6 Decisions to Make Before You Die

Decide who will handle your medical and financial affairs

Senior couple with lawyer
Conversations about where you want to spend your final days or who will inherit your house after you die are difficult, but the consequences of failing to plan can be financially and emotionally draining for your family. Knowing your wishes have been followed will give you and your loved ones peace of mind.

Research by Todd Whatley, an elder law attorney and adjunct professor at the University of Arkansas School of Law, shows that 70 to 80 percent of elder adults do not have advanced directives – legal documents that give instructions about end-of-life care.

“No age is too soon” to create the documents, says Howard Krooks, president of the National Academy of Elder Law Attorneys. Though the trigger for getting these documents together is typically aging or facing a life-threatening medical condition, Krooks points out that even 18-year-olds no longer fall under their parents’ guardianship. If getting hit by a car leads to a coma, a judge would become involved to appoint a guardian to make medical decisions.

[Read: Dear Sons: Can We Talk About Death and Dying?]

A variety of documents, such as a medical power of attorney, living will and last will and testament, will lay out your instructions for end-of-life care. They will cost about $100 to $250 each, but without them your family will pay about $5,000 in legal bills, Krooks says. There are some documents available online, but Krooks recommends going through an attorney because planning must be carefully assembled and individualized.

Instructions can be as specific or general as anyone wants to make them, and you can change your mind about what you want at any time, says Ruta Kadonoff, vice president of quality and regulatory affairs for the American Health Care Association. Greg Crist, senior vice president of public affairs for AHCA, says the process does not begin and end with a single conversation. “It’s not easy,” he says. “These are topics people tend to run from, not to.”

If you are being admitted into a nursing home, the director of social services will help you understand what documents you need and tell you and your family how to obtain them, Kadonoff says.

Experts say the following six documents should be in place:

1. Medical power of attorney. Also known as a health care proxy or health care surrogate, this document allows you to appoint someone to make medical decisions on your behalf when you are unable to do so. Whether you’re in a vegetative state, can no longer understand medical instructions because of advanced Alzheimer’s disease or can no longer communicate, you’ll need someone to pass on your wishes to your health provider. Your doctor will determine when you are unable to make your own medical decisions. When this happens, the person you selected for medical power of attorney, or your “agent,” will make medical decisions on your behalf.

Choose someone you trust and someone who knows what your wishes are, Krooks says. Your agent – often a family member, but sometimes a friend or neighbor who may live closer – will communicate your decisions about end-of-life care. Would you want everything possible done to keep you alive if you were declared brain dead and on a feeding tube? Would you want to undergo surgery if your chance of survival was low? Would you agree to trying a new medication? An attorney can help you understand what details you should include in your document and what your options are.

If you do not have this document and are incapacitated, a court will appoint a guardian for you. Some states have laws about whom these decisions fall to. Without having this document, Kadonoff says, you’re leaving decisions to someone who may or may not be the person you would have chosen.

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2. Living will. You can detail in a written statement which medical treatments and measures you do and do not want undertaken when you become incapacitated. This document addresses whether you want to be kept alive by machine, such as a ventilator or feeding tube. Some people want to be kept alive at all costs; others would prefer to end all measures for resuscitation.

Without this document, families could have serious disagreements, or someone who doesn’t share the individual’s values may be making the decisions. “You’re saving your family from making wrenching decisions for you without knowing what you would want,” Kadonoff says.

Creating the document saves money for taxpayers as well. For example, Whatley says Medicare could save 10 percent if more people had a living will. People often are given lifesaving treatments and extensions to their lives that they would not have wanted, he says.

[Read: A Crusade to Talk about End-of-Life Care.]

3. HIPAA form. People named in HIPAA forms have access to your private medical records. You could name the agent from your medical power of attorney, or additional friends and family members who may want to speak together to evaluate options and make medical decisions on your behalf. Families could also want this document to help doctors evaluate their own medical history.

4. Last will and testament. What happens to your property and assets after you die is determined by your last will and testament. You determine who receives your real estate, jewelry, savings, investments and any other assets you have. A home you own jointly, such as with your spouse, would automatically go to your spouse. If you have digital assets such as blogs or social media accounts, you may will the login and password. An “executor,” typically a lawyer that you choose, is responsible for making sure your will is carried out.

A court decides who receives the assets in cases where a last will and testament does not exist. In the case of a home, for example, a court would likely decide that three siblings share it equally. “But what if you didn’t want that?” Whatley says. “What if there was one child you were estranged from?”

Most importantly, a will appoints a guardian for your children if they are minors. You could also will your pets – pet trusts are growing more common, Krooks says. In this case, people set aside enough money to properly care for their pet, determine who becomes the owner and make sure the animal receives medical attention.

5. Financial power of attorney. When you give someone financial power of attorney, you are giving that person the right to access all or portions of your finances. The document goes into effect immediately after it is signed. You may decide to do this so you have someone you trust to help you with handling your expenses, such as medical bills, tax returns or withdrawing money from the bank. This person would also be in charge of your finances when you become incapacitated.

Failing to procure this document results in a costly legal battle for your family in which a court will select a guardian.

6. Letter of instruction. Though you will not need an attorney for this document, it could be important in guiding your loved ones during their time of grief. The letter gives information about how to conduct your funeral service, whether you want to be buried or cremated, and whom to contact after you die. It is often a good idea to prepay for your funeral if you are able, Krooks says, because it is overwhelming for families to handle the details in the midst of their loss.

[Read: Making Sure Your End-of-Life Wishes Are Followed.]

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