Make It Last – Ep 11 – Summer Trips, Living Wills & Advance Directives
As summer approaches, we discuss travel tips for folks in retirement. Also, I cover living wills and advanced directives. We talk about what documents are important and why, and how to make sure that you don’t have a problem with making health care decisions in the future.
Make It Last with Victor Medina is hosted by Victor J. Medina, an estate planning and elder law attorney and Certified Financial Planner™. Through his law firm and independent registered investment advisory company, Victor provides 360º Wealth Protection Strategies for individuals in or nearing retirement.
For more information, visit Medina Law Group or Private Client Capital Group.
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Click below to read the full transcript…
Burt: Welcome to “Make it Last,” helping you keep your legal ducks in a row and your nest egg secure. With your host Victor Medina, an estate planning and elder law attorney and certified financial planner.
Victor J. Medina: Everybody, welcome to Make it Last. It’s Victor Medina. I am your host. This is the show that helps you keep your legal ducks in a row and your financial nest egg secure. I have to admit something, which is I am not live in studio today. I am on a little vacation with my family.
If you’ve gotten up early to listen to the show, well, thank you for doing that. I’m probably up early because we’re out on vacation, too.
I’ve pre‑recorded this ahead of time. It’s still going to be a great show. Stay tuned to this. I’m actually going to offer you a few travel tips that I’ve come across specifically around the area of your estate planning and retirement planning. I want to make sure everyone is on track with that because it’s affecting my life.
We’re going to talk today also about a really important estate planning document or set of documents which has to do with your living will and your instruction directive, because it turns out that most people here that they should have one. They just don’t know what a good one is, and so this will help illuminate that.
First, I want to tell you about the trip that my family are going to be taking. It’s first family trip that we’ll have in almost a year. It seems like there’s so much going on this days between the kids’ activities, they’ve got sports their involved in, and school. It just gets harder and harder to find the time away.
My wife was at a silent auction for one of the kid’s schools and bid on the right to go get a few nights in Colonial Williamsburg. That’s where will be while you listen to this show. We’re going to be in Colonial Williamsburg, will be visiting the Historic Triangle of James Town, York Town and Williamsburg.
The family and I will be out there learning how to make butter, the old‑fashioned way, and make paper out of pulp. It’s going to be fantastic. It’s going to be a great trip. Great trip. I don’t even mind that as this is airing live, I’m probably exhausted because my wife wants us to get up at four o clock in the morning, so that we can avoid the traffic around Washington DC.
I have agreed to do it. I don’t mind that I’m late. I’m sure that the coffee will help me get over that. If we could just figure how they made the coffee in the 1700s. Anyway, that’s where we’re going to be.
I was thinking about traveling, and sought of the things that come up with are people around their finances and retirement and estate planning and what good tips would be, for them when they traveled because I was trying to figure out for myself.
Back in the day when you took a trip, I don’t know if people remember that. First of all, you used to have the atlas. [laughs] You would buy the map book, and it would have every state. Then, if the state were really big, those states would be across a few pages. Then, they’d be in alphabetical order. They wouldn’t be in order about where the regions were.
If you wanted to go from New Jersey to Maryland then back to Virginia, you’d be going from the Ns to the Ms to the Vs [laughs] just to make sure that you stayed on track. Anyway, that was back in the day. Now, everything’s on the phone. You get the phone to give you directions. If the phone doesn’t give you the directions, the car will give you the directions.
The last thing that you can do anymore is actually ask a gas station, because even they don’t know anymore. They ask you to check your phone. First tip is to make sure that you know where you’re going and to print those directions out. More importantly, let people know what your travel arrangements are.
What we find sometimes is that, it’s back in the day where if you had Mom and Dad, you would call Mom and Dad when you got to wherever you were going. If you are Mom and Dad, and they’re worried about where you’re going, you’ve got to let the kids when you’ve arrived. To this day, my mom sends me a text message when she lands on some plane trip that she’s taking.
She travels back and forth between New York and now Charleston, South Carolina. It’s nice to know when she’s landed when she’s traveling, make sure everything’s safe on that. You want to have people know where you’re going to be so that if something happens, they can expect that you’re going to be in one place or the other or figure out how to get in touch with you. I think that’s a good step.
The next step is to think about bringing some of the more core, essential, estate‑planning documents with you. Now, when we do the estate planning documents, we put them together in this big red binder. It’s this huge thing. People say, “Do I have to take this with me everywhere I go?” No, of course you don’t have to take that with you.
