Seniors: Have You Secured Your Future?

When the time comes, do you know who will be there to make important decisions for you?

We recently visited Advance Health Care Directives, living wills, power of attorney (POA) and POLST. These are all legal documents put in place to ensure decisions regarding your health align with your preferences when you are no longer capable of communicating your desires. When not prepared for this last phase in life, you could end up with a court appointed conservator who may or may not have your best interests at heart.

As you now know, Durable Power of Attorney for Health Care is someone who will make decisions regarding your healthcare when you are no longer able to. But did you know powers of attorney have different levels of authority and can serve other areas of your life?power-of-attorney

  • Financial Power of Attorney allows your agent to make decisions regarding your finances and property.
  • General Power of Attorney has a broader scope, giving your agent the ability to make any and all personal decisions and healthcare choices.
  • Limited Power of Attorney has limited authority on the types on decisions you would like them to make.
  • Durable Power of Attorney is given the ability to make decisions for you both now and if you become incapacitated.
  • Springing Power of Attorney only has authority when you become incapacitated.

judge-hammer1If no POA is named, your family members may decide to file a petition with the court if they feel you are unable to meet certain requirements for your health and safety, or if you lack the capacity to manage your financial affairs. A conservatorship is comparable to an individual given legal guardianship over a minor.
There are two types of conservators:

  • Conservatorship of the Person – conservator makes personal decisions for the conservatoree
  • Conservatorship of the Estate – conservator makes financial decisions for the conservatoree

Often times, the court appoints the same person to act in both capacities. This may or may not be the person you would have chosen, were you able to make that decision.

Does one have any advantages over the other?
Power of Attorney is a relatively low-cost and private way of naming a trusted individual to carry out your wishes. In regards to a conservatorship, the court proceeding is not only costly, but the person named as your conservator might not be the same individual you would have chosen.

You can save your loved ones from headaches and guessing games by having open conversations with them about what you want and deciding on your Advance Health Care Directives.MeandGrandma

Coming up, we’ll discuss how to go about choosing a healthcare proxy.

 

 

 

Sources

  • http://www.elderattorneyoffice.com/cda.aspx?content_type_id=8169
  • http://www.mayoclinic.org/healthy-living/consumer-health/in-depth/living-wills/art-20046303

 

 

Your Life, Your Choice

Always be prepared. It’s something we’re taught from the time we’re old enough to enter the Scouts and continues throughout life. Be earthquake ready; have car insurance; build a hefty emergency fund; bring a sweater. All these ideas are so commonly repeated, but what about being prepared for the last major event in life? Few people like to talk about it, but it’s important that we do. Having the “end-of-life” discussion with your loved ones is a necessity.conversation

Although it may be uncomfortable or even a bit scary, it is better to address end-of-life issues while you are alive and well. When you have everything in place, there will be no confusion on what you would have wanted and your family may grieve in peace, rather than handling messy paperwork. Over the next few weeks, we will discuss and simplify the options you have in expressing your wishes for when the time comes.

Two birds, one stone.
The Advance Health Care Directive is now the legally recognized format for living wills and has also replaced the Durable Power of Attorney for Health Care (DPAHC). You can now include either or both of these in one document.

Whereas the traditional living will states your desire not to receive life-sustaining treatment only if you are terminally ill or permanently unconscious and DPAHC appoints an individual to make health care decisions on your behalf; an Advance Health Care Directive allows you to do a number of things:

  • You may appoint another person to be your health care “agent” to make health care decisions for you once you are unable to do so yourself.
  • Identify your primary physician.
  • Specify your preferences about accepting or refusing life-sustaining treatment such as CPR, feeding tubes or breathing machines.
  • Leave instructions on receiving or declining pain medications
  • Make decisions on organ and tissue donations.
  • Otherwise formally express your health care wishes, values and beliefs.

*If you have a valid DPAHC, you may want to review it to make sure it still accurately reflects your wishes. If your DPAHC has expired, you will need to replace it with an Advance Health Care Directive.

