A Nelson Mandela Kind of Christmas

Angels We Have Heard On High

Just there, in the next room; as if a friend has just arrived, oh Elysium! We can just barely hear the music of Love's voice. If we could only see it!    Inspired by the poetry of Emily Dickinson

“We live by faith, not by sight.”     Paul of Tarsus, Early First Century Letter to Christians in Corinth
 

“What we know of the world is only the tip of the iceberg. Submerged beneath the surface of the visible world are mysteries too vast for you to comprehend. If you only could see how close I am to you.....” Sarah Young, “Jesus Calling”, December 12^th


Sometimes we talk of the magic of Christmas as if it is like pixie dust sprinkled in the air which makes us all generous, kind-hearted, and jolly; even sometimes against our will.

One of the definitions of magic is “the art of producing illusions by sleight of hand”. In other words tricking your eyes to think something impossible has occurred. Another definition of magic is “the use of charms or spells believed to have supernatural power.”

When we speak of the magic of Christmas we have in mind something else entirely. We are actually referring to a sense that the world really is a better place after all. Even if just for one single, silent night. We also speak of the magic of Christmas with wistfulness - Wishing for Peace on Earth.

What makes the world a better place? I hope it is something much better and more real than magic.

We all know by now that the one with the most toys at the end of life is NOT the winner. Don't get me wrong, toys are fun. Fun is good! But, when we think of a better world, we are also thinking of our better selves. Instead of trickery or some artificial jolliness dressed up in red and white, I wish for a world full of Nelson Mandelas.

We know deep in the recesses of our hearts that when we offer our best self to the world; the self that offers forgiveness to our enemies. Our best self sets aside what we want long enough to hear the cries of the hearts of those around us; then the magic of Christmas is real.

Because He was born. 
Because He loves. 
Because His promises are sure. 
A Merry Christmas Throughout This World!

Take Inventory! Take Photos! Take Action!

Guest Blog, written by Karen Fisher, Professional Fiduciary, www.bishopfiduciary.com

Tangible personal property is one asset class many clients don’t spend a lot time managing during their lifetime.   With some thoughtful planning, potential problems can be averted when it comes time to settle their estates.

For example, in one particular estate, the decedent owned many books.  The books had not been appraised when the spouse died years earlier.  When the surviving spouse passed away the books were to be divided equally among the siblings, but they began to fight over them.  I invited a book appraiser to look at the collection. It turned out there were many books important to California history and worth 50 times the initial estimated valuation.

The siblings agreed to donate the books to libraries specializing in California history.  Had the client known of the significance of the books, she might have made a different decision in her estate plan, thereby reducing family turmoil during the estate settlement process. 

Not all personal property will turn out to have significant value.  As baby boomers begin to retire and downsize, there is a glut of used furniture and other household items.  Many thrift and consignment shops are at capacity. 

One way to actively manage tangible personal property is to take a current inventory and record it in a journal indicating the location of any items not on site (such as jewelry located in a safe deposit box at a financial institution).   When items are sold or gifted or, when additional items are purchased, the journal can be updated.  Keeping current on an inventory has several advantages.  One, it assists the client in decision making when they are preparing their Will or Trust.  They can readily view the journal and decide how they want to divide up their property.  Two, for clients who have already created their Trusts or Will, they can use the inventory to update their plans. 

After creating an inventory, consider obtaining an estate valuation of the value of the personal property.  Many people have an unrealistic idea of the value of their assets, either they assume a very high value, or they don’t realize the worth of some items.  An inventory and realistic valuation can assist in gifting decisions.  

As professional fiduciaries work with older clients, we can help reduce potential conflict later by taking inventory; taking photos with notes; and encouraging clients to take action by seek appraisals or indications of value from experts.

 

From Morocco to the Moon

Take a vacation and layer on a presentation at the National Guardian Association "NGA" and you get an odd combination of pre-presentation jitters and pre take-off nerves in the simulated Shuttle take-off at the Kennedy Space Center. Then, you can relax by going ‘round the world in 80 minutes at the Disney Epcot Center. 

