PULL THE PLUG- A PRIMER ON ADVANCE CARE DIRECTIVES

If you become very ill or injured, you may not be able to make health care choices for yourself. You want your health care providers to be clear as to what type of care you prefer during those times when you are unable to speak for yourself. If family members are uncertain about the type of medical care you want they could disagree with each eachother leading to hard feelings or even expensive litigation. An advance care directive is a legal document that tells your providers what care you agree to in advance of this type of situation. With this document, you can tell your providers what medical treatment you do not want to have and what treatment you want no matter how ill you are.

GREAT NEWS FOR MEDI-CAL RECIPIENTS!

Wonderful news for many people who are on the Medi-Cal program.

California is very generous when qualifying low income and middle class families for Medi-Cal  benefits, but there has been a nasty underbelly to this. California has an extremely aggressive and harsh estate recovery program.

As I have explained before on this blog, under current law there is a very real problem going on where impoverished people are forced to repay the government for the cost of their healthcare with their life savings after they die— often the family home.

MEDICARE ADVANCE CARE PLANNING Q&A

  **This content is Provided by DocuBank^® 

Medicare:  Helping You Make Your Wishes Known

Starting this year, Medicare is making it easier for you and your doctor to have conversations about your medical wishes.  This is good news.  These conversations are important.  They help you think about what’s important to you and help you get the care that you want when it matters most.

Having these conversations about your health care wishes is part of Advance Care Planning, or “ACP” in medical jargon.  ACP also includes creating legal documents about your wishes, called advance directives. 

More good news — you might be ahead of the game if you’ve done your estate planning.  Like many estate planning attorneys, I include an advance care directive as part of my standard estate planning package.   

o   Advanced Health Care Directive (says whom you want to make decisions for you if you can’t and expresses your goals for care or your medical wishes if you can’t make decisions for yourself)

o   HIPAA Release (a special document that may or may not be separate.  It names the people you want to be able to talk to doctors and get your medical information on your behalf, in addition to your health care power of attorney.)

If you have advance directive documents, the next step is to talk with your loved ones and your doctor about your wishes, and make sure both have copies of your advance directives.

Below are answers to some common questions about your new Medicare benefit.

P.S. This is also a good time to review your advance directive and see if it still reflects your wishes.  For example: Do you want or need to change whom you’ve appointed to make healthcare decisions for you if you can’t?  Is this person still alive and capable of performing this role?  Do you still have the same goals if your health is compromised?  Do your treatment wishes still reflect these goals?  If you’d like to change your documents please consult with an estate planning attorney. 

Q&A:  Medicare Benefit for Advance Care Planning

• How is Medicare making it easier to talk to my doctor about my wishes? 

Advance Care Planning (ACP) conversations are important and can be sometimes lengthy.  It was hard for doctors to fit this conversation into the time frame of your regular office visit, which you know can feel very rushed as it is.  Medicare recognized this and decided to pay doctors separately to have these important discussions with their patients.  By paying additionally for Advance Care Planning conversations, Medicare is giving doctors the time to have this discussion with you.  Medicare pays physicians in half-hour increments for ACP.   

• Are discussions about my wishes voluntary?  

ABSOLUTELY.  You can bring up the subject, or your doctor can do so in the course of giving you appropriate care.  You always have the prerogative to accept or decline to have this conversation. 

•      What will a discussion about my wishes be like?  

ACP discussions are for explaining and discussing your wishes and your advance directive documents.  Since you already have advance directives, you and your doctor will discuss the choices you’ve made.  You can also ask your doctor questions and get clarification about medical terms or situations that might arise, and to make sure that the selections in your documents reflect your actual wishes.

• Should my doctor have a copy of my advance directives?

YES.  To have this discussion, your doctor is likely to (and should) ask you for a copy of your advance directives.  A great option my firm offers is to enroll clients in the DocuBank® advance directives registry to make it easy for your doctors and hospitals to get your advance directives right away, 24/7/265.  Just give your DocuBank® Emergency Card to the doctor’s office staff when you sign in.  They will use it to immediately get your directives and put them in your chart.  

• Does talking about ACP mean I eventually want to “pull the plug?”  

NO!  Not at all. Advance Care Planning is about figuring out and communicating your wishes — WHATEVER THEY MAY BE.  This could be a discussion about wanting everything done to extend life as long as possible in all medical situations.  Or it could be about wanting to be kept comfortable above all else in the case of a terminal illness.  Or it could be a myriad of scenarios/choices in between, depending on the circumstances. 

