Healthcare has been dominating the national news and has sparked a lot of debate about medical costs, elder care, and end-of-life care.

One rather controversial op-ed piece by Richard Dooling for the New York Times highlighted the lopsided spending on life and lifestyle sustaining medical care for octogenarians and nonagenarians.  He suggested a reorganization of medical care priorities, such as shifting government dollars from bypass surgery and titanium knee-replacement surgery for elderly patients to preventative care for children at pennies on the dollar.

Among the responses to this article – ranging from outrage to applause – was a letter to the editor from Adele Welty in Flushing, Queens, a “73-year old grandma” who pointed to the importance of advance directives as one solution to generational medical care cost gap Dooling described.

I am a strong proponent of advance directives, which will clearly identify for doctors, nurses, hospital staff, and family members your wishes regarding emergency medical care and end-of-life care should you become incapacitated.  In fact, just recently I heard from the family member of a client who was able to instruct medical personnel as to the client’s wishes about life-saving care and life support using an advance directive signed two weeks prior.

Adele paints a grim picture of “being put in some sort of time warp of machine-generated life support, tortured with tubes and left to rot in an undignified and helpless state with no hope of recovery, a heartbreaking burden to [her] children” as her reason for signing an advance directive.  But you need not have Adele’s fear to know that an advance directive is just another responsible part of your overall estate plan, ensuring that your life and legacy are in your control to the very end.

James D. Perry

In high school, it was foggy car windows at the look-out point.  In college, it was a sock on the doorknob.  When you finally got your own home, you could rejoice in the fact that you didn’t have to sneak around for sex anymore…until the kids came along and it was locked doors and stolen weekends.

It seems like all our lives, we expend considerable effort to protect the privacy of our most intimate encounters, but a recent Los Angeles Times article pointed out the near-impossibility of finding an unmonitored moment between consenting adults in nursing homes.

Faced with always-open doors, watchful staff, and roommates, a nursing home resident can quickly go from relatively independent lifestyle to a lock-down experience with maid service and medical oversight.

A 2007 study published in the New England Journal of Medicine showed that 53 percent of adults ages 65 to 74 report being sexually active.  That figure drops to 26 percent for adults ages 75 to 85.  The drop can be attributed to multiple factors, including declining health, lack of potential partners, – women have a longer life expectancy than men – and even the lack of available privacy in long-term care facilities.

New York Times source, Professor Eddie Hargrove says that hand-holding, kissing, and petting “probably would go further than a little medication at 10 o’clock at night” setting up the premise that sexual activity is beneficial to one’s health at any age.

So, as Ira Rosofsky of the Times asks, “does it make sense that it’s easier to get a conjugal visit in jail than in a nursing home?”

The Nursing Home Reform Act of 1987 contains a Residents’ Bill of Rights, which requires federally funded nursing homes to recognize a resident’s right to privacy and to accommodate his or her personal needs.  The law’s aim here is to ensure that nursing homes provide an environment in which each resident can “attain and maintain his or her highest practicable physical, mental and psychosocial well-being.”

And in California, the Welfare and Institutions Code specifies that residents have the right “to live in an environment that enhances personal dignity, maintains independence and encourages self-determination,” and “to participate in activities that meet individual physical, intellectual, social and spiritual needs.”

But it’s safe to say that a vast majority of nursing homes are not measuring up, and residents are faced with a choice between forgoing the frisky behavior or risking an embarrassing intrusion by staff or roommates.

It’s enough to make them feel like over-protected teenagers, again.

James D. Perry

Family dynamics play an interesting role in drafting an estate plan. 

Every so often I meet with clients who, for whatever reason, just don’t like a son-in-law or daughter-in-law, and want to figure a way to keep their son or daughter’s inheritance in the family in the event of a divorce, death, or other unexpected life event.

Fear of a child’s divorce is a common problem in estate planning. Clients are concerned that the inheritance they leave their adult children will become community property subject to 50/50 division upon divorce. This simply isn’t the law in California.

California is a community property state.  But stocks, bonds, cash, property and other assets that are passed through inheritance to an individual are considered separate property - as long as they remain in the name of the recipient.

If your kids are careful with their inheritance, it won’t get lumped into the marital assets.  But this is where family dynamics come into the equation. They need to somehow resist the request of their wonderful, loving husband or wife to add his or her name to inheritance. This is the hard part.
 
Financial columnist Liz Pulliam Weston gave an excellent explanation of this subject in a recent article in MSN Money. Ms. Weston points out that some couples can’t imagine keeping separate assets, some remain pragmatically enthusiastic about individual accounts, and others incorrectly assume the law requires them to share.  The decision to keep an inheritance separate can take a great toll on the marital relationship causing a great deal of stress.

You can hope that your adult child would respect your wishes under pressure, but estate planning is all about creating peace of mind for now and later.  In such a situation, I might suggest that a trust be set up instead to ensure that whatever assets you leave go solely to those you intend.

Discussing these details with your attorney will better enable him or her to develop a plan that will best suit your life and your estate.

James D. Perry