Fiduciary Ethics
My attorney husband and I do not share office space or cases; but we can and do share the stage occasionally. We recently took a trip to Florida to present on fiduciary ethics at the NGA annual meeting. The audience was enthusiastic about participating in the Ethics Jeopardy game. Questions and answers flew fast a furious. The game presentation is a fun, interactive "pick-me-up", but we all realize the topic is crucial.  All who serve as a person’s trustee; agent; conservator or guardian have a duty to put themselves in the shoes of the person they are serving. 

The guidelines promoted by the NGA, a national organization created to educate guardians and fiduciaries across the country, are based upon a person centered philosophy. Here is a tip for anyone who takes the test on fiduciary ethics. Use the mnemonic device, SHOES.

Attorneys Acting As Guardian? Varies State to State.
The presentations I attended were very informative. One of the joys of attending the National Guardian Association meeting is learning different perspectives across states. For instance, the range of perspectives on attorneys also acting as a guardian revealed very different views of conflict of interest in different states. In California this is frowned upon. In other states, especially in rural areas, it is expected.

Plain Language for Special Needs
In another presentation, the speakers talked about how to help disabled adults understand human rights. "Where Human Rights Begin—Human Rights and Guardianship for Individuals with Developmental Disabilities—In Plain Language" is offered by the Guardian Association of New Jersey, Inc. "GANJI". The booklet was designed to build personal understanding of human rights concepts. It can help open a dialog with disabled clients about their rights and responsibilities. This dialog can then become a part of our planning for special needs individuals.

Walk in Their Shoes
Whether our client walks in sandals or moon boots, fiduciaries are called to put ourselves in their shoes as we plan how best to serve their interests. If you have a situation where you do not think the trustee is serving your client’s or a family member’s best interests, please call our office for a consultation with a highly experienced professional fiduciary.

Oh, so you want to know what SHOES stands for?  Remember these:
S - Security of client’s person and assets are first priority.
H- wHo’s Money Is It Anyway? - Not Yours!
O - Offer good judgement and oversight.
E - Empathetic and equal communication.
S - Seek legal authority for your actions.

The Effects of Color on Our Brain

What is your favorite color?

This month, we are re-posting with permission an excerpt from an article, Color's Effect on the Brain, by one of my favorite artists, Beth Summers, Artist, Licensed Psychotherapist.  

Nambia Sand Dunes, Plein Air, Pallette Knife Oil Painting by Beth Summers,
Used by permission.

"Blue is universally most often selected [as a favorite color].  Photo cells in the brain are sensitive to blue light and its healing effect. I climbed these sand dunes, two steps upward, one back, to reach the top.  Like many of life's accomplishments.  Namibian desert dunes are famous for color under bright blue skies.

We are physiologically designed to see color with our eyes, but it takes language for a color before we can experience it.  The Himba Tribe in Namibia has only two words for color: "zuzu" and :"vapa"...light and dark. Their perception of sky is dark and water light.

The history of language over 30 generations shows that we have developed more than 1000 words for green. According to some, exposure to green fosters creativity.

'Experiments prove that walks in nature provide better cognitive skills than in urban areas.'

William Lidwell, University of Houston."

 

To read the full article, see http://bethsummersartist.blogspot.com.

 

The answer to the question, “What is your favorite color?” can give insight into inner wishes. Our new LegacyMapping process uses color to help people make choices in the transitions of aging and to tell their life story in a beautiful way.  Click  to find out more about this process at our website.

 

If you want more You can read an article in About.Com about the possible effects and reactions to various colors by clicking here.

What is your favorite color and why?  Tell us in the comments section below.

 

 

Is It A Business? or Is It A Service? Part 2

Can A Fiduciary Form a Corporation?

