Advanced Directives 101

Avoid being adrift in a medical emergency. Have Advance Directives in place.

What is an advance directive? Documents that help people communicate their wishes if they are unable to make wishes known due to illness or injury. Three types of advance directives: medical power of attorney; out-of-hospital Do Not Resuscitate Order; Directive to physicians, family or surrogate decision-makers.

A Medical Power of Attorney:
Gives another named person the authority to make medical decisions about health care issues if the individual is no longer capable of making them, personally.
Does not apply to voluntary inpatient psychiatric care or other medical procedures such as: convulsive treatment, psychosurgery or abortion. A physician must comply with the wishes stated in the medical power of attorney or allow or arrange for the transfer of the patient to another health provider who will comply.

An Out-of-hospital Do Not Resuscitate Order does the following:
Allows for a natural death with peace and dignity in an outpatient setting
Must use the state of Texas’s mandated form
Requires 2 witnesses or 2 physicians (read and follow the form’s instructions carefully)
Applies to CPR, transcutaneous pacing, defibrillation, advanced airway management, and artificial ventilation
Applies to emergency rooms, outpatient hospital care, physicians’ offices and clinics
Does not apply to inpatient care. The DNR must be rewritten.
What? A DNR could be effective in the Emergency Room; however, the same patient could be put on full code after admission to the hospital. A DNR does not translate to hospital care.

An Advanced Directive to Physicians or “Living Will” does the following:
Tells what kind and how much life-sustaining medical treatment an individual wishes in the event of a terminal condition or irreversible condition.

An advance directive may be revoked by the individual at any time, regardless of mental status or competency. Simply put, the individual may change his or her mind.

If there are no advance directives, Texas law allows for relatives to make medical decisions. Any such decision must be in keeping with the previously communicated wishes of the patient, if the wishes are known.

Make your wishes known. Contact an elder law attorney and have your estate planning documents prepared, so that your medical care decision-making will not be left to others, not knowing what you would have wanted, leaving them at sea during an emergency.

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Texas Guardianships: The Steps

Guardianship is a legal process to protect an incapacitated individual from abuse, neglect, and exploitation. Guardianship provides for the person's care and management of assets.

The individual who needs to be protected is called a "ward." The person who is court-appointed to assist the ward is called a "guardian." There are two types of guardians.

A Guardian of the Person takes care of the physical well-being of a ward, and a Guardian of the Estate takes care of a ward's property. A guardian is appointed by a judge after a legal proceeding. Often both a guardian of person and a guardian of estate are appointed, and this may be the same person.

The steps involved in becoming a court-appointed guardianship include:

Filing an application with the court requesting that a qualified guardian be appointed.

Serving the application to the proposed ward.

Notifying the proposed ward's relatives.

Obtaining a physician’s statement on nature and degree of the proposed ward's incapacity.

Holding a hearing before a judge to determine whether a guardianship is necessary.

Qualifying the guardian, taking an oath, and receiving letters of guardianship.

Guardianships may be contested by the ward or another individual.

Guardianships may be temporary, in an emergency. These are intense, quick, and limited guardianships.

Guardianships are often permanent. They are 'permanent,' but the court reviews them annually to safeguard the care and rights of the ward.

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Texas Guardianships: The Cast of Characters

If someone files documents with the court asking to be made guardian, that person is the Applicant. The Applicant will be represented by an attorney during the legal proceedings at the courthouse.

After an application for guardianship is filed, the judge must appoint an attorney for the proposed Ward. This attorney is called an Attorney Ad Litem. The Attorney Ad Litem represents the wishes of the proposed Ward during the guardianship proceedings. The Attorney Ad Litem and the proposed Ward work together.

If the guardianship is uncontested, a hearing will be set, the court will hear the evidence, and the judge will appoint a qualified guardian.

If the guardianship is contested, the proceeding becomes more complex and time consuming. In contested situations, the question may not be whether the proposed Ward needs a guardian but who may serve? There may be more than one person applying. If so, each applicant has an attorney.