Unstoppable: Advance Directive + POLST
POLST (Physician Orders for Life-Sustaining Treatment) has been legally recognized in California stock-footage-hospital-bed-handssince 2009. POLST is meant to complement an Advance Health Care Directive, particularly for those who are seriously ill or have been diagnosed as terminal. With POLST in place, your end-of-life health care wishes have been translated into actionable physician orders, meaning your wishes are implemented and followed without delay.

Who can complete an Advance Health Care Directive?
Any California resident who is at least 18 years old (or is an emancipated minor), of sound mind, and acting of his or her own free will can complete a valid Advance Health Care Directive. You do not need a lawyer to assist you. The only exception applies to individuals who have been involuntarily committed to a mental health facility who wish to appoint their conservator as their agent.

Start the process today by looking over the forms for Advance Health Care Directive and POLST with your loved ones:
http://ag.ca.gov/consumers/pdf/ProbateCodeAdvancedHealthCareDirectiveForm-fillable.pdf
http://capolst.org/wp-content/uploads/2014/01/CAPOLSTform2011.pdfPOLST

Look out for our upcoming discussion on Power of Attorney and Conservatorship.

 

 

 

Sources

http://www.mayoclinic.org/healthy-living/consumer-health/in-depth/living-wills/art-20046303

http://www.cmanet.org/about/patient-resources/end-of-life-issues/advance-directives

 

Silencing the Stigma

Last month, we discussed the social, institutional, and self-stigmatization of mental illness in the elderly and their ramifications. This week, we will discuss current efforts to eradicate mental health stigma and improve access to care.

How can we influence the media’s depiction seniors with mental illnesses?

notebook2004While the media promulgates inaccurate and damaging stereotypes about mental illness, it can also be a source of positive change in the battle against social stigma. For example, the movie The Notebook (2004) provides a genuine portrayal of strain and heart-ache accompanied by dementia. The vast majority of mass media, however, reinforce social stigma through stereotypical presentations of mental illness.

Organizations such as the Center for Mental Health and Media and Mental Health Reporting have launched their own campaigns to counter prevailing stereotypes by educating the public. They have also posted tips for reporters and screen writers to avoid promoting stigmas. Writers should:

  • Ask, “Is mental illness relevant to the story?”
  • Verify statements that mental illness is a factor in a violent crime. A past history of mental illness is not necessarily a reliable indicator.massmedia
  • Avoid using language that implies people with mental illness are violent.
  • Double-check specific symptoms of diagnoses with valid mental health resources, as necessary.

Ultimately, these organizations hope to inform writers that meaningful stories do not need to peddle incorrect and damaging stereotypes about the mentally ill. They have also initiated their own media campaigns to bring awareness to mental health stigmas.

The biggest advances in combatting stigma against mental illness have come through public policy

The passages of the Mental Health Parity and Addiction Equity Act (MHPAEA) and the Affordable Care Act (ACA), also known as Obamacare, have profoundly improved access to resources for the mentally ill.

mhpThe MHPAEA (2008) ensures that financial requirements (ex. Co-pays, deductibles) and treatment limitations (time of stay in hospital) for mental health or substance abuse disorder benefits are no more restrictive than corresponding surgical or medical benefits.

The ACA (2013) builds upon the principles of the MHPAEA and expands access to mental health services for geriatric patients in a number of ways:

  1. Employer-based insurance for seniors no longer can deny coverage based on preexisting psychiatric acaconditions.
  2. The ACA contains provisions that will increase quality of care in nursing homes.
  3. Healthcare institutions that are categorized as “Health Homes” or “Medical Homes” will receive increased federal funding, which will make mental health treatment more accessible for the disabled and elderly.
  4. All states will be required to have some level of mental healthcare coverage, though specific services are decided on a state-by-state basis.
  5. Medicaid has been expanded in 27 states. Medicaid’s broad range of mental health and community support resources mean that millions more people will be able to obtain treatment for psychiatric disorders.

