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Case
Raises Awareness of End of Life Planning Concerns
Written By: Attorney
Jeffrey A. Marshall
, CELA*
In
Florida
last week, Terri Schiavo was reconnected to feeding tubes.
Her case brought the heartbreaking issues and conflicts that
families confront in making end-of-life decisions for incompetent loved
ones back to public attention. These
problems are especially acute where, as with Terri Schiavo, there has been
no advance planning
In 1976, Karen Ann Quinlan's parents' battle to
remove their daughter from life supports caught national attention.
In 1990, it was
Nancy
Cruzan's plight that reached both the front pages and the U.S. Supreme
Court. And now, in 2003, it
is Terri Schiavo's tragic turn.
Since 1990, Terri Schiavo has been in what her
doctors have determined to be a "persistent vegetative state."
She is being kept "alive" only through the use of feeding
tubes. Unfortunately, because
Mrs. Schiavo did not make a written record of her wishes in advance, it
has fallen to judges and politicians to decide whether this treatment
should be continued or withdrawn. A
long, horrific, and entirely avoidable legal and political battle has thus
added to the suffering of her husband and parents.
On October 15th, Mrs. Schiavo was removed
from her feeding tube, apparently ending a decade long struggle by her
husband to allow her to die. Mr.
Schiavo had the support of the state and federal courts throughout his
battle, but was opposed by his wife's parents.
Then, just as it appeared that this sad case was finally going to
end,
Florida
politicians decided to extend it.
Florida
passed legislation which gave Governor Jeb Bush the discretion to overturn
the court orders and direct the reinsertion of a feeding tube.
Within hours the Governor signed the order, thus continuing Mrs.
Schiavo's marginal existence and expanding the controversial litigation.
The issues are difficult and troubling.
But, Terri Schiavo's case is exceptional only in the amount of
public controversy and political interference it has engendered. These
kinds of circumstances don't just arise every 12-14 years - they
confront families every day. End-of-life
decisions need to be made whether or not the patient has planned in
advance. But, when there are no advance directions from the patient, the
decisions are much more difficult and troubling and also more likely to
reach the courts and public attention.
There is a long established legal and medical
consensus that competent patients have the right to refuse unwanted
medical treatment. And there
is also an established consensus that incompetent patients have the same
right to refuse treatment as do competent patients.
The problems with incompetent patients, of course, are how can we
understand their desires and who has the authority to exercise their
rights.
What can you do to assure that your values are
respected if you are ever unable to make health care decisions for
yourself? It is critical that
you create a well-considered advance directive.
Then, if you ever lose the capacity to speak for yourself, better
decisions will be made and your family's doubts, burdens and guilt will
be lightened, because you took the time to provide instructions and
authorization so that someone will be able to speak for you.
The most popular advance planning tool is the
"living will." However, for most residents of
Pennsylvania
, having a living will is insufficient - the document of choice should be
the health care power of attorney. (For more information on health care
powers of attorney and living wills, see the article, "Legal Tools for
Medical & Financial Decision Making" on the
Marshall, Parker & Associates'
website: http://www.paelderlaw.com/legaltools.html
)
According to published reports, fewer than 1 in 5
adults have an advance directive. If
you are one of the four in five who has not done advance planning, you are
leaving yourself and your loved ones open to the unkind fate of courts and
(as shown by the Schiavo case) of ideologically or politically motivated
state politicians.
In
Pennsylvania
, the chance that your family will wind up in court is substantially
greater than in many other states, because
Pennsylvania
laws do not specifically authorize your family members, even if they are
in agreement, to make health care decisions for you.
An update of
Pennsylvania
's inadequate laws regarding advance directives and end-of-life
decisions is now being considered by the Legislature, but the proposed
revision ignores the issue of how decisions should be made for the 80% of
adults without an advance directive.
(For a copy of the current legislative proposal, see the reference
to Senate Bill 492, below).
If you don't want to be a Terri Schiavo, get an
advance directive now. In
that document, you want to designate: (1) which person you want to make
health care decisions for you when you can't make them; (2) the kind of
medical treatment you want or don't want to receive, especially at the end
of your life; (3) your desires in regard to comfort and freedom from pain
if freedom from pain might potentially detract from your consciousness or
hasten the moment of your death; and (4) any other important instructions
regarding your care and treatment.
Here are some web resources on the issues addressed
in this article:
A good source of information which presents both
sides of the Schiavo case is the Tampa Tribune's special report,
available online at: http://reports.tbo.com/reports/schiavo/.
Pennsylvania
's complicated 49 pages of proposed legislation on advance directives is
available online at: http://www2.legis.state.pa.us/WU01/LI/BI/BT/2003/0/SB0492P0529.pdf.
Additional information on advance directives is also
available on the Marshall, Parker & Associates' website, www.paelderlaw.com.
Automobile
Registration Available for Seniors at a Reduced Fee
Written
By: Geriatric Planning
Specialist Michael Rentko
The
Pennsylvania Department of Transportation provides eligible seniors with
considerable savings on the costs of automobile registration.
The normal cost for automobile registration is $36.
Eligible seniors may receive the registration for just $10.
Only one vehicle registration is allowed per eligible senior.
To be eligible
for this benefit, a senior must meet the following criteria:
C
The individual must be retired and receiving Social Security, SSI
or other government retirement benefits.
