Discussing end of life arrangements for yourself or your loved ones can be difficult. While challenging emotions can arise from the thought of our last days, ensuring an end of life plan is in place can guarantee that your final wishes are carried out as planned and, maybe more importantly, help alleviate stress from the loved ones who will manage your estate. We asked a panel of local experts to share their knowledge of pre-planning and its associated benefits.
What are you talking with your clients about more in this new world with Covid-19?
KARA GANSMANN: With estate planning, clients are always looking for peace of mind with the right estate planning tools like wills or trusts, durable powers of attorney, and health care proxies. However, in this era of Covid-19, clients are focusing more on healthcare powers of attorney and advance directives. Having these in place before an illness like Covid-19 strikes ensures your health wishes are thoughtfully planned. We are also speaking with clients about how to execute legal documents either with minimal contact or no contact. Covid-19 has created challenges for ensuring legal documents are validly executed while maintaining safe social distance with notaries and witnesses to the documents. Whether our clients are in nursing homes or able to meet at a safe social distance, we are following the law for these signings and offering peace of mind to our clients.
JASON CLAMME: From a business perspective, we are telling those interested in services about the protocol we go through to keep them safe from the virus as they receive the care they need. We strongly encourage isolation for the patient and family caregiver(s). For palliative care patients, we are offering a TeleCare alternative for communicating with their nurse practitioner. We have also put in place visitation restrictions at our care centers, screening measures, and mask usage requirements. Many team members who work at our administration building have been working remotely and those who need to be in the building are practicing safety measures and social distancing. As far as advance care planning, we have always discussed this with patients and family members as they come on to our services. We encourage all patients to have an advance healthcare plan in place. During COVID-19, people have become more aware of advance care planning and how it may impact them if they should become positive for the virus and be hospitalized. We are certainly answering those questions for them and helping them document their plan so they know their wishes will be honored.
DUSTIN OSBORNE: We have been doing a lot of virtual pre-planning of cremation and funeral arrangements with families since Covid-19 began. We have an exceptional digital presentation that shows all of our funeral and cremation merchandise and service offerings. By sharing our computer screen online with a family, they are able to make selections from the convenience of their own home. Virtual planning is available through Coble Funeral & Cremation Service at Greenlawn Memorial Park, Greenlawn Memorial Park, and Oleander Memorial Gardens.
JOHN ZACHARY: Fortunately, we are just reminding clients that they should have their affairs in order. We discuss pre-planning with all new clients and help them put together plans for both wanted and unwanted outcomes. Covid-19 has given us the opportunity to remind folks the importance of doing so for those that did not want to pre-plan previously. It has been a wake-up call for those refusing to ask, “What happens if….” We guide our clients through tough conversations and help them discuss decisions with their family members and other important relationships. We have had two different clients lose a parent to Covid-19 this year which hits home for us. However, in 2020, we have had clients lose more family members to other factors than to Covid-19 which is why pre-planning is always a part of our new client onboarding process.
The thought of pre-planning can seem overwhelming. What is a good first step to get the process started and when should that happen?
OSBORNE: If pre-planning seems overwhelming, please remember that it is a lot easier to plan now than to wait until after a death occurs. Many families tell us how relieved they feel after they pre-plan with us. One common statement that the families who pre-plan tell us is, “You made the process so easy.”
CLAMME: We recommend starting a conversation about your advance healthcare plan with loved ones using something that spurs a discussion: a movie, TV show, recent illness or death of a family friend, or something that is in the news – like COVID-19. It’s easier sometimes if you share your thoughts and feelings first and then ask the other person what they think or what they want for themselves. It may be a little uncomfortable to have such a discussion, but it is much more uncomfortable for a loved one to suddenly be put in the position to make these decisions without having a clue as to what their family member would want. This can add additional stress and even cause family discord during an already overwhelming situation. We believe that planning should take place as early as possible and even speak to many college-age adults about putting a plan in place in the event something should happen. As we say, it’s better to be ten years too early than ten minutes too late. Certainly, anyone with a serious illness or chronic condition should consider having a plan and discussing that plan with their loved ones to ensure they receive only the medical interventions they wish for and that meet their goals for care should they become unable to communicate for themselves.
