12/14/17

People are hiring doulas to help them die

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By Molly Shea

Chad Lewis charges $20 to $25 an hour to assist the gravely ill and their families.

When Chad Lewis’ mother passed away seven years ago from complications from diabetes, he couldn’t stop thinking about her death. “It wasn’t loving and sweet,” he says. “It was chaotic and angry and scary.”

So Lewis, a 39-year-old who lives in Astoria, set out to find a better way to process the end of life, ultimately making a career shift from Broadway stage manager to death doula.

Doulas who aid women in giving birth have been trendy for years, but now a different type of support person is helping people navigate life’s other major passage. Dying people and their loved ones are hiring death doulas to help them coordinate end-of-life care and vigils, plan funerals and provide a sympathetic but unattached ear.

The profession first came into being in the early aughts and is growing increasingly popular. In 2014, Suzanne O’Brien launched the New York City-based Doulagivers, an online training program for death doulas.

“I can hardly keep up with demand,” says O’Brien, who also holds monthly seminars at an Upper West Side branch of the New York Public Library.

The process usually starts with a patient deciding how they want to die and outlining that with the doulas.

“It’s similar to a birthing plan … Where [do] you want to die? What kind of room you want to die in? What [do] you want to be looking at? What [do] you want it to smell like?” says Shelby Kirillin, 41, a Richmond, Va.-based death doula. She charges between $1,000 and $3,000 as a retainer fee, and asks for payment upfront to avoid chasing down money posthumously. She’ll also work pro bono if a situation merits it.

The “scary” death of Chad Lewis’ mother led him to become a doula.

“I had one young girl say she wanted to die in a yurt,” says Kirillin of a client who’s currently planning her own death. The girl’s cancer condition makes a yurt too impractical, so Kirillin is getting creative. “We decided on mosquito netting over her bed, and twinkle lights to look like stars.” After she takes her last breath, her loved ones will put wildflowers in her hair.

Death doulas also help out after someone passes. Lewis, who charges $20 to $25 per hour, likes to create a basic plan to take care of issues such as child care, grocery shopping and bill payment, to clear up mental space for grieving families.

And more than anything, the professionals help patients process what they’re going through.

“Families buffer pain — you hate to see people you love in pain. And doulas aren’t buffers,” says Kirillin. “Instead of saying, ‘OK, let’s see if we can give you meds,’ I’ll say, yeah, ‘I bet you are in pain. Tell me about it — what does it feel like?’”

When Richmond resident Mel Titus’ best friend of 31 years, Kim, was entering the final stages of her battle with cervical and breast cancers last year, they were introduced to Kirillin.

They were skeptical at first, but Kim (whose last name is being withheld for personal reasons) decided on a death doula so she could manage her death the way she did her life. “She was a processor,” says Titus. “She really liked that she could come up with a plan and do things a certain way.”

And for Titus, Kirillin provided emotional support during an impossible time. “I would have tough days, and I’d call Shelby, and she’d walk me through it,” she says.

Kirillin helped the duo plan Kim’s visitor schedule, and what music they’d play and books they’d read in the final days. Taking care of logistics freed them up to reminisce about Kim’s life, and even laugh about how things were going. “We actually had some funny moments, believe it or not,” says Titus. “It’s sad, but it can be a happy thing, too.”

Complete Article HERE!

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11/30/17

They Comfort Strangers, So No One Dies Alone

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David Wynn, 62, and Carolyn Lyon, 74, in Santa Ana, Calif., volunteer at a hospital where they accompany patients who are near death and don’t have loved ones to be with them in their final hours.

By Liyna Anwar

When patients are near death, and don’t have loved ones to be with them, David Wynn and Carolyn Lyon rush to the hospital.

“They have no one for various reasons, you know, they’ve outlived family, they’ve never married,” Lyon says.

For about six years, Lyon has been comforting patients in their final hours at St. Joseph Hospital in Orange, Calif.; for Wynn, it’s been about nine years.

“For some reason I always wonder about the person’s mother,” David Wynn says. “She saw him first, and I saw him last. It was her and me that are the bookends of this person’s life. So each time that I leave a patient who has died, there is this element of sadness.”

But this kind of work also has its rewards. Wynn remembers one man who was estranged from his family.

“I was sitting there with him and I heard somebody at the door. Turns out it’s his son,” Wynn says. “And he, I guess, felt a little bit uncomfortable, and so he asked me to stay.”

Then, the patient’s daughter came in. “These are people who hadn’t seen each other in maybe 10 or 20 years,” Wynn says.

While the family members exchanged apologies, Wynn recalls the daughter saying, “I don’t even know why I was angry at you, I don’t even remember.”

“And they said, ‘We’re going to try to be a family again,’ ” Wynn says.

“You know, we talk about the last senses to go would be the sense of touch and hearing,” Wynn says. “And I hope that there was enough left of the dad that he had some sense that this bad situation had been healed through his death.”

Wynn says he felt honored, simply to witness that reconciliation, at the end of the man’s life.

Complete Article HERE!

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11/26/17

Families turn to death midwives for help with final passage

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Anna Benton, of Milwaukee, left, Georgette Paxton, of Madison, center, and Jennifer Snow, of Waunakee, look over Heather Ockler, of Monona, who is playing the role of a dying person wrapped in a shroud during a home funeral demonstration. It was part of a death midwife class taught last month by Sharon Stewart, who helped aspiring death midwives practice skills such as washing and shrouding a body. Death midwives, sometimes called death doulas, are increasingly helping families prepare for and navigate the death of loved ones, in addition to or instead of hospice care and funeral homes.