Collectively, this means that mental health services will be more accessible than ever before to the majority of Americans, including geriatric patients. Though these policies are an important step forward, it is important to remember that social and self-stigmas are powerful factors in care quality and access, especially for seniors. Furthermore, the ACA only mildly addresses the most pressing issue facing seniors—the lack of geriatrics-specialized physicians and healthcare workers.

Fortunately, numerous colleges offer stipends and scholarships to encourage medical and graduate students to pursue specialty training in geriatric care. The American Association for Geriatric Psychiatry (AAGP) and the Geriatric Mental Health Foundation (GMHF) also support yearly scholarships for students who hope to obtain training in geriatric-focused medical care. As the Baby Boomer generation ages, these scholarships and programs will likely become more common in the nation’s medical colleges and healthcare training institutions.

Next week, we will discuss how practicing gratefulness in your daily life can improve your mental health.

Fit, 50+ and Fabulous

“Well Mrs. Foster, you can’t keep doing what you’ve been doing. There are going to be some changes you need to make, since your body is changing as well.”

The words of my mother’s doctor didn’t quite make sense to me at the time, but little did I know the changes he meant were going to affect our entire family. She had just turned 50, and didn’t find anything wrong with her current routine, but his suggestions were ones that were looking long term, towards a happy, healthy life.

checkup
Many women find that their lifestyle habits that worked well in their 20s and 30s don’t always result in the same outcomes as years continue to pass. Between hormones and hot flashes, there is lot that changes in these years that can increase risk for heart disease and stroke. But the following tips are designed to help maintain your weight, keep a healthy heart, and a strong and happy life!

Consider B12Grilled Fish Entree in Barcelona

  • B12 is a vitamin needed to support healthy blood and nerve cells
  • As we age, it becomes more difficult to absorb certain nutrients, including B12
  • Try to get your daily dose from fish and other lean meats or a supplement if vegan or vegetarian

Be Salt Savvy

About 72% of salt in the American diet comes from processed foods
Diet plus age puts us at increased risk for hypertension and heart disease
Aim for about 1500 mg or less of salt per day
Try switching salt for some flavorful herbs and new recipes
Reducing processed foods also means more whole foods, helping you to stay fuller longer

Watch Iron Intake

  • The average woman begins experiencing menopause around age 50
  • This means the body’s iron needs are significantly decreased
  • Check your multivitamin for iron, and ask your doctor if the levels are too high
  • While the body needs iron, too much can cause liver and heart damage

How-To-Avoid-OsteoporosisCalcium is Your Friend

Vitamin D and calcium in the body begin to decline around age 40
More post-menopausal women are at risk for osteoporosis and bone fractures
It’s never too late to start adding rich sources of calcium into your diet:

 Spinach
 Broccoli
 Kale
 Low Fat/Fat Free milk and yogurt

Go Mediterranean!

  • As we age, our blood vessels become less elastic
  • This means women in or beyond menopause are at an increased risk of heart disease
  • Studies have shown that adding Mediterranean eating habits into one’s diet can be especially helpful in prevention and associated with longer survival without disease
  • This includes a large consumption of fruits and vegetables, whole grains, olive oil, and moderate wine

Of course, you don’t have to be 50 to use these tips for yourself and your family member, you can start today! It’s never too late to adopt some of these practices. While it would be a great stress relief to go on a cruise to the Mediterranean, it’s an even bigger one to know that your habits now will help your heart down the line.

family

Survivors: Life After Stroke

stroke2As the treatment technology progresses, more than 7 million Americans have survived strokes today. If you are or have a stroke survivor in your family, please be positive, because the hope of getting better is never gone. Please be patient, since the recovery is a life long process. Please be informed, since there are a lot of changes brought by the stroke you should acknowledge. Today we talk about life after stroke. The information is crucial because it matters to the survivors’ recovery, rehabilitation, and next stroke attack prevention.