GANSMANN: Think first about your goals or needs for pre-planning. Are you concerned with protecting a spouse or other loved ones during your incapacity or illness or after your death? Are you concerned with ensuring your wishes are carried out precisely? Do you worry about family conflict? Taxes? Probate or simplicity? Do you have out-of-state documents or documents that no longer met your loved ones’ needs? Knowing your goal for an estate plan can help your attorney make personalized recommendations that fit your needs, your assets, and your loved ones.
ZACHARY: We typically have three scenario conversations with new clients that may not have done any pre-planning before. The first is if something happens to them today, an immediate death, and we walk them through what they do already have in place such as beneficiaries, registrations on assets, legal documents, etc. We explain the process their family members will go through on their behalf. Death is usually easier to discuss than full incapacity which is the second scenario we discuss. This involves a longer-term scenario where they may be a financial and physical burden on their loved ones. The third scenario is if something happens to a loved one. Whether a spouse, child, parent, or a sibling. It can be unpleasant, but we have experience and we can share real life stories that make the conversation about education instead of overwhelming emotion.
What do pre-planned arrangements typically encompass and how can they alleviate some of the stress of responding to the passing of a loved one?
GANSMANN: For estate plans, a will or trust will determine how your estate passes to your loved ones on your death. These pre-planning legal documents should specify in general terms who inherits your estate, how much a person can inherit, and when that person can inherit. Your attorney should speak with you about your specific assets to ensure that your estate can direct those assets in the manner that makes sense for your needs. Pre-planning includes a regular review of your existing estate plan with an attorney to ensure that it still meets your needs and remains valid. After a person passes away, one of the biggest hurdles our probate clients encounter is trying to locate all of their loved ones’ assets. We recommend that our clients keep a list of their assets with their estate planning documents to alleviate this stress during a time of grief. We also advise our clients to share aspects of their estate plans with trusted people so they will know where to locate your legal documents. These simple steps offer ease to administering an estate in a time of grief.
CLAMME: Each state has its own forms to document your advance directive. We generally use the NC combined Healthcare Power of Attorney and Living Will form in our workshops, but you can get separate documents as well. The Healthcare Power of Attorney portion allows you to designate an advocate to speak for you in the event you are in an accident or suddenly become ill and cannot speak for yourself. The Living Will portion of the form allows you to stipulate the medical interventions you want and do not want – again given the scenario you are unable to speak for yourself. These forms require two witnesses and must be signed in the presence of a notary and be notarized to make them legal. Another form is the Medical Order for Scope of Treatment, or MOST, form. This is a form that you can fill out with your physician and again stipulate which medical intervention you would want or not want. This form is signed by your doctor and becomes part of your medical record. People should keep in mind that these forms can be changed as your wishes change. You simply fill out the forms again and go through the witness and notarization process to make the changes. Many people revisit their decisions and revise these documents during major changes in their lives.
OSBORNE: Pre-planning involves two parts. The first part is where we gather the information that we will need for an obituary and death certificate. We also discuss all of the service options that we have and ask families open ended questions regarding their wishes. We focus on personalizing each service, whether it’s burial or cremation. The second part is pre-payment. Pre-paying has many benefits to the consumer including an inflation proof contract that protects families from future price increases. Families have the option of pre-paying in one lump sum or making payments over three, five, ten, or fifteen years. Pre-planning is also available for cemetery plots, markers, mausoleums, cremation memorialization, and opening and closing of plots.
ZACHARY: Pre-planned arrangements should first include a comprehensive look at your situation, including assets, income, insurance, legal, and taxes. Once you have a baseline of what the future looks like in an ideal scenario, then you can test the unexpected. There’s no better way to relieve the stress that comes from a losing a loved one than to run through the scenario ahead of time and create a game plan. It’s a difficult conversation, but the peace of mind that it will give to your survivors is unsurpassed – and knowing that your survivors will continue to be able to reach their goals will allow you to enjoy life more today.
How can my family and I be legally prepared for the end of life?
ZACHARY: For the legal aspect, we recommend that our clients work with a qualified estate planning attorney to make sure their documents are in order and drafted in accordance with their wishes. This is a conversation that we start with every one of our clients, and it begins with reviewing their goals. We will then recommend which documents might be appropriate based on a clients’ financial situation and coordinate with their legal professionals to have those documents drafted. The legal process of settling an estate can be daunting, even more so after losing a loved one. Getting your legal affairs in order will give you peace of mind and alleviate the burden on your loved ones.
