Greetings, all,
In February MY Neighbors successfully completed the first month of our Pilot Program! Suddenly we have 24 Pilot Member and 22 Service Providers (although the number of Members is padded with Board Members, most of whom are not currently requesting services). As of this writing we have filled 27 Service Requests since we opened our “virtual doors" on February 1. Service requests have been coming in slowly and we are filling them quickly. If you are a Volunteer, you may not have even received a Service Request yet. However, as our number of Members slowly increases so will the volume of requests. Based on the feedback we are receiving from Members and Volunteers, we’re calling our first month of operation a rousing success.
There are currently over 120 people on the MY Neighbors Interest Group email list. For now we are continuing the practice of posting periodic updates on the web site and sending a link to the email list.
What We Learned from Carole Spainhour
Thirty-five of us gathered at the Micaville Presbyterian Church on Monday night to listen to Carole Spainhour, the principle attorney at Elder Law Carolina in Asheville. Her law practice is devoted to Elder Law and Estate Planning and as we learned from her superb presentation, she is an expert in this field. (For more information about Carole and her firm, visit their web site here.)
Following are a few takeaways from my notes:
Carol began with some affirmative words about the Village to Village Movement on which MY Neighbors is based. “Staying at home,” she said, is a big concept. It requires preparedness. Aging is a gradual process, and often children get drawn into the care of elders near the end of life. Elder parents are frequently “close to the vest” with information, which means end of life information can be hard to find when children or other responsible adults most need it. Many elders are not good record keepers.
“Try to make it easy for your family when you become sick or die,” said Carole. “It pays benefits to you as well.” She advocates the concept of “family preparedness” for end of life issues as well as emergencies. We should develop an “emergency notebook index,” a well-organized list of essential information that your neighbor or a family member might use if necessary. Compiling such information together and managing it will potentially make life much easier for others in case of an emergency, illness or death.
“Most of the planning work occurs while you are still alive,” said Spainhour. End of life issues are typically much more complex than what happens after death. “Websites like Legal Zoom are great at spitting out documents,” she said, “but having a plan maximizes the chance that things are going to work out as we wish.”
Carole recommends that if you have a person you trust to make medical decisions on your behalf you should designate a Health Care Power of Attorney. A Health Care POA is preferable to a “living will,” since these documents are often ignored by family members and doctors. However, Spainhour emphasized that a Health Care POA is of value only if “you talk and keep talking” to the person you have appointed. She encouraged us to “talk to all of the children.” Hospitals work by consensus in decision-making and family members should ideally be united about a person’s wishes for end of life care. Make sure copies of the document designating your Health Care POA are easy to find. Above all make sure your children and your doctor have a digital copy.
The state of North Carolina has a “Medical Order for Scope of Treatment” document, also known as “MOST.” Patients complete the document with a physician. MOST is a physician order issued with the informed consent of the patient regarding end of life care. The MOST form is obtained from your doctor or a hospital. (You will find further information on MOST and a sample form on the website of the North Carolina Medical Society.) Be sure to make the documents easy to find. The North Carolina Secretary of State also maintains an online registry for advance directives here. The booklet “5 Wishes” (which is widely used locally) allows us to provide similar information, but it needs to be scanned and shared with your doctor and family members.
Carole reminded us, “We have a constitutional right to direct our treatment. But what the family and doctor look for are evidence for our wishes for our medical care.” Emergency Medical Technicians are supposed to look for the MOST form on the fridge.
If you have a person you can trust to make financial decisions for you, you should also appoint a Financial Power of Attorney. This person manages your financial affairs, pays your bills, etc. in the event you become incapacitated. It is crucial that this person be trustworthy. “It’s like giving someone your pocketbook,” said Carole. Since financial institutions are reluctant to deal with Financial POA’s due to the fear of lawsuits, she suggests completing the in-house POA form from your bank, brokerage and wherever else you have money.
Spainhour also recommends we also complete a Health Insurance Portability and Accountability Act (commonly known as “HIPAA”) Waiver form. Medical providers cannot legally disclose your health information without your permission. A HIPPA Waiver may be necessary for family and neighbors to understand your medical information, and it is sometimes necessary even after death.
Finally, Carole Spainhour recommends that elders consider setting up a Living Trust in order to avoid probate. The Living Trust names a trustee who can become the legal owner of the assets and can step in to assist financially if necessary. (Having an out of state fiduciary is a problem, so Carole strongly recommends an in-state trustee.) While many people select a child to be either a Financial Power of Attorney or the trustee of a Living Trust, in her experience this is not always the best choice. A financial institution or lawyer can also be appointed as a trustee, which insures a competent trustee who will act in the grantor’s best interest. You want to avoid probate if possible, so many of us should consider setting up a revocable Living Trust. Anything that would normally go through probate should be transferred into the trust, especially as we near the end of life. Retirement accounts, annuities and other assets with specified beneficiaries do not need to be included. When asked about cost, Spainhour estimated $1000 and up to set up a living trust.
Those of us who heard Carole Spainhour learned a lot. For those who were not able to attend, I hope this summary will be helpful. Happy spring; just don’t put away the snow shovels yet.
Chip Poston
Board Chair