Throughout various life stages, we may have the opportunity to prepare for change, or we may be called upon to adapt to the unexpected. Many of us are likely to face the difficult situation of caring for a loved one experiencing a significant decline in health. Even when someone has taken steps to assemble a detailed estate plan, there may be instructions that were not specified during the planning process related to certain health directives.
The following checklist can be useful for individuals reflecting on their personal decisions and for families preparing for life-changing events based on the diminishing health of a loved one. The checklist is divided into three sections to highlight important items that may need to be addressed at different stages of declining health.
Addressing Significant Health Events and End-of-Life Planning
Section 1: Personal Instructions Designated Through an Estate Plan (Wills, Trusts and Other Documents)
▢ Are wills and trusts up to date? Have non-retirement assets, such as a joint brokerage account or a hard asset such as a house, been retitled to a trust to avoid probate?
▢ It is important to review account beneficiaries to make sure that no changes need to be made. Are primary and contingent beneficiary designations up to date and accurate for accounts such as IRAs, 401(k) plan accounts and insurance policies?
▢ Have HIPAA authorizations (for medical information release) and a medical power of attorney and a durable power of attorney been assigned and documented? This especially extends to living wills, which may include specific instructions on what measures should be used to extend life.
▢ Has another person been named on the checking account other than the loved one (usually defined in the durable power of attorney for finances) so that someone can write checks to make payments for monthly expenses?
▢ Many times, trusts and wills do not detail how personal property such as jewelry and family heirlooms should be divided among the beneficiaries. If a loved one expresses their wishes (either in writing or in person), this action can avoid potential difficulties among family members.
▢ Is there a plan in place for digital assets, such as digital photos or social media accounts? A digital estate plan should include a list of digital assets and a designated trusted contact.
Section 2: Where to Live (Considering Assisted Living)
▢ For loved ones who need daily assistance, are they willing to move from their current home to a different home (downsizing) or assisted living? Local community service organizations or religious organizations can provide access to social workers to help locate a suitable facility. They also can provide guidance to determine the appropriate type of assistance, which can include in-home care, assisted living or 24/7 care.
▢ If a loved one does not want to move, challenges can arise when selecting and retaining resources for regular in-home care or 24/7 care. Agencies are available that can help families find suitable assistance. Additionally, home improvements such as the installation of ramps and chair lifts and modifications for bathrooms, kitchens and entryways may be needed. Medicare may pay for some of these alterations.
▢ It is important to follow up on any insurance policies for long-term care by contacting the agent/insurance company to determine how to process a claim (policies should be available for reference).
Section 3: Decisions Related to End-of-Life Planning
▢ Social workers and medical professionals can advise on whether hospice or palliative care will be needed. Social workers and/or nurses can explain the differences and make recommendations.
▢ The family should know if arrangements are already in place for funeral services, burial or cremation. A conversation might be necessary to understand specific instructions and to make sure expenses can be covered with median funeral costs estimated to be more than $7,000, depending on the various arrangements.
▢ Additional decisions might need to be made regarding medication, feeding and care. The individual named in the medical power of attorney ultimately has the responsibility, but it is crucial to make sure that family members are aware of such decisions.
When helping a family member or friend facing declining health, it can be overwhelming to delve into financial matters. We understand that the idea of making end-of-life preparations for someone close to you can be difficult and highly emotional. We encourage you to contact your financial advisor if you need assistance or additional information.