Be Prepared: Changes by stroke
Surviving a stroke, we first should admit that stroke changes life, both physically and emotionally. Stroke causes brain injury that may affect how people move, communicate, think and act. Here are some common general changes survivors might experience after a stroke:

  • Weakness or paralysis on one side of the body
  • Difficulty speaking or swallowing
  • Tire easily
  • Change in personality, performing improper language or behaviors
  • Difficulty with memory, judgment, and problem solving
  • Difficulty with peripheral vision and problems with visual cognition

Other changes are dependent on whether it is left- or right-brain injury. Generally, one side of the brain controls the opposite side of the body. For example, right-brain injury may result in weakness or paralysis on left side of the body. The survivor also tends to lack awareness of the left side.
At the same time, stroke survivors also go through a series of changes emotionally. Many of them experience frequent emotional instability. Other changes include:

  • Depression
  • Lack of motivation and indifferent
  • Unexpected feeling of anger, anxiety and frustration

The above are common changes that stroke survivors would go through during the recovery process. It’s best for family members and patients to be prepared and recognize these changes in time.

Returning Home
When the patient is medically stabilized, the physician may recommend returning home. Some stroke patients are afraid of this process for the fear of having another stroke attack. There are a lot of other fears due to this change of setting that we also need to understand. For instance, some may feel that their friends and family will abandon them. Or they fear that their loved ones are not competent in proper caretaking. Being surrounded by other people at home may also make them realize their disability, which can be hard to accept. Therefore, family members and hospital staff need to work together to prepare for the transition.stroke1

When is the right time?
There are four major factors to consider when assessing whether getting back to home is a good decision. Stroke survivors at home need to have ability of self-care, meaning one should be able to accomplish some basic daily activities. Also since the medical care still continues, the patient needs to have the ability to follow medical advice as well. It is also highly recommended that a caregiver, either family member or hired professional staff, assist the patient when needed. In addition, the survivor needs to have the ability to move around and communicate, so that they can ask for help in an emergency.

Adapt your home
Before welcoming your loved one home, family members should work with professional staff to change the home setting, making it safe, accessible, and comfortable for the stroke survivor to live.
First, you need to check every corner of your home and be diligent about hidden hazards that may cause falls and other accidents. Measures like taking up the throw rugs, having more lighting, using a non-skid mat, and fixing your floor or staircase are highly recommended. Further action, like installing a raised toilet seat, safety grab bars or handrails can also be helpful. You may also want to build a ramp so that patient can move around as much as possible.

Caregiver
Caregivers are often the spouse, adult child, or parent who provide most of the care for stroke patient at home. Since the recovery process is a challenge for both patient and caregiver, we suggest the two sides to share decision-making and feelings as much as possible. The caregiver’s responsibilities range from providing physical assistance, taking care of the survivor’s everyday life, to managing financial affairs, and providing emotional support. In other words, the caregiver needs to cover almost every part of the stroke survivor’s life.
However, we should not neglect that caregivers also need care themselves. Try to encourage the survivor to be as independent as possible. This will not only relieve your pressure but also help the survivor’s recovery progress. While you encourage your loved one to participate in leisure activities, you can also try to have fun. It’s totally fine to take a break, which would be beneficial for both you and your patient. A paid professional caregiver is also a choice many people turn to. While you try to take good care of people in you life, remember to take care yourself as well.

Resources
http://www.stroke.org/site/PageServer?pagename=surv
http://www.strokeassociation.org/idc/groups/stroke-public/@wcm/@hcm/documents/downloadable/ucm_309716.pdf
http://www.strokeassociation.org/idc/groups/stroke-public/@wcm/@hcm/documents/downloadable/ucm_309720.pdf
http://www.strokeassociation.org/idc/groups/stroke-public/@wcm/@hcm/documents/downloadable/ucm_309723.pdf