Will New Tool Help Dementia Patients and Their Doctors?

A new tool may help doctors predict life expectancy with dementia to enable patients and families to make important, informed decisions on long term care.

Researchers think that a new tool for dementia patients could help these individuals, as well as their care providers better communicate about the disease and risk of death and develop future care plans as it progresses by predicting life expectancy with dementia.

Dementia is a non-specific clinical syndrome that involves cognitive impairments with the level of severity to interfere with social or occupational functioning.  The disease involves at least two areas of affected cognition – memory, language, reasoning, attention, perception, or problem solving.  Memory loss by itself isn’t necessarily dementia, because there can be many causes of memory loss. Some of the most common types of dementia are Alzheimer’s disease, Lewy body dementia, frontotemporal dementia and vascular dementia.  Dementia may require substantial long term care, and life expectancy with dementia would be helpful for families to plan appropriately.  See here for more details.  https://galligan-law.com/elder-law-questions/

McKnight’s Long-Term Care News’ recent article entitled “New tool predicts life expectancy of dementia patients” reports that almost half (48%) of residents in nursing homes have a diagnosis of Alzheimer’s disease or other dementias, according to data from the Centers for Disease Control and Prevention.

“In those cases, a tool like this can be an incentive to start such a conversation, which should be held before there are too many cognitive obstacles.” said Sara Garcia-Ptacek, a researcher at the Karolinska Institutet in Sweden.  She went on to note that this discussion could be about where someone would prefer to live, at home or in other accommodation, or anything else that needs planning.

The tool uses four characteristics to predict life expectancy: sex, age, cognitive ability and comorbidity factors.

In the intensive research, investigators tested the tool using data from more than 50,000 patients who were diagnosed with dementia between 2007 and 2015.  These researchers found that that the tool was able to predict three-year survival following a dementia diagnoses with “good accuracy.”  The new tool also found that patients who were older, male and had lower cognitive function at diagnoses were more likely to die during that time period.

Although dementia is always a difficult situation, both for the patient and the family, this tool predicting life expectancy with dementia will help everyone make more better, more informed decisions about long term care and caregiving.

Reference: McKnight’s Long-Term Care News (Jan. 26, 2020) “New tool predicts life expectancy of dementia patients”

 

Continue ReadingWill New Tool Help Dementia Patients and Their Doctors?

Making End of Life Decisions Part of your Estate Plan

End of life decisions are an important part of your estate plan.

If your end of life decisions are important to you, there are a handful of documents that are typically created during the process of developing an estate plan that can be used to achieve this goal, says the article “Choosing a natural end” from The Dallas Morning News.

The four documents are the Medical Power of Attorney, the Directive to Physicians, the Out-of-Hospital Do-Not-Resuscitate, and the In-Hospital Do-Not-Resuscitate. Note that every state has slightly different estate planning laws. Therefore, you will want to speak with an experienced estate planning attorney in your state. If you spend a lot of time in another state, you may need to have a duplicate set of documents created. Your estate planning attorney will be able to help.  In Texas, attorneys often prepare the Medical Power of Attorney and Directive to Physicians, and Do-Not-Resuscitate Orders are prepared by medical systems.  See Mary’s excellent blog for further background https://galligan-law.com/living-wills-and-medical-powers-of-attorney-why-they-are-important/.

For the Medical Power of Attorney, you are appointing an agent to make health care decisions if you cannot. This may include turning off any life-support systems, refusing life-sustaining treatment and other end of life decisions. Talk with the person you want to take on this role and make sure they understand your wishes and are willing and able to carry them out.  You have the right to change your agent at any time.

The Directive to Physicians, which is basically the Living Will of Texas, is a way for you to let physicians know what you want for comfort care and any life-sustaining treatment in the event you receive a diagnosis of a terminal or irreversible health condition. You aren’t required to have this, but it is a good way to convey your wishes. The directive does not always have to be the one created by the facility where you are being treated, and it may be customized to your wishes, as long as they are within the bounds of law. Many people will execute a basic directive with their estate planning documents, and then have a more detailed directive created when they have a health crisis.  It and the Medical Power of Attorney serve to nominate and provide guidance to your healthcare decision-maker on end of life decisions.

The Do-Not-Resuscitate (DNR) forms come in two different forms in most states. Unlike the Directive to Physicians, the DNR must be signed by your attending physician. The Out-of-Hospital DNR is a legally binding order that documents your wishes to health care professionals acting outside of a hospital setting not to initiate or continue CPR, advanced airway management, artificial ventilation, defibrillation or transcutaneous cardiac pacing. You need to sign this form, but if you are not competent to do so, a proxy or health care agent can sign it.

The In-Hospital DNR instructs a health care professional not to attempt CPR, if your breathing or heart stops. It is issued in a health care facility or hospital and does not require your signature. However, the physician does have to inform you or make a good faith effort to inform a proxy or agent of the order.

If you have specific wishes for your end of life decisions, especially if you want a natural end, speak with your estate planning attorney about how to legally prepare to protect your wishes.

Reference: The Dallas Morning News (Jan. 12, 2020) “Choosing a natural end”

Continue ReadingMaking End of Life Decisions Part of your Estate Plan

Funeral Planning: Not a Festive Thought, But A Kind One

Funeral planning as part of your estate plan provides clear, final wishes, names a person to execute them and helps your family cope at a difficult time.

No one wants to do funeral planning, but leaving instructions for your funeral and burial wishes relieves loved ones of the burden of making decisions and hoping they are following your wishes. In addition, says the article “Important to provide instructions for preferred funeral, burial wishes” from The Leader, it also prevents arguments between relatives and friends who have their own opinions about what they think you may have wanted.

What often happens is that people make their funeral plan and final wishes part of their estate plan.  In some states, burial wishes are found in a will.  However, this often presents a problem as the will is usually not looked at until after the funeral. If your loved ones don’t know where your will is, then they certainly won’t know what your wishes were for the funeral.  Without clear written directions, spiritual practices or cultural traditions that are important to you, may not be followed.

An estate planning attorney can help you create a document that outlines your wishes and will have suggestions for how to discuss this with your family and where it should be located.  In Texas, much like in New York as referenced in the article, there is a form that allows you to name an agent who will be in charge of your remains.  In Texas it is called the Appointment for Disposition of Remains.  You can give your instructions to that person in the document which takes the mystery and a lot of the difficulty out of the process.

In Texas, if you don’t name a person to control the disposition of remains, there is an order of priority for decision makers, including spouses, a child, a parent and so on.  If you wouldn’t want those individuals making these decisions, an Appointment for Disposition of Remains is essential.

For funeral planning, one option is to go to the funeral home and arrange to pay for the funeral and go to the cemetery and purchase a plot. In Texas, a pre-need, pre-paid irrevocable burial plan may also be excluded from Medicaid for long-term care purposes.  See here for more on that topic.  https://galligan-law.com/elder-law-questions/

Some people wish to donate their organs, which can be done on a driver’s license or in another statement. This should also be authorized on you Medical Power of Attorney so that your agent has the authority to do so.  Donating your body for medical research or education will require researching medical schools or other institutions and may require an application and other paperwork that confirms your intent to donate your body. When you pass, your family member or whoever is in charge will need to contact the organization and arrange for transport of your remains.

A comprehensive estate plan does more than distribute assets at death. It also includes what a person’s wishes are for their funeral and burial wishes. Think of it as a gift to loved ones.

Reference: The Leader (December 7, 2019) “Important to provide instructions for preferred funeral, burial wishes”

Continue ReadingFuneral Planning: Not a Festive Thought, But A Kind One