We also give people the documents on a thumb drive. You might make a hard copy of some of the more important documents. The important documents are not going to be anything about the trust or the will or what you do with your assets when you die. They’re going to be the documents that help people make decisions if something happens to you.
You would take things like your power of attorney. You might take your advance healthcare directive and your HIPAA release. We’re going to talk later in the show about those documents and what makes effective ones.
You can go ahead and take photocopies of them and put them in an envelope and mark what they are so that if somebody’s looking for them or something happens to you, you get in an accident, or you’re traveling with somebody, you’ll be able to locate those documents and use them.
Now, another service that exists, there’s two different ones. There’s one called DocuBank, another called Everplans. Those are services that will collect your important documents. It’s like a Medi‑Alert badge.
They will send you a card that you can keep in your wallet or in your purse, and that’ll tell you how to get your documents. You get a little dial‑in number and a code, and you hit it, and boop, all of the documents come out. You get them faxed to you, or you get them emailed to you.
That’d be a way of keeping those documents with you without actually printing them out. You would have the service that allows you to get them. Those documents are important.
If something happens to you, specifically, if you get in a car accident and somebody needs the ability to make medical decisions for you, we can’t be waiting to hunt around for how to contact that person. We want either the documents there or in addition to the documents being there, you’re going to want somebody who’s been contacted.
You guys have the contact information on the documents, their phone number and their email address. They can have their snail‑mail address, but they’re not going to mail them a letter or a postcard. That’s the worst kind of postcard [laughs] that you could receive. “Hey, got into an accident, you know, can you come? Please?”
You definitely want a way of contacting them and having people know where those documents are. That would be a good thing to have those documents with you when you travel. Last one in the area of finances is more of a practical thing.
I do a fair amount of traveling for business. There’s different programs that I attend with other lawyers and other financial advisors and making sure that I’m doing this at the highest level. When I travel, I will have a couple of things that help me on the financial side.
The first thing that I will do is I will only use one particular credit card, and not one that has a very high limit on how much I can spend when I go and travel. The reason for that is, I don’t want to use my debit card. If that gets swiped and stolen, they’ll clean out my account. I’ll have to fight to get that money back.
If they take a credit card that has a high limit, they might be able to run that up. Then, I’ve got to fight with the credit card company. I might be away for a week before something’s raised or something gets shut down. I’ll try to use a credit card that I use exclusively for travel that’s got a lower limit. That way, I don’t get too much in trouble with that.
The second thing you can do is you can make an advanced call to the credit card company to let them know that you’re traveling and where you’re going to be traveling, so that their fraud department doesn’t get nervous when they see a lot of charges from a strange location. That’s based on a lot of software programs and algorithms.
For me, they know I’m going to travel a lot to Florida. I almost never have to let them know that I’m going to be in Florida, because I’m in Florida four times a year for a program that I’m in. If I’m going to travel to someplace unique, I’m going to be in Virginia, I’m going to let them know that I’m going to be in Virginia.
That way, they don’t block the credit card or worry about it. We’re able to ease the transition off of that. Then, look, I’d be remiss if I didn’t tell you what my dad taught me, which is if I’m going to be traveling in the car, I’ve got to get that sucker checked out and make sure the wheels are ready to go. He’s fastidious about making sure [laughs] the car’s ready.
Victor: You can be sure that on this trip to colonial Williamsburg, we went ahead and made sure that the car was ready to go for a six‑hour trip. Those are the quick travel tips. Listen, when we come back for the next segment, I’m going to talk to you in detail about some of these important planning documents, specifically the healthcare directive and the living will.
These are going to be ones that you need to get right. Do me a favor and stick with us on come back from the break. We’ll talk more about this. This is “Make It Last.”
Victor: Welcome back to Make It Last. I’m going to spend this time talking about two estate planning documents which is not fun to talk about because they have to do with what happens if you get sick and you need end of life care.
It’s not fun to talk about these; however, it’s so important that I’m going to risk alienating everybody talking about these important documents because I think that you need to hear about it.
They are the Disability Planning documents that help make health care decisions. Now, I’m going to walk you through what they contain because there’s a lot of confusion on them. Most people are going to refer to them as a Living Will or a Health Care Power of Attorney.
The first thing we need to do is talk a little bit about what that document is, what are they, and how do you create them. There’s lots of different kinds.