GANSMANN: Meet with an attorney to ensure that any existing estate plan remains valid and continues to meet your goals. If you don’t have an estate plan, an attorney will make legal recommendations for your specific assets, needs, and goals for your loved ones. At a minimum, your estate plan should include essentials like a will, a durable power of attorney, a healthcare power of attorney, and advance directives. These documents are intended to cover your needs during any period of incapacity as well as end of life. There are times when an attorney may recommend trusts or other planning tools for asset protection depending on your specific circumstances. And because estate planning is not the only aspect of end-of-life planning, your attorney will also want to involve other trusted professionals in your life to weigh in on certain aspects of your plan. These professionals, like financial advisors, insurance agents, and CPAs, will offer opinions on how to meet all of your end-of-life plans.
CLAMME: Certainly, people should have a will to document their financial wishes. Although we encourage patients to have a will in place as knowing they have one can reduce stress and anxiety, this is not our area of expertise. As far as an advance directive, the bare minimum would be to have a Healthcare Power of Attorney to designate your healthcare advocate. Of course, you will need to be sure to choose someone who will truly advocate for your wishes. Due to the emotions connected to making such decisions, sometimes a family member may not be the best person to choose for your advocate.
OSBORNE: Pre-arrangements through Coble Funeral & Cremation Service at Greenlawn Memorial Park are done on a contract that is legally regulated by the North Carolina Board of Funeral Service. Families that choose cremation are also able to sign a self-authorization for cremation which is legally durable beyond death. This makes it very clear and legally binding that the desired type of service for the person who pre-arranged was cremation.
What is an advance directive and how can it help me?
CLAMME: An advance directive is the same as an advance healthcare plan. It is a way to document your wishes in the event you are unable to speak for yourself due to an accident or sudden illness. How it helps is that it ensures your wishes for medical interventions are honored and your goals for care are met. A good example of how it helps is seen in the case of Terri Schiavo. Terri’s husband believed Terri did not want to be kept alive in a constant vegetative state with no chance for recovery. However, her parents believed the opposite and fought for years to keep her alive. Had she had an advance directive, Terri’s wishes would have been honored and she would have had the end of life she wanted. So, ultimately, an advance directive lets you determine the ending of your own story. You determine what type of death you want.
ZACHARY: An advance directive is something that lays out your wishes if you’re unable to communicate those wishes on your own. They are very important documents, and we have seen firsthand how impactful they can be. Without these directives, it can leave an unintended burden on your loved ones, who could be forced to make decisions about your care without knowing whether it is something you truly want. This painful decision-making process can be easily eliminated with the proper drafting of these documents.
GANSMANN: An advance directive is a legal document designed to outline your health care choices for life-sustaining health care when you become so ill you are unable to make or communicate your health decisions. In this document, you can make specific instructions for prolonging your life if you become terminally ill, permanently unconscious, or suffer from severe, unrecoverable cognitive loss. Life prolonging measures could include artificial hydration or nutrition, mechanical ventilation, dialysis, and other forms of health care that sustain your life. In the age of Covid-19, many clients are carefully calculating their choices under an advance directive. An advance directive is helpful in identifying your wishes for end-of-life care. It outlines your directions so that your loved ones do not have to guess at making the “right” decision for your needs.
How can I financially prepare for the end of life to prevent a financial burden on my family?
ZACHARY: The first step is understanding, as soon as possible, what potential costs could be in the future and how they might affect your long-term financial plan. You can then start to make adjustments now to accommodate those expenses should they arise. Using analytical tools and sensitivity analysis, we review our client’s household financial information and test a handful of scenarios. The result is an illustration of the financial impact of each scenario. From there, we talk about client preferences for funding any shortfalls and solutions for addressing the concern. For example, one of the largest potential costs that we cover in pre-planning is long-term care expenses. With the average cost of a private nursing home room at $91,980 in the Wilmington area (source: Genworth’s 2019 Cost of Care Study), the costs can be enough to cause a heavy financial burden on any household. To mitigate, you could purchase long-term care insurance or earmark an asset, such as real estate or investments. Risk management is an integral part of financial planning. As we all know, life can change quickly and things don’t always go exactly to plan. Looking at these scenarios ahead of time and being proactive will avoid you having to go into crises mode when you get hit with the unexpected.
CLAMME: We do not advise our patients or families on how to financially prepare for the end of life. We do sometimes help them find current resources, if needed, to assist them with needs due to their illness that could lead to additional financial burdens. If they have such concerns, we suggest they contact a lawyer or financial advisor as they are better equipped to answer such questions.
