Many of my clients want to remain in their homes for as long as they are mentally and physically able to do so. Nowadays, with the Pandemic, people who avoid going into a residential care facility, such as an assisted living or a skilled nursing home, are much less likely to get Covid-19 and other communicable illnesses that spread easily in senior living facilities. This reality motivates seniors to consider the option of remaining at home as long as possible.
If assistance is required with their activities of daily living then they want such assistance to be provided at home so long as it is feasible. Preparation for such in home care includes planning around one’s present and anticipated personal care needs, financial needs and estate planning documents.
A long term personal care plan is needed. Personal care entails a wide variety of needs: Bathing, toileting, dressing, walking, meals, doctor visits, shopping, household chores, banking, and paying household bills. Some people rely on family members or friends who live with them to take care of these many activities.
Being proactive helps: Ask your health care provider to recommend any improvements to your household environment to facilitate your personal care. Consider hiring a traveling nurse to make an in home evaluation. For example, does your bathroom need to be fitted with grab bars? Do you need a wheel chair ramp to your door? Consider engaging an emergency 24/hr./7day service to assist you at the push of a button on a pendant you wear around your neck. Do you have someone to make routine welfare checks to see you are well? Do you have someone to take you grocery shopping or to do shopping for you? Do you have meals on wheels? Do you need in home care services to assist you with your activities of daily living? Are the people you trust acting in your best interest?
Personal care planning also involves having an Advance Health Care Directive (AHCD), Health Insurance Portability and Accountability Act (HIPAA) Waiver, and possibly even a Physicians Order Regarding Life Sustaining Treatment (POLST). The AHCD allows you to say how you want to be treated, how you don’t want to be treated, and whom you want as your agent to make health care decisions for you when you cannot make them yourself. AHCD’s come in a wide variety of types (such as the California Medical Association (CMA) AHCD, the California Statutory AHCD, and a wide variety of attorney drafted AHCD’s). AHCD forms are available at your physician’s office, local hospital, Hospice, attorney, on-line and many stationary stores.
Any long term personal care plan needs to factor how the expenses are to be paid. A budget needs to be planned and financial planning needs to be done to make sure that that there is adequate money. There are certain financial planners – eldercare financial planners – who specialize in financial planning for senior citizens. The attorney who does the legal estate planning needs to know what personal care and financial planning are in place in order to draft estate planning documents that take the same into consideration.
The estate planning documents need to provide authority and guidance for others (agents, trustee) to act in furtherance of the personal care plan and the budget. Specifically, the power of attorney would need to say the agent is to pay for and to hire certain types of services related to providing in home care and to modifying the house to make it suitable. It would also authorize the agent to hire financial advisors to assist in the financial planning. That agent would then be able to utilize retirement funds and other assets held outside of a trust to pay for such expenses. Likewise, the trust would also need to speak to these same issues to allow the trustee to utilize trust assets in furtherance of these same objectives.
Putting a plan together involves accessing different resources to meet different needs. The Lake and Mendocino County Area Agency on Aging (“AAA”) has put together a useful Resource Directory for Older Adults. The AAA can be reached at 800-510-2020 or 707-468-5132. Website: www.lakecountyca.gov/Page9118.aspx.
Dennis A. Fordham, Attorney, is a State Bar-Certified Specialist in estate planning, probate and trust law. His office is at 870 S. Main St., Lakeport, Calif. He can be reached at dennis@DennisFordhamLaw.com and 707-263-3235.