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Five Ways to Be Proactive About Your Care Choices

Maria_144pxMany of my clients have definite ideas about how they want to be cared for if they are ill later in life.  I hear clients expressing very clear wishes about where they want to live and what type of care they wish to receive and do not wish to receive.    With planning and communication, you will have greater certainty that your wishes will be carried out. Here are five ways to plan ahead for the type of care you envision for your future:

  1. See your Attorney. Your estate planning attorney can help you create legal documents that can go a long way toward ensuring you will receive the type of care you want.  The first is a Power of Attorney that will appoint a trusted person to handle your financial affairs if you are unable to do so.  Your appointed agent will be able to use your assets to pay for whatever care you may need.  The second is a Health Care Proxy that names a person to make health care decisions for you if you are unable to do so.  The third is a HIPAA Authorization that will list individuals who have permission to receive information from your physicians and others about your medical care.
  1. See your Doctor.   A conversation with your physician is an important step in deciding what type of care you wish to receive and clearly expressing your wishes about your care preferences.  There are many medical directive forms available that allow you to be very specific about the care you would like to receive in particular situations, including end of life care.   It is wise to complete these forms and express preferences after you have had a conversation with your doctor in order to understand the options and the implications of each care choice.  The care you choose may be very different from that of another person, based on your age, your health, your personal experiences, and your personal preferences.  Making clear and educated choices about your health care now will allow your Health Care Agent to make health care decisions for you based on your known wishes, rather than having to guess about what your wishes may be.
  1. Educate Yourself About Housing Options. Where do you want to live as you age?  Many people are firm in their desire to remain at home for as long as possible, even if they require help to do so.  There are more resources than ever to receive care at home.  Individuals called Aging Life Care Managers (also sometimes called Geriatric Care Managers) can assist in evaluating the type of assistance needed and coordinating those who will provide care or assistance at home.  There are also many options for those who do not wish to stay in their home as they get older.  Learn about the housing options available in the area you wish to live and the cost.  If you are a person who enjoys being socially active, a continuing care retirement community may be a good choice.  There, you can have your own apartment, but join others for activities or for meals if you choose.  If you want a quieter setting, a senior housing complex where everyone has their own apartment may be preferable.  If you need assistance with things like cooking, bathing, dressing or transportation, an assisted living facility may be appropriate.  If you need skilled care, nursing home care may be required.
  1. Understand how you will pay for care. If you need assistance or care at home, or in an assisted living facility or a nursing home, there will be a cost associated with that care.  Care costs may be paid with your monthly income (Social Security, pension) or your assets (proceeds from a home sale, cash, investments, etc.).  If you have long-term care insurance, those benefits can be used to pay or defray the costs of care.  If you do not have assets or insurance to pay for care, you may be eligible to receive Medicaid benefits, which are the public benefits that pay for long-term care (at home or in a nursing home) for individuals who are unable to pay the cost of their own care.  Eligibility for Medicaid benefits can be complicated.  If you think you may need Medicaid benefits to pay for care in the future, take the time now to consult with an elder law attorney and understand the eligibility rules and how they apply to your particular situation.
  1. Identify and Inform your Team. No matter how certain you are about the type of care you wish to receive, you can be sure your wishes will not be carried out if no one but you knows what they are.  Plan in advance by identifying a team of individuals who will help you carry out your wishes – your attorney, your financial advisor, your Health Care Agent, your attorney-in-fact, and an Aging Life Care Manager are all important members of the team.  Involve these individuals early on in your planning process. Express your wishes to them clearly and repeatedly.  Share with these individuals the health care documents your attorney has prepared or those you have completed with the assistance of your physician so they can ask you questions and get a good sense of your wishes before a crisis occurs.

Take these steps while you are able to put appropriate legal documents in place, express your housing and care preferences, and communicate those preferences to the people who will help you carry them out.  Your family will thank you for being proactive and giving them a roadmap for your future care.

Attorney Maria Baler is an estate planning and elder law attorney and a partner with the Dedham law firm of Samuel, Sayward & Baler LLC. She is also a director of the Massachusetts Chapter of the National Academy of Elder Law Attorneys (MassNAELA). For more information, visit or call (781) 461-1020.  This article is not intended to provide legal advice or create or imply an attorney-client relationship. No information contained herein is a substitute for a personal consultation with an attorney.

December 2016