1. Living Wills, Health Proxies: Vital Documents for Everyone Tips for Chronic Illness and RVers By: Martin M. Shenkman, CPA, MBA, PFS, AEP, JD

2. CaveatsCaveats Nothing in these slides or any accompanying presentation is to be considered tax, legal, investment or other professional advice. The information is merely provided for educational purposes and no action should be taken without the individual consulting his or her own tax, estate, legal, financial, investment, insurance and other advisers. The hosts and sponsors of this program are NOT responsible for its content or accuracy

3. Overview of Living Wills, Health Care Proxies and HIPAA Releases Definitions and basic planning Definitions and basic planning

4. Designate a Person to Make Health Care Decisions and Access Medical Records Agent (successors) Agent (successors) Powers (religion) Powers (religion) Signature (State law) Signature (State law) Move (state; facility) Move (state; facility)

5. What is a Health Care Proxy? A legal document in which you authorize someone to make health care decisions for you if you are not able to do so A legal document in which you authorize someone to make health care decisions for you if you are not able to do so It can address a broad range of related issues: burial, last rights, hospice care and more It can address a broad range of related issues: burial, last rights, hospice care and more It is not only about pulling the plug It is not only about pulling the plug

6. Step 4: Communicating Your Health Care Wishes

7. What is a Living Will? A living will is a legal document in which you make statements as to your health care wishes A living will is a legal document in which you make statements as to your health care wishes Not binding in all states but can be an important tool to communicate your wishes to your agent and loved ones Not binding in all states but can be an important tool to communicate your wishes to your agent and loved ones Address religious and other personal health care and end of life decisions Address religious and other personal health care and end of life decisions What do you want for palliative care, hospice, companion care and other decisions What do you want for palliative care, hospice, companion care and other decisions

8. Step 4: Authorize Access to Your Private Health Information

9. What is a HIPAA Release? A legal document in which you authorize a person, called your HIPAA Representative, to have access to certain medical information (your PHI or Private Health Information) A legal document in which you authorize a person, called your HIPAA Representative, to have access to certain medical information (your PHI or Private Health Information) This can be a help when you want someone to monitor your care and interact with medical personal but you are not at a point where you have to turn over medical decision making authority This can be a help when you want someone to monitor your care and interact with medical personal but you are not at a point where you have to turn over medical decision making authority This can be very important for someone living with a chronic illness that might have an attack or unexpected hospitalization and wish help but not to abrogate decision making (COPD, MS, Crohns) This can be very important for someone living with a chronic illness that might have an attack or unexpected hospitalization and wish help but not to abrogate decision making (COPD, MS, Crohns)

10. Who Should you Name as Agent for Medical Matters? Usually you would name the same person as Agent in your living will, health proxy and HIPAA release, but not always Usually you would name the same person as Agent in your living will, health proxy and HIPAA release, but not always Does the person have the emotional temperament to deal with the potentially tough decisions Does the person have the emotional temperament to deal with the potentially tough decisions If you have an existing health condition does the person understand how it affects you If you have an existing health condition does the person understand how it affects you Is the persons religious perspective similar to yours Is the persons religious perspective similar to yours Will the person you name interact well with other loved ones Will the person you name interact well with other loved ones Name only one person at a time Name only one person at a time

11. What Authority Should You Give Your Medical Agents? Interact with medical professionals Interact with medical professionals Make medical decisions if you cannot that are consistent with your wishes Make medical decisions if you cannot that are consistent with your wishes Hire companion and other care Hire companion and other care Make hospice and related arrangements Make hospice and related arrangements Purchase a burial plot or make other funeral and related arrangements Purchase a burial plot or make other funeral and related arrangements

12. What Authority Might You NOT Give Your Medical Agents? To make decisions if you are capable of doing so To make decisions if you are capable of doing so Violate your wishes as set forth in your documents Violate your wishes as set forth in your documents

13. Merely Signing a Legal Form Alone is Never Enough ? Your agent must know what is expected and have a real understanding of your wishes Your agent must know what is expected and have a real understanding of your wishes Key information must be accessible – health insurance details, names and contact information on medical providers and more Key information must be accessible – health insurance details, names and contact information on medical providers and more A copy of your legal documents should be made a part of your patient records A copy of your legal documents should be made a part of your patient records

14. RVer Tips for Living Wills Which state law should apply to your health proxy Which state law should apply to your health proxy Where should you sign your living will and health proxy Where should you sign your living will and health proxy Consider taking a thumb drive with PDFs of your health proxy, living will and HIPAA release and medical records Consider taking a thumb drive with PDFs of your health proxy, living will and HIPAA release and medical records Can you use a format that is more likely to be accepted in other states (e.g., 2 witnesses and a notary) Can you use a format that is more likely to be accepted in other states (e.g., 2 witnesses and a notary)

15. Living Wills and Your Other Legal Documents Keeping the confusing names of legal documents clear Keeping the confusing names of legal documents clear

