Friday, November 25, 2011

Health Care Proxy 101 and 201

How important is a Health Care Proxy ("HCP") in your life?

Simply, if you are over the age of 18 and in need of medical care (or your family needs access to your medical information) and are unable to communicate then all your medical decisions will be made by the medical community and your family will have no say in your care!  In other words, the doctors will make all your life and death decisions independently of your family and retain all that decision making power in their hands.  The reason for this is not because the medical community wanted it, but the government placed that responsibility on their shoulders.

So the HCP is a document that acts as a buffer between the state's mandates and your family.  With the HCP, your family or the people you trust the most in the world, will be able to direct your medical care in those circumstances where you are unable.  People often ask "When would I not be able to make my own medical decisions?"  Simple, you are in a coma, unconscious or have a diminished mental capacity.

A simple story will illustrate how important the HCP is in your life.  A family drops their daughter off at college for the first time.  After a tearful good-bye in the parking lot, Mom and Dad go home leaving their daughter all alone.  The next morning, Mom and Dad receive a horrific phone call.  Someone from the college tells them their daughter is in a hospital.  Mom takes the phone and demands to know what happened and is told that since the daughter is over the age of 18, they cannot tell Mom anything since to do so would violate the Federal Government HIPAA laws. (These HIPAA laws are also known commonly as the health privacy laws.)  Mom and Dad drive up to the college and are directed to the hospital still without knowing anything.  At the hospital they get the same response.  Since there is no HIPAA compliant document authorizing the medical professionals to discuss their daughter's chart with them, the hospital refuses.  Six months later, and after going to court to become the court appointed guardian of their daughter, who is still apparently in a coma, the medical professionals finally agree to tell what has happened.  On the night they left their daughter, she had apparently consumed a large quantity of alcohol and had alcohol poisoning.  They then told Mom how they had treated the daughter.  Unfortunately, and much to the horror of the medical staff and Mom, one of the drugs they had used was one to which the daughter had an allergy.  This explained why the daughter had not responded to treatment but also left the daughter permanently brain damaged.

The moral to this story is this:  If Mom and Dad had a signed HCP from their daughter before she went to college, Mom  would  have been able to immediately tell the doctors of the allergy and daughter would be perfectly fine today.

Where can you find a HCP.  You can find them almost anywhere you look.  They are available on-line, at hospitals and doctors offices, in bookstores, in business supply stores and in general practice attorney offices.  The only problem with this easy availability is beware of the prices you may pay!  Simply because a document has a title, use a checklist to see if the document will perform the function(s) you need.

  1.  Have you named your primary and alternate agents with current phone numbers?
  2.  Have you included specific instructions about the "heroic measures" you will allow to sustain your life?
  3. If the only thing keeping you alive are the "heroic measures", have you specified the number of days you would allow this to continue?
  4. Have you specified if the agent can act for you if you are physically fine but simply mentally incompetent?
  5. Have you addressed the Do Not Resuscitate ("DNR") orders that are NOT to be followed and the conditions in which they are to be followed?
  6. Does the document conform to the HIPAA laws?

If you have answered "No" or "I don't know" to any of the 6 questions above, be aware you may have a document that is ineffective.

For those who have been following my blogs, this document is the first critical step in estate planning.  From a legal perspective, estate planning is the series of documents that ensure who is protecting me and my family and who is in control of me and my family, whether I am alive and well, alive and not well, or when I pass away.  The HCP allows my family to protect me and control what is done to me during my lifetime if I am unable to do so.  The HCP is extinguished if I rescind the document or when I die.

Wednesday, November 23, 2011

I Don't Need an "Estate Plan" Because I Have No Assets

In my last blog we met a typical family that had acquired assets over the years.  In this week's blog we will meet another typical family, one that finds it hard to meet their monthly living expenses, never mind saving for retirement!

Roger went from being a standout athlete student in high school to barely hanging on in college.  There were a lot of reasons for the dramatic change, but most importantly, he met Sandy.  Sandy was vivacious in high school and had been on the cheerleading squad.  She maintained her easy-going outlook on life in college and attended a number of parties. Through a careless mistake at a party, they became parents.  Roger was in his Junior year and Sandy in her sophomore year.

