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Will, NRO, Doctor and Documents

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Documents and information for seniors 65+Are you a guardian or a senior or a self sufficient senior?  Do you have  documents such as life and insurance policies, will, nor and other critical information where your guardian, beneficiary and/or fiduciary can find them?   Documents that specify critical personal, financial and medical information, including a doctor list, and having that information readily available, can save your life.  In today’s health care environment, most seniors 65+ see a doctor for different specialties. Knowing the name of your doctor and their contact information and documenting that information for immediate access is critical. Your doctor is familiar with your health, procedures that have been performed, medicine they have prescribed, and have medical records on file that can be provided at a minutes notice.  Doctor information is only one example.  It is important to have your all of your critical information, i.e. medical information, legal information such as your will, living will and non-resuscitation order (NRO), and financial information equally accessible.

You may or may not be aware but most emergency rooms (ER) do not have any access to crucial medical, health, insurance or legal documents provided during a previous visit.  It does not matter whether it is the first or fiftieth visit, or whether you were only at the ER the previous day, you have to provide medical history, on-going treatments from your doctor, and list of medicine every single time you visit the ER.  For convenience, and in the event memory fails the patient, or whether you are unable to provide the information, having the necessary documents available to your guardian, beneficiary, fiduciary or just a family or friend is an absolute must.

social security number documentsAnything can happen at any time, so preparation is the key.  And the accuracy of critical documents is of paramount importance.  A Living Will, Non-Resuscitation Order (NRO) and a Power of Attorney (POA) are three documents that should be generated sooner rather than later.  They are valuable tools  for your guardian, family and care givers.  Not only can a doctor, hospitals and guardians abide by the wishes of a patient using a living will, it also gives family members the resource they need to make difficult decisions at a difficult time.   Similarly, an NRO prevents family and/or guardians from having to make life saving decisions when it may not be in the best interest of the patient.  And a Power of Attorney allows decisions to be made by a third party on the behalf of the patient.   My father became disoriented at the hospital the evening we brought him to the ER  and refused written approval of a life saving procedure.  It was a lesson learned that almost cost him his life.

In summary, plan ahead.  Ensure others have knowledge of the location of legal, financial and medical documents and make that critical information accessible by designated person or persons such as your guardian, beneficiary or fiduciary. This could mean adding names to those who have permission to access your safety deposit box and notifying your guardian, beneficiary and/or fiduciary the location of relevant documents and means of access, such as a key.

 (read more at http://www.yalemedicalgroup.org/stw/Page.asp?PageID=STW000357):

Critical Information Listbirth documents for proof of identity

  • Social Security Number and Social Security card, Date of Birth and birth certificate, Driver’s License Number and drivers license, and Mother’s Maiden Name (as Applicable)

For all documents, it is smart to keep original and a copy in the event the original is lost or damaged.  These type documents are also very important during emergency situation to serve as proof of identity.

For each medicine you take, be sure to note the name, generic name (if applicable), dosage, when medication is taken and the strength.  You will be asked at each visit to the ER if there have been changes to your medicine so be sure to maintain the accuracy of your list.  It is a good idea to carry a list in your purse or wallet.  And provide a copy to the person or persons whom are most likely to accompany you to the ER or doctors office.

  • Surgery and Medical Procedures

For the ER, the name of each surgery and the year of each procedure is generally adequate for your  medical procedure history.  Legal matters, such as lawsuits, generally require the specific date, name of the doctor who performed each surgery and the hospital where each procedure tool place.  So keep this information in a master list, just in case.  When my father suffered injury from a medicine recall, it was EXTREMELY difficult to dig through records to find all of the required information and details of each surgery.  Unless you and/or your family have been diligent in your records, it may be nearly impossible to gather this level of information.  Suffering an injury or loss is bad enough.  Not being able to get compensation would be even worse!

  • Doctor and POC Info

Doctor at hospital ERInformation for your doctor certainly includes  name(s) and contact information for each current primary care doctor and specialist.  However, it is also important to have that information for a doctor who has treated you in the past.  This is especially true for a doctor with specialization who performed surgery or other treatment of significance.

  • wills and living will documentsAdvanced Directive to Your Doctor, Family or Surrogates 

Advance directives are written instructions regarding your medical care preferences. Your family and doctor will consult your advance directives if you are no longer able to make your own health care decisions. Having written instructions for your guardian, beneficiary, fiduciary, family and doctor can help reduce confusion, disagreement, and anxiety.