An Advance Health Care Directive or a health care proxy, basically, is a document that you sign that, one, empowers somebody to make healthcare decisions for you. Two, talks about the kind of care that you need in certain circumstances. You think about it as two separate documents.
In New Jersey, we call the Health Care Power of Attorney a proxy, a health care proxy. Then, we call the living will, we call that an Instruction Directive. That’s the kind of care that we need. Those are two documents that are essential.
The best way that you can make sure you’re using the right one is that in our office we use the one that New Jersey has blessed for our New Jersey clients, and then the one that Pennsylvania has blessed for their Pennsylvania clients.
If you just go online, you Google “New Jersey Advanced Healthcare Directive,” you’ll be directed to a site on the government’s website. It’ll say nj.gov. You will be able to download this document. It says PDF.
When you download it, don’t be frightened because it will have three documents in this big, long PDF. It looks confusing with all these instructions, but it’s not confusing.
In the first document, it says the proxy, and you fill it out. The second document is the Instruction Directive, and then the third document, watch. It’s just the proxy and the Instruction Directive together.
They combine them, and they call it the Combined Advance Directive for Health Care. That’s what they call it. The one that you should sign is the third one. It’s the third one. You want to make sure that you have gone ahead and sign the third one.
You don’t have to sign all three, just the third one. That will be the New Jersey form of document for making health care decisions. That’s great, and we like that.
There’s one wrinkle though. The wrinkle is that that document is a state document, created by a state government. It does not cover federal privacy rules.
People have heard the word, HIPAA. Sometimes, they think HIPPO. It’s not HIPPO, HIPAA. That stands for the Health Information Portability and Accountability Act.
That law governs the disclosure of your private medical information, and it’s a federal law. You might imagine the state form does not cover the federal privacy rule. Then, what we want to make sure happens is we sign a HIPAA release.
That HIPAA release is going to nominate authorized representatives, basically, people who can access your private medical information.
Now, we’ve got the Combined Health Care Directive. That’s document one. That’s actually document 1A and 1B, two things in one. Then, we got the HIPAA release.
The next document you want to think about is called the “POLST.” The POLST, it’s P‑O‑L‑S‑T, stands for the Practitioner Order for Life Sustaining Treatment.
The reason why this is different is this is actually a medical order. It’s a physician’s order. It goes into your medical file, and it’s a little bit more powerful than the Instruction Directive because it’s, basically, like a doctor’s order. “Take three pills a day.” It’s going to be, “Don’t give me intubation”, and “I don’t want CPR if I become permanently unconscious.”
Whatever you want, it’s what the doctor signs. That’s in your medical file. It doesn’t exist elsewhere.
You can keep a copy in your refrigerator, but where it’s most effective is with your medical file when you get admitted to a hospital in terms of long‑term care. We like that POLST, the petition order because it, basically, sets it in the file so that you have to follow it.
I would say that those four documents are the core documents that I would think about for health care‑related decisions, especially as you get older.
Do you need a POLST right away? Probably not. Life sustaining treatment, you could probably get by with one of the other documents until you get a little bit older, a little bit sicker, and there’s something specifically that you’re dealing with.
Maybe, that’s a good time to think about the POLST where you’ve been diagnosed with Parkinson’s, or Alzheimer’s, or something like that, but at that time, maybe, you think about a POLST.
If you just go with the first three, the Combined Advance Directive, like 1A and 1B, and the HIPAA, that’ll be pretty good.
Now, that document I talked about, the Combined Advance Health Care Directive, there’s two documents in one. It’s important to realize that that document only becomes effective when you become incapacitated.
It’s not there, like a set of stereo instructions for somebody to follow, whether or not you get a heart attack at home. The EMTs, they’re going to come, and they’re going to resuscitate you. They’re not going to be reading that and say, “Oh, never mind. Don’t do anything.”
No, this is a document where you become incapacitated, the fact that you go into the hospital. You get sick, and you’re sitting there recovering, and they try to figure out whether or not they should put in a feeding tube, or whatever.
If you are conscious, you’re going to talk about what you want, and you’re going to tell them. You’re not incapacitated. The other important part is that it’s revocable and changeable at any time.
No matter what you list on there, no matter what you list, you’ll be able to make changes. You want to think about updating that on a regular basis just like you update the rest of your documents.
You may want to look at your Power of Attorney, and your trust‑related documents. It doesn’t matter what it is, you want to update it. Update your health care decisions too because it’s going to be important to review those.