Due to their upbringing and pressure from the families, they decided to get married in a hurry and have the child.  After a whirlwind of planning, they were married and shortly thereafter, their daughter Emily was born.

The pressures of fatherhood, studying and needing to work a full-time job at a fast food restaurant to meet the basic needs of his family was getting to Roger.  His grades dropped and he found himself desperately wanting to go out with his "buddies" but felt compelled to get home to his wife and child.  Sandy discovered that being a new mother took all her energy.  She couldn't believe how much effort went into caring for Emily and by the end of the day couldn't wait for Roger to get home so she could have a little time to herself.  Because Roger was working at a minimum wage job, they couldn't afford day care and finding a baby sitter was expensive.  Roger finally had to quit college because his grade point average hit an F so he picked up more hours at the fast food restaurant.  He applied for a few other jobs that promised more pay, but was told that without a college degree, he wasn't suitable. They also lived with Sandy's parents and Roger felt his in-laws looked down on him as a "leech."

When Emily was almost two years old, Roger and Sandy were at the family Thanksgiving celebration with Sandy's parents and her family.  While the women were preparing the table, Sandy's uncle asked Roger if he had an estate plan.  Roger looked at the uncle and explained to him that he and Sandy had nothing other than the clothes on their back and the necessary items needed to keep their child safe.  Roger told the uncle that estate planning was for rich people and that he and Sandy were fine.

What Roger forgot, or never knew, was that estate planning is not about just the money, or assets.  Indeed, estate planning is deciding what to do about everything that is precious to you.  For example, if Sandy was involved in an accident a was in a coma, Roger would have legal basis to make her health care decisions.  Similarly, if she owned anything in her name alone, he would have no legal basis to make financial or legal decisions for her.  Worse, if something happened to both of them, then the most precious thing in their lives, their daughter Emily, would get caught up in  a vortex of legal proceedings and could end up in a foster home while the courts decided who would look after her until she was eighteen years old!

Estate planning is setting plans in place that consist of legal documents and financial products to ensure that whether we are alive and well, or alive and not well, or when we pass away, that we protect those we love from the misfortunes the world will throw our way.

The first thing Roger and Sandy need to decide is who will look after Emily if something happens to them.  This decision is captured in Last Will and Testament and makes sure that the people you know will care for your child will be put in charge.  Just having the Will in place is not enough.  The family should also have a contingency plan in place that if anything happened to Roger and Sandy, that a family member or guardian picks up Emily right away so she never has to go into foster care.  In addition to this legal document, they need to put some of Roger's earnings into a life insurance policy for Emily's benefit.  The Will should also set up a testamentary trust for Emily's benefit so the money is protected for her and that nobody else can take it from her while she is young.  Once they have Emily taken care of, they then have of the next step in their estate planning adventure.

The second step is to make sure they each have a Health Care Proxy.  This is the legal document that allows a person to make medical decisions for someone who is unable to do so because they are unable to articulate what they need.  The document should conform to the HIPAA laws, and should put all the decision making authority in the hands of the agent except for one decision.  The one decision that an individual should make and never leave for their loved ones is the answer to this question.  "If th e only thing keeping me alive is a machine, how many days would I allow the machine to keep me alive before I pulled the plug?"  This decision is about the so called "heroic" measures that doctors in hospitals can use to keep us alive when we are in a terminal condition.  Now that Roger and Sandy have taken care of Emily and the decisions regarding themselves during their lifetimes, we can finally turn to their assets, or "stuff".

Again, control over stuff depends on who owns the stuff.  If Roger and Sandy have a joint bank account, typically what they have is a joint account with right of survivorship.  In a practical sense, they each own 100% f the asset,and if one of them wasn't competent or living, the survivor would have control over the account.  Roger needs to have a Power of Attorney wherein he names Sandy as is agent so she can handle all his legal and financial affairs.

Notice that both the Health Care Proxy and Power of Attorney are the documents needed if one is alive but not able to communicate with the world around them.  The purpose of this blog is to emphasize that estate planning is about protecting your family and leaving your family in control of their destiny.  So even though Roger and Sandy feel they don't need estate planning because they have no "stuff," they absolutely do need a plan in place to take care of their most precious possession, their daughter Emily.

