Living Wills and Medical Powers of Attorney – Why They Are Important

Medical Power of Attorney agent discussed health care decisions with family member
It is important to discuss medical preferences with your medical power of attorney agent.

Living Wills (referred to in Texas as “Directives to Physicians and Family Members”) and Medical Powers of Attorney are important if a person becomes incapacitated, whether that status is permanent or temporary. These are part of a comprehensive estate plan, and you’ll want to take care of this before a medical emergency arises. That’s the recommendation from the McPherson Sentinel article “Advance health care directives important to all adults.”

Documenting your wishes about future health care lets a cognitively healthy person express his or her wishes with a clear perspective. Unfortunately, only one in four American adults has their medical power of attorney and/or living will in place. Many wait to begin the planning process until they are in their 50s or 60s. The problem is, life doesn’t have a plan. Tragedy can strike at any time in life. A serious illness or an accident can occur leaving the family wondering what the person would have wanted.

You do not need to be in an “end of life” situation for a medical power of attorney to come into play. The agent you name in your medical power of attorney makes a health care decision for you any time you cannot communicate your wishes, yourself. This could happen during a routine medical procedure that is not life threatening.

The living will, on the other hand, sets out your wishes in the event you have a terminal condition, death is imminent, and you do no want your life to be prolonged by artificial means. Artificial means may include, among other things,  being placed on a ventilator or receiving artificial nutrition and hydration.

Under Texas law, your agent under a medical power of attorney may make the decision to withhold or withdraw life support, unless you have limited that power in the document. That is why a living will or a directive to physicians may not be legally necessary, if you have named an agent in a medical power of attorney. But many people opt to have a living will in addition to a medical power of attorney. They would like to give their own instructions for end of life decisions as opposed to putting the burden on the agent named in the medical power of attorney.

One thing to keep in mind is that a medical power of attorney is different from a financial durable power of attorney (in Texas – the Statutory Durable Power of Attorney), which gives a person the right to act as another person’s agent and conduct business and financial matters on his or her behalf.

It’s very important that the people you designate as agents in a medical power of attorney or living will are told that they have been named. You should designate an initial agent and then one or more successor agents in case the first person named is unable to act. Your agents need to fully understand what your wishes are and what kinds of treatments are acceptable to you. Communication is the key and you need to make sure that you and your agent have discussed your preferences.

The people you select as agents under your medical power of attorney should also understand that health care decisions for you need to be made according to your wishes and not their wishes or the wishes of other family members.

These documents should be prepared for you as part of your overall estate plan, with the guidance of an estate planning attorney. Be aware that the laws vary from state to state, so you’ll want to work with an attorney who knows your state’s laws. If you relocate to another state, you should update your medical power of attorney and living will to conform with that state’s laws.

Finally, make sure that your medical power of attorney and living will are located in a place where they can be easily found in an emergency.  Your agents should each have a copy they can bring to the hospital, if necessary. The important thing is that the medical power of attorney and living will can be found and used in a time of crisis.

Reference: McPherson Sentinel (April 17, 2019) “Advance health care directives important to all adults”

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Social Security Benefits – What Happens When a Spouse Dies?

Social Security benefits can change after the death of a spouse.
What happens to Social Security on the death of a spouse?

Imagine both spouses are receiving Social Security when one spouse dies. What will happen with their Social Security checks?  How does the survivor obtain death certificates? How complicated will it be to obtain survivor benefits?

First, what happens to the Social Security monthly benefits? Social Security benefits are always one month behind. The check you receive in May, for example, is the benefit payment for April.

Second, Social Security benefits are not prorated. If you took benefits at age 66, and then turned 66 on September 28, you would get a check for the whole month of September, even though you were only 66 for three days of the month.

If your spouse dies on January 28, you would not be due the proceeds of that January Social Security check, even though he or she was alive for 28 days of the month.

So, when a spouse dies, the monies for that month may have to be returned. The computer-matching systems linking the government agencies and banks may make this unnecessary, if the benefits are not issued. Or, if the benefits were issued, the Treasury Department may simply interrupt the payment and return it to the government, before it reaches a bank account.

There may be a twist, depending upon the date of the decedent’s passing. Let’s say that a spouse dies on April 3. Because he or she lived throughout the entire month of March, that means the benefits for March are due, even though they are paid in April. If a check was not issued or sent back because of the date, it should eventually be reissued.

Obtaining death certificates is usually handled by the funeral director, or the city, county or state bureaus of vital statistics. You will need more than one original death certificate for use with banks, investments, etc. The Social Security office may or may not need one, as they may receive proof of death from other sources, including the funeral home.

If you were already receiving spousal benefits on the deceased spouse’s work record, Social Security will in most cases switch you automatically to survivor benefits when the death is reported.  Otherwise, you will need to apply for survivor benefits by phone at the 800 number for Social Security or in person at your local Social Security office.

If you had only received a spousal benefit as a non-working spouse and you are over full retirement age, then you receive whatever your spouse was receiving at the time of his or her death. If you were getting your own retirement benefits, keep in mind that you will not receive a survivor benefit in addition to your own retirement benefits. Social Security will pay the higher of the two amounts.

Survivor benefits will begin effective on the month of your spouse’s death. If your spouse dies on June 28, then you will be due survivor benefits for the entire month of June, even if you were only a widow or widower for three days of the month. No matter what type of claim you file, you will also receive a one-time $255 death benefit.

Reference: Tuscon.com (March 13, 2019) “Social Security and You: What to do when a loved one dies”

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Elder Law Community Follows Proposed New Alzheimer’s Legislation

Assistance may be on the way for those with younger onset Alzheimer's disease.
Assistance may be on the way for those with younger-onset Alzheimer’s disease.

Elder law issues can also affect those under 65. About 200,000 individuals aged less than 65 have younger-onset Alzheimer’s disease, according to Clay Jacobs, executive director of the Greater Pennsylvania Chapter of the Alzheimer’s Association.

“The need to reach everyone affected will grow significantly in the coming years,” he said.

A bipartisan effort in Congress to make these elder care services available to younger people affected by Alzheimer’s disease recently resulted in the introduction of new proposed legislation known as the “Younger-Onset Alzheimer’s Disease Act.”

Nutritional programs, supportive services, transportation, legal services, elder-abuse prevention and caregiver support have been available through the “Older Americans Act” since 1965. However, under the current law, only individuals over 60 are eligible for these kind of elder care services.

“These programs would make a huge difference in the lives of individuals living with younger-onset Alzheimer’s disease, who don’t have support services available to them,” said a Congressional hearing witness Mary Dysart Hartt of Hampden, ME, a caregiver to her husband, Mike, who has young-onset Alzheimer’s.

Another bipartisan effort in Congress affecting elder law involves the proposed “Lifespan Respite Care Act” to help communities and states provide respite care for families. This legislation would earmark $20 million for fiscal year 2020, with funding increasing by $10 million annually to reach $60 million for fiscal year 2024. The program lets full-time caregivers take a temporary break from their responsibilities of caring for aging or disabled family members.

Elder law attorneys are following this legislation in hopes that the new laws, if passed, will provide additional ways to help those afflicted with early onset Alzheimer’s disease and to ease the burdens on full-time caregivers.

Reference: McKnight’s Senior Living (April 3, 2019) “Bill would aid those with younger-onset Alzheimer’s disease”

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