16. Overview of Estate Planning Documents and How they Relate to Your Health Proxy Power of Attorney Power of Attorney Agent to handle finances Agent to handle finances Springing vs. not – may involve medical considerations Springing vs. not – may involve medical considerations Special provisions to include – e.g. having your agent pay for your health proxies medical decisions Special provisions to include – e.g. having your agent pay for your health proxies medical decisions Living Wills Living Wills State your health care wishes State your health care wishes Address specific health issues Address specific health issues Religious issues Religious issues Health Proxies/HIPAA Releases Agent to make medical decisions based on living will Selecting agent What powers to include Revocable Living Trusts Unique importance to those with health issues Boilerplate forms rarely address nuances needed for chronic illness Relationship to other documents

17. Medical Documents – Making it Practical For Your Agents to Act You need more than just a legal form You need more than just a legal form

18. Organize Information So Your Agent Can Act Agent (names, numbers) Agent (names, numbers) Physicians (names, numbers Physicians (names, numbersspecialty) Insurance info Insurance info Selected health info Selected health info

19. Organizing Emergency Info #1 People forget and panic. Dont put off creating an emergency list People forget and panic. Dont put off creating an emergency list Type up a list on your computer so you can update it Type up a list on your computer so you can update it Disseminate the list to key people, ask for their help and tell them what they might need to do to help Disseminate the list to key people, ask for their help and tell them what they might need to do to help Your estate planning attorney should have a copy of each document in their file Your estate planning attorney should have a copy of each document in their file

20. Organizing Emergency Info #2 Organize the list by category (e.g., general physicians, specialists, religious advisers, family/loved ones) Organize the list by category (e.g., general physicians, specialists, religious advisers, family/loved ones) Give only the key facts someone will need to act in an emergency (name and contact info, medical institution, insurance company and policy info, office/home and cell number, email, etc.) Give only the key facts someone will need to act in an emergency (name and contact info, medical institution, insurance company and policy info, office/home and cell number, email, etc.) List info needed for emergency action (e.g., account number, policy number, etc.) List info needed for emergency action (e.g., account number, policy number, etc.)

21. RV TIP: Organize Emergency Information Rvers, or anyone who travels extensively, should take extra precautions to make sure information is available when needed Rvers, or anyone who travels extensively, should take extra precautions to make sure information is available when needed Carry an extra set of originals with you Carry an extra set of originals with you Consider a web based personal information locker and give a trusted person the info Consider a web based personal information locker and give a trusted person the info Email updated emergency info list to key people whenever there are major changes Email updated emergency info list to key people whenever there are major changes

22. Medical Decision Making – Communication is Key You need to discuss your plan You need to discuss your plan

23. Communicate with Your Agent and Loved Ones Educate and inform your loved ones and agent about your wishes, what they may need to do to help, where theyll find info they need Educate and inform your loved ones and agent about your wishes, what they may need to do to help, where theyll find info they need

24. Communication Tips Explain your health care concerns, family issues, personal wishes, religious considerations, and so forth to your agents and loved ones (dont assume they know!) – tell all so they can help properly Explain your health care concerns, family issues, personal wishes, religious considerations, and so forth to your agents and loved ones (dont assume they know!) – tell all so they can help properly Discuss with family, friends or others involved in your life what your wishes are Discuss with family, friends or others involved in your life what your wishes are Can those you expect to rely on really help? Have alternatives Can those you expect to rely on really help? Have alternatives Express your wishes in face to face meetings and then confirm key points in writing Express your wishes in face to face meetings and then confirm key points in writing

25. Living Wills and Health Proxies – A Process not a Single Act Dont sign it and forget it! Dont sign it and forget it!

26. Review, Revisit, Revise Nothing remains static Nothing remains static –Family situations –Health –Comfort with Agent –Where you live

27. Living Wills – Whats Next? Understanding medical decision making is not enough – Take action Understanding medical decision making is not enough – Take action

29. Action Steps: Your Action Plan Write it down or it wont happen Write it down or it wont happen Set small goals – make decisions, hire a lawyer, gather information – even devoting an hour a week or month will get you there Set small goals – make decisions, hire a lawyer, gather information – even devoting an hour a week or month will get you there Tell others – including advisers Tell others – including advisers Get help and guidance to get started – an initial consultation with a physician or other health care adviser can jump start the entire process Get help and guidance to get started – an initial consultation with a physician or other health care adviser can jump start the entire process

30. Summary: Living Wills; Health Proxies and HIPAA Releases Choose an appropriate agent and several successors Choose an appropriate agent and several successors Hire a lawyer to draft documents that work for your personal medical, family and religious situation Hire a lawyer to draft documents that work for your personal medical, family and religious situation Discuss modifications to standard forms: Discuss modifications to standard forms: –Existing health issues –Religious beliefs (or an indication that you dont want religious restrictions) Sign then distribute originals and/or copies Sign then distribute originals and/or copies Update as your medical situation evolves or feelings change Update as your medical situation evolves or feelings change