarly ranked. Here in the US, it is sadly “normal” for caregivers of elderly or sick parents to feel frustrated, unappreciated, and resentful. But, it doesn’t have to be that way. With advance planning, strong communication, and family coordination, the potential for a disharmonious relationship can be greatly reduced.

Proper planning should not only account for the legal issues involved, but also the personal and interpersonal issues, too. Schedules should be worked out, structures put in place, and legal documents prepared. Getting your lawyer involved early in the process ensures all issues are identified, contingencies prepared for, and the transition into caregiving is as easy as possible for both you and your parents.

Dedicated to your family’s health, wealth, and happiness,
Marc Garlett 91024

Long-term care 91024Much has been written about our nation’s need to help mothers in the workplace. Many benefits, such as maternity leave and nursing stations, are present or well on their way towards implementation in many U.S. states. And with employees working later in life, due, in part, to the rise in the regular Social Security retirement age, it is becoming increasingly important that we start to talk about the crisis facing the other end of the spectrum: America’s working daughters, many of whom are also mothers.

According to the Census Bureau, 44 million unpaid eldercare providers work in the U.S. Many of these people are family caregivers: The Bureau of Labor Statistics reports that in 2013-2014, “[t]here were 6.3 million elder care providers who cared solely for someone with whom they lived.”

The impact on working daughters is significant. In addition to lost wages, Social Security and retirement benefits drop when women earn less due to caregiving responsibilities. And that’s only for the women who are fortunate enough to stay in their current positions. Many must quit their jobs or take less demanding, lower-paying work so that they can care for their elderly family members.

By planning in advance, you can mitigate the risk that caregiving an elderly parent will have on your family.

It begins with getting comfortable talking with your parents (or your children if you are in the senior generation), openly and honestly about late in life care. When families work together there doesn’t need to be a burden, but instead the whole family can create a plan that most effectively uses the family’s resources to create an outcome that supports everyone.

We can look at these issues proactively with your family during a Family Estate Planning Session, which is what sets us apart from other law firms which are typically only focused on creating legal documents to pass on financial assets after you (or senior family members) die.

When handled the proactive way, however, estate planning is not just for the wealthy; it’s for all families who want to work together to use their resources in support of intergenerational well-being.

Dedicated to your family’s health, wealth, and happiness,
Marc Garlett 91024

Wills and Trusts 91024“Black Heirlooms” has not received any Oscar nominations even though it is filled with award winning lessons about family. The film was made by 32-year-old Amanda Brown, whose grandmother’s long-term illness ripped her once close-knit family apart for lack of long-term care planning.

Profiled recently in the New York Times, Brown’s film is “about the extended uncomfortable, intergenerational conversations that we do not have enough of and that her family did not have until it was too late.”

Vonley and Edna Mae Royal raised eight children together. Vonley had several businesses during life that provided a small inheritance for his wife after he died. Following his death, the Royal children tried to get Edna Mae to talk about how she wanted the estate divided after she died. She proved resistant to such a discussion, however, and so her children backed off. “We didn’t want to give her the impression that we were trying to gain some kind of advantage,” said her son Gary.

Unfortunately, Edna Mae had a stroke in 2009. Shortly thereafter her children became divided on how she should be taken care of, whether or not she could make decisions for herself, and who should have power of attorney over her affairs. The family eventually wound up in court, exhausting any inheritance they might have had on legal fees and dividing the children.

Today, 90-year-old Edna Mae is taken care of by five of her eight children; the other three do not speak to their siblings and rarely see their mother. The inheritance that Vonley and Edna Mae worked so hard to provide to their children is gone. In the film, Edna Mae’s granddaughter Amanda wonders, “Now that the family is divided, what was the point of working so hard to keep everything intact?”

If you have been putting off this type of conversation in your family, we can help. Executing a comprehensive estate plan can be extremely fulfilling, knowing you are providing and protecting an inheritance for your children, making your wishes known and alleviating your family of the burden of guessing the right health care choices for you.

If you would like to learn more about estate planning for your family, we can help. We can also assist you with that all-important family discussion (which could just be one of the most important discussions your family ever has).

To your family’s health, wealth, and happiness,
Marc Garlett 91024

Long-term care 91024This Thanksgiving holiday, as multi generations of my family gather together, I can’t help but reflect on the lifetime of love and support my parents have provided to me and my children. I’m also very aware of their own special issues. Did you know, a person who turns 65 today has a 70% chance of needing some type of long-term care at some time in their remaining years? That’s according to the U.S. Department of Health and Human Services and on average, women will need 3.7 years of long-term care while men will need 2.2 years of care. Only 20%, however, will need care for longer than five years.

If you or your parents don’t have the financial resources to pay for this long-term care – either through a nursing home stay or in-home care – you should consider long-term care insurance to fill the void. And while annual premiums will vary according to your age and health status, they can all be fairly expensive.

Here are some tips to reduce the cost of long-term care insurance:

Buy young. Since premiums rise as you age, purchasing a long-term care policy when you are younger can mean cheaper premiums. Just be sure you are aware that premiums can increase as you age, so be sure to discuss this with your insurer.

Shorten the benefit period. Lifetime policies are the most expensive, and since statistics show that most of us will not need long-term care for more than five years, you can save thousands of dollars in premiums if you buy a short-term policy.

Lengthen the elimination period. Most policies have a 30-90 day waiting period before coverage begins. If you can make this period longer, your premiums will be cheaper.

Reduce daily benefits. If you can pay for some of your long-term care needs yourself, you can reduce the daily benefit amount on your policy, which will result in lower premiums.

Share the care. If you are married and both of you are buying long-term care insurance, a shared care policy could provide you both with more coverage for less money. A shared care policy provides a pool of benefits that are shared between you and your spouse, so if you buy a 5-year shared care policy, the two of you would have 10 years of benefits. If your spouse only uses 3 years, you would have 7 years of benefits to use.

Take the deduction. Your long-term care insurance premiums may be deductible. If they meet the requirements for “qualified” long-term care expenses, they can be deductible, with the amount depending on your age and tax year. For 2014, the long-term care premium deductibility limits are $1,400 for those more than 50 but not more than 60, $3,720 for those more than 60 but not more than 70, and $4,660 for those over 70.

To learn more about long-term financial planning for your – or your parent’s – golden years, give me a call and let’s chat over a cup of coffee.

To you family’s health, wealth, and happiness,
Signature - Marc