They ask about your organ donation wishes. You may have different thoughts at that point in time, but look, it’s a good time to have reviewed it.
In the next segment, I’m going to talk a little bit more about what’s in the Advance Health Care Directive because they ask you about different questions and things. I wanted to make sure we’re clear about what that is.
Before we break, there’s a couple of rules about signing one. These are important. The first rule is that you can only name one person at a time. You can’t name a committee, and say, “OK, well, I want two people, and then they both have to agree.”
Nope, that’s no good. If you do that, you don’t have a valid Advance Health Care Directive. It’s important that we name one person in charge at a time. This document has to be signed by you. You just can’t fill it out and not sign it on the back
In New Jersey, they either want two witnesses or a notary. You know me by now. In our practice, we do both, two witnesses and a notary. We just want to make sure everything is all buttoned up.
You have to sign this thing the right way or it won’t be effective. That will ruin the whole reason why you put the planning in place in the first place. You want to make sure to do that.
Victor: When we come back from the break, I’m going to talk to you a little bit more about what’s in the documents, how to make smart decisions, but that’s going to suppose that you know what’s in a document.
Pause this or take a break or run out and doing a Google search if you’re listing online and get that New Jersey form because we’re going to talk about how to fill it out and make sure that we are making the right decisions when we come back with Making It Last. Stick with us.
Victor: Hey, everybody. Welcome back to Make It Last. We are talking about advanced health care directives. We are talking about living wills. This is the cheeriest stuff that you’re going to…No, I’m kidding. [laughs] Listen, it’s important. It’s important. You’ve got to make sure this stuff’s in place.
Everyone’s heard of Terri Schiavo Everyone’s heard about what happens when there’s family members fighting about what kind of care to be provided. You don’t want that to be your family. You’ve got to step up, act like an adult, get these documents done, and that means listening to our radio show that’s talking about health care directives.
It’s not bad. It’s not happy. I’m not happy to be talking about it. You should be happy to listen about it because this is important stuff.
Now, when you get that document, I told you before we’re going to talk about the specific New Jersey document. If you’ve gone ahead and Googled it and gotten the one that’s got three documents in one, it’s got the proxy first, it has the instruction directive next, and then it has the combined one in the back.
I’m going to talk about what goes into the living will and the instruction directive because it’s a little bit like chose your own adventure, like those books where you read them, and it says, “If you want Johnny to go up the hill to the right go to page 43.” That’s a little bit of how these are worded.
The first thing that it asks you is to check a box. The box says either, “I can envision some scenarios in which I do not want medical care to be provided,” or on the other box it says, “Give me all medically appropriate care no matter what it costs.” You chose one of those.
If you chose that you want all medical care, if that’s what you chose you want, that’s it. You’re done filling out the rest of it. I mean, you’ve got to talk about organ donation and things like that, but basically, you’re done because you said, “I want all medical care to be provided to me.”
That will essentially end the conversation because you have spoken about your wishes and your wishes are, if you see something broke, fix it. That’s OK. That’s an OK decision to make.
Now, most of the population does not make that decision. They go to the other way and say, “Look, there are some circumstances in which I don’t want care to be provided.” In which case you go to page 43. It’s not really 43. [laughs] You go to the next page and it says, “Which circumstances are the ones in which you do not want care provided?”
They give you three options. They talk about a terminal condition, so when you are going to die. They talk about a permanently unconscious state. That’s the permanently vegetative state. You’re in a coma. They have an incurable and irreversible illness. What’s that? That’s actually the most complicated one. I’ll leave it for last.
The terminal condition is basically two doctors have independently examined you and determined that you are within ‑‑ now watch this ‑‑ X amount of time before you die. X is a blank that you have to fill out. You get to decide what the definition of terminal is.
If you want terminal to be defined when you die within a few days left, that’s one thing. You might say terminal is like if two doctors say I’m going to die in the next six months, I’m terminal. That’s it I’m done.
Now, what’s important here is that is a little counterintuitive for what people wish. Most people say, “If I don’t want any extra care and I want to make sure that happens as soon as possible, I’ll mark down a few days as my choice.” That’s actually the opposite.
Because if you mark down that I’m going to die within a few days that means that they’re going to give you care all the way through up until the point in time as when you’ve just a few days. You’re getting extra care. It’s the opposite, right?
