(This post originally appeared in the Times of Israel)
As the owner of a Geriatric Care Management company, I know first-hand how agonizing it is for adult children to make care decisions for a cognitively impaired parent who has not made his or her wishes clearly known or enabled anyone to make the decision. And I know exactly what needs to be done to avoid it. But when it came down to sitting down and doing it, I stalled.
I’m not alone, I know. There are loads of studies out there that show that, despite the tremendous importance of advanced planning, a significant number of us haven’t done it.
Why the resistance? There are many reasons…. Fear of confronting our own mortality, fear of giving up control, anxiety about the expense involved, avoidance of what will be a tough conversation with our loved ones, especially where family dynamics are complicated. And anyway, here in Israel we have great faith in the national motto of hakol yehiye beseder – everything will be OK.
But when we got hit with Covid-19, ‘everything will be OK’ went right out the window. I took a deep breath and dove in – and convinced my parents to as well. I hope you and your loved ones will do the same. Here is what you need to know:
1. Advance planning is a process. It is much more than simply signing a bunch of documents and filing them away in a cabinet. It requires reflecting on your current health status, values and preferences. And it requires an open conversation with your loved ones. A trusted professional like a Geriatric Care Manager can guide you through the conversation and can also mediate any challenging conversations or family conflicts that may arise. There are many online tools available as well, like this Conversation Starter Kit.
2. Take the time to organize all your important documents and financial information so it will be easier to manage safely as you get older, and so that a loved one can easily step in to take over when needed. Our Planning Toolkit can help you get started – click here to download your free copy.
3. Work with a qualified elder care attorney. One you feel comfortable with, who will provide you with all the information you need to make decisions, who will explain things clearly in your native language and who will be available for your questions and concerns. Once you have decided on your agent(s) and articulated your preferences, your attorney will create a personalized set of documents that may include:
- General Power of Attorney (יפוי כח כללי נוטריוני ): This document appoints someone who can handle administrative matters for you if needed, such as going to the bank or government offices. The General Power of Attorney is valid for as long as you have full cognitive capacity and can be useful if you have limited mobility or if you or are out of the country for an extended period of time.
- Ongoing or Continuing Power of Attorney (יפוי כח מתמשך): Similar to what is known in the U.S. as a Durable Power of Attorney, the Ongoing POA allows you to choose in advance a person(s) who will handle medical, personal and financial affairs for you in the event you lose cognitive ability to do so yourself. The Ongoing POA can include lifestyle decisions such as moving to a care facility as well as medical decisions but does not cover “end-of-life” decisions. The Ongoing POA offers a great deal of flexibility – you can nominate as many people as you wish, and can specify if they may act separately or if they have to make decisions together; you can limit the scope of their authority and make specific provisions concerning how your affairs are to be managed; and you can decide in advance who will make a determination of your cognitive capacity. This is a relatively new document in Israel and can only be prepared by an attorney who is specifically certified to sign and file Ongoing Powers of Attorney.
- End-of-Life Decisions: Pursuant to the Terminally Ill Patient Law (חוק החולה הנוטהלמות) there are two documents available to facilitate end-of-life decisions; both are subject to a medical determination that you are not cognitively capable of making your own decisions AND that you have less than 6 months to live. The Advance Directiveallows you to state, in advance, what kind of medical interventions you would want or not want in certain circumstances and a Power of Attorney appoints an agent who will make medical decisions for you. You can choose to sign just one of the documents, or they can be combined. This document is the closest equivalent in Israel to a DNR (Do Not Resuscitate) and DNI (Do not Intubate).
- Bank Account Longevity Clause (סעיף אריכות ימים): In joint bank accounts, this clause allows a surviving partner permission to continue using the account before a probate order is received. Without it, the account will be frozen upon the death of any member on the account, inaccessible by the surviving partner until a probate order is received. Most joint accounts today include a Longevity Clause, but older accounts may not have it.
Your attorney will also offer solutions for other specific concerns you may have, such as adding a family member as a signatory to a bank account or registering a warning note in the Tabo to prevent fraud. He or she will also help you check with your financial institutions if they have their own forms that must be signed in order to give another person the right to manage your assets and affairs.
A note about online documents. Some of the documents above are available online, but we advise to work with an attorney. These are important and complex decisions and you want to make sure everything is done properly. And make sure that both you and your agents have copies!
4. When choosing an agent
- Most people chose family members as agents, but you don’t have to. Your agent can be a family member, close friend or advisor.
- Knowledge is helpful. Someone familiar with medical procedures and treatments may be able to make better decisions as medical power of attorney; the same goes for someone with experience in accounting as financial power of attorney.
- You can choose more than one agent. For example, you can have one agent for financial power of attorney and another for medical. Or you can have multiple agents for both. This is can be a good way to spread the responsibility around, especially if there’s a good chance one of your agents might be unavailable when needed or overwhelmed by the tasks at hand.
- Above all, choose someone who you completely trust to always put your needs and well-being first. Feelings may get hurt when you choose one family member over the other – but at the end of the day it is your decision.
Preparing for aging is truly a gift to give yourself and your children. No one expects to have a stroke, or develop dementia, or manage a global pandemic. Covid-19 has been my wake-up call. I hope it will be yours too.