By DAVID WAHLBERG

Before Valli Warren’s husband died last year after a long illness, the Stoughton couple knew they wanted a home funeral and green burial.

But they weren’t sure how to make those things happen. They turned to Sharon Stewart, who delivered ice packs to preserve the body, shared videos about how to wrap it in a shroud and taught pallbearers how to carry it out of the house on a board.

Stewart also helped Warren file paperwork, including a permit letting her transport her husband to Circle Cemetery, near Barneveld, where he was laid to rest without being embalmed or using a casket or vault.

“She walked me through every phase,” Warren said.

Stewart is a death midwife, a new kind of occupation that provides emotional, spiritual and practical support to families before and after death — in addition to, or instead of, hospice care and funeral homes.

The service, which has emerged around the country over the past decade, is analogous to what birth midwives do compared to obstetricians. Some who offer the assistance call themselves death doulas or end-of-life midwives.

‘Back to their roots’

Whatever the title, the providers say they help people “take back” the death process from hospitals and funeral homes. Services include leading family discussions about death planning, sitting vigil with people as they die, helping family and friends wash the body afterward and aiding in tasks such as selecting memorial cards, sending obituaries to newspapers and closing social media accounts. It often involves home funerals or green burials.

“We’re taking families back to their roots, the tradition of when we were born and when we died in our own homes,” said Stewart, a former detective who lives near Brooklyn, south of Madison. “We laid in honor in our parlors, and the community came together to provide care for the family.”

Liz Humphries, a former birth midwife and hospice nurse who recently added an end-of-life doula service to Seasons of Life, her senior care company in Middleton, said, “It’s about reclaiming a really sacred and beautiful human experience.”

Mary Paulauskis, a former hospice nurse from Madison, has added what she calls end-of-life transitions counseling to her business, Mindful Awakenings, through which she teaches meditation.

Paulauskis focuses on helping people think about who and what they want around them as they die. She also coaches loved ones on what to say to a dying person and how to interact — letting them know it’s OK to lie next to the person if they want to, for example.

“It’s creating a space of whatever the patient said they want,” Paulauskis said.

Many people don’t realize that there are several ways to dispose of bodies without embalming, including new, greener types of cremation, said Angie Buchanan, a death midwife in Waukesha who trains death midwives around the country. She informs clients of the options and guides them through their choice.

“We’re the water that runs between the rocks of the medical profession and the funeral industry,” Buchanan said.

Dr. Toby Campbell, chief of UW Health’s palliative care program and a board member of Agrace Hospice and Palliative Care in Fitchburg, said he understands why death midwives are catching on. He said hospice care typically includes two or three visits a week from a nurse or social worker, and an occasional call from a doctor.

“That leaves about 99 percent of the time you and your family are on your own,” Campbell said. “That’s a big space. There are giant gaps between the health care system and death, even including hospice.”

Jim Olson, president-elect of the Wisconsin Funeral Directors Association, said caring for a body after death and managing a funeral are big jobs. Most people will continue to seek help from funeral directors, he said.

Death midwifery is “another alternative for families, which we think is great,” said Olson, who owns Olson Funeral Home and Cremation Service in Sheboygan. “Am I afraid it’s going to affect my business? No, absolutely not.”

There is no licensure or government certification for death midwives. Experienced practitioners, such as Stewart and Buchanan, offer training, as does the New Jersey-based International End of Life Doula Association, which held a session in Madison last year.

Many training programs offer their own certification. The burgeoning field is in a similar situation to massage therapy in the 1990s, before doctors pushed for its regulation, Buchanan said. In Wisconsin, certification for massage therapists started in 2003, with licensure beginning in 2010.

Fees for death midwives vary. Buchanan said she charges $100 for a consultation and up to $2,000 for services covering the whole death process. Stewart has accepted donations of $100 or $200 from some clients, but she doesn’t plan to establish rates until she retires from her day job, at the state public defender’s office, and devotes more time to death midwife duties.

Paulauskis said she plans to charge $25 to $50 for a counseling session and negotiate rates for other services but let people pay what they can. An academic adviser at the UW-Madison School of Social Work, she plans to continue making her living in other ways.

Humphries, who started her end-of-life doula service last month, said she might charge $40 to $100 an hour but offer a sliding-fee scale for people with low incomes.

Humphries is also an organizer of Walking Each Other Home Madison, a group that started in 2014 to help people carry out home funerals and green burials. People can rent the group’s home funeral kit, which includes a body board, ice packs, soap, lotion, diapers, latex gloves and small bags of rice to place over the dead person’s eyes to keep them closed.

‘The personal touch’

Stewart, who has long volunteered at Monroe Clinic’s hospice program, said she saw the need for a more personal death service after her brother died in a car crash at age 19. She was 21.

Police came to the house in the middle of the night, told her mother her son was dead and left. Stewart wanted to see her brother’s body before he was embalmed, but the funeral director wouldn’t let her, she said.

“There had to be a better way,” she said.

Later, as a detective for the Lafayette County Sheriff’s Department in Darlington, Stewart tried to deliver death notifications with more sensitivity. But she wasn’t able to do all she wanted to help grieving families. After a shoulder injury forced her to retire, she discovered death midwifery.

“I thought, ‘This is it. This is the personal touch. This is the attention that families need,’ ” she said.

At a death midwife class she taught last month, Stewart told students to help dying people reconcile with others if they ask, separate arguing family members at the bedside if necessary and encourage loved ones to say goodbye and leave the room if the dying person wants to die alone.

“Your job as a death midwife is to be an advocate for that dying person,” she said.

