What Nobody Wants to Think About...

Sognfjord, Norway

Today's topic is one that is difficult to think about, but very necessary in order to go into the future with confidence:  Who will make decisions for you if you cannot?

Nobody has a crystal ball, so we don't know what kind of challenges may be up ahead.  Maybe you'll get really lucky and stay reasonably healthy, cognitively intact, and able to make your own decisions until you are quite old, and then have a short, precipitous decline...that's the best case, I think.  Not quite as desirable is a period of illness, but with cognitive abilities intact.  And, of course, nobody's first choice is gradual intellectual decline.  Somehow, we have to plan for all of those contingencies.  

Let's be honest, this is about maintaining control of outcomes, and if you don't make serious plans, you are actually choosing to roll the dice.  For example, if you don't have advanced directives the default is for medical professionals to do everything they can to save your life, regardless of the outcome.  That may be your wish, but if it is not, if you do not want to be maintained on life support when there is no possibility of recovery, it will happen anyway.  Regarding your finances, if you don't designate someone to act in your best interest should you become incapacitated, eventually a court appointed guardian will be appointed to do so, but it is also possible that someone could exploit your resources before that happens.

So, how do you choose the person or persons who will be able to make decisions for you if you are no longer able to do so?  Let's consider health care advanced directives first.  It is important that the person you designate lives near you, since they may be needed in an emergency.  It should be someone that you have discussed your wishes with, and ideally that person shares your views on how much medical care you wish to have under different circumstances, or at the very least, is willing to honor your wishes.  Who might this be?  It may be an adult child, and if you have several children, it may be possible to name more than one, or one to back up the other, which spreads the responsibility around somewhat.  

But what if, for a variety of reasons, your children are not a good choice or you do not have children or other relatives who could take on this responsibility?  Or let's say your family members have a different view of how much medical intervention is desirable.  You may want no extraordinary measures taken because you feel you are at the end of a good long life, but your family may want everything done because they are not ready to let you go. We have seen situations where there have been complicated relationships between parents and children that make it difficult to either discuss this issue or to rely on children when the time comes.  Or what if you have always been an independent, autonomous person, and you don't want to burden your children with making these decisions for you? 

Sometimes trusted friends are a better choice than family.  The nature of a peer relationship makes it easier to discuss such sensitive issues, although it may be necessary to choose someone somewhat younger (or at least healthier) than you are to ensure the arrangement endures for your lifetime.  When thinking about who to ask to take on this important responsibility, we suggest you look for someone who has the emotional strength necessary, and ideally someone you have known for a very long time.  What you are really looking for is someone who has no other agenda and no personal stakes in the outcome.  In other words, you can count on them to do what you want.  

We have known people to enter Continuing Care Retirement Communities as a way to not be a burden to their children.  And this does work, in a certain way, as the facility will take over to make decisions.  However, it is also true that the facility may have its own agenda that can subtly drive those decisions, as we've mentioned in previous posts (See:  Thinking About What Comes Next, 3/15/16).

Remember when Judy's mother was alive we had a Geriatric Care Manager who also had Medical Power of Attorney when we were out of town?  In the end, that allowed her to accompany Avis in the emergency room, and she was familiar with her wishes.  This worked for us, in part, because Judy had worked with the woman for many years and trusted her.  If there is a trusted professional that you have a long relationship with, whose honesty you have seen demonstrated, and who has no investment in the outcome other than honoring your wishes, it would be possible to designate them to make decisions for you.  

The financial issues are definitely more complex, just because of human nature.  One of the reasons that my mother chose me to be her Financial POA is because she knew that I did not need the money.  She also knew my philosophy, which was that the money was there for her use, and I encouraged her to spend it for her own comfort, not to try to preserve the estate.  These are questions you can ask yourself about whomever you are considering for this role:  Is this someone whose judgment in money matters matches mine?  Do I have confidence that this person will watch out for my best interests?  You will be asking the person to take on a responsibility, so is this someone who would not mind doing that?

What if you feel you do not have anyone you can rely on fully when it comes to managing your money or who might be overburdened by the responsibility?  When I think of an ideal arrangement for someone who wants peace of mind about what will happen should they be incapacitated I'm unfortunately reminded of the many cases I saw where someone was exploited.  It makes me wary of the motives of those who might be seen as the obvious people to turn to, such as attorneys and accountants, and even in some sad cases, family members or paid caregivers.  

I struggled to come up with a recommendation. What I have come up with may be a little more complicated than just naming someone as your Financial Power of Attorney, but it may also provide a little bit of a safety net.  I would suggest that perhaps the same person you have turned to for Power of Attorney for Health Care could be designated to supervise a bookkeeper or accountant who would take over the day-to-day finances.  That way you are not overburdening your friend or relative with the bill-paying, and the POA for Finances (your friend) can keep an eye on the overall financial situation (including investments and savings).  Likewise, the bookkeeper or accountant could make sure money is handled in appropriate ways. I would suggest monthly statements from the bank and other financial institutions go to both the bookkeeper and the POA.  It is very important to choose someone you trust for both positions.  You also gain the added security of not relying just on one person, but having a second person for oversight. 

Your goal is to set up a solid safety net so that you are cared for medically and financially in the way you wish, allowing for all of the possibilities and unknowns.  Then, once you have it set up, you can go back to not thinking about it and hope that you never have to exercise those options.  

That's what we're doing.