Documenting Your
Decisions with Advance Directives
Written
By: Attorney
Jeffrey A. Marshall
, CELA*
Advance
care planning is a process through which you consider your
personal values about medical treatment and the care you want to
receive at the end of life, discuss those values with your
family and others close to you, and complete documents that
record those decisions for the future.
It is the best way to help ensure that your values,
wishes, and choices will always be known and respected.
The legal tools that document your
decisions are called advance directives.
Pennsylvania
has recently re-written its laws regarding advance directives.
An advance directive is a written or spoken
statement you make today to control the health care treatment
you will receive in the future. It gives your family and health
care providers your directions and decisions about medical care
in case you cannot, at some future time, speak for yourself.
In it, you may name a spokesperson (agent or
representative) to make decisions on your behalf.
Pennsylvania
law recognizes a number of forms of advance directive.
A living will provides treatment
instructions regarding the types of medical treatment and care
you want to receive or refuse at the end-of-life. This document
is typically used by people to describe the point at which they
would no longer desire certain types of life-prolonging medical
treatment, but it may also document your desire for continuation
of treatment. A
living will is a limited document because it is operative only
when you have an end-stage medical condition or are permanently
unconscious. As a result, living wills apply to only a small
fraction of the decisions caregivers must make.
A health care power of attorney appoints
a person of your choice to make health-care decisions whenever
you are unable to make decisions for yourself. Your spokesperson
(agent) can act regardless of whether you are terminally ill or
permanently unconscious. You can include your treatment
instructions and guidance as to your preferences regarding
end-of-life care and other situations that may arise in the
document.
An appointment of health care
representative designates a person to make health-care
decisions for you. You
can make your designation in writing or by personally informing
your physician or health care provider of the person or persons
you want to act as your representative.
You can also specify that certain individuals should be
excluded from making decisions concerning your care.
A mental health advance directive is
a written document that expresses your choices for treatment
related to mental health care in the event that mental illness
makes you unable to make decisions.
There are also several forms of physician
orders that may be used to provide advance treatment
instructions. These
documents are a unique form of advance directive because they
are actual physician treatment orders.
∙
A do-not-resuscitate (DNR) order is a medical
order written by a patient's attending physician that directs
medical personnel to forgo cardiopulmonary resuscitation (CPR)
if the patient's heart or breathing stops. The order, sometimes
referred to as a "no code" or "comfort
care," is usually placed on the patient's chart.
There are several varieties of DNR orders. The
traditional DNR order is given by the doctor of a hospital
in-patient directing that resuscitation not be performed in the
event that the patient's heart or breathing stops. A second
variety of DNR which gives similar instructions for
non-institutionalized individuals is the Out of Hospital
Do-Not-Resuscitate order.
∙
A POLST order is standardized form containing
physician orders detailing the scope of life-sustaining medical
treatment to be provided to a patient. POLST stands for
physician-order-for-life-sustaining treatment.
Creation of an advance directive is an
important step in the advance care planning process.
But you should recognize that it is only one step.
Your advance directive will not accurately reflect your
preferences unless you have taken time to reflect on what is
important to you in life and what gives your life meaning. What
kinds of situations do you fear facing in the future? Would you
ever want to limit certain types of treatment? Do you want to be
sure that you will receive certain types of treatment?
Who is the best person to speak for you if you are ever
unable to speak for yourself?
If your family is to understand and follow
your wishes, they really need to participate with you in your
planning. Family
conversation today can spare your family members from the agony
of having to make painful decisions in the future without any
meaningful guidance about what you would really want.
Important issues can be considered while there is time
for reflection and discussion.
By planning in advance you can provide your
family and other care givers with the information they will need
to make the most appropriate decisions for you.
They won't have to guess what you would want.
All too often families are forced to make medical
decisions for a loved one during a crisis while under great
emotional stress. Studies of close family members show that they
do not automatically know each others wishes even under the best
of conditions. Spouses very often guess wrong about what kind of
treatment their husband or wife would want. The more your family
knows, they less they will have to guess and disagree and argue.
Effective advance care planning is a
blessing you can bestow on yourself and the people closest to
you. A crisis
situation may not give you the opportunity to discuss critical
issues with your family. The
time to plan is now.