OSBORNE: We offer convenient monthly payments to those who pre-plan both funeral and cremation services. We meet with families and give them a funeral or cremation estimate that includes a single payment option and payment plans.
What financial documents are most important when pre-planning?
ZACHARY: There are some very important legal documents, such as Will, Living Will and Healthcare Power of Attorney, but the Durable/General Power of Attorney is what is most used when it comes to your financial affairs. We also believe your beneficiary forms and registrations/titling on assets and accounts is just as important. Getting a power of attorney is one piece of a complex puzzle and will allow someone to act on your behalf, but we have seen more headache around beneficiary forms and not titling accounts properly. Don’t underestimate the financial forms themselves which carry a significant legal weight. These can all be handled individually with the financial institution, such as bank or investment accounts, or with the county if it is real property titling.
What challenges can be avoided by having an end of life plan?
GANSMANN: First, without a plan in place, you lose control over decisions relating to your care, your preferred housing, and your finances. If you cannot make these decisions for yourself, someone else may be making these decisions on your behalf. It may not be the person you would trust to make the decisions. Worse still, the decisions may not be the same decisions you would have made. Second, without a plan, you may be failing to provide for your loved ones or dependents. If you are incapacitated during life, your failure to plan could devastatingly and financially impact your spouse. You don’t want to impoverish your spouse with expensive care needs by failing to pre-plan. Further, without a plan, on your death, your assets may not be distributed to the people you want or in the same way you would want them to inherit from you. Third, without a plan, you could experience a financially devastating loss of property or assets during your life. Most people do not want to see their life savings spent on end-of-life care. Pre-planning offers an element of asset protection while ensuring that any potential care is covered. Many times, without a plan or even the most foundational legal documents like a Durable Power of Attorney, a person’s only remaining option could be an expensive guardianship.
OSBORNE: Pre-planning makes it very clear to your loved ones as to the type of service you want and whether you want burial or cremation. We also gather vital information that will be needed for social security, a North Carolina Death Certificate, Veteran’s organizations, etc. during the pre-planning process so families won’t be faced with gathering all the information after death occurs.
CLAMME: Family conflicts and feelings of guilt and anguish can be avoided if people have an advance healthcare directive because their wishes will be known, and no one has to guess what they would want as far as medical interventions. People would have the type of death they want instead of the one someone else feels they should have. People should ask themselves, “What do I consider to be a good quality of life?” Then put a plan in place to ensure that’s what they get and are not left to live in a situation that does not meet that standard. Realistically, an advance healthcare plan can also reduce financial liabilities for extensive medical interventions the patient did not want and that would not meet their standard for a good quality of life.
ZACHARY: The biggest is the emotional burden on your family. People don’t want to talk about the ugliness of death and incapacity, so the conversations are avoided. However, there is no greater peace of mind than knowing you are doing exactly what that person wanted in some of the most difficult moments in life. If you are forced to make a decision, such as deciding to discontinue life-prolonging measures for a parent, it is much easier if you knew that is what they wanted and you have a document that shows it. Do not underestimate the weight of making these tough decisions. Doctors will typically turn to the family regardless of what the estate documents say. With a little pre-planning, your family can review the documents to guide their decisions.
How can people without a spouse feel supported during their pre-planning process?
CLAMME: They can rely on a family member or friend to support them through their pre-planning process – someone they feel has their best interests at heart. If they feel more confident with a professional, such as an attorney, he or she can help them complete the needed forms for documenting an advance healthcare plan. They can also rely on their doctor if they choose to complete a MOST form. Medicare now pays for such consultations with physicians to encourage these types of conversations. Your physician can walk you through the different types of medical interventions and also discuss your goals for quality of life as they relate to these interventions.
OSBORNE: Many people who are single pre-plan. Once someone goes through the death of a loved one and it isn’t preplanned, they realize on a deeper level the need to pre-plan and remove the burden from their loved ones. Many people who pre-plan bring a close trusted friend or other family member with them.
ZACHARY: We tell folks that you maintain your independence by being proactive with pre-planning decisions. We have many clients that do not have a spouse or children and they struggle with pre-planning because they do not have the typical folks to list on legal documents. Therefore, it is even more important for these folks to pre-plan. Without naming people or companies of your choice, you may find your toughest moments in life being handled by case workers, attorneys, and/or other folks that are complete strangers and never had a conversation with you. Build a relationship with your financial planner and/or estate planning attorney and they can guide you through options and give you control over the process before it becomes a crisis.