Most professions can form a simple businesses structure which allows an owner experienced in the work to train employees and pass on knowledge, processes, and goodwill.  It also can shield them from personal liability.  (For an overview of the issues surrounding business formation, see Part 1,  first posted on 8/7/13).

This does not work for fiduciaries.  According to the California probate code and the business and professions code which established the licensing and oversight of professional fiduciaries, only an individual can be named as a fiduciary.  An attorney can offer these services, but they are not allowed to advertise that they offer these services as part of their legal practice.

 

To make things more complicated, most tax advisors recommend that the IRS can and will disallow an agent's personal income which they assign to their corporation.

If a corporation offers fiduciary services, it must be formed as a Trust Company. Professional fiduciaries who plan to attend the Northern California Education Day for Professional Fiduciaries Association of California (PFAC) on September 12, 2013 will have a chance to gain insights from a number of panelists, including attorneys, on whether fiduciaries can engage in a business formation.  You can read this article (Part 1 & Part 2); request our overview by commenting below; and, listen to how other fiduciaries have chosen to address this topic; then speak with your business advisors and form your own opinion.

Why bother thinking of fiduciary services as a business at all, if we are hindered from forming a corporation? 

Developing Field Craft

 

Our practice as professionals is built around offering expertise in the practical and legal requirements of closing or managing an estate.  This expertise is built over time and a variety of case experiences, not just the singular experience of handling a family member’s estate and taking the classes to obtain a license.

As Malcolm Gladwell has become famous for noting about Master Class level performance, “The emerging picture from such studies is that ten thousand hours of practice is required to achieve the level of mastery associated with being a world-class expert—in anything,” writes the neurologist Daniel Levitin.   The point made in Gladwell's  book, Outliers, is instructive. To stand out: patiently and consistently build expertise through practice, more practice, and even more practice. 

Where can a new professional fiduciary “practice” in our field without putting ourselves and our clients at risk?   Here is one reason for a corporation in our profession. To create a structure that mutually and collaboratively supports experienced fiduciaries and trains new fiduciaries in their field craft.

Services can be businesses.  Businesses can offer services.  But, the service offered by professional fiduciaries is best when offered as part of a collaborative group; formed to support each other and present the marketplace with the right information needed to select just the right fiduciary to fit a particular situation. Only a professional business structure can give potential clients the comfort of working with someone with a long-term, consistent business plan.

 

Only a professional business structure can give you the boost you need. If you are interested in how the ACE Fiduciary Group can help you excel in your marketplace find out more at www.ACEfiduciary.com.

Is It A Service? or, Is It A Business?

What type of business structure best fits professional fiduciaries? Part 1

Professional Services Offered

When professional fiduciaries take on clients, we work for the benefit of a living person who needs help making decisions and after a death, for the beneficiaries of the estate. We are licensed by the state of California to be estate Administrators, Conservators, and private trustees. We are a bit like family members who take on these roles out of obligation, duty or love: but we are not like family members in a number of ways.  One of these is we are not part of the family system.  This means we tend to be able to work towards the goal and minimize inter-family conflict. The other is that we charge reasonable fees for our services.

Sometimes a family member chooses not to collect fees for this work (although they are entitled to do so).  Professional fiduciaries are building a professional presence through our practice, and we earn fees for this vital service; but is it a business?

The work of a fiduciary is a cross between personal services and business management.  Professional fiduciaries handle much of the same type of work as a bank trust department, but we can also offer the types of services that banks cannot  -  Conservatorships and Financial or Health Agent.  The nature of our “business” is personal. We often form deep, abiding, long-term relationships  with our clients and their family. 

Business Formation

Businesses are formed to better organize people into focused activities to serve clients in a consistent and dependable manner. Because a corporation is deemed a “person” under the law, business owners sometimes form a  corporation, even when there is only one owner and that owner is the only employee.  Business owners do this because a properly formed and maintained business structure can shield the individual owner from business liability. Individuals create a business structure to shift some expenses to business expenses; hire employees; and, create an entity that can be sold or passed on to the next generation. 