When Laurie Larson’s husband, Dennis Presser, died suddenly from a heart attack at age 54 four years ago, Stewart helped Larson and her two teenage children navigate the chaos.

Stewart joined Larson when she met with a funeral director to plan the funeral, which took place at the funeral home.

She organized an intimate gathering for family and close friends at the crematorium, with candles, incense and music. As Presser’s body lay inside an open cardboard cremation box, people read poems, told stories and colored the box. Then they placed him in the chamber, and Larson hit the ignition switch.

“I would never have had the energy to create that beautiful ritual,” said Larson, of Madison. “Sharon helped me in so many ways that I never would have thought I needed to be helped.”

Warren’s husband, Spencer, died at 64 from amyotrophic lateral sclerosis, or ALS, also known as Lou Gehrig’s disease.

Stewart helped the couple carry out their wishes. His body remained at home for three days, instead of being whisked off to a funeral home. “I had time to be with him; it was very healing,” Warren said.

As family and friends came for the home funeral, volunteers changed ice packs beside his body as he lay on their bed for viewing. Warren drove him to Circle Cemetery, where gatherers sang and played guitar before shoveling dirt over his shrouded body.

“It was the most natural thing I’ve ever experienced,” Warren said.

Complete Article HERE!

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11/24/17

Death doulas: Bringing death, dying and grief out of the shadows and into the light

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By Jennifer Ackerman, Regina Leader-Post

Elizabeth George was “tickled” to see what came after death.

She knew what she wanted her death to be like and she wasn’t afraid.

Diagnosed with colon cancer in 2010, Elizabeth told a friend she wanted three things to happen when she died: A singing circle, for a few select people to be present, and for her body not to be “whisked” off right away.

“Elizabeth really wanted to have a good death,” recalls one of her close friends, Ruth Blaser.

A childhood experience with death may have been what made Elizabeth so particular about her own passing. She lost her mother at age 11.

“She felt like the family response had been extremely unhealthy,” says Emily Wilson-George, one of Elizabeth’s two daughters. “They basically took everything that had belonged to her mother out of the house within the week and never spoke about it. She didn’t want that or anything remotely similar.”

Three days before she died, Elizabeth met with two death doulas. Together, along with friends and family, they ensured her death would go as planned.

A home vigil was organized. Elizabeth’s body was not whisked off to the morgue or a funeral home. Rather, she was moved to her dear friend Joyce Bethune’s house, gently placed on a massage table in a room full of tropical plants and a water fountain — a place where she found peace.

Joyce Bethune, left, and Ruth Blaser stand where they held a home vigil for their good friend Elizabeth George in Regina. George passed away last January from colon cancer.

Elizabeth’s fearless and accepting attitude toward her own mortality is often the exception.

“When you talk to people about how they feel about their own death, it’s a bit of a mood killer,” says Wilson-George. “It’s not really considered an acceptable topic of conversation.”

But an emerging cohort of death doulas in Regina is bringing death, dying and grief out of the shadows and into the light.

“There seems to be more healing when we can be sharing through grief, sharing through death,” says Denise Seguin Horth, one of the death doulas who met with Elizabeth. “So many other cultures embrace death more.”

Seguin Horth trained to become a death doula in 2016, through Beyond Yonder Virtual School for Community Deathcaring in Canada.

During a 14-week online course, participants learn advanced planning, home funerals, post-death body care, end of life financial considerations, grief, celebrant skills, death care rituals and more. A practicum is recommended, but not required.

“I feel that people have been so distanced from death that grief is heavier. It’s almost like a secret … It weighs on you and it just keeps you anchored down,” says Seguin Horth. “When we can talk more about death and talk more about grief openly without the taboo, … it seems to help that energy flow elsewhere so that we can move on.”

Sharon Pulvermacher — who also met with Elizabeth — did her training in 2014. She has been fascinated by death and the stages of grief since Grade 12 when she wrote a paper on death and dying.

Pulvermacher says being a death doula not only gives the dying person and their families a safe space to express themselves, but it’s also an opportunity to share with them their end-of-life options.

She says many people don’t even realize it’s within their rights to take the body of their loved one home for a vigil or home funeral, if that’s what they want to do.

“It’s … giving them a few more ideas, a few more tools, that they can imagine a little bit more largely than what they would do otherwise,” says Pulvermacher.

Defining death doulas

Definitions vary, but the core role of death doulas is to provide comfort and support to the dying and their families. Death doulas do one-on-one sessions, home vigils, simply sit with the dying person in the hospital holding their hand, and more.

“All death doulas have different niches. For me personally, I feel drawn more to accompanying those who are dealing with grief,” says Seguin Horth, who volunteers at Regina Wascana Grace Hospice.

She works with a variety of people — those who may have lost a limb or a pet, recently divorced or, like Elizabeth, someone who is in the last days of their life.

Besides the practical services death doulas offer, such as planning home funerals or helping with living wills, they also act as a sounding board for people to express their fears and musings about death, the afterlife and more.

A death doula brings no emotional or personal baggage that a friend or family member might and allows people the freedom to express themselves fully.

Sharon Pulvermacher is one of a few death doulas in Regina.

Where it began

Phyllis Farley, a key U.S. figure in the birthing centre movement, attended an end-of-life care conference in 1998. At the time, she was a chairwoman at the Maternity Center Association, an organization devoted to providing high-quality maternity care. She realized the same hands-on help and emotional support women receive when giving birth is just as important during death.

“We’re more than willing to, and very happy to in many cases, celebrate the birth of a child. While the potential of connections and the wonderful things they might do is always there, we don’t know that, but yet we celebrate it,” says Charisma Thomson, a professor at the University of Regina whose research centres on the anthropology of death.