In these situations, the judge may appoint a Guardian Ad Litem to sort through the information and make a recommendation to the court. The job of the Guardian Ad Litem is to be a neutral fact-finder, investigating the situation and determining what would be in the proposed Ward's best interest. At court, the judge will listen to all sides. The judge will consider the Guardian Ad Litem's recommendation, weigh the preferences of the proposed Ward, and review the doctor's medical report before deciding whether a guardianship is appropriate. If so, the judge will appoint a guardian for the Ward.

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Texas Guardianships: What are They?

Guardianship Basics
At times, a person may not be able to care for his or her own personal or financial needs. Texas law provides a remedy, guardianship, so that a person's affairs may be supervised by the court.

This is a legal action of last resort, which may be necessary for various reasons. It may be used when estate planning fails, when there is no estate planning documents at all, or it may be appropriate when others will not accept the power of legal documents.

A guardian is appointed by the court and legally stands in the shoes of the person under disability, the Ward.

After appointment, the guardian has the same rights and responsibilities as the ward. The guardian is not personally responsible but only serves as the Ward's agent.

Limited or General?
A guardianship may be general or limited, depending upon the severity of the disability. The court may only award the necessary powers to the guardian. No more, no less.

Person or Estate?
A guardianship may be of the person. This means that the guardian manages the Ward's personal affairs, such as medical or placement decisions. A guardianship may be of the estate, which means that the guardian manages the Ward's financial affairs. Many times, a guardianship is for person and estate, simultaneously.

Temporary or Permanent Guardianship?
A temporary guardianship may be sought when there is a threat of immediate harm to the Ward or the Ward's estate. A temporary guardianship is a response to an emergency. The temporary guardian will only be granted the necessary protective powers. Temporary guardianships must be reviewed later.

A permanent guardianship is granted to protect a Ward or his/her estate on a more lasting basis. A permanent guardianship is based on a doctor's medical evaluation of the Ward. There is a full hearing before a judge. If the judge orders a permanent guardianship, it is intended to last for the life of the ward, if statutory mandates are fulfilled by the guardian.

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Pat Summit Diagnosed with Early-Onset Dementia, Plans to Continue Coaching Basketball

Tennessee women's basketball coach Pat Summitt has no plans to stop coaching despite being diagnosed with early onset dementia, according to her video on YouTube and Sports Illustrated:

Speaking from her home in Blount County, Tenn., with her dog Sadie sleeping on her lap, Summitt said she would not stop coaching. "I plan to continue to be your coach," Summit said. "For that reason I will be relying on my outstanding coaching staff like never before. We have always collaborated on every facet of Lady Vol Basketball; and now you will see [assistants] Holly Warlick, Mickie DeMoss and Dean Lockwood taking on more responsibility as their duties will change significantly. I love being your coach and the privilege to go to work every day with our outstanding Lady Vol student athletes."

The UT athletic department confirmed to SI.com that Summitt told her players about her early onset dementia in a team meeting on Tuesday. " Obviously, I realize I may have some limitations with this condition since there will be some good days and some bad days," Summitt said in letter posted on the university's website.

Summitt told The News Sentinel that she often felt low at times last season and second guessed some of her decisions. "There were some mornings I would wake up and think I don't even want to go in," Summitt said. "That didn't last long but it was like 'What's wrong with me? What's going on with me?' She told The Washington Post that "sometimes I draw blanks."

Her son, Tyler, a junior at Tennessee and a walk-on on the men's basketball team, told The News Sentinel, "Nobody accepts this. And there was anger. 'Why me?' was a question she asked more than once. But then, once she came to terms with it, she treated it like every other challenge she ever had, and is going to do everything she possibly can to keep her mind right and stay the coach."

Summitt said that she didn't consider retirement. She told The News Sentinel that she was encouraged after speaking with Dr. Ronald Petersen, the director of the Mayo Clinic's Alzheimer's Disease Research Center. "He's the one who told me you can coach as long as you want to coach and no one else had said anything like that to me,'' Summitt told the newspaper. "I haven't talked to him [lately] and I even thought about calling him sometime soon and telling him where I am with this. He was so positive [saying] 'You can work through this.'"