These are all reasons that some professional fiduciaries have used a corporate form for their businesses.  A commonly used business structure in California is an S-Corp. While useful to many types of small service businesses, it may not be helpful in offering fiduciary services.

The form of a business structure is determined by state law.  Each type of structure approved under California law has a different purpose. Some, like limited liability partnerships, are only available to certain types of professions (for example, attorneys) not to fiduciaries.  If you would like an overview of issues surrounding business formation and structures, send an email or post a comment below.

 

Sign up to follow this blog and stay tuned for Part 2 - Can A Fiduciary Form A Corporation?

Heed Early Warnings - Lessons on Dying from Romeo & Juliet

We are enthusiastic season ticket holders to The California Shakespeare Theater in Orinda California. The production of Romeo and Juliet by William Shakespeare in this season is superb. Go see it if you can! The Director, Shana Cooper, brought an element of mime to the production which really underscored the love story. Even more, she brought this perspective, "Romeo and Juliet is not a story about the stars controlling our destinies - it’s about the urges and vulnerabilities of being human." This makes me think of our ultimate vulnerability - death.

Even though the parents of Romeo and Juliet could not have predicted their children’s passion nor their tragic deaths, they could see some early warning signs. We too, can sense and prepare when life sends us early warning signs to be prepared for our own or a loved one’s death.

The first early warning sign occurred on the day of their births. A live birth is a 100% guarantee that death will follow at some point. Between that first breath and our last, we all look for meaning in our lives. Yet, something about the birth and death experience offers us the potential for experiencing a sacred moment. Our spirit’s release from the earth is a sacred time; as sacred as the morning dew on a new soul loosed upon the earth in birth.

A bit like the Nurse who cared for and loved Juliet, even though she was not her own family; I find that I am like a "midwife unto heaven’s gates" for many of my clients. This makes me ponder the experience we will all face. I find a kind of comfort, hope, and joy in seeing the sacred surrounding us in our final breaths.

What is the nature of this experience? According to the Kaiser Permanente, Palliative Care group, our experience of dying is quite different today than it was for people 100 years ago. Instead of an expected, yet quick event; we now approach death as if we can forever order a pill to avoid it. As Dr. Robert A. Johnson likes to point out, "People used to just die! Now,
                      we ..... 
                                                are.....

                                                                         dying..........."
The course of dying is often a slow progression. This means that if we make it to our 75^th birthday, in 90% of the cases, there are early warning signs to death. Only 10% - 15% of diseases create a sudden death, the kind where we just fall asleep and die.

All other disease trajectories provide some clues that we need to use to help us prepare for this event before we have lost the ability to make medical, financial and spiritual decisions. At a recent East Bay PFAC meeting, Kathy E. Dalziel, RN, MSN with Kaiser Permanente, Palliative Care Group, pointed out over 50% of the patients were incapable of making their own medical choices in the time leading up to their death.
 
According to palliative care providers, 60% - 65% of Americans will enter death after either mild cognitive impairment has begun or an initial major organ system failure has left the elderly patient weaker for a period of time¹.

40% of Americans will die due to dementia or mental frailty; normally within 10 years of initial presentation of mild cognitive impairment or within 6 - 8 years of an actual dementia diagnosis².

20% - 25% of Americans will enter death within 2 - 5 years of initial and ongoing major organ system failure³.

20% - 25% of Americans will expire due to the onset of an incurable cancer. Decline may be over a few years, but often within just a few months⁴.

For young people, like Romeo & Juliet, when death occurs, it is more often sudden or due to external causes - homicide, accident or suicide. Thankfully, the percentage of deaths in those under age 24 has been shrinking with increased medical knowledge and protections. Today, more parents of teens use a pretty good early warning system which could have been used by Romeo or Juliet’s parents to avert their tragedy. They encourage their children to talk to them.