    • Living Will

In time of crisis, making life saving decisions is a huge responsibility.  And it is hard to think clearly.  Having a living will on hand reminds your guardian and loved ones what you desire in given situations, eliminating the stress and responsibility of making decisions on their own.  The hospital and ER will ask if you have a living will.  They will also want a copy of the document to put on file.  So be sure you bring your living will with you to the hospital and ER.  And if you do not already have one, ask your local hospital for the information you need to develop a  living will.  It is much earlier than you realize.

    • Medical or Health Care Power of Attorney (POA)

A POA is a legal document that designates an individual — referred to as your health care agent or proxy — to make medical decisions for you in the event that you’re unable to do so. However, it is different from a power of attorney authorizing someone to make financial transactions for you. Power of Attorney (POA)
If you do not already have a Power of Attorney (POA) established, I strongly suggest you get meet with an attorney to generate one at your earliest convenience. You never know what tomorrow brings. And finding yourself in a situation where critical documents is needed but is either unavailable or has never been generated can cost your life. We certainly were not expecting to need a power of attorney the night my father went to the ER. The amount of blood loss due to internal bleeding and shock to his body led to severe confusion. My dad needed blood, and he needed it fast. Yet without a power of attorney the hospital ER needed my father’s signature. But in my father’s state of mind, the request was misinterpreted as conspiracy by the hospital staff. He refused to sign. Thankfully, after almost two hours, I was able to convince him to scratch a barely legible signature. We met with our attorney the next morning to get a power of attorney established. I hope you benefit from our hard lesson learned and get that piece of critical information now!

    • Do Not Resuscitate (DNR) Oder

do not resuscitate (DNR) and non-resuscitation order (NRO)Deciding on a DNR is no small decision.  You or your loved one probably already know whether you desire to have drastic measures performed to save your life.  While it seems somewhat logical, there are situations when you may no longer wish to have such procedures performed and a non-resuscitation order (NRO) is desired.  This often means denial of cardiopulmonary resuscitation (CPR) that is used if your heart stops or if you stop breathing. My father had pancreatic cancer.  And while he is my beloved hero, I understood  his decision to have a DNR on file.  It just did not make sense to perform drastic measures when it only  meant extending what had become a physically painful existence.  This is a very personal decision for the ailing individual and for family member or guardians.  But we also found that my father needed to know we would be able to continue with our lives once he was gone.  He needed to know that we supported his decision whatever it may be.  It is a difficult conversation, but one that makes sense under the right circumstances.  So it is recommended to try and find the strength to discuss a NRO document with your loved one.  So when they face a terminal illness or have reached the final phase of their life, the decision has already been made.  Advance directives do not have to include a DNR order, and you don’t have to have an advance directive to have a DNR order. Your doctor can put a DNR order in your medical chart.

  • Financial Accounts

Most people think they have their financial accounts and associated information on hand.  But you likely have more than one account.  Checking accounts, savings accounts, Christmas club accounts, CDs, 401(k) accounts, other investment accounts, pension documents, annuity contracts and/or other accounts at financial institutions should all be documented.  The account name, account number, account type and account owner should be included in your list of critical information.

  • Life Insurance Policy

policy documents for life insuranceYou may or may not have a life insurance policy.  A term insurance policy is intended to expire at the time other financial investments are adequate to cover financial needs.  If you have or had term insurance, you will need to check the policy to see if payout still applies.  For a whole life policy, the value of your policy will depend on the date the policy was bought and the contractual value at time you cash in the policy.   Some financial institutions provide a small value policy at no cost.  These may or may not have terms that specify payout only when certain events occur, such as loss of limb or motorized vehicle accident.  You will need to check each policy to determine contractual requirements.  Have a copy of each policy and log the name of the institution providing the insurance coverage, policy number, the owner and the beneficiary so that the document can be more easily located if missing when needed.

  • Medical Insurance Policy

Most people carry medical insurance cards in their wallet or in  their purse.  This may only be Medicare but if you have additional insurance, such as Medicaid or an independent policy, be sure you have them all available.  Place the original policy in a safe and secure location as cards can be misplaced.   Depending on your situation, you may want to carry your card and a copy of your loved one.  My father had issues with forgetfulness and lost his wallet many times.  Our decision to carry a copy of his Medicare card was a smart decision that helped us more than once.