But we deal with death differently.

“Here we have an individual at the end of their life, who we should be celebrating because we know what they’ve accomplished,” Thomson says. “Yet it’s that moment when … people just turn their back on them and really kind of silence their voice.”

At 80 years old, Farley founded an organization called Doulas to Accompany and Comfort the Dying. The program taught doulas how to listen and relate to the dying person, as well as do more practical things like helping with a living will.

The field grew and made its way to Regina, where there are about 10 death doulas. Some charge for their services, some don’t. Every death doula is different, and every person who seeks their services is looking for different things.

For Elizabeth’s daughter, the death doulas were invaluable.

“I think that having the death doulas not only provided the ritual that allowed us to process (her death) better, but it relieved a lot of the pressure,” she says. Not having to worry about the practical and procedural aspects of the vigil meant she could focus on being with her mom and getting closure.

But for many, the response to death may be much like when Elizabeth’s mother died — pushing death away.

Thomson traces society’s shift — from direct involvement in what happens to the body after death, to the current very institutionalized process — back to the Civil War in the United States, when embalming became common practice.

“You have Dr. Thomas Holmes during the Civil War starting to use embalming to send the soldiers back home … Once we start to add this clinical aspect to it, people I think believed it was beyond their abilities,” says Thomson.

As embalming became more popular, families sought professionals to do it — taking aftercare out of the hands of the family.

Around the same time, society decided priests were not qualified to declare time of death, and from then on only medical specialists could. Thomson says this shift also pushed death closer to the clinical realm rather than a personal one.

“We view death, or in North America anyway, … as though it is an illness or a disease or something that we can overcome with technology and science,” says Thomson.

And today, death happens in a hospital more often than not. When somebody dies, their body is typically moved to the morgue or the crematorium swiftly, giving family and friends little time with the body.

Bethune remembers a different time when home vigils were common.

“There was time for people to say their goodbyes and the whole process was a natural process,” she says. “I think we’ve just gotten so far away from that.”

She says having death doula services to help with things like home vigils or simply talking people through death is essential.

“It means that we don’t push our grief down into our subconscious, into our bodies. It means that we deal with it, that this is a natural part of life,” says Bethune.

Elizabeth wanted her family to have the time to say goodbye. So instead of denying the inevitable, she met it with playful curiosity.

“I know it sounds strange, but I’m a bit tickled at what’s coming next,’ Elizabeth told Seguin Horth, who describes that approach as beautiful. “She went past the fear.”

Denise Seguin Horth works as a death doula, and is shown standing at Riverside Memorial Park Cemetery. Death doulas support people in the process of dying.

During her meeting with the death doulas, Elizabeth was asked about her belief system and what she wanted her friends, family and the doulas to do when she died. According to Blaser, they also asked her what she imagined death to be like — a bold question friends and family might not feel comfortable asking.

“It was like mom didn’t have any doubts about what the death doulas were about,” says Wilson-George. “I was sitting there being like, who are these people? They’re sitting in on what’s a pretty personal time.” But in the end, she was grateful for their role in her mother’s end of life.

When the time came, Elizabeth’s vigil lasted a full 24 hours.

Someone from Alternatives Funeral & Cremation Services moved Elizabeth to Bethune’s home from the hospice, which she had entered just five days earlier. With no official certification or oversight board, death doulas are restricted from physically transporting a body.

“We sang her out of hospice with a favourite song of hers, and she had a quilt that had been made specially for her, draped over her,” recalls Pulvermacher.

Then they sang her into Bethune’s home where Seguin Horth and Pulvermacher positioned her body on a massage table and placed ice packs around her — looking after the practical and hygienic aspects of the vigil. They also made sure the family knew what to expect in terms of how the body would act in the hours after death.

A few close friends and family stayed the entire time. Others came and went to pay their respects. More songs were sung and memories of Elizabeth shared. Wilson-George remembers the feeling in the room as surprisingly intimate and radiantly positive.

For Blaser, the process with the death doulas helped her prepare.

“When Elizabeth died, I (felt) a sense of peace that we really accompanied her well and that it was her time to go,” she says. “That doesn’t mean that I don’t miss her. I do. But it’s not a wrenching kind of grief.”

For Emily Wilson-George it meant closure. After having seven years to imagine what her mother’s death would be like, Wilson-George went through so many different kinds of dread. The death doulas, along with friends and family helped minimize that fear.

“I think that they way that we managed to honour her death was something she would have approved of,” she says. “The feeling in the room that evening with the death doulas … it was so positive.

“I’m grateful to them for creating the space, for creating the opportunity.”

Complete Article HERE!

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11/21/17

Taking Over Your Aging Parents’ Finances

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When to step in — and how to guide their financial future

by

In the year 2011, the Baby Boomer generation started turning 65. Over the next 13 years, 10,000 Boomers will reach retirement age every day.

For the adult children of the Baby Boomers, these are not abstract statistics but real-life turning points that can provoke uncertainty and anxiety. But consider the advice of certified financial planner and author Lise Andreana:

“There is no time like the present to begin preparing for your aging parents’ financial future. Being proactive can help minimize a great deal of stress and uncertainty down the road — for your parents, yourself, and your entire family.”

The Simple Dollar is here to help you begin the journey of guiding your parents through this stage of their lives. We’ll cover how to approach the conversation, documents you’ll need, costs to consider, and more. Let’s get started.

Table of contents

Broaching the subject
Power of attorney
Document checklist
Long-term care costs
The sibling situation
Glossary
Additional resources

The Talk: How to handle a sensitive subject

Every family is different, and yours may have its own quirks or hangups about money. Although no size fits all, here are some suggestions on having The Talk with your parents:

When is the right time?