 Take Stock & Talk
 On the other hand 73.5% of the deaths in the U.S. in 2011 were experienced by people 65 years or older ⁵. These were most often due to cancer, heart disease, chronic respiratory or liver conditions. These diseases give us the "gift" of talking with our loved ones about what is on our hearts.

With the average age expectancy at 78.7 years, if you are over the age of 65, don’t wait to review your written wishes.

Make sure you exercise your choice to have the loved one or person of your choosing available to you during this time. Once you begin to see some of the early warning signs if disease or mental incapacity begins to impair your life, talk to your loved ones about your wishes and what you might need. Don’t let our culture’s current perspectives on death keep you in denial. Instead, find someone to help you navigate this conversation with your family.

If you do not have a nearby family member who can serve your needs, you may benefit from talking with us about what a professional fiduciary can offer. Having a ready, willing and able health agent and qualified financial agent is crucial to reducing your worries and increasing your peace. 
 
At each decade, review your estate plan. After you turn 75 years old, take stock of your circle of care regularly. If needed, choose a licensed agent and advocate to help you navigate through your own end of life choices. Our fiduciaries are trained in a unique LegacyMapping™ process to walk alongside you and help you to discover and document your wishes, needs and choices.
Footnotes:
1, 2, 3, 4 -  Lynne, Joanne, Kaiser Permanente, Palliative Care Disease Trajectories.

5  Miniño AM. Death in the United States, 2011. NCHS data brief, no 115. Hyattsville, MD: National Center for Health Statistics. 2013.  

Have Your Cake And Eat It Too!

Do you want to find a way to pass on family values to your adult children; control where your charitable dollars go; provide hope for future generations; reduce your current income tax and ultimately your estate tax?

Who doesn't want to do that?  All you need is more than $5,000,000 in extra assets ($10,000,000+ would actually be better). Add a family foundation; a charitable lead trust and this recent IRS private letter ruling. You get to have your cake and eat it too. Read on.

A recent private letter ruling as reported by the Planned Giving Design Center allows an individual to direct that a charitable lead trust created by him can make payments to the private foundation also created by him. This is a deductible gift for Federal gift tax purposes and no portion of the trust property will be included in the gross estate.

What is the catch? The three-legged stool concept. There is a long-standing principal of charitable trust instruments. The Settlor (or any beneficiary) may not be the trustee and the beneficiary.  An independent, professional fiduciary can be helpful to keep the benefits flowing and avoid problems with the IRS. Learn about The ACE Fiduciary Group here www.acefiduciary.com.

In this instance, the IRS has ruled that in order to keep the benefits planned for this estate, the trustor may not serve as the trustee or retain an interest in or right to alter or revoke the trust.  In this scenario, the funds paid from his charitable trust to his foundation must be separately managed and administered by an independent committee.   Again, keeping the concept of the three-legged stool in tact.

If you expect to accumulate more than $5,000,0000 in assets during your lifetime, this is a good hat trick to know about. Combined with the incentive to reduce long term capital gains taxes, it could be just the right strategy. Talk to a qualified estate planning attorney and tax advisor about your particular situation. Read the full ruling and analysis http://www.pgdc.com/pgdc/charitable-lead-annuity-trust-qualifies-gift-tax-deduction-and-excluded-estate.

Even without an extra large estate, high income individuals are taking a look at how a Charitable Lead Trust can be used to benefit a specific charity while reducing taxes on long-term capital gains.     http://www.pgdc.com/pgdc/charitable-giving-just-got-more-affordable.

Imagine if you had a large estate.  Where would you like to leave a legacy of hope? Post your comments here.

Financial Wellness - Part 2

How does Financial Wellness differ from Fiscal Capacity or Financial Independence?

 

Fiscal capacity is the ability to understand and decide about financial transactions. Fiscal capacity changes over the course of our lives. Financial independence depends more upon outside factors and early life choices like saving money, scrimping and a bit of luck.  Financial wellness is attainable by anyone at any age and in any situation.