• It is appropriate for my doctor to talk about my wishes when I’m healthy?  

YES! Advance Care Planning is not just for sick people. Your doctor may have an ACP discussion with you at your Medicare “Annual Wellness Visit.”  ACP discussions are recognized by the medical profession as a component of high quality care at many points in your life and health.  In fact, hospitals have been required for 25 years to ask patients if they have an advance directive.

• What else is included in an ACP discussion?  Is ACP also about sharing whom I want to make decisions for me if I can’t?  

YES.  This is at least as important as talking about your wishes. You can also talk about organ donation and other related matters.

•  Is there a co-pay for ACP conversations with my doctor?  

There is no co-pay when these discussions occur during your Medicare Annual Wellness Visit.  There may be a co-pay at other times, depending on your Medicare plan. 

• Must I always talk with my doctor for Medicare to pay for an ACP discussion?   

No, not necessarily.  You may also be able to talk with a nurse practitioner, physician assistant, or other staff person who is supervised by your doctor — if your the doctor’s office permits this.  Sometimes patients prefer to talk with these other health professionals, feeling that they are more compassionate or not as rushed.

• This is an uncomfortable conversation for me.  Are there real benefits to forcing myself to do this?  

YES!  Research shows that patients and their loved ones benefit from having advance care planning discussions.  Studies have found that talking about choices for care – regardless of the specific care choices you make — increases patient and family satisfaction with their care.  It also has been shown to reduce the emotional burden and distress on caregivers.  The evidence bears out that talking about your wishes is a tremendous gift that you can give to yourself and to your loved ones.

• Where can I find my advance directives? 

If you have completed your estate planning you should find your advance directives in your estate binder or file. If you are enrolled in DocuBank you can just view them online.  Or, if you have a fax machine, you can use your card to call and receive a faxed copy.  

©  DocuBank^®  March 2016.   Reprinted with permission.

SHOULD A MARRIED COUPLE HOLD TITLE TO REAL ESTATE IN JOINT TENANCY?

When you buy a home your real estate agent will ask you how you want to hold title. As a married couple in California you have a few choices, with different legal and tax consequences.

Here is the analysis you need:

OBAMA: IF HEALTH CARE IS A “RIGHT FOR ALL” WHY ARE OLDER CALIFORNIANS LEFT OUT?

In the midst of today’s celebration around the Supreme Court’s decision to uphold the Affordable Care Act, President Obama said:
“Five years ago, after nearly a century of talk, decades of trying, a year of bipartisan debate, we finally declared that in America, health care is not a privilege for a few but a right for all.”

Perhaps he doesn’t know that impoverished Californians ages 55-65 are one of the few remaining groups that will have to pay for all of their own medical care.

For those of you who have been following my posts about Medi-Cal, you know that I put out an alert that going on Medi-Cal under Covered California could lead to the loss of your family home if you are between 55 and 65 years old. This is new news to for the many people who have just qualified for Medi-Cal because of the expanded program (Thanks Obama!), but as my post on Medi-Cal recovery explains, it is old news for everyone who has been dealing with the fact that Medi-Cal is a LOAN, not a public service, once you hit 55 (or if you are unlucky enough to fall in any of the other recovery categories). 

SHOULD I INCORPORATE?

So your business is up and running (or on its way!) and suddenly you wonder, what is that incorporation stuff all about anyway?

I too had to ask myself the same question when I started my own law firm. I was surprised at how much inaccurate and confusing information exists on the Internet.  (Yes, even after taking Corporate Law, I still love to Google.  Actually, my triple checking everything is probably a certifiable personality disorder).  

Sadly, over my years of practice in this area, I’ve also found that even professional advisors often give misleading and unclear advice on the topic.

SHOULD I FILE FOR BANKRUPTCY?

The bill collectors are calling.  You hate the poor soul who delivers your mail.  You stopped using your credit cards in public to avoid that embarrassing look the teller gives you when the card is declined.  Your paycheck doesn’t look like it will ever stretch to meet your debt and you don’t know what to do… so what about that bankruptcy thing?

There are two main types of bankruptcy for the average person with a lot of consumer debt:  Chapter 7 and Chapter 13.

Chapter 7 is often preferred because it comes the closest to wiping the slate clean.  Your debt.  Gone.  (Of course there are exceptions, Ask Roxy readers know that there are always exceptions in law— that is what makes it fun!).  Chapter 13 has this ugly term associated with it called “repayment plan” so let’s dig into the details of Chapter 7 first.