The paper reported that Summitt has formulated a plan that involves mental activities, such as reading and doing puzzles at night before going to sleep. Summitt told The News Sentinel that her maternal grandmother had suffered from severe dementia.

One of the icons of women's basketball, Summitt has led UT to eight national championships and 1,071 career victories, the all-time winningest coach in NCAA basketball history, regardless of gender. This will be her 38th season coaching at the university. Summitt said she does not plan on speaking about her condition in the immediate days ahead.

"I've been honest and shared my health concerns with you and now we'll move forward to the business at hand -- coaching a great group of Lady Vols," she said. "For the time being, I hope you will respect my privacy regarding this matter."

Read more: http://sportsillustrated.cnn.com/2011/basketball/ncaa/08/23/Pat.Summitt.dementia/index.html#ixzz1Wh2HiILZ

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Shine on Brightly

A friend called, recently, asking what she should do with a relative’s ashes. She had found them in a closet in a Tupperware container, much to her surprise. I was reminded of Section 711.002 of the Texas Health & Safety Code, which sets out the priority for possessing a decedent’s remains and the duty to inter them. The Code also provides the form for appointing an agent to control disposition of remains. A handy and oft overlooked estate planning document that everyone needs and is particularly important if there is a family squabble about who controls the remains, what shall be done with them (cremation vs. burial), or where they shall be placed (an urn vs. burial with a spouse? If there is more than one spouse, then who should be interred with whom?).

Chatting at the proverbial water cooler with elder lawyers at the probate court, they chimed in, spinning yarns of potentially unlawful situations detailing the blow-back of ashes scattered from a chartered airplane to the payment made to a captain of an ocean-going vessel with instructions to cast the urn into the depths, hundreds of miles out to sea.

However, the most beautiful and creative use of ashes may be found at the online fine art gallery, “Shine on Brightly,” selling the newest variation on the theme of memento mori. But “Shine on Brightly” offers not just the memorial jewelry of old but memorial art—fine art, that is, including dichroic glass pendants, handmade textiles, custom books, memorial painting, and urns fashioned of wood, glass, and hand-made ceramics. See http://www.shineonbrightly.com

Like other estate planning documents, the appointment of an agent to control disposition of remains provides certainty and peace of mind. Let your loved ones know what you want and what you don’t want. Be sure to write it down and leave your estate plans in a safe location where they can be accessed easily and timely.

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Top Documents a Woman Ought to Have...or Know Where to Find

In some ways, it's a woman's world. Women live longer than men. It's a fact. In the US, the average woman can expect to live to be 80.93 years old (compared to the average man whose life expectancy is 75.92 years). For more facts, see the World Fact Book compiled by the Central Intelligence Agency.

What this means is that women, being women, are caring for others--whether they are caring for ailing spouses, serving as court-appointed legal guardians for disabled wards, or handling the probate of estates for family members whom they have out lived. Women, due to their longevity, are also depending upon others for assistance, often relying upon caregivers during their incapacity and later, after death, to distribute their assets according to their wishes.

Smart women plan ahead, for themselves and for others. Here are the top documents a woman ought to have...or know where to find:

• Will
• Letter of instruction
• Trust documents
• Housing, land, and cemetery deeds
• Escrow mortgage accounts
• Proof of loans made
• Proof of debts owed
• Vehicle titles
• Stock certificates and savings bonds
• Brokerage accounts
• Partnership and corporate operating agreements
• Tax returns
• List of bank accounts
• List of all user names and passwords
• List of safe-deposit boxes, location, and keys
• Durable health-care power of attorney
• Authorization to release health care information (aka HIPAA release)
• Living will
• Do-not-resuscitate order (aka DNR)
• Personal and family medical history
• Life insurance policies
• Individual retirement accounts
• 401(k) accounts
• Pension documents
• Annuity contracts
• Marriage license
• Divorce papers
• Child support information/QDRO
• Discharge papers for veterans (DD Form 214 & SF-180)
• Birth Date, Place of Birth, Social Security Number

Organize the documents; safeguard them; share their location with trusted family members, so that if they become necessary, they can be found easily.

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