As individuals retire or age into Medicare, their insurance situation can change dramatically. There are a multitude of options open to those with Medicare. The terms are different, the prices are different, the products offered are dramatically different each year.
The purpose of this column is to give those who are eligible for Medicare, or soon to be eligible for Medicare, some understanding of their insurance options and how it could impact their health and finances.
These questions and answers are meant as a guide to help you understand the complex questions you are now thinking about. Each individual's specific situation may create a different solution. You shouldn't necessarily do what your friends, family and neighbors do.
Q: I recently have heard about something called a health care proxy. What is it? Why would I need one? Do I need an attorney to get one?
A: I love talking about health care proxies. This is such a wonderful protection for everyone.
Health care proxy comes under the heading of advanced directives. Advanced directives is a fancy term given to those tools that allow you to pre-determine or pre-decide your health care. There are a number of types, and I am going to briefly touch on each and why you might want them. The types I will talk about are: do not resuscitate order (DNR), health care proxy (HCP) living will and medical orders for life sustaining treatment (MOLST).
A DNR is an actual medical order given by your attending physician which states that in a situation where your breathing has stopped and your heart has stopped, those who respond will not administer cardio pulmonary resuscitation (CPR) for the purpose of restarting your breathing or heart. There are two types: a hospital DNR (which is only valid while in the hospital) and a non-hospital DNR, which covers all other locations. As I noted this is a physician order, so it is a document that is signed by your physician, not by you. You request it, but your physician enacts it.
If you have a non-hospital DNR, be sure to display it prominently in your home. If it is tucked away in a file cabinet, the emergency medical staff will attempt to resuscitate you. They must see the actual document. They cannot take your family's or caregiver's word that you have this on file somewhere.
You asked about a health care proxy (HCP). The HCP is a document used to designate an individual or individuals who will make medical decisions in the event you are not able to communicate your decisions. There are a number of versions of this document available. Most hospitals, medical offices and attorneys have copies they can get to you. You can also get versions online, but be sure it is a version accepted in New York state. In New York state, a health care proxy can be completed and signed by anyone over 18 years of age. When ready to sign this document have two individuals who are not related to you, like a neighbor or classmate or people sitting at the next table in the restaurant, sign as a witness. This witnessing of your signature is simply to state that you didn't sign the document under duress and you were aware of what you were signing.
Once signed and witnessed by two adults, this is a legal document. The HCP does not give those you appoint the right to override your wishes for medical care. The HCP gives them the right to make decisions when you cannot communicate your wishes. It is assumed that you will inform the appointed individual(s) that they have been appointed as your HCP and you should communicate your wishes clearly to them.
Most forms have instructions along with them, so that you can fill it out properly. There is information that must be explicitly indicated on the HCP form in order for your appointed proxies to be allowed to make decisions.
The HCP form is very easy to complete and it gives you control over your future. It means that in an emergency someone you trust will be in charge of your medical care and decision making. All of us should have a HCP completed.
The next item is the living will. In many states the living will is a legally binding document. In New York state it is considered a supportive document. It gives the physician and your family some indication about how you feel about particular medical procedures and treatments. Your appointed HCP can use the living will to help guide their decision-making process on your behalf. Your physician can help guide your family and appointed proxy in making medical decisions to follow your living will and the expressed wishes it contains.
The living will can be thought of as a narrative of your medical wishes and desires. It doesn't need to follow a particular format or form, but there are templates available to help guide you through the process.
The last type of advance directive I will cover is the MOLST. In New York state the MOLST is legally binding document that applies across all health care settings. A MOLST form is advisable for people who are seriously ill, who might be in the last year of their life or have particularly strong health care wishes. This is a four-page, bright pink document that includes medical orders from your physician and the previously reviewed advanced directives. This is signed and renewed by your attending physician regularly. This MOLST form is a set of orders and directives that are transferable from facility to facility and setting to setting. This is ideal for an individual who is frequently hospitalized, or in a skilled nursing facility. The MOLST may not be necessary for everyone.
A source I commonly refer people to and ask questions of myself is the Chautauqua County Health Network in Jamestown. CCHN is also a source for some of these documents, the MOLST and health care proxy. CCHN contact information is 338-0010, or 200 Harrison St., Jamestown.
CCHN also has a health care proxy registry. This is an actual online registry of your health care proxy. This allows medical emergency responders, medical staff and hospitals access to these documents. This is a useful idea, as we don't always have this information on our person when we are ill or in an accident.
Once these documents are completed, I would recommend giving a copy of all these completed forms to your family and medical practitioners. You can't expect that individuals and physicians make good decisions on your behalf, if you don't inform them of what you want done.
Advanced directives do not include power of attorney (POA). A POA is a financial tool that you can use to give someone you trust the ability to pay bills, and handle all types of financial transactions on your behalf. POA has nothing to do with health care, unless it is writing a check to pay a medical bill.
To answer the second part of your question: Why do I need an advance directive? I would say that everyone age of 18 or older have at least a health care proxy completed. This allows for medical decisions to be made if you cannot communicate. Say you are unconscious, in a coma or during surgery; it allows for the person(s) you designate to make decisions guided by information you have communicated to them. It puts the decision-making power of your health care in your hands and the hands of someone you trust.
We never know when an accident or medical emergency will take place. This small amount of pre-planning and communication allows you to be in charge, whether you can actually speak or not.
The last part of your question: "Do you need an attorney to complete a health care proxy?" The answer to this is no. A HCP can be completed by anyone over the age of 18. This document is considered legal and binding, once it is signed by you and witnessed by two individuals (also over the age of 18).
This document is pretty easy to complete. It asks for your name and the name of the individual you are appointing as your health care agent and that individual's contact information (address and phone number). It asks for additional health care agents (if you want to appoint a backup person or persons).
You have space to write special instructions. If you want the proxy to have an end date there is an opportunity to add that date. Some individuals complete HCP documents for use during a serious illness or injury. If you wanted to appoint a health care agent while you were having surgery, this form could be completed with an end date. Once your surgery is over you want the proxy to end. I can understand why an individual might want to do this. I would counter with: if you trust that individual for this specific period of time, why not leave the HCP document with no end date, and just trust them with this responsibility indefinitely?
After this information is completed on the form, you simply sign it, add your address and phone number. Then have it witnessed by the two individuals who watched you sign the form. Then it is finished. You then copy it, to give your physicians, hospitals and family copies. You send it CCHN to put on their HCP registry.
You have just taken a few giants steps to protecting yourself and your loved ones from difficulties later. Appointing a HCP allows for better outcomes for your health care. You need to remember to tell your health care agent that they are appointed. You also need to communicate your health care wishes. Your health care agent can make the decisions you would want in a situation where you can't.
Janell Sluga is a geriatric care manager certified and works for Senior Life Matters, a program of Lutheran Senior Housing, and has worked in Chautauqua County with seniors for more than 18 years. She is HIICAP (Health Insurance Information, Counseling & Assistance Program) counselor-trained by Office for the Aging. She does not sell insurance or represent any insurance company. She is an unbiased source of insurance and education to help seniors choose the best option for them.