End-of-Life Issues and Care Planning

There's no easy way to start discussing end-of-life issues. It's normal for people to experience all sorts of emotions. Fear about your future and the future of family and friends is common. So is a sense of acceptance and resolve to enjoy the remaining days. But there's one piece of advice that's generally good for everyone: it helps to prepare.

The legal system is frequently called on to address end-of-life care. One of the major concerns arises when people become incapacitated in their old age and can no longer make their own decisions.

But healthcare decisions still must be made, and this responsibility usually falls on loved ones. Both you and your family and friends can benefit from proper end-of-life planning.

General Health Care Decisions

Healthcare decisions are a sensitive subject. As people grow older, they may lose the ability to make end-of-life medical decisions and communicate those decisions to doctors and family members.

Although doctors can provide helpful insight from a medical point of view, it is ultimately up to you to determine the best course of action. Do you want life-sustaining treatments? Do you want to be on life-support? These are questions you should consider in order to plan for these types of situations.

Care Needs and Various Care Settings

Older adults and their loved ones should discuss if they want to be cared for at home or eventually live in a nursing home. There is a range of assisted living facilities and different levels of care services. It is possible to find a solution that provides the feeling of independence while protecting their well-being.

Families should also discuss approved healthcare providers, clinical trials, and how to handle a terminal illness. Older patients may only want treatment from certain care teams and clinicians and turn down care options from others. This can be especially true in advanced cancer patients.

Palliative Care Basics

Palliative care is health care for serious or life-threatening illnesses that focuses on the following:

• Medical care for symptoms and pain relief
• Treatment to cure the illness

Palliative care is often used when doctors focus on the quality of life more than healing an illness. Patients can choose to continue treating the illness or focus only on symptom management during palliative care.

Caregivers may need to make difficult decisions during this time if the older adult is not conscious or able to make decisions. Having an end-of-life care plan can ensure that an older adult's wishes are respected after incapacity.

Hospice Care Basics

Like palliative care, hospice is often used as end-of-life care for seriously ill patients or those with a short life expectancy.

Hospice focuses on the person's quality of life and aims to keep them as pain-free and comfortable as possible. Unlike palliative care, hospice doesn't aim to treat the illness.

Loved ones can struggle to make hospice and end-of-life decisions for older people. It is helpful to give them peace of mind by having end-of-life wishes, such as a do not resuscitate (DNR) order, listed clearly in legal documents.

Giving Decision-Making Power to Someone Else

There are some advanced care planning tools you can use. These legal documents can help everyone prepare to deal with healthcare-related end-of-life issues:

• Advance directives
• Living wills or health care directives
• Healthcare power of attorney
• Financial power of attorney
• Durable power of attorney
• Living trusts

Prepare an Advance Health Care Directive

An advance healthcare directive contains your healthcare wishes should you become incapacitated. People often use advanced health care directives to specify:

• What kind of medical treatments they want to receive
• Whether they'd prefer to be in a hospital or care facility
• Whether they want life-sustaining treatments, such as clinically assisted nutrition and hydration interventions
• Issues such as organ donation and artificial life support

An advance health care directive sets out your wishes for doctors and family members to refer to later. It's relatively easy to prepare but generally isn't binding. This means it isn't always legally binding when a doctor has an objection to your wishes.

Prepare a Living Will

A living will is a binding document that serves the same purpose as an advanced health care directive. A living will contains your directions for your care – whatever they might be.

Many people use a DIY living will to direct doctors to withhold treatment at a certain stage. Other people direct their doctors to use all possible means to extend their life.

A living will differs from an advance health care directive in that it is legally binding, meaning your doctors are legally required to follow your wishes.

Grant a Power of Attorney for Healthcare

You might prefer to appoint someone to make care decisions for you. Granting a power of attorney for healthcare to someone you trust will empower them to make decisions on your behalf.

A power of attorney for healthcare can be detailed and drafted to specify your wishes — much like with an advance healthcare directive or living will.

It's commonly used to give decision-making power to an unmarried partner or friend. It is useful for anyone who otherwise wouldn't have the authority to make these decisions for you.

Planning for Financial Decisions

Managing property and finances can become challenging near the end of your life. Bills, taxes, investment decisions, and business considerations never cease to pile up.

Yet many people lose the ability to handle their affairs or lose track of them as health care decisions take priority. You can prepare to deal with these issues as well.

Giving someone durable financial power of attorney is an option. If you become incapacitated, a designated person can manage your financial affairs. Doing so also protects your family from having to deal with the hassle of living probate.

They will be able to take actions like:

• Paying bills and taxes in your name
• Managing your real estate and investments
• Accessing your financial records
• Buying insurance for you
• Collecting retirement benefits
• Paying for health insurance

Creating Trusts and Handling Costs

You may also want to consider creating a living trust. Trusts are flexible accounts that pool together assets managed by an appointed trustee. You can specify how things should be done and appoint someone you trust to manage it as the trustee.

Whether your loved one creates a trust or not, everyone must discuss long-term care costs. The health care system is expensive, whether it involves assisted living, hospital stays, or at-home care. Many people can find help through Medicare or Medicaid, but there will be other non-covered costs. However, an elder law attorney can help with planning regarding the cost of care.

Funeral Planning

Your loved one can make decisions about their body after death. Having clear afterlife wishes takes some pressure off the family and provides peace of mind.

There are costs involved with funerals, celebration of life ceremonies, burial, and the paperwork and processes after someone passes away. Discussing how these costs are handled before a loss is helpful.

Legal Help When Starting the Process

If you need help developing an estate plan or setting out your health care wishes, it's best to consult an attorney specializing in estate planning law for legal advice.

You can still run into legal issues or unclear decisions even when your family has written documents. You can speak with an elder law attorney if your family is focused on broader concerns.