  • Long Term Insurance Policy

Some treatments result in the need for care that falls under some long term insurance policies.  Since the terms in each policy vary, you will have to read your policy to determine what is and what is not  considered a covered expense.  There may also be a waiting period; so filing a claim as early as possible is important.  Be sure to compare Medicare coverage (including home care) and long term insurance.  Knowing what decisions make the most sense can saves time, save money and reduce stress.  You may document the coverage and when you will use which policy as a tool for making smart and timely decisions.  Whether you do this or not, be sure to know where the policies are located so timely and educated decisions can be made when needed.  Have a copy of each policy and log the name of the institution providing the insurance coverage, policy number, and the owner’s name so that the document can be more easily located if missing.

  • Other Important/Special Occasion Dates (i.e. Anniversary, Family Birthdays, Green Card)

Personal dates of importance may not save your life, but having this critical documentation can save you embarrassment and regret.  Forgetfulness becomes more of an issue for seniors 65+.  Documenting  information on wall calendars, entered into computer calendars and/or other electronic devices is a great way to reduce issues associated with memory concerns.  In fact, if you are comfortable with electronic devices, there are applications and software designed to remind you of special dates so gifts, cards or calls are on time.  If you are not comfortable with electronic devices, there are basic computer classes for seniors.

  • Post Office Box, PO Box and safety deposit boxPO Box and Safety Deposit Box

If you have a PO Box or safety deposit box, be sure that your guardian and/or loved one(s) know where they are located, give them a general idea of contents, and location of any required key or access code(s).  If you do not have a PO Box or safety deposit box and keep critical information filed in a non-secure (vulnerable to thieves, fire, or other threat) location at your home, you should consider a change.  Forgetfulness can lead to lost documents and safety hazards become more likely to cause damage as seniors age.

  • Will

If you do not have a will, get one!  It does not matter how old you are, whether you are married, or whether you have children.  Your heirs and beneficiaries will have to suffer through the legal challenges and headaches of timely and expensive probate if there is no will.  And if you have no beneficiary, paying for burial expenses and other costs related to your funeral will create stress and a financial burden on your family.  A will can be very simple or very complex, depending on the level of information you wish to include. Be sure your will is stored in a safe and secure location.  If you went through an attorney, they should have a copy.  The most important thing is to get a will. Don’t let the government get more than their share.   You can always add detail at a later date if desired.  If you have a family lawyer, have them file a notarized copy with your records.

    • Your will defines personal desires regarding asset distribution and name the beneficiary or beneficiaries of your estate.  This include insurance policies, jointly or solely owned assets, trust assets or company assets.  You must also consider any debts your currently owe.  With the potential of sizeable medical bills, make sure your heirs are not unnecessarily burdened with debts.  Beneficiaries should be clearly identified.  Relatives may come out of the woodwork claiming rights so eliminate any confusion with beneficiary designation(s).  You may also wish to define how to distribute specific items, including personal belongings.  This helps to eliminate bickering over assets among heirs
    • Identify who will be the guardian of any children.  In your golden years, children typically have lives of their own.  However, there are unique situations, such as a special need child currently in a special care facility, whom require designation of a new guardian.
    • will, beneficiary, policy, documentsUse your will to specify your wishes about your funeral such as cremation or any preference for a religious service.  It is not critical that this information be included in your will.  You may already have funeral arrangements documented or even submitted to your preferred funeral home.  Another option is to include specific funeral wishes in your will.
    • If you wish to donate any organs or other body parts after your death, state so in your will.   If there is a preference regarding how organs or body parts are used, such as for medical teaching purposes or for transplant, be sure to include any limitations.  If you are interested in donation, it is recommended that you have your local courthouse to include that preference on your driver’s license, if applicable.
    • Be sure that you consider, and name, the executor of your will.  The selection is critical to ensure that obligations, legalities and family issues are handled professionally, without bias, after your death.   The individual will be responsible for asset distribution to heirs, cover debt, and care for any dependents.

Now that you have your list of critical documentation, be sure that others know the location of  the information, have access to paperwork, and have access to accounts.  This means adding someone else or others to your account, signing paperwork to provide them access to your safety deposit box and PO box.  Having all of your information documented is only good if there is adequate and ready access to that information when it is needed.

Also important is documenting online user name(s) and password(s) along with any Personal Identification Numbers (PIN).  This type of information has a tendency to change more frequently so maintaining an accurate record is a continual process.  Yet without access to the most current information, your hands are tied when online access is needed.  Even with some effort to keep up with this information, we had issues with access to two accounts.  In most cases, you can contact the account provider to have information reset, timely access is a challenge.  And if this happens during tax season, a frustrating activity becomes even more frustrating.

In summary, document all critical information, maintain its accuracy, have ready access,  carry a copy of applicable documentation, and store originals in a safe and secure location.

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