For further information on
Pennsylvania
’s new law on advance directives and tools to help you with
advance care planning see,
Marshall
,
Parker & Associates
Advance
Care
Planning
Resource
Center
at the following link: http://www.paelderlaw.com/advance_care_planning.html
.
Attorney Marshall can be contacted at webmail@paelderlaw.com
or at 1-800-401-4552
New
Spousal Impoverishment & Waiver Amounts Announced for 2008
Written
By: Attorney Jeffrey A. Marshall, CELA*
The
Centers for Medicare and Medicaid Services (CMS) has announced a
number of new qualification and protected resource and income
levels for the Medicaid Long Term Care benefits.
The following new levels are effective beginning
January 1, 2008
.
Community
Spouse Allowances
In
general, when your spouse is in a nursing home or needs home
care under the PDA Waiver program, he or she will not qualify
for Medical Assistance (Medicaid) benefits until your combined
savings are reduced to a certain level.
That permitted level of so-called "available
resources" varies with each situation.
For nursing facility residents, the
Pennsylvania
general rule is that the community spouse can keep ½ of the
amount of available resources that were owned by the couple on
the date of admission to the nursing facility.
However, this protected "Community Spouse Resource
Allowance" is subject to a ceiling and a floor as noted
below.
In
addition to being allowed to keep the resource allowance, the
community spouse is also entitled to have a certain minimum
level of income called the Minimum Monthly Maintenance Needs
Allowance. The income allowance is also subject to a ceiling and
a floor. If the
community spouse does not have the required level of income, the
spouse may be allowed to keep some of the institutional spouse's
income. If the
income diverted from the institutionalized spouse is still
insufficient, the community spouse may be able to keep
additional resources.
These
community spouse resource and income allowances are adjusted
annually. Effective
January 1, 2008
, the new base standards will be as follows:
ü
Minimum Community Spouse
Resource Allowance - $20,880.
ü
Maximum Community Spouse
Resource Allowance -$104,400.
ü
Maximum Community Spouse
Monthly Income Allowance - $2,610.
Note:
The Minimum Monthly Income Allowance remains $1,712 - it will be
adjusted on
July 1, 2008
.
Federal
Benefit Rate
The
Social Security Administration has announced the SSI Federal
Benefit Rate Standards for 2008 as follows:
ü
Individual - $637.00 per
month
ü
Couple - $956.00 per
month
PDA
60+ Home Waiver Program
The
Federal Benefit rate is used to determine qualification for many
Medicaid public benefit programs including the Department of
Aging 60+ Home Waiver program. The income limit for the Waiver
program is equal to 300% of the SSI Federal Benefit rate for an
individual. This means that effective
January 1, 2008
the new income ceiling should be:
ü
$1,911 per month - PDA
60+ Medicaid Waiver Program Income Limit
Under
current
Pennsylvania
requirements, individuals with income above this limit cannot
qualify for the PDA 60+ Home Waiver program.
Attorney Marshall can be contacted
at webmail@paelderlaw.com
or at 1-800-401-4552
Home
Safety for People with Alzheimer's Disease
Written
By: Attorney Jeffrey A. Marshall, CELA*
The
National Institute on Aging has produced a helpful booklet on
home safety for people with Alzheimer’s disease.
The booklet is designed for those who provide in-home
care for people with AD or related disorders. Its goal is to
improve home safety by identifying potential problems in the
home and offering possible solutions to help prevent accidents.
The free booklet is available online at
http://www.nia.nih.gov/Alzheimers/Publications/homesafety.htm
Attorney Marshall can be contacted
at webmail@paelderlaw.com
or at 1-800-401-4552
Learn How to Protect
Your Assets from Long Term Care Costs at our FREE Community
Workshop
-Marshall, Parker & Associates’
Attorneys Jeff
Marshall, and Brenda
Colbert will present a free consumer workshop on Protecting
Your Assets from Long Term Care in Clarks Summit this month.
Reserve
your seat by calling 1-800-401-4552 or visit our registration
page online.
-Saturday,
November 17th from 10:00 AM until
12:00 PM
The
Inn
at
Nichols
Village
in
Clarks
Summit
If you would like someone from
Marshall
, Parker & Associates
to speak at your next meeting, please contact Melissa Bottorf at
570-321-9008 or mbottorf@paelderlaw.com.