 

For example, think about when you got an allowance or earned some spending money as a child.  What did you do with it?  I remember a big stuffed panda bear.  I designed and sold my own Christmas Cards and earned a princely sum of …….wait for it….. $10.  I thought I was RICH!  I saved some, gave some at church and used the rest for that soft, cuddly panda bear I had been wishing for. The panda bear was a reminder to me for years of what it felt like to be independently wealthy.

 

At 10 we learn to save for what we want, relying on parents or others to take care of our financial needs.

At 25 we learn to live within a budget and often rely on elders to help us secure our first job.

At 35 we become a homeowner and investor, relying on realtors and other professionals to provide advice and assistance. We learn to handle a number of financial choices through education and experience.  At times our education comes out of our mistakes.  At younger ages, we have time to recover.  As we age, financial mistakes can severely impact our standard of living.

Fiscal capacity is built over time from learning how to handle money.  It is knowing how to make good decisions and how to take action to insure our financial wellbeing.  This includes such areas as keeping important papers organized; paying our bills timely; having a clear understanding of income and expenses; being able to understand financial statements and make decisions about investments or evaluate the performance of an investment advisor; being able to understand the risks and benefits of possible deals or financial transactions; being able to prepare for and file required taxes regularly. Protecting and preserving assets and wealth for our own enjoyment and for those whom we wish to bless.  Fiscal capacity can also erode over time.

To retain our financial health and well-being as we age, it is vital that we regularly take an honest look at our abilities.  Elders can become prey to elder financial abuse when their fiscal capacity declines and they do not have a trustworthy circle of care.   The National Center on Elder Abuse, US. Dept. of Health and Human Services cites the following as to who are elder abusers;

“In the only national study that attempted to define the scope of elder abuse, the vast majority of abusers were family members (approximately 90%), most often adult children, spouses, partners, and others. Family members who abuse drugs or alcohol, who have a mental/emotional illness, and who feel burdened by their caregiving responsibilities abuse at higher rates than those who do not.”

As we age, it can help to reduce our stress to rely upon people who are trained and licensed to handle certain aspects of our financial needs.  Building a core group of professionals and friends who can be part of our circle of care will make it easier for us to focus on what we value and cherish during our remaining days on earth.

If financial wellness is not age or circumstance specific, what does it look like?  A person who is financially well has basic living needs met through shared community property; their own earnings or savings; inheritance; gifts, or pubic benefits. They are generous yet know what is needed for their sustanence.  They do not steal, gamble or borrow more than they are capable of paying back.

 

Financial wellbeing includes a lower stress level about money because we can trust that those basic needs will continue to be met in the foreseeable future.

We learn what we can do for ourselves;

We handle what we know about; and,

We find trustworthy people to provide help where needed.

Also,  just like a well-run business, we can incorporate checks and balances in our financial system to guard against abuse. When we have financial wellness, our life is not focused on worry about money but rather enjoying the fruits of our labors and finding ways to share our values where we can do so.

You can learn more about Loren Acuña and The ACE Fiduciary Group at

www.ACEfiduicary.com

Financial Wellness - Part 1

While discussing financial wellness recently with Pam Campbell, Sales Director for Byron Park of Walnut Creek, my first thought about this concept was protection and preservation of wealth.  Considering the idea more fully over the past week, I see a rich depth to this concept that can be useful at any age or season of our lives.  It might actually come down to an idea heard recently at church  - - - “our job in this life is not so much about getting rich but more about being rich”.  

A business is considered sound financially when the inflow exceeds the outflow by an amount that can be expected to continue growing over time.  A Chief Financial Officer is often employed to help a business plan future income and control expenses in order to achieve a financially sound business.

 

An individual’s financial health is more often looked at in the negative.  We see areas that indicate imbalance or fear for future financial stability: a pending bankruptcy or losing wealth due to poor decisions or fraud. 

 

A recent study by the American Psychological Association found that “money” was named as the top stressor by 75% of the respondents. Not surprisingly, another poll by Associated Press/AOL found a high correlation between high debt levels and health problems such as heart attacks, headaches, ulcers, and depression.  So, while there is a pretty clear measure of financial un-wellness, there is less agreement about what constitutes financial wellness. 