Many senior care experts recommend following the 40/70 Rule. As you approach 40 and your parents approach 70, it can be the most opportune time to discuss financial issues, as well as long-term care, estate planning and other relevant topics.

It’s better to address the situation proactively than to wait for a crisis to unfold, which could force your family into making decisions on the fly.

Are my parents already having trouble?

Be on the lookout for warning signs that your parent may be struggling to manage his or her finances, which can include:

  • Unpaid bills
  • Bounced checks
  • Calls from creditors
  • Unusual or frivolous purchases

What’s the right approach?

To help prevent conflict with your parents when you talk about finances, consider the following.

  • Keep the circle small.
    Discussions involving a few key people can be less intimidating than a full-blown family meeting that could leave your parents feeling like you’re ganging up on them.
  • Focus on positives, not negatives.
    Don’t frame your concerns in terms of physical or mental decline. Keep the focus on a bright future for the entire family.
  • Treat them as peers and equals.
    Help your parents understand that you’re trying to look out for them, not look after them. Invite them to join an ongoing conversation.
  • Find an ally.
    Your parents might be more receptive if your family attorney or financial planner joins the discussion in the role of an objective third party.
  • Make a show of solidarity.
    This subject presents an opportunity to do a thorough check of your own finances to see that everything’s in order. This way, your parents might not feel that you’re singling them out or passing judgment.
  • Avoid fighting words.
    Certain words and phrases — including always, never and nothing — have a tendency to put people on the defensive and shut down communication. It can happen in any kind of personal relationship, including parent-child.

When in doubt, preserve your parents’ dignity. Be aware of the potential for wounded pride — speak respectfully and tread lightly.

Expert opinion

“Start the conversation early. Put in place a plan your family can follow when your parents can no longer make decisions on their own. … It’s important to ask questions and help your parent come to a decision on his or her own terms.”

Terri Rasp
Director of Sales, Analytics, and Training

StoneGate Senior Living, LLC

Power of attorney

A power of attorney, also called a POA, is a legal document that grants a person or organization (known as the agent or attorney-in-fact) the authority to act on behalf of someone (the principal) in specific financial, legal and health-related matters.

A POA with you as the agent and your parent or parents as principal could play an integral role in helping you protect their financial well-being. With a power of attorney in place, you will be able to act quickly if a parent suffers a medical emergency, for example, or experiences a steep decline in mental competence.

Should I use a lawyer for a POA?

The answer is, most likely, yes. You don’t necessarily have to go through an attorney, but it’s probably the wisest course of action. The power of attorney process can vary from state to state, and trying to go it on your own could result in a costly oversight.

Unless you’re an attorney or a financial adviser, you may not have the expertise to navigate these waters. Also important is the fact that a professional often brings some much-needed objectivity to a situation where emotions can cloud the issues.

Can I get a POA on my own?

Some legal advice websites let you download a printable version of your state’s POA form. However, bear in mind that you’re dealing with the complexities of legal documents and contracts. There’s no shame in seeking the advice of your family attorney, your financial adviser, or both to help you craft a POA that addresses your family’s specific needs.

What’s the best time to get a POA?

The key factor in a child-parent power of attorney is obtaining it proactively, before the parent loses the ability to manage their own affairs.

What kind of POA should I get?

A lot depends on the current status of the parents and when the family wants the POA to take effect. An attorney may recommend a durable power of attorney, which contains a durability provision to ensure it remains in effect if the principal’s condition changes. The change in status could be a sudden medical issue that leaves the parent debilitated or a deterioration in mental capacity.

A power of attorney covering financial affairs differs from a health care POA, which means you’ll need to address those issues separately.

What if my parent has dementia or Alzheimer’s?

Depending on the laws of your state, getting a POA for a parent who has dementia or Alzheimer’s disease may require a letter from a physician affirming that your parent understands what the POA means and can legally consent. If a parent is deemed unable to meet that standard, another option may be for the child to become an adult guardian or conservator instead — a process that would require a judge’s approval.

Is a power of attorney the same as a living will?

No, there’s a difference. A living will expresses the signer’s wishes regarding medical treatment in the event he or she loses the capacity to make decisions (for example, whether extraordinary measures should be taken to preserve their life or resuscitate them). This kind of document is sometimes called an advance health care directive.

As with a power of attorney, state-specific versions of living wills are available online. Still, it’s wise to consult an attorney about the specifics of your situation.

Obtaining power of attorney: 3 key steps

Expert opinion

“Prior to cognitive decline, I advise my clients to help their parents establish the proper paperwork. This includes the creation of a will, durable power of attorney, health care power of attorney, and advanced directives. The power of attorney forms are very powerful documents that should only be in the hands of somebody your parents trust. Whether that is a family member or a professional, it is up to them.”

Nate Byers
CPA/PFS, MBA

JBC Wealth Advisors, LLC

Financial document checklist

Here’s a list of important documents for reviewing a parent’s finances. These records will help you get a better idea of income and financial obligations. Double-check this list with your financial adviser to see if anything needs to be added.

_ Bank accounts
_ Credit card statements
_ Monthly bills (utilities, rent/mortgage, subscriptions, etc.)
_ List of loans and other debts
_ Social Security statements
_ Social Security benefit verification letter
_ Pension, 401k and annuity documents
_ Tax returns (for three to seven years)
_ Investment documents (savings bonds, stock certificates, brokerage accounts, etc.)
_ Insurance policies — life, health, and property
_ Vehicle titles
_ Property deeds
_ Dues-paying memberships (HOA, AARP, clubs, etc.)
_ Birth certificates and marriage licenses

Don’t forget …
_ List of their usernames and passwords for online customer portals
_ Combination/keys to their safety deposit boxes

Expert opinion

“The first thing that children should do is to start aggregating information on the parents’ financial information. Help your parents consolidate their holdings. Fewer bank accounts can save you tons of time.”

