Mom & Dad's Health: What You Need to Know

August 27, 2015

As much as I don’t want to admit it, I know my parents are getting older and soon I’ll assume the role of caregiver for them. It’s a role I take on reluctantly, and one I’ll probably avoid for as long as I can. I have my own family now and I don’t need any more responsibility than I currently have. My greatest fear is I’ll get a call and find out one or both of my parents have had a traumatic event—an automobile accident, a fall, a heart attack, or a stroke has struck down the strongest people in my life and it’s now my duty to look after them.

If you can’t relate to me yet, you will soon. So what do you need to know to be prepared for this inevitable life change?

HIPPA release authorization

You rush to the hospital in a panic and find neither the hospital’s emergency room staff nor the attending physician will tell you very much about what happened to your parent. Why is that? The Health Insurance Portability and Accountability Act (HIPAA) was passed by Congress in 1996. One of its provisions ensured the privacy of health care information. HIPAA prohibits health care workers from discussing medical information with anyone other than the patient. If you don’t have a HIPAA release authorization naming you as your parent’s personal representative, then their doctor (or anyone else at the hospital) may refuse to give you any information. This can include your parent’s health insurance company. If you want to be involved in their medical decisions and act an advocate for them with the hospital and their insurance company, you’ll need to be their designated personal representative. You should have HIPAA release documents filed with both your parent’s physicians and their health insurance provider.

Durable Medical Power of Attorney

Now suppose your worst fears are confirmed. Your mom or dad has had a fall or a stroke, leaving them incapacitated. Perhaps their mild dementia has gotten much worse and they are angry and confused. The doctors are telling you there are three possible courses of treatment and someone must decide which course to take. To make matters even worse, your brother who hasn’t communicated with the family in the last ten years has just arrived, and he has some ideas of his own. Your parent is suffering. What do you need to take control and get them the help they need? If you have a Durable Medical Power of Attorney you can make the medical decisions for them if they’re determined to be medically incapacitated by their physicians. It’s “durable” because once it’s put in place it remains in force until it’s rescinded. It appoints you as their responsible person who will make decisions on their medical care if they are unable to do so. You’ll be empowered to act as their representative and make the choices they would want if they could act for themselves. Only those named as a personal representative  on the medical power of attorney (so, not your estranged brother) will be able to weigh in on health decisions. It’s always a good idea to put this document together now, while everyone is healthy, so you don’t have to worry about these possible scenarios.

Living will

Things go from bad to worse, and as the days drag on your parent gets weaker and lapses into a coma. The whole family is distraught and arguing over the treatment plans. Your parent’s doctors tell you they can continue to provide medical care, food and hydration, and even take drastic steps to keep your parent alive. Alternatively they can set up hospice care and offer a comfortable and loving path to the conclusion of your parent’s life journey. How is that decision made? If your parent has made a living will they will have left their instructions on how they want to be cared for when they are too incapacitated to state their own wishes. A living will designates the person who is responsible for fulfilling their wishes. The living will also establishes the medical conditions and time frames empowering the responsible person to make the decision to suspend aggressive medical treatment, and take actions to make the patient as comfortable as possible. If your parent has made a living will they will have given clear instructions for their final care, and empowered their representative to carry out their wishes. Without a living will, doctors will have few choices other than providing aggressive medical treatments even if the outcomes are uncertain and your parent’s comfort level is compromised.

Financial Power of Attorney

As time goes on and your parent remains incapacitated, you take over responsibility for looking after their affairs. The rent still needs to be paid and the utility bills pile up. You want to be able to look after their concerns but you don’t have the resources or authority to act for them. What do you need? If they’ve given you or someone they trust a Financial Power of Attorney they will have designated an agent to look after their financial interests. This allows you to cash their pension checks and pay their bills for them. You should check ahead of time to see what their financial institutions require. Some banks and investment companies want very recent documents and some want the powers executed on their own in-house forms. Asking first will reduce the number of frustrations when you need to act. Also, your parent may want to put reasonable restrictions and limits on what you can do with this power. The Colorado Bar Association has a good discussion of this topic on their website.

Will

The unimaginable happens, and your parent passes away. You are emotionally distraught and left with a profound sense of loss and endless questions on how their estate will be settled. It is very helpful in this situation if your parent executed a will before they passed away.  A will names an executor who can look after their estate. The will provides instructions for the distribution of their property, the care of dependents (if any), and their wishes for funeral services. If your parent dies without a will, the state has laws which determine how their estate will be divided among surviving relatives. Having a will in place reduces family arguments over the distribution of property and ensures your parent’s wishes are fulfilled. This will give you peace of mind and certainty at a time of emotional stress.

How do I get these documents in order?

The first step is to have a serious discussion with your parent and find out what their wishes are in all of these scenarios. Once you have established their wishes, get the necessary documents and have them signed, witnessed, and notarized. The best way to accomplish this is by utilizing an attorney. You can find one through the Colorado Bar Association website and search for Estate Planning. For most folks with average assets, a complete estate plan with Power of Attorneys, Living Wills, and Wills should cost between $400 and $600. This will be money well spent if you ever need these documents. Alternatively you can find the Colorado Power of Attorney (includes both medical and financial) and the Living Will on line and get them executed yourself. If your parent is a PERA member or retiree then you can contact PERA to get a Power of Attorney form that is specific to PERA (however, PERA will accept the Colorado Power of Attorney form, above, in lieu of the specific PERA form). HIPAA releases generally need to be obtained directly from each doctor or medical facility, so work with your parent to ensure you have forms for every physician. If you can, it’s best to be proactive with your parent’s physician and caregivers, and find out what they need to help your parents when they can’t act for themselves.

It’s ironic, but even though they had almost nine months to prepare to look after you, you may not have any time to prepare to look after them. If you take the time now to get these documents in place, you will be well-equipped to deal with the institutional and financial concerns for your parents.