Assisting the Elder and Ourself in Transition
Transitions are inevitable. Planning for a smooth, controlled and satisfactory transition is critical to maintaining harmony and reducing fear. Failure to plan for a transition is tantamount to planning for chaos. Having a transition plan can set life priorities. We should set our own priorities and plan before a medical emergency or an urgent financial crisis takes decisions out of our hands. Our spouses, family and critical partners should be confident they understand the priorities and can assist in making decisions, or if necessary, make decisions for us.
Let’s look at several basic concepts.
Emergency Information. Most common checklists can help us organize and provide checklists for basic information. But we all have a good idea of what information must be immediately and easily available for our families and agents.
In a medical crisis, a basic history, medication list, family and professional contacts should be at hand. Consider that everyone close to a person suddenly ill may be disoriented and required to act quickly. It is unrealistic to expect a calm and practiced reaction to the news that a parent or spouse has just been taken to the hospital emergency department.
A list of financial accounts, user names, passwords, trusted advisors should be created, maintained and shared with those who need it. Important documents should be secure, but your trusted partners should know where they are and how to access it.
Medical Events. There should be an adequate healthcare power of attorney or advance directive that one’s chosen agents have. These can be on the phone, hard copy in an easy place to access or in the Cloud. Just as important, the designated agent, whether spouse, child or friend, should understand how you feel about health decisions. If you cannot speak for yourself, are you confident your agent will? Are they willing to assist you? Will they be available? We once had a Delaware client request a relative in Oregon be the primary agent. Of course, it was impractical and the Oregon relative wisely declined once they were told.
There are two ways medical decisions are made if you cannot speak for yourself. The “Best Interest” standard and “Substituted Judgment.” Best Interest means what doctors, social workers and others think. Substituted Judgment means what you want. Are your healthcare agents ready to substitute your judgment for anyone else’s? Have you had an honest discussion with your healthcare agent?
Living Arrangements. Whether because of medical condition or age, we may have to change how we live. What is your plan? Saying that you plan to be carried out of your house is what will happen if you don’t plan, but not the way you expect! You won’t be carried out in a coffin, but on a gurney. After an unplanned hospital visit, you will be in a rehabilitation facility. Suddenly you learn you will not go home as it is unsafe for you. With little research and planning, you are placed in a less than optimal nursing home.
This is not our parents’ nursing home! There are many housing choices for us to make. Continuing care communities, independent living and assisted living sometimes offer the best care and options available. But action is required. The best communities have waiting lists. With some investigation can have a good idea what appeals to you. Delay is not a friend. Resistance is the enemy. Control is what you want. Do not wait until you feel children or others are forcing you to make a decision. And remember, the best communities are choosy. If they feel you are being forced to apply to their community, they will reject your application.
Driving Transition. Want to start a conversation that tears families asunder? Try suggesting that one should give up driving. We live in a mobile world and the inability to travel at will places one at a significant disadvantage.
But the privilege of driving comes with responsibility. We wait until one has the maturity and physical ability to make the myriad of judgments necessary to drive safety. Many of us approaching middle age begin to have reduced visual acuity at night and begin to drive much more cautiously. How do we know when it is no longer safe or prudent to drive?
AARP and AAA both have several assessments online that can be used.
The State of Delaware Division of Motor Vehicles also has a section devoted to senior driving.
Financial Transitions. Every one of our clients has heard how we present estate planning: that incapacity planning is critical. If one fails to plan, then the default plan is eventually someone, a spouse, child, relative, nursing home or the State will go to court to have a guardianship imposed. Guardianship law makes up a significant part of our practice. Failure to have a valid and useful power of attorney is the primary reason petitions for guardianship are filed.
Guardianship is the process whereby the court appoints an individual or entity and gives them the authority to make medical, personal and financial decisions for the person the court finds lacks capacity to make those decisions for themselves. This authority is limited. Whenever a major decision must be made, such as selling a house, then the guardian must return to court and file an application for permission. In Delaware, selling real estate usually requires three distinct court filings. This is all at the expense of the person who lacks capacity.
We need to decide not just who will be our decision-making agents, but how we will be assisted. Just because we have trouble balancing the checkbook or paying a bill on time does not mean we need someone to take over. The question is who will assist us?
Will a child help us with everyday financial management? Or will you prefer to coordinate with a daily money manager? Will a professional agent such as a trust company be a better choice? Will children have the ability and the time to assist?
Conclusion. Our clients are more active and engaged than ever. They want to make their own decisions and have their own plans followed. We expect to have long professional relationships with them. It is necessary to recognize that transitions will take place. Trusted professionals can help clients with transition strategies. Plans that recognize change will take place will leave clients in control and reduce stress and chaos that can accompany these know transitions.