Resources for Advanced Directives

While we know we need advanced directives, many of us have not taken the steps to create this document.  Here are several resources:

1.      Five Wishes, https://www.agingwithdignity.org

2.     PREPARE^TM for Your Care, https://www.prepareforyourcare.org/welcome

3.     Put it in Writing: American Hospital Association (AHA),  https://aha.org/2017-12-11-put-it-writing

4.     The Conversation Project, http://theconversationproject.org

This website also has resources for communities to create a Conversation Project Sabbath.  Log on and share the information with your clergy.


And, of course, there is always an attorney who can help you work through your decision making process.

Writing an Advanced Directive is Hard

The Washington Post August 12, 1029 issue contained an article written by an ICU nurse.  She discussed her hesitation and indecision to write a living will, yet she sees the agony when families of patients under her care do not have one.  According to her information based on a 2017 study, only one-third of Americans have any sort of advanced directives. And this statistic includes health care professionals.


So why is their such a gap between thinking about advanced directives and actually creating them?


“The first barrier to advanced-care planning is often understanding what is involved…. An advance directive is a document that usually includes two separate elements: naming a health-care surrogate and creating a living will.”


The author points out the difficulty of looking at a form that may not have any bearing on the patient’s condition.  When a person is healthy and creating a living will, fantasizing about what may happen in the future can be a useless exercise.  The suggestion is made to appoint a surrogate or health care power of attorney with whom you can talk to about what you really want and about what’s really important to you when you are facing end of life decisions.


Another barrier to creating the document or discussing the issues with family is fear of talking about death.  So how do we overcome the fear?  Perhaps by “Framing end of life planning as a service to loved ones…”  The author of the article filled out “Five Wishes” which is an online document. She named a health care proxy and two backups.  She then wrote she did not want her life to be artificially prolonged by machines. She then had 2 friends witness the document which was legally necessary in her state and she put the form in her file cabinet.  


The important element is she has shared the location of the document with the important people in her life.  It’s great if one takes the steps to create the documents only to hide the documents where no one will find them.  


If you would like to read to entire article, look for “I’m an ICU nurse.  I know I need an end-of-life directive. So why can ‘t I bring myself to write it?” by Andrea Useem, August 12, 2019, The Washington Post. 

What are your thoughts about this dilemma?  Do you have advanced directives and a health care proxy?

Photo by Andy 'Thrasher

Payment for Caregivers

Several months ago an article appeared in the local newspaper about being compensated for family caretaking.  While I knew about programs for low income families in my county, I was not aware of concerns for middle and upper income families.  It seems that if the individual made gifts to their caregiver and then went into a skilled nursing facility and applied for Medicaid, the individual would be under the “5 year lookback” period (monies that were given to others for 5 years prior to the application for Medicaid) and if the amounts were substantial, the gifts might create an ineligibility period for Medicaid.

The attorneys (the authors of the article) suggest creating a written document that spells out exactly what services will be offered and the reasonable amount of money given for each service.  For example, with meals (who will do the shopping, cooking and cleaning up), who will do home maintenance, who will do the bookkeeping (bill paying, balancing the checkbook), and who will provide transportation (who buys the gas, services the car, pays for insurance and/ or car payments).  Also, it is suggested that a written log be kept of the time and money spent. 

Record keeping is essential.  Look into a “Caregiver Agreement” with an attorney to make sure the individual will not be penalized if he/she needs to go on Medicaid.  Also, talking with an attorney may educate you as the caregiver about your responsibility to report your income to the IRS. 

Thoughts?  Comments? 

We've Moved

But are we organized?  We unpacked, hung a few pictures, continued to give away “stuff” that couldn’t fit in the space and now we are reorganizing.  Take heed, if you are planning a move, add several months to the timetable to reach that sense of “moved in”. 

Of course, during the process, life continues:  laundry, grocery shopping, pre scheduled appointments, cooking, etc.

Lessons learned:  complete post office change of address forms 6-8 weeks in advance of the move; contact credit card companies, insurance companies (health/car/homeowners/renters/life), family members, doctors, financial services, mail service pharmacy, shopping sites that have your address preprogrammed in their system, charities you may want to receive mail from, and any other contacts from whom you receive mail.  Go to AAA or go online for a change in driver’s license and owner’s card.  To easily donate clothing or small household items, keep a few large bags or small boxes in which to put things that you thought you could use and now realize you can’t.

And after the move is completed and the organizing/reorganizing is done, sit back and celebrate.  You are entering a new phase of your life.  Focus on the positives, the negatives will always be there.

And think about the following: Does my will need to be changed?  Do I have a secure place for my important papers and do the important people know the location? 

Please share this and encourage your friends to subscribe.  My goal is to have 100 subscribers by the end of 2019.

Moving/