GANSMANN: Plan early and build a network of trusted people and professionals who can help you in times of illness, incapacity, and after your death. These people could include relatives, trusted friends or colleagues, attorneys, financial advisors, tax planners, religious leaders, insurance agents, and funeral or cremation organizations. The professionals will guide you through the relevant aspects of end-of-life planning as relevant to that field or industry. These professionals have resources available that will ensure your end-of-life needs can be carried out with dignity and in the manner you intend.
What special considerations should business owners take if they want their business to continue after their passing?
ZACHARY: Business owners need to take special consideration to make sure proper arrangements are made, especially in a closely held business. There are employees and often clients that rely on your services and, without a proper plan, the business could simply disappear if the owner or a key employee dies or becomes disabled. There are strategies using life insurance, such as buy/sell agreements, which will allow other owners or key employees to buy out a surviving spouse’s business interest, to avoid the risk of a fire sale. Key person insurance is a way to protect the business from the death of a key employee, or business overhead expense (BOE) insurance can help cover business overhead expenses if an owner or key employee becomes disabled.
Are there special challenges associated with crisis planning vs. long-term end of life planning?
GANSMANN: Plan early with help or get help if you didn’t plan ahead. First, for pre-planning: arm yourself with a strong Durable Power of Attorney that allows you to appoint a trusted person to make financial transactions on your behalf if you are unable to make those transactions for yourself. This document is the foundation for any kind of long-term care planning. With the right provisions in this document, you can plan for long-term care needs and transfer or manage your assets according to those needs. Without this document, planning becomes challenging at any phase. In working with pre-planning clients, I help people preserve and manage assets. For example, we can ensure that a person receives the kind of long-term care they need in a care setting they choose. We will plan for a spouse’s ability to remain in the marital home while providing for the other spouse’s care needs. We can protect assets to ensure they are not lost or spent down to pay for care. An added benefit to pre-planning allows clients to provide a legacy gift to their children or grandchildren. With pre-planning, I always ask, “How much do you want to protect?” and “How soon do you want to start protecting it?” In the crisis-planning context, I help families preserve at least some of their assets, but I cannot always help them preserve all of their assets. Crisis planning allows some clients to preserve at least some of the assets to provide for a loved one’s needs while still eventually qualifying long-term care benefits. If given the choice, all of my clients would have opted for pre-planning in lieu of the stress, financial devastation, and emotional heartache of crisis planning.
OSBORNE: It is much easier on loved ones when planning is done in advance instead of after death occurs.
CLAMME: From a healthcare provider perspective, especially one that provides hospice care for those with a life expectancy of six months or less, we can only recommend that people have an advance healthcare plan in place and that plan be communicated with loved ones. Any planning that someone can do to ensure they live their life to the very end based on their beliefs, goals, and ideals is a good thing to have in place.
Where can people find additional resources or planning tools helpful in end-of-life planning?
ZACHARY: Start with your trusted professionals such as financial advisors, estate planning & business attorneys, and tax professionals. At Pathfinder, we bring all of those professionals together to help our clients plan for the future and make sure that if something goes wrong, there’s a backup plan in place to protect interested parties, such as family, business partners, and customers.
CLAMME: We are hoping that sometime soon we will be able to resume our monthly workshops at our Wilmington office and hospice care center in Bolivia. For now, we are willing to work with groups who would like to set up a virtual workshop via Zoom or other online conferencing platform. Once we do resume our workshops, we’d love to see people there. They can access the schedule on our website or find it listed on our Facebook page. At that time, groups and churches will again be able to request a free workshop for one of their meetings. People can also look for information on our website, LifeCare.org or go to LifeCareResponds.org, which has information we put together to help people feel supported during the uncertain times of COVID-19. The site has a short video on advance care planning to answer people’s questions as to what it takes to put a plan in place. While there, they can download a copy of the combined NC Healthcare Power of Attorney/Living Will form so they can legally document their wishes. They can also request a copy of our workbook that will help people discuss advance care wishes with loved ones, document wishes, and also write down other important information for loved ones.
OSBORNE: We offer free funeral and cremation planning price estimates. We also offer a Personal Planning Guide that is very detailed and a great place to document your funeral or cremation wishes and many other details.
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