Scott W. Johnson
Owner, WholeVsTermLifeInsurance.com

Long-term care costs

When looking at long-term care solutions, be aware that private insurance and Medicare have some limitations. While Medicare and insurance do provide coverage for medical treatment and prescription drugs, custodial care such as long-term care facilities and home health care may be a different story. As a 2013 study points out, Medicare:

  • Pays only for “medically necessary care in a skilled nursing facility” — which is not the same as an assisted living center.
  • Pays for home health care “under very limited circumstances and for brief stretches of time.”

In some unfortunate cases, coverage gaps in Medicare and private insurance can lead to families exhausting financial resources (known as “spending down”) until their parents qualify for Medicaid. To help prevent this worst-case scenario, you may want to consult a financial planner about some proactive options such as:

Long-term care insurance (LTCI)

Expenses covered by long-term care insurance generally include assisted living, nursing home, adult day care, Alzheimer’s care facilities and hospice. The key is encouraging parents to buy coverage early, before they develop health problems.

Pros and cons include: LTCI can be pricey, although it could cover some expenses that Medicare or private insurance do not.

Long-term care benefit plan

This option involves converting a life insurance policy into funding specifically for long-term care. These insurance conversions are also called life care assurance, Medicaid life settlement, or life care funding. It’s commonly used as part of a spend-down strategy to receive Medicaid eligibility.

Pros and cons include: This strategy can provide an immediate source of funding. However, the family will lose the death benefit that an unconverted insurance policy would have provided.

Reverse mortgage

Some aging homeowners turn to reverse mortgages (also called home equity conversion mortgages) to turn their equity into cash while still retaining ownership.

Pros and cons include: Although it can provide a cash infusion, using a reverse mortgage to pay for senior care is a potentially risky, “last resort” type of move. Not everyone will qualify, and defaulting could lead to loss of ownership.

Medicaid

Unlike Medicare, Medicaid is jointly administered by the federal government and individual state governments. As a result, eligibility requirements and other rules vary from state to state.

In general, though, Medicaid recipients must have low incomes and assets with very low value. The program is intended to benefit the poorest Americans, so many middle-class families likely don’t qualify.

To get more information, check with the agency that manages Medicaid in your state. You can also contact an elder law attorney in your state or visit these websites:

Claiming your parents on your tax return

To claim a parent as a dependent, your financial support for them must be substantial — at least 50% of the total cost for housing, food, medical care and other items. Also, the parent can’t earn more than the personal exemption for that tax year (which was $4,050 in 2016).

So, unless your parent has a very low income and you pay more than half the cost of keeping them cared for, they probably wouldn’t qualify as a dependent. If the parent does qualify, you could receive tax benefits such as the Dependent Care Tax Credit and reduced taxable income.

To get definitive answers, ask your tax preparer. You can also call the IRS or make an appointment at a local Taxpayer Assistance Center.

Expert opinion

“When budgeting for an aging parent, Medicare costs need to be factored in. They pay a monthly premium for Medicare Parts B and D for life and then also a Medigap or Medicare Advantage plan to pay for the things like deductibles and coinsurances that Medicare doesn’t cover.”

Danielle Kunkle
Co-founder, Boomer Benefits

The sibling situation

Among adult siblings, the care of aging parents has the potential to spark conflict like few other subjects. Handling parents’ finances is no exception.

It’s not uncommon for someone who takes the lead as caregiver to feel overburdened and resentful toward a sibling taking a less active role. Fortunately, a personal care contract or caregiver agreement can help ensure that the sibling who makes the most sacrifices is at least financially compensated.

Under this type of agreement, parents or other family members agree to reimburse the family member acting as caregiver. Compensation options include:

  • Direct payments (the income will be taxable)
  • An estate plan, or additional consideration in the parent’s will
  • Transferring homeownership to the caregiver
  • A life insurance policy with the caregiver as beneficiary

An elder law attorney can help you draw up a caregiver agreement. As for the form that compensation takes, families should think carefully about options that could lead to future conflicts between siblings (specifically, an estate plan or home transfer).

About those conflicts…

Even if you have a financial arrangement in place, don’t forget that sibling caregivers often have emotional needs in addition to financial ones. Expert tips on how to defuse conflict and increase support include:

  • Stay in communication, even if it’s just a weekly call
  • Arrange for someone else to step in every now and then so the caregiver can have time off
  • Ask for outside help (family counselors, social workers, clergy, etc.) when conflict becomes unmanageable

Expert opinion

“Personal care agreements are valuable for two very different reasons. One is emotional, for the family caregiver to feel as though they have a ‘real’ job and have at least a written record of what they need to do. Many have to cut back on work or stop working during a period of caregiving. The agreements can also serve as a record of the work done for siblings.”

Michael Guerrero
Senior Benefits Adviser

Elder Care Resource Planning

Complete Article HERE!

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10/26/17

We need to address questions of gender in assisted dying

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Gendered risks challenge the idea that women will always be acting autonomously.

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One of the principal motivations behind current efforts to legalise assisted suicide in Victoria and New South Wales (and most jurisdictions) is patient autonomy. However, research suggests “gendered risks” may thwart women’s autonomy in end-of-life decisions, making them uniquely vulnerable to assisted suicide laws.

