[3] Horizons: Legal and Financial
- Team Writer
- 7 hours ago
- 6 min read
Video Module 3 Transcript
Welcome. Planning ahead for medical, legal and financial concerns helps ensure that wishes are honored, and affairs are well-managed. And in situations that may involve cognitive impairment, preparation is crucial.
Planning is essential because having cognitive changes that are out of the normal range for your age, education, and life experiences may impact your decision-making about estate and end-of-life plans down the road.
So let's first start with a brief overview, so you can better understand the different types of cognitive issues.
When doctors refer to cognitive impairments, they generally categorize them as either minor or major impairments. Major impairments are significant, and often fall under the big umbrella we call Dementia. In addition, there's a point to consider: minor cognitive impairment, often called MCI, is also different from normal age-related cognitive changes. Let's explain.
Age-related cognitive changes are considered less severe than minor cognitive impairment, and may involve trouble finding words or remembering names as quickly, taking longer to solve relatively simple math problems, or difficulty juggling multiple appointments in a single day.
Examples include: "I can't recall our neighbor's last name. I have to look it up or it comes to me, but like an hour later."
"I just can't seem to add the proper tip on a restaurant bill anymore." or "It's harder to go anywhere without my GPS."
However, if you or your loved one are experiencing these types of minor cognitive challenges, it is still important to talk with a doctor early on, and consider a cognitive screening to get what's called a baseline assessment. You want to know several things: Is it normal aging, or are the difficulties related to stress, depression, infection, medication, or other common causes of changes in thinking? That said, if a person is diagnosed with a bit more advanced condition, it may be called minor cognitive impairment.
So what does that exactly mean? Minor cognitive impairment is the in-between stage between the expected decline in memory and thinking, which usually happens as we age, and the more severe syndrome of Dementia.
Although a person can progress from MCI to Dementia with MCI, impairments with memory, language, or judgment, et cetera, are generally not sufficient enough to require assistance with the activities of daily living, like dressing, eating, bathing, running a household, decision-making, and more. MCI may remain stable over time depending on the nature of the cause or causes.
So you may be asking yourself, what exactly is Dementia? In brief, Dementia results from biological changes to brain tissue typically caused by one or more neurocognitive diseases or disorders. Dementia is not a disease itself. Instead, it is a syndrome, a group of many progressive symptoms. In medical terms, Dementia is officially labeled as a major neurocognitive disorder, NCD. Generally speaking, the diseases and disorders that underlie the symptoms substantially affect our ability to perform activities of daily living, including rational and reasonable decision-making.
Let me be clear, no matter your age or health status, it's always good to think through your legal, health and financial wishes sooner rather than later, while you can still be considered to have the capacity to make decisions on your own. And that's why you're here to learn about the steps you can take.
Different types of legal professionals can assist with creating advanced directives and important estate documents. Most notable are estate planning attorneys and those attorneys specializing in elder law.
Now, let's discuss advanced directives.
Especially when concerning healthcare aspects of your life,
advanced directives are documents allowing individuals to express their preferences, values, and treatment choices, in case of incapacitation. Incapacitation is when an individual lacks the mental capacity to make informed decisions. When someone is incapacitated, they may be unable to understand the nature and consequences of the document they are signing. In the context of Dementia, where cognitive capacities diminish over time, advanced directives become invaluable tools for ensuring that one's wishes are respected, even when the ability to communicate or make decisions is slowly compromised.
Next, let's discuss powers of attorney. There are both durable and non-durable powers of attorney, also known as a P-O-A. A non-durable POA is used primarily for singular transactions or purposes like selling property, or opening and closing a bank account. However, when there is a progressive health condition such as Dementia, consider establishing a durable power of attorney for healthcare, sometimes called a healthcare proxy, to ensure continuity in decision-making, even as capacities recede. As the name suggests, it endures and is used for more than one transaction or representation. You may decide to have just one individual represent you in all aspects of your life, or you may elect to have separate individuals focus on particular decision-making.
Living wills: a living will allows you to outline medical treatment preferences, life support, and end-of-life care. It permits you to state your choices regarding resuscitation, feeding tubes, and other medical interventions, specify under what circumstances you would want, or not want, certain treatments. Here are some additional suggestions for documents and actions you may wish to consider.
Your will: draft or update your will to ensure the assets of your estate are distributed according to your wishes.
Trusts: consider creating a trust to manage and distribute assets of the estate equitably, and so that funds are made available to help your beneficiaries, timed to their future financial needs.
Guardianship: If you have dependents, consider designating a guardian who will care for them in case you are no longer able to do so.
Medical history: gather information for healthcare providers and maintain a comprehensive record of medications, surgeries, allergies, treatments, and next-of-kin and responsible parties' contact information. Include any family medical histories of individuals like parents, siblings, grandparents, aunts, uncles, and cousins, that have had particular conditions or disorders you're aware of.
Although sensitive and emotionally complex, include, if able and willing, any knowledge you have of adoptions or familial connections that others may be unaware of. Those insights might provide clues to a diagnosis or guide future healthcare decisions, if you are unable to share that information due to a decline in cognition.
In addition, review your finances and insurance coverages, and consult professionals for guidance on managing resources effectively. Take stock of your current financial situation, including assets, debts, income sources, and insurance policies. Also, if you or your loved one is a military veteran, there may be benefits worth exploring.
Sooner rather than later, investigate long-term care insurance options, to help cover potential costs associated with Dementia care at home or in a long-term care community. If available, it may be worth considering policies that combine life and long-term care coverage.
Periodically review and update your legal insurance and financial plans, especially if there are changes in your health, family structure or financial situation.
Openly communicate wishes and plans in the legal documents with family members and the designated individuals.
Ensure that those involved know the preferences and have copies of relevant documents, when durable and non-durable powers of attorney documents, as well as other important estate or advanced directive documents are created. Whether for medical, legal, or financial decision making, you should produce several signed copies. Keep them secure, yet make them easy to find for those acting on your behalf, if they don't already have copies. Consider a document pouch that may help protect them from being inadvertently misplaced, consumed by fire or destroyed in a flood, if needed later on, to perform bank transactions or other essential duties. The POA may need to provide an original document, but always make sure they are returned if possible, once viewed for authenticity and confirmation.
Today, there may be ways to use an app on a smartphone that can help digitally scan the documents as a backup, but the originals should be closely guarded. In addition, it's relatively common for folks to put a specially marked container or vial inside the refrigerator that provides first responders and others with the basic whereabouts of critical advanced directives, one's medical needs in an emergency, and possible allergies. If you or your care partner are headed to the hospital, having copies of those papers readily found, so that they can be taken with you, may save time, effort, and heartache, should wishes not be followed for lack of clear direction.
Lastly, on this point, consider wearing an ID band of some kind on your wrist or placing one on your care partner to help first responders and others obtain more information.
Presently, when it comes to advanced directives, many healthcare systems and hospitals are getting proactive and initiating and encouraging them to be created, shared, and stored securely with them beforehand. Check with your trusted professionals and local medical providers to see if such a program exists in your area.
In conclusion, when facing the potential for Dementia or other cognitive impairments, it involves thoughtful consideration, clear communication, and guidance from legal, medical, financial, and insurance professionals. Take action today and reach out for help creating or updating your important estate documents and advanced directives.
Thank you for joining me, and I hope you found this information helpful. It was my pleasure to be with you.