How to Incorporate Medical Care Decisions into Your Estate Plan

My last report covered all the medical care documents you’ll need, such as your HIPAA Authorization, health care power of attorney (HPOA), living wills and advance directives.  Today I lay out some working guidelines for making important medical care decisions.

Do not resuscitate/hospitalize

It’s common for older patients, especially frail ones in nursing homes, to have do not resuscitate (DNR) and do not hospitalize (DNH) orders.

Research indicates CPR rarely helps these individuals recover and instead makes their deaths violent rather than peaceful.

The idea behind the DNH is that at some point people do not benefit from hospitalization for every new ailment or development.

Instead, they should be kept comfortable wherever they are residing until they pass.

People who agree with those thoughts and believe they are in those situations can use the documents to decline CPR or hospitalization in advance.

Making Your Instructions More Effective

Remember that one of the criticisms of living wills is that they often aren’t followed for various reasons. Consider these steps to ensure your preferences are known and followed.

Put it all in one document

You don’t need a separate HPOA and living will or advance directive plus a HIPAA authorization.

Most estate planners now prepare one comprehensive document, and many states now have model forms available that combine the documents.

Several websites also offer either the state-approved forms or their own recommended forms.

Approved forms for each state are offered at www.caringinfo.org. You also can find sample documents, labeled Five Wishes, from Aging with Dignity (www. agingwithdignity.org; 888-5-WISHES). Some websites offer free documents while others charge modest fees.

Be sure it is valid

The documents have to be valid in the state where you are present at the time treatment is considered.

Some states require two witnesses for the documents to be valid. Others require three witnesses. A few states require notarization.

If you spend time in more than one state or travel a lot, your documents need to be valid in all states involved, or you need separate ones for each state.

A good Estate Planning attorney can help determine the best solution for your case.

Don’t keep it to yourself

To reduce disagreements and misunderstandings among those around you, it makes a lot of sense to discuss details with the people you designate as proxies.

Share general beliefs and plans with your family and loved ones. Your proxies need to know your preferences, so they can make decisions in specific circumstances that reflect your wishes.

Each of them also should have a copy of the document.

Of course, the medical providers need to know about your plans and wishes.

Your regular physicians should have copies or a notation in your records that the documents exist with contact information for any proxies or agents.

Many states now have online registries. If you register the documents then medical providers can easily search and find them.

Even with these tools, difficult decisions might have to be made by loved ones.

But you can ease the burden and provide a framework for action by including medical decision making in your estate plan.

Though I list sources of forms and documents, I don’t recommend that most people complete these on their own.

This is part of an estate plan and should be finalized with the guidance of your estate planner.

Keep in mind that most states allow a doctor or hospital to refuse to follow the instructions for reasons of conscience.

So, you should discuss preferences and philosophy with your key medical providers.