While eligibility under the Victorian and NSW bills requires that a patient must be suffering from a terminal illness from which they will likely die in 12 months, the concern for women is that the final decision to end their lives may nevertheless be influenced by risk factors that challenge the rhetoric of “choice”. Here are some of those “gendered risks”.

Longer life span

Women tend to live longer than men. This means they are more likely to develop diseases and disabling conditions, or experience elder abuse and discrimination, both of which could motivate the desire for assisted suicide.

The Australian Law Reform Commission’s report on elder abuse recognised that women are significantly more likely to be victims than men, and that the rate of neglect of older women could be as high as 20%.

More likely to experience their partner’s death

Women are also more likely to experience the death of a partner or spouse due to their relative longevity, and to be deprived of this support and companionship in older age. A 2013 Australian study found that living alone is an important predictor of suicide in older adults.

A 2016 US study found that loneliness was a key motivation for assisted suicide requests of patients with “psychiatric” disorders in the Netherlands. Of the cases reviewed, 70% were women and 76% were 50 years or older. One women in her 70s “without health problems” said she experienced life without her husband as a “living hell” and “meaningless”.

Fewer economic resources in old age

Women have fewer economic resources when they are older, the time when decisions about assisted suicide are most likely to occur.

This entrenched economic disadvantage limits their options for care and means they are more likely to face other financially related adversities.

Women are also more likely to have to pay for care than men due to their male partners and families being less likely to care for them.

All these factors could influence a decision on assisted suicide.

More self-sacrificial and less assertive

Women are arguably more self-sacrificial and less assertive than men, whether by nature, socialisation or simply in terms of society’s ideals about femaleness.

So, they may be more likely to request assisted suicide to spare their loved ones the burden of caring for them, or be persuaded that their life is unworthy of others’ care and their family’s resources.

In a study of assisted suicides where the majority of cases were women, the fear of being a burden was a prominent reason for deciding for death. The ethic of self-sacrifice was summed up by a friend of one of the suicides, who said:

She felt it was a gift to her family, sparing them the burden of taking care of her.

Preference for passive suicide methods

Women demonstrate a stronger preference for more structured, passive methods of suicide, with significant physician participation.

It is clear that increasing numbers of women decide to die when offered the more passive options of assisted suicide. The rate of assisted death of women in the Netherlands, Oregon and elsewhere is nearly four times that of the usual female suicide rate.

One explanation might be that decisions for assisted suicide fit in with cultural expectations of women as passive and compliant, and play out gender expectations of subordination and dominance in a profession where physicians are still predominantly male.

More likely to attempt suicide

Women are more likely to attempt suicide than men, as they are more prone to psychological problems such as depression.

While mental illness does not qualify a person for assisted suicide under the Victorian and NSW bills, neither does it disqualify them.

If assisted suicide is legalised, women’s greater propensity to attempt to take their lives as a result of psychological problems, coupled with their preference for more passive methods of suicide, could have a harmful compounding effect on women’s decisions to die. This may already be evident in the 2016 American study.

Entrenched patterns of violence against women

Female assisted suicide needs to be considered in light of pervasive male violence against women, particularly against intimates. Research indicates striking similarities between the broader patterns of male violence against women and at least one kind of assisted death: “mercy killing”.

American and Australian studies indicate that there are more female mercy killings in those countries, mostly by men, who are most often the woman’s partner, and these are characterised by the same themes of domination, possessiveness and control as other gender-based violence.

The prevalence of violence against women in Australia (particularly intimate partner violence) is a serious problem, and so it is vital that we understand whether the dynamics underlying other forms of gendered violence that result in the deaths of women may sometimes also underlie female assisted suicide.

Taking into account gender differences in health care is important. And if there is potential for gendered risks in legalising assisted suicide, this requires further consideration and research in advance of any legislative change.

These insights challenge the presumption that women who decide for assisted suicide are always exercising autonomy. Legalisation could in fact compound oppressive sociocultural influences and facilitate the last of many non-choices for some women.

Complete Article HERE!

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10/11/17

Palliative Care: To Live ‘The Best That You Can’

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Wendy Van de Bogart of Canton had a variety of palliative care when she was treated for cancer, but it wasn’t called that, and if it had been she would have been worried. Many people confuse palliative care with end-of-life hospice care.

By THERESA SULLIVAN BARGER

When Wendy Van de Bogart was diagnosed with stage 3, HER-2 positive breast cancer, she asked her oncologist whether her treatment plan was to get rid of the cancer or just make her comfortable.

“We’re not treating this palliatively,” she remembers him saying. “It’s just to kill the cancer. We’re giving you everything to fight it with everything we’ve got.”

But while she received chemotherapy, a mastectomy, radiation and preventative medications, she also received palliative care. She just didn’t realize it because nobody used the term.

“It’s probably a good thing, because I would have thought I was on my way out the door,” says the Canton mother of three.

Some of the palliative or supportive care was provided through her cancer treatment providers, the Center for Cancer Care at Charlotte Hungerford Hospital in Torrington and at Yale New Haven Health’s Smilow Cancer Hospital, and some she found on her own, with mixed results.

Following her surgery, her clinical team connected her with a physical therapist to help her get her range of motion back and help with some swelling (lymphodema). She sought out a dietician friend, herself a cancer survivor, for nutritional advice. She saw a therapist to help her deal with the stress, a naturopathic physician for vitamins and a hypnotist someone recommended.

Van de Bogart’s experience is fairly typical. The medical community, cancer patients and their families routinely equate palliative care with hospice care. They’re not synonymous. While both are designed to provide support and symptom management to people with a serious illness, hospice is intended for people whose physicians have determined they have six months or less to live and who are no longer actively fighting the disease.

