Please - Do Not Neglect to Prepare a Living Will!

Albuquerque, NM(Zone 7a)

This began with an old thread under "What happens when it's me?" http://davesgarden.com/place/t/457717/

I know this is an old topic, but I am resurrecting it because of its importance. I urge everyone right now to do a Living Will or Health Care Directive. Also do a Power of Attorney, and consider one that only goes into effect under specific conditions where you are incapable of acting on your own.

A month ago my 59 year old brother in law was quietly walking down a street in San Francisco with his 14 year old son who was visiting him for the summer. Harry suffered a brain aneurysm and fell to the ground. He was rushed to the hospital where brain surgery was performed, and he had a stroke the following day. In the weeks that have followed, a second brain surgery was done, and a tracheotomy was performed to help him breathe. He has faded in and out of consciousness. Last Friday, a permanent shunt was implanted in his head to drain fluids from around the brain. It was insufficient, and on Monday, a second shunt was implanted. Doctors cautiously believe he will eventually recover, but will be unable to work and faces a very long period of rehabilitative care. He cannot speak right now because of the tracheotomy and has been unresponsive after the second shunt surgery. He has been in Intensive Care for a full month now.

He left no medical instructions, no will, no anything. As a result, his two adult children (in their late 30s) from a previous marriage, hired an attorney and got a Durable Power of Attorney that gave them immediate control over all their father's affairs, regardless of his medical condition. They have not been in touch with him for many years, but they are legally his next of kin. My husband, his brother, has no legal say. They now have closed his apartment, sold his car and his furniture, and are legally in charge of all his property, finances, bank accounts and stock accounts. They said their main concern was getting reimbursed the $4,000 they paid the attorney to do the Durable Power of Attorney. In the past month they visited the hospital only twice, and that was because the doctor insisted on meeting with them for consent to further treatment. Blessedly, he has excellent medical insurance which pays all the current bills and will pay for future rehabilitative care, but only if he remains in the state of California. These adult children both live out of state and are in California only until the end of the month, when they will have finished disposing of his property. They plan to leave then, regardless of their father's condition, and they will not talk to us or anyone else.

Doctors believe he may recover, but it will take many, many months in a rehabilition facility when/if he is able to be moved. Right now they cannot even move him out of Intensive Care into a regular hospital rom. And he will have no apartment, no car, no money and no furniture. He will not be able to work and will have no income to replace these things. I doubt these adult children gave a thought to that, or that they care a whit.

Preparing for end of life or potential medical challenges is very difficult and emotional. We all tend to put it off, and the result can be a dreadful snarl of events that none of us would choose for ourselves. Plus, not speaking our wishes puts family members in the unfair and stressful position of having to think for us, to guess at what we would want when that should not be their responsibility.

There is a lot of information available through Google. We found these espeially helpful:
http://estate.findlaw.com/estate-planning/estate-planning-overview/
http://www.uslegalforms.com/ftool/patty.htm (offers forms for purchase that are state-specific. We are using these.)

We also ordered QuickenWillmaker 2007 and found it helpful for guidance but frankly too full of complex legalease for us. We then ordered state-specific forms from the http://www.uslegalforms.com/ftool/patty.htm site and are now using those as the basis for our own final versions. For our needs, we chose "Durable Power of Attorney Effective Upon Disability". and a Healthcare Directive specific to New Mexico where we live. We will finish these this week and then take them to an attorney to review for legality, appropriate content, etc. and have them notarized. It is not necessary to hire an attorney to do the whole job, but it IS essential to have all documents checked out before finalizing them. Remember, you can always go back and revise the documents.

Please, please don't put this off. Stuff happens unexpectedly in life and then it's too late to go back and do the paperwork. My brother-in-law's situation was a wakeup call for us. We would give anything right now to know his wishes and be able to carry them out, but we can do nothing.

So.App.Mtns., United States(Zone 5b)

Yeah, I need to do that too. Thanks.

Las Vegas, NV(Zone 8a)

I am thankful that DA has all that in order. The two times she has been in the hospital unable to make decissions on her own, we had in writing her wishes. She has everything in order, down to picking out and paying for her headstone. Her DS had done all that before she passed, it was a load off her children.
I'm sorry you all are going through that. It is really sad and too often reality.
Take care~ Karen

Anne Arundel,, MD(Zone 7b)

june--excellent advice and by the way. bless you times 10 for volunteering with nursing home patients.
Unbelievable what some kids to their parents when given the chance.
At my husband's insistence, we got durable POA for my mom, for me before her major surgery last fall. Didn't need to use it then, but this spring Mom got pneumonia and it was a relief having the POA in place so we could- pay bills and do some other things. She has more free cash than we do to get the grass cut and stupid stuff that needed to be taken care of at her house.

Be aware POA expires on death. You may wish to check other financial things to see if you want Payable On Death just to make the will process easier.

Couldn't believe the details that came to mind once Mom appeared critical for a time. What really is her financial situation? Can she afford assisted living if needed? What to do with house?

And she had a breathing crisis with the pneumonia and got intubated (breathing machine) It is very uncomfortable, requires the patient to be drugged while on it and very difficult first couple days after taking it off--Mom told us she wanted do die for a few days. (another patient told me she felt like she'd been beat up) The doctors strongly advised me to put a DNR in her file because at almost 90, while CPR may work it can be physically traumatic to patient. And Mom has chronic leukemia and heart problems. You seriously have to wonder what amount of medical intervention is warranted, for what sort of expected quality of life, for what length of time afterwards.

Albuquerque, NM(Zone 7a)

Sally - Thanks for the reminder to keep things updated.
Things change in our lives and it's easy to forget to do
that. With all my "preaching" I've been negligent about
updating and will put it at the top of my To Do list. I've
read of cases where Pay Upon Death instructions were
lost by banks or financial institutions so it's good to check
up on them periodically.

I'm so sorry about your Mom and am very aware of the toll
it takes on families trying to do the right things while struggling
with these decisions. You raise good questions about medical
intervention. In hospice we do only palliative care and a DNR
is mandatory. I'm assigned to very elderly patients, most of
them with dementia and the physical conditions that come with
advanced age. Patients are kept fed, clean, oxygenated and pain
free but no extraordinary lifesaving measures are taken.
Oddly many come in with medical expectancy of a few weeks
but in the calm, attentive atmosphere of hospice they often go
on for as long as a year before passing peacefully. I spend as
much time counseling families as I do with my patients.


Oakland, CA(Zone 9b)

One of the newer issues that has arisen is Palliative Care. Oregon has taken the lead in this area and the POLST form (Physician Orders for Life Sustaining Treatment) is a general form that has been standardized and can be used for consulting with any doctor or HMO. Interestingly enough, the website specifies a very specific Wausau brand pink paper (#65 Cover Pulsar Pink, to be exact) although it says any color paper can be used; the CPP is specified so that the form can be easily copied or faxed.

This form is to be used IN ADDITION to an Advanced Health Directive, not in place of it. Some of the newer Health Directive forms include the POLST section, but many older ones do not (ours does not, for example, although it was created only 2 yrs ago in early 2007).

The form can be downloaded at: http://www.finalchoices.calhealth.org/polst-form.html

Other info about the form can be found at http://www.finalchoices.calhealth.org/polst-hcp.html, such as an FAQ and a POLST Consumer Brochure.

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