 

By the way, the above study about stressors found similar result across all age groups EXCEPT those over 65, who reported lower levels of stress. Possibly this age group grasps the idea of financial wellness better than the rest of us.

What is Financial Wellness?  Is it the same as financial independence or fiscal capacity?  I would argue that financial wellness is not about the amount of wealth we have accumulated but more about knowing what we are capable of handling at each stage of life and having the wisdom to ask for help appropriate to our needs at each stage.

A good example of this in the business world is an entrepreneur who has the wisdom to bring in managers whose skills complement and supplement what the entrepreneur can offer.

Why do you think those surveyed over the age of 65 have less stress about money? Could it be they have learned to live within their means; or, they have learned the secret of a generous mindset; or, they have learned to appreciate and value what life offers over what money can buy – love, peace, joy and hope? These mental attitudes allow us to see a bigger picture of the value of human life which  can help us be rich at any level of monetary wealth.

 

If you are curious about this topic and would like information about the community event at Byron Park in Walnut Creek, please contact Pam Campbell for details. 
 

You can also receive an alert when the next installment of this blog on "Financial Wellness - Part 2" is posted by entering your email address above.  What do you think about Financial Wellness?  Be rich and share your thoughts.

 

Do Not Resuscitate (DNR)

How Do I Tell People What I Really Want?

This past week the story and controversy surrounding the death of an 87 year-old woman who did not make her end of life wishes known in writing was covered in the news.  The article by Lisa M. Krieger, "CPR Flap Could Have Been Avoided" in the Mercury News discusses an important form which many people do not know about or confuse with an Advanced Health Care Directive.

While a POLST does not insure a peaceful passing, it does help your health agent know what types of decisions you would want should you become unconscious and unable to choose not to accept certain medical procedures. Paramedics and doctors are not required to follow a DNR form in your wallet or language in the standard form used to name an agent for Health Power.

If you are terminally ill or frail elderly, there are three documents that will allow someone you choose to help you in your final hours. Otherwise, the hospital, doctors, paramedics and all other persons will follow standard medical protocol to keep your body functioning.

The Advanced Health Care Directive.

Many people think an Advanced Health Care Directive will be sufficient. The purpose of this document is to name a person who can make health decisions for you when you are unable to do so. This is why the hospital wants one on file when you are admitted. Doctors and medical personnel cannot make this decision for the patient. While important, since the Advanced Health Care Directive is prepared by an attorney not a doctor, paramedics and emergency personnel do not need to follow any particulars included on this form. In addition, in an emergency there is not time for them to read a legal manifesto.


The HIPPA Authorization Release.

As people age or when they are ill, it can become difficult to manage health care matters - from remembering and getting to doctor appointments to asking the doctor pertinent questions. If you have ongoing health issues, are terminally ill, or elderly, you should also consider signing a HIPPA release form to allow your health agent or another designated person to speak with your doctors about your health care needs. This can be given to more than one person and it is used even while you are competent and able to make your own decisions to allow someone else to speak with your doctors. In the event that you need assistance with health care issues, a HIPPA release form is the only way that someone else can discuss your health needs with the medical community.
The Physicians Order for Life Sustaining Treatment or "POLST".

The medical community developed a solution to help people discuss their end of life wishes in detail with their doctor. It is one page, printed on pink paper and signed by your treating physician. I tell my clients to post it on an entry wall or bedroom door so paramedics and others can see it. This allows the paramedics to not perform CPR, should that be your wish.

Otherwise, once CPR is started and a person receives oxygen, the heart can continue even when the brain is no longer working. Once emergency resuscitation is started, only a POLST or a decision by the named Health Care agent can stop normal ICU and emergency life sustaining treatments.