“They view us as the death squad,” says Dr. Henry Schneiderman, palliative care physician with St. Francis Hospital and Medical Center in Hartford. “The conflation of hospice and palliative care is 103 percent of the general population and 100 percent with health care.”

Palliative Care Vs. Hospice

All of hospice is palliative care, but not all palliative care is hospice, says Colleen Mulkerin, director, palliative care, social work and spiritual care at Hartford Hospital. Palliative care, and the medical sub-specialty, palliative medicine, is specialized medical care for people living with any serious illness, including cancer, heart disease, stroke, Alzheimer’s, Parkinson’s, kidney disease and diabetes, according to the Center to Advance Palliative Care. It focuses on providing relief from the symptoms and stress of living with a serious illness with the goal of improving both the patient’s and family’s quality of life.

“The exciting thing about palliative care — you don’t have to accept anything or give anything up,” Mulkerin says.

Palliative care recognizes that there’s a person and a family invested in the treatment of the illness, she says. While the oncology team’s focus is on battling the cancer, the palliative care team is providing the support that the person and caregivers need from the time patients receive their diagnosis, through treatment and follow up care.

“We often get asked to assist patients and families with clarifying their goals. That can include advance care planning and symptom management,” says Dr. Laura Morrison, an attending physician at Smilow Cancer Hospital who is Yale New Haven Hospital’s director of palliative medicine education. “It’s really not at all about dying. It’s really about living the best that you can.”

While palliative care doctors may prescribe medications to help with pain, nausea and depression, the other forms of palliative care include therapeutic massage, cognitive behavioral therapy, acupuncture, reiki, pet, art or music therapy, help with finding financial support and guidance on writing advance directives, which spell out the patient’s wishes for end-of-life medical interventions. Some cancer centers offer massage and mental health support to the patients’ caregivers, since lessening their stress helps everyone.

Studies Reveal Benefits

Multiple studies show that patients who receive palliative care live longer with a better quality of life. A study reported in the New England Journal of Medicine in 2010 concluded that people with metastatic lung cancer who received early palliative care had less depression, improved quality of life and survived 2.7 months longer than those who did not receive palliative care.

According to an Institute of Medicine study published in 2014 in the Journal of Palliative Medicine, palliative care results in “a better patient experience with improved communication and less distress; better quality of care with less aggressive end-of-life care and more use of home and hospice care when appropriate; equal or even better survival; and significant cost savings,” of an average of $2,700 per person.

“When symptoms are better controlled, when patients are coping better emotionally and when people are able to make sure their treatment aligns with their goals, we know from the literature that people do better and so do their family members,” Morrison says.

Why The Misconception?

Palliative care remains misunderstood, advocates say, because it’s a fairly new specialty, and the holistic approach to patient care has been foreign to Western medicine’s more recent focus on medical specialties.

“So often, in Western medicine, we’re asked to give all control up to our medical team,” says Dr. Kathleen Mueller, medical director at the Center for Integrative Medicine at St. Francis Hospital and Medical Center in Hartford. “I think what we’ve lost is what we can do ourselves. What we can do is work on food, movement, relationships and stress reduction. If you can make yourself more whole going into chemo, you’re going to come out better on the other end.”

While cancer treatment facilities’ palliative care services differ somewhat in how they’re staffed and the support that’s offered, most patients are referred to palliative care by their doctors or nurses. Patients are told they can ask for support, but most don’t ask.

“I think it’s really hard to mobilize the resources if you’re not referred. You’d have to have a really skilled patient or family member,” Mueller says. “I do as many lectures as I possibly can to physicians and nurses to let them know this is available, and still I will have someone say, ‘Why didn’t I know you were here 10 years ago?'”

Even in the medical field, palliative and hospice care are linked, so many oncologists incorrectly view palliative care as end-of-life care, says Morrison. Some providers are moving toward calling it “supportive care,” she says.

MD Anderson Cancer Center in Texas conducted a study that found clinicians referred patients to palliative care sooner and were less distressed about it when it was called “supportive” rather than “palliative” care.

Most subspecialists who treat serious illnesses, Schneiderman says, operate in warrior-mode doing battle against disease; some see a referral to palliative care as a defeat.

As a result, “palliative care is brought in too late. Hospice is brought in too late,” he said. “It’s always too soon until it’s too late.”

UConn Health provides palliative care, but calls it “support care” on the “Patient Resource Center” pages of its website.

“I did some research and found cancer centers, [including MD Anderson,] were moving more towards ‘supportive care,'” says Sarah Loschiavo, a nurse practitioner who serves as the gatekeeper to supportive services offered to cancer patients. “We decided that [patients] would feel more comfortable with ‘supportive care.'”

Financial Burdens

Living with the uncertainty of breast cancer is challenging for patients and their loved ones, and the added financial burden of copayments and missed work magnifies the stress.

Van de Bogart was receiving chemotherapy in the winter, which is always a challenging time for her family financially because her husband’s business is slowest during the winter months.

One day, when she was receiving an infusion, the social worker stopped by and sat with each patient, asking if there were any issues she could help with. Although Van de Bogart had rated financial concerns as only 1 out of a possible 10 on a questionnaire about sources of stress, the social worker asked her about it. She admitted that the cancer added further strain to the family’s budget.

“She ended up getting some grants from some local cancer funds,” Van de Bogart says. The social worker filled out the application forms for her, and got the family some grocery store gift cards.

“That was really helpful,” she says. “I didn’t seek her out.”

Complete Article HERE!

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