If you want to be takes off life support as soon as possible or if you don’t want a feeding tube or if you don’t want to be brought back with CPR then you would say a few months, right? Six months. Because that would mean you’re within six months. Any time within six months, they’re not going to do anything more then. That’s it. They’re not going to provide the care for you.
Most of our clients chose the middle one. The middle one is a few weeks. They define terminal as a few weeks.
Then the next decision after terminal is permanently unconscious state or permanently vegetative state. Now this usually raises a lot of questions with my clients. They say, “Well, I don’t want it to happen to quickly. What if I wake up? I might wake up.”
We go through the language. The language says that there’s two doctors that have personally examined you and concluded that you’ve irreversibly lost any meaningful contact with your surroundings. Basically, say you’re not coming back.
If people are concerned about that, then we say, “Well, maybe we write a little language in there that says don’t withdraw life support until at least 14 days.” Give you some time, but you’re not around forever. That’s a permanently vegetative state. Most people get that.
The last one, the incurable and the irreversible illness, that’s the harder one because we really don’t know how that is defined. For most people it means things like Alzheimer’s or a Parkinson’s condition or ALS. It’s basically where you’re not terminal, but your also not necessarily coming back. You won’t be cured from this. You won’t be able to get recovered.
People might want to talk about what kind of care they want in those situations. Now, for most of our clients what we do there is we leave that one blank because we wait for the diagnosis to come. We’re in constant contact with our clients. We’re doing reviews all the time. We’re sending out these video newsletters and things like that, so we’re in front of them.
They know that they need to come to us if there’s a change that they need to make. We council them on this document. We said, “Look, wait. Wait for you to be diagnosed with something and then after then if it turns out that you want to make a change, or you want to cover that situation, we’ll know the kind of care that you might be provided.
When you’re in end stage with a Parkinson’s condition there’s specific things. You may not want to be intubated. There’s certain kinds of medical procedures and you might want to describe those with specificity and not just be restricted to a couple.
Back to the choose your own adventure, terminal, permanently unconscious or incurable and irreversible illness. Then when you chose one of those it says, “OK, in those situations go to page 37.” All right. In those situations what kind of care do you want provided or not? Do you want CPR provided or withheld? Do you want artificial hydration and nutrition provided or withheld?
The artificial hydration and nutrition, that’s the feeding tube and that’s the IV. I usually counsel clients that if they marked yes for a permanently unconscious state then they probably want to mark yes for the artificial hydration and nutrition. Because if you’re in a coma, if you’re breathing OK on your own, jeez, if they feed you then you could be around for a long time. That’s typically not what people want.
Once you get through that, you’ve gotten through the majority of the instruction directive. Really the last thing to do is this little free writing exercise where they give you a bunch of blanks. If you want to talk about special conditions, you had a mother or father that had this and you don’t want that, then you would talk about it there. All right?
That will help you fill out your advance health care directive. Go do it or make sure that it’s done. You don’t even have to see a lawyer for this one. All right? It’d be nice if you came to see a lawyer for the rest of your estate planning, but you just download it and, boom, you’re ready to go.
Also remember that you need the HIPAA release or else the people can’t view the private medical information. As you know, we think that this is just one component of a comprehensive estate plan.
This doesn’t cover managing your finances if you get sick. It doesn’t cover getting access to the IRA or anything like that. It doesn’t cover managing your financial life. It’s just your health care. You need to think about the other one as well and make sure that that’s in place.
Jeez, look, just like that we’re done with talking about advanced healthcare directives and living wills and it was painless. Painless. All right? You’re still here. It’s just good planning.
I want to thank you for joining us. Thank you so much for listening to the show this week. I want to thank all the production crew for how they make us sound great.
If you have a special topic that you would like us to talk about, go ahead and send an email to feedback@MakeItLastRadio.com.
If you like the show, then do me two quick favors. The first is share it with a friend. If there’s somebody that you know that could benefit from this, share the link with them and then go have them subscribe on iTunes.
Victor: Because not only will they listen to future shows, but they can go back and listen to whatever shows happened in the past and they can get all caught up to date.
The second favor is go onto iTunes and leave a positive review. They rank these shows based on the number of positive reviews that are out there. We would love it if you would leave a nice review about this show so that other people can find it and other people can learn as well.
That’s all we’ve got for this week. Thank you so much for listening to Make It Last where we help you keep your legal ducks in a row and your financial nest egg secure. Remember, I was on vacation this week, but I’ll be back next week. See you next Saturday.
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