Long Term Care and How to Decide

(Administration on Aging) As you age, you can feel better knowing there are steps you can take to ensure that your wishes, both medical and financial, are carried out the way that you want them.Advance care planning entails discussing your wishes, completing legal documents, and appointing a health care decision maker.

Having your decisions squared away and clear, so that there are no misunderstandings or second-guessing, can be the greatest gift you can give to your loved ones, and yourself.


Advance Care Plan Considerations

You should consider these questions as you plan:

  • What are your values and beliefs? When developing an advance care plan, consider your concerns, values, spiritual beliefs, or your ideas about what makes life worth living. A variety of user friendly publications and guides on advance health care are available at the American Bar Association.
  • What do you want for yourself? Most people think about the way they wish to face death or disability but may be uncomfortable discussing these topics.Sometimes sharing your own ideas, if you are helping someone, or reviewing the situations of other family members or friends who have been in similar situations, can help
  • Who do you want as your decision maker? Decide who should make decisions for you if you cannot. Choose someone who will understand and be able to carry out your wishes even if they include stopping life-sustaining treatment. You should also name a back-up agent to make decisions, in case the first person is not able to do so.

Will I Need a Lawyer?

Most people are unable to handle the complexity of planning their medical and financial futures on their own. Consulting an elder law attorney, who deals daily with the issues surrounding old age, can be the first step in the advance care planning process. Elder law attorneys can help you create a legal framework to ensure that your medical and financial wishes are fulfilled. Some general functions they perform are:

  • Preparing Advance Medical Directives or “living wills”that clearly state what medical treatments you wish, or do not wish to receive if you can’t answer for yourself
  • Preparing power of attorney documents, identifying the person you trust to make your decisions when you cannot
  • Estate planning in the form of last wills and testaments and/ or  “living trusts” that direct where your assets will go after your death
  • Exploring your qualifications for Medicaid, and if appropriate, applying on your behalf
  • Advocating, on your behalf, on disputes from insurance companies either for health insurance,long-term care insurance, or life insurance
  • Help your loved ones seek legal guardianship or conservatorship, if prior planning proves insufficient and you have lost capacity
  • Employment and retirement matters
  • General advice and counsel on issues surrounding aging

Legal Steps for Medical Well-being

“Advance directive” is a general term used to describe these two types of documents:

  • Living wills (sometimes called “advance health care directives”) are written instructions for care you wantor do not want in the event that you are not able to make medical decisions for yourself. State laws vary, so it is important to check on your state’s requirements when completing  these documents
  • Appointment of a health care surrogate or Medical power of attorney (also called a durable power of attorney for health care) is a document that names someone to make health care decisions for you when you cannot.
  • The powers granted in a durable power of attorney are those described in the document, or included by state statute.  Those powers only include health care decisions, if the document or statutes include the authority to make health care decisions. The law varies by state law- you should consult an experienced attorney for advice on your states’ requirements.

Good to Know

If you are incapacitated, a guardianship would give another person (often a loved one) legal authority to care for your personal and property interests.

Advance directives should list the treatments you do and do not want to receive. For example, you may choose to have your doctor include a Do Not Resuscitate (DNR) order in your medical record. This tells all health care providers that you do not want them to attempt life-saving measures such as cardiopulmonary resuscitation (CPR) in the event you have heart attack or respiratory arrest.

Bright Idea

Keep your planning documents easily accessible and in more than one place. It is important that your health care decision maker has a copy, or can access a copy quickly in an emergency. Give copies to appropriate family members and friends, your physician, and your lawyer. Consider carrying a wallet card.

Legal Steps for Financial Well-being

The following legal documents can help you protect the assets you’ve earned through your lifetime, and keep you in control of how they are used for your care:

  • A Durable Power of Attorney gives the person you choose the power to manage your financial estate and make your health care decisions if health care authority is included in the document or included by state statute.  A Durable Power of Attorney is effective when signed, unless the document says otherwise. A Power of Attorney must satisfy state requirements for “durability” to be used when you are no longer able act on your own. Each state has its own laws enumerating the specific powers a grantee can hold and can be found online, typically on a state government website, or through a legal professional
  • In a Living Trust, your assets are put into a trust that is administered for your benefit during your lifetime, and then transferred to your beneficiaries when you die. This type of trust can avoid or minimize the need for probate. You can maintain control of the trust through your lifetime. The trust should name a successor trustee to control the assets if you become incapacitated and after your death. Trusts are strongly recommended for large or complex estates or in states that have an especially complex probate process.
  • Families with large estates should consult an expert for advice about income, estate and inheritance tax planning.

Bright Idea

Ensure that your family and other important people in your life understand what your wishes are, and what is included in these documents. Discuss your wishes with the person who will make your health care decisions, and be sure that they are comfortable with their role, and that they can be available to carry out your wishes.


Administration on Aging