C
The annual income of the individual must be below $19,200 during
the past registration year. Individuals must provide an estimate for the
upcoming year that does not exceed $19,200.
Income includes Social Security, SSI payments, retirement benefits,
annuities, interest, dividends, capital gains, business rental income,
wages, public assistance and unemployment compensation.
C
The automobile must be registered in the qualified individual's
name. For example, in a married situation where a wife makes $20,000 and
her spouse makes $19,000, they can receive the benefit as long as the
automobile is in the name (jointly or solely) of the individual below the
maximum income, in this case the husband.
C
Completion of Department of Transportation form MV-371.
For additional
eligibility questions or to receive an application visit the Pennsylvania
Department of Transportation's website at: http://www.dmv.state.pa.us/forms/index.shtml
or contact them by phone at 1-800-932-4600.
Tricare
for Life
TRICARE for Life is most appropriately thought of as
a secondary payer to Medicare. It
is available to all retired uniformed service members and eligible family
members who are enrolled in Medicare Part B, and have up-to-date
information in DEERS (Defense Enrollment Eligibility System).
There is no cost for the coverage, except the part B premium.
Typically, Medicare will pay first, and TRICARE will
pay the remaining out of pocket expenses.
However, there are some services, such as pharmacy and mental
health counselors, that Medicare will not pay, but TRICARE will pay with
an annual deductible and a co-payment.
Other services, such as Chiropractic care are payable by Medicare,
with co-payments, but not TRICARE. Also,
there is still another category of services not payable by either Medicare
or TRICARE. These services
include routine eye exams, hearing aids, and long term custodial care.
If you currently have other health insurance and are
considering dropping it, you are best advised not to do so until you are
entitled to TRICARE for Life, and only if your own health conditions would
warrant doing so. If you
choose to keep private health insurance, TRICARE becomes a third payer.
For more information on TRICARE for Life, call:
1-888-DOD-LIFE (1-888-363-5433) or www.tricare.osd.mil.
For more information on enrolling in Medicare Part B,
call: 1-800-772-1213, or www.ssa.gov.
To update your information in DEERS, call
1-800-538-9552.
"Legal
Tools for Seniors" Presentation Scheduled for North Central Geriatric
Interest Network
Attorney
Matthew Parker of Marshall, Parker & Associates' has been asked to speak at the
North Central Geriatric Interest Network's November meeting about Legal
Tools for Seniors: What
Professionals Need to Know.
This presentation will give attendees a better
understanding of powers of attorney, health care declarations ("living
wills") and other commonly misunderstood legal documents.
The North Central Geriatric Interest Network meets
quarterly at rotating locations and is open to both professionals and
members of the public who are interested in services, issues, and advocacy
for the aging adult. November's
meeting will be held at the Hillside Assisted Living Facility,
2725 Four Mile Drive
, Montoursville, on November 11th at
8:30 AM
. If you would like to
attend, please contact Virla at 322-4436.
"Understanding
Medicaid" Presentations Set for
Wilkes-Barre
and
Lewisburg"
Getting good information about options for long term care is critically
important for seniors. Four out of every ten people reaching age 65 will
spend some time in a nursing home and many more will require home care and
assistance with daily living.
The Elder Law Firm of Marshall, Parker & Associates' is
known throughout
Pennsylvania
for the expert help we provide seniors who are faced with long term care
needs. We help families struggling to care for their loved one at home
find the programs and financial help they need.
If nursing home placement becomes necessary, we work
with the facility to help make the transition go as smoothly as possible.
We make certain that the nursing facility gets paid in a timely manner
while helping the family qualify for government programs that help pay the
costs.
Marshall, Parker & Associates'
occasionally holds free educational forums to help educate families about
the options that are available to pay for long term care in the home or a
nursing home. Join us for one
of these free presentations and learn what you need to know about how to
get the help you need and protect your family's financial security when
your spouse or parent is faced with a long term illness.
Each presentation is
FREE and open to seniors, their families, elder care professionals, and
anyone else who needs to learn more about this complex subject.
Each presentation lasts about 1 ½ hours, including a "Question
& Answer" Session.
-Lewisburg:
Thursday, November 13th at
6:30
PM
at
Evan
Community
Health
Building
,
Staples
Plaza
,
Rte 15
-
Dallas
:
Saturday, December 6th, 2003 at 10:00 AM Stax & Company,
Memorial Highway, Dallas
Reservations
are suggested, but not required. SIGN
UP ONLINE
or call 1-800-401-4552 for more information or to reserve your spot for
one of these free seminars!
Do
you have a friend or colleague who would enjoy reading the
Elder Care Law Alert? If
so, please feel free to forward it to them. Simply use the "Forward"
button on your e-mail program.
To
subscribe or unsubscribe to the Elder Care Law Alert,
simply
send your request to:
webmail@paelderlaw.com
Does
Your Club Or Organization Need A Speaker?
If
you are interested in having an attorney or geriatric planning specialist
from
The
Elder Law Firm of Marshall,
Parker & Associates' speak to your group, or at an
upcoming event, please contact
our
Public Education Coordinator, Melissa
Bottorf
at
mbottorf@paelderlaw.com
or 1-800-401-4552
*Attorney
Marshall
is certified as an
Elder Law Attorney by the National Elder Law Foundation under
authorization from the Pennsylvania Supreme Court
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