This is a continuing series using information from the booklet written by the National Institute on Aging working with the National Institutes of Health called: Talking with Your Doctor. (U.S. Department of Health and Human Services, NIH Publication No. 05-3452 August 2005 (Reprinted April 2010)
Planning for care in the event of a serious illness is much like planning for your death, the only difference is that instead of planning for the care of your estate you are planning for the care of…you!
Think for a moment: What happens to you if you get sick? You can probably handle that. Now what happens if you get really sick, like a flu or diarrhea that leads to dehydration? That’s a little more difficult. Now what happens if you fall and break your arm, leg or hip? Or maybe you get some serious pneumonia or, heaven forbid, cancer (I mean the life threatening kind)? Now the worst: what happens if your mind is not working and you can’t make decisions? Do you have a plan in place?
Who cares for you in these situations?
Along with a will or a trust a person should have an Advanced Health Care Directive (AHCD). Advance directives are written instructions letting others know the type of care you want if you are seriously ill or dying. These can be in the form of a health care proxy or a living will.
A living will records your end of life wishes for medical treatment in case you are no longer to speak for yourself. I have seen these inserted into an estate plan in the section generally titled: Advanced Health Care Directive. I have also seen additional directives outside the estate plan: a Do Not Resuscitate (DNR) form or a Physicians Order for Life Sustaining Treatment (P.O.L.S.T.). The DNR is just signed by you but the P.O.L.S.T. is signed by you and your doctor (hence the phrase, “Physician’s Order”. The P.O.L.S.T. for is a little more comprehensive and is printed on bright pink paper so that emergency personnel are more likely to see it among the sea of white papers in a binder or on a refrigerator (think EMT). You may want to visit http://capolst.org/ for more information.
Health care proxies, or agent/attorney in fact/surrogate, should a be a person you choose to advocate on your behalf to ask questions and find resources when you can’t or carry out your instructions listed in your P.O.L.S.T. or other directives.
While AHCD’s are legally valid everywhere in the United States, each state has its own laws regarding format and wording. You will need to check with your attorney regarding the laws in your state. For example, the P.O.L.S.T. is accepted in California but not in Oklahoma. According to the According to the National POLST organization (http://www.polst.org/ ) many states are now going through the process of accepting this form but you will still need to discuss this with your attorney.
Paying for medications
This is a direct quote from the pamphlet:
“Don’t hesitate to ask the doctor about the cost of your medications. If they are too expensive for you, the doctor may be able to suggest less expensive alternatives. If the doctor does not know the cost, ask the pharmacist before filling the prescription. Then call your doctor and ask if there is a generic or other less expensive choice. You could say, for instance: “It turns out that this medicine is too expensive for me. Is there another one or a generic drug that would cost less?”
Your doctor may also be able to refer you to a medical assistance program that can help with drug costs.”
In case you weren’t aware, Medicare prescription drug coverage is available to people with Medicare. For information call 1-800-MEDICARE (1-800-633-4227) or visit the Medicare website atwww.medicare.gov
What about driving?
In my post on December 10, 2013 I discuss the difficult conversation your loved one might have with you regarding driving. If you find that it is becoming more difficult to drive, it’s harder to see the road, you are bumping into things, and drivers are getting worse when they drive around you then it may be time to hang up the keys. Your doctor may have access to resources or organizations to help you plan for these events. It would make it easier on your family and the people around you if you do the research first on public/private transportation availability and recognize that if they approach you that they really are concerned.
I very rarely have clients that want to move into assisted living from their homes but if it becomes difficult for a home helper or caregiver to assist you and you find that you are not getting out to socialize then it may be time to move into an assisted living community. I will dedicate a whole post regarding this issue because there are still a lot of ways to stay at home that you may want to investigate before you make this decision.
Next: Discussing Sensitive Subjects