Thursday, November 3, 2011

Wednesday, November 2, 2011

Follow a typical family's future with a typical "estate plan"

Meet Jane and Mark who are New York State residents.  They met in college 45 years ago, married and had 2 children, Jennifer and Peter.  Jane worked for 20 years as a school teacher after her youngest entered grade school and has retired.  Mark became an engineer and worked until he retired at age 70. 

The children, Jennifer and Peter are married, but Jane and Mark are not close to their son and daughter-in-law.  In fact, their son, Peter, has become somewhat estranged because of the poor relationship between his wife and his parents and as a result, Jane and Mark don't see their 3 grandchildren as often as they would like.  Their daughter, Jennifer, made some poor choices and not only has had difficulty with earning a living but has also been in and out of a number of relationships and is currently going through a divorce.

Jane and Mark, have some legal documents that they acquired shortly after Jennifer, their youngest, was born.  The documents in their possession are 35 years old and consist of a Will and Power of Attorney.  The attorney who prepared these documents was a general practice attorney and the documents he prepared gave everything to the spouse and if the spouse per-deceased, then everything went to the children equally.  Mark and Jane did not have the original Will in their possession.  About 10 years ago, Jane was facing a surgical procedure, so she had a Health Care Proxy created at that time.  Mark doesn't see the need for a Health Care Proxy since he has never been sick in his life.  They had talked about updating the documents but every time they would decide to do something, life would get in the way.  In fact, the attorney who created the documents is no longer in practice.

Financially, Jane and Mark have a mixture of assets.  In the early years they were concerned with paying bills and school loans and never formed a cohesive plan for the future.  As a result, they took advice from friends, family members and co-workers until Mark was 65 and then they worried about being comfortable in retirement.  Jane remembered that the person who serviced her retirement plan had some ideas about "rolling over" those retirement funds so she and Mark met with the representative and he suggested an annuity.  They owned their house jointly, a summer home jointly and various bank accounts jointly.  These all totaled about $1,200,000.00.  Jane had about $800,000 in her retirement account from being a teacher, and Mark had about $900,000 in his retirement account.  On top of that they each had $250,000 life insurance policies naming each other as beneficiaries and Mark had a "fun" investment account with which he dabbled in the stock market and it had about $150,000 in it.  All told they had $1,200,000 jointly, Jane had $1,050,000 of various funds in her name and Mark had $1,300,000 worth of assets in his name for a grand total of $4,5550,000.

Just as they were finally deciding to have everything reviewed Mark and Jane were in a severe car accident, the result of which was Mark suffered a traumatic brain injury and Jane was hospitalized with her jaw wired due to the injuries to her face.  So who is in charge of Mark and Jane and their "stuff"?

Jane, by writing, asks Mark's treating doctor to tell her about Mark's condition.  The doctor politely asks if Jane had a Health Care Proxy and discovers that Mark never believed in them.  The doctor explains to Jane that he is bound by the Federal HIPAA laws (the so-called privacy laws) and he cannot legally discuss Mark's case with her and that she has no authority to give directives as to his care.  Jane is devastated because she knows that if the only thing keeping Mark alive are the machines, then he would choose to have them turned off rather than be kept alive.  Finally, the doctor determines there is no hope for Mark, and after meeting with hospital administrators comes to Jane, who is being visited by a distressed son Peter, and asks if they would consent to removing the machines, in essence, killing Mark.  Peter takes the news badly and informs the doctor that his Dad was a fighter and would never give up and refuses permission.  Jane is still wired and doing poorly.  The doctor leaves and Mark's family is left with the agony of indecision.

A few hours later, the doctor comes back and informs the family that Mark passed away due to his injuries.

Suddenly Jane is caught up in a whirlwind of details dealing with the passing of a spouse.  She is asked what is to be done with the body, who will be in charge of the funeral arrangements, who is going to pay the bills and when, and it seems that every time she responds to one request five more come at her.  Peter offers to help, but Jane isn't sure where Mark kept all the papers and suddenly realizes she doesn't really know what she and Mark had.  She is feeling lost.  A few days later, Mark is buried, after the funeral parlor has received its payment.  Now the attention turns to the assets.

Peter suggests she gets an attorney to help her and he calls the attorney who recently helped him with a traffic ticket and with whom he had been discussing the possibility of filing a bankruptcy.  The attorney agrees to help and during the discussion with Jane and Peter tells them he will be charging 5% of the gross estate as his fee and explains that this is standard in the industry.  Since they have no other point of reference, the two agree to the fee.  The attorney asks Peter and Jane to gather statements for all the assets in Mark's name and to get him the original Will.  He also asks for a retainer payment of $15,000 against the final fee which they pay.

Peter goes to the house and after hunting through Mark's papers finds the copy of the Will and statements for the insurance policies, the retirement account and the joint bank accounts.  He cannot find anything for the "fun" account.  He calls the attorneys office and leaves a message.  After hearing nothing back from the attorney he goes to the attorney's office and drops of what he has found.  A few weeks later, the attorney calls and tells him that the copy of the Will is not sufficient and that he needs the original Will.  Peter goes to the address where the original attorney was located and finds that the attorney is no longer there and he cannot get the original Will.  Peter leaves a phone message at the attorney's office explaining what he found.  By this time Jane has been released from the hospital and Peter feels he in longer needed.

A few weeks later the attorney calls and tells Jane that since there is no original Will, he will have to go through a proceeding in court to have the copy accepted instead.  Since the attorney would have to make this special appearance he explains he will have to bill some more and requests another check.  By this time, six or seven weeks have passed. The attorney gets the copy approved and the court then requires he sends a Waiver letter to Mark's extended family so that everybody is in agreement with the terms of the Will and that they have no interest in the assets.  Unfortunately, a few family member do not respond to the letter, so a second request goes out.  Another 8 weeks pass but finally the judge decides there are no contests, so he issues the orders that allow all of Mark's personal assets to be put into Jane's name.  The life insurance and retirement accounts passed to Jane outside of the probate court's jurisdiction because she was the beneficiary on those accounts, yet for the computation of the fees, those items were included in the gross estate.  The attorney's final bill was 5% of the $1,300,000 in his name plus the extra for the proving of the copy of the Will.

Jane had not been doing well and after all the stress suffered a heart attack and passed away.  Peter and Jennifer argue about the funeral arrangements and Jennifer wants to know when she will get any money since she is in the middle of a divorce.  After checking, Peter discovers that Mark was the beneficiary of the life insurance policy and the retirement funds but Jane had never put a contingent beneficiary.  As a result, the companies tell him that Jane's estate will receive the money and that he has to go to probate court before they will release anything.

The State of New York makes a claim for 16.7%  of the estate as an estate tax, which is paid.

Peter goes to the lawyer who handled his father's estate and again faces a fee of 5%.  18 months later, the judge issues the final order of distribution and Jennifer and Peter get their inheritance.  Jennifer's divorce is not finalized, and her soon to be husband's lawyer argues that the inheritance should be included in the equitable distribution.  Peter had listened to his attorney, and filed for bankruptcy a few months after his mother died.  The end result, Jennifer lost half her inheritance and Peter lost $190,000 of his inheritance, the amount owed to his creditors when he filed bankruptcy.

Did Mark and Jane know that this is how their story would unfold?  Is this how you would want your story to unfold?  Or would you rather know that with proper planning, Mark and Jane are in charge of all decisions regarding their health care and the protection of their assets whether they are alive and well, or alive an not well.  In addition, they could have avoided the court system, the payment of New York estate taxes, the payment of 10% of the estate in attorney's fees and that both Jennifer and Peter would have kept all their inheritance no matter what happened in their lives.  

If you would like to be in charge and protect your family, stay tuned for the next blog in the series, "What is the purpose of a Health Care Proxy and a Living Will?"  If you want to skip ahead, then go to www.lifelawllc.com and leave a message with your question or to view the video about Estate Planning 101, go to http://www.youtube.com/watch?feature=player_embedded&v=NXu9iCW-DOg