Below you’ll see links to samples of each form and a short word to remember their use. Review your health care directive to determine if the people you named many years ago are still able to serve you. If changes are needed, a simple amendment with your attorney will keep your written wishes up to date. Should you find, as some of my clients do, that those persons named earlier can no longer serve due to death or illness, you may want to consider naming a licensed, professional fiduciary.

URGENT! First Priority - Advanced Health Care Directive. Attorney Document.
Everyone over the age of 18 years of age should have one. This legal document names who will decide for you in case you can no longer make your own health decisions. Best if prepared by attorney with estate planning package, but the State of California offers this free form here. Second Priority - Assistance with Health Care Management
If you are diagnosed with a significant illness or find that you have trouble remembering what to ask your doctor, it may be time to ask a family member; your health agent; or a patient advocate to assist you in getting the medical care you need. Click here to see sample wording.
Third Priority - POLST. Doctor's Orders 
Make your specific medical wishes known by discussing the options with your doctor and putting it in writing. Then post nearby. Especially important if you have been diagnosed with a terminal illness or you are a frail elder. Click here to see a sample. 

Have You Been Cocooning Lately?

It’s been unusually cold this winter. Have you felt it deep inside your bones? Wrapped in a blanket, hunkered down. Under the weather. Sometimes we just want to cocoon for awhile, especially if our body is fighting off a cold. Occasionally, I just sit and soak up the sunshine or warmth and allow my natural body rhythms to help me back to health.

Sometimes, we cocoon when we need to slow down our life rhythm to accommodate new changes. Taking some time to take in recent experiences is a healthy way to manage stress in life. It usually gives us the refreshment we need to re-ignite the fire of our inner motivation.

Yet, there comes a point in a person’s life when this cocooning process is the dominant mode of life. Sometimes a terminal illness causes this. Or the inevitable frailty of old age causes us to cocoon. This process looks like shutting down to the outside. While a person cocoons, they hold on to only a few routines that must be done and let go of many activities that once gave them pleasure. Sometimes it is only for season, but sometimes it is a way of protecting themselves.

He Sings For The Fun Of It
When we watch those we love detach, sometimes all we see is the decline and not the inner joy. The decline scares us when we remember their earlier vitality. We wish for a return to what used to be. Sometimes they do too.

More often, people seem to sense when it is time to slow down and soak up the warmth or just enjoy simple pleasures. While we say things like "She is failing" or "He is declining", they seem to be thinking, "I am getting closer now!" For example, I know someone who has had to get his food through a stomach tube for a number of years since he had throat cancer. Even though he cannot swallow food, he sings little songs all through the day to cheer himself and his wife.

Not Failing, Cocooning
Rather than saying someone is "failing", let’s change the idea to "cocooning". Who wants to be seen as failing? We all want to be seen as capable, even if we need help in some areas of our life. I never wanted an "F" in school and I certainly don’t want it life either.

When we cocoon, we do so with hope that a re-invigorated butterfly will emerge. When in this state, whether because we are ill or frail, we need special care from those near by. This weekend my husband enthusiastically took on the job of making me soup. He helped me do a necessary task when I was not up for it. Maybe later, we’ll both need someone to cook healthy, tasty meals for us. Although, I am sure they won’t equal his.

It may take a village to raise a child, but as I have written elsewhere "it takes a stage crew for our final act". When we are older, we need to identify a trusted circle of care we can rely upon.  This will help us experience the kind of quality of life that protects us, leaving room for joy even as we prepare for "lift off".

TAP Into Your Circle of CareTM
As my mom likes to remind herself, "just because we have needs, does not mean we are needy". What keeps us from being "needy"? One way is to do an honest assessment of our needs and have conversations with others about our capabilities as we age. That way we are better able to seek and accept the type of help we’ll need at various stages of life. Even if your motto is "Need No Help", remember we all rely upon other people during our lifetime. The very fabric of our civilized lives is built upon mutual needs being fulfilled.

As we age, no matter our age, here’s the only question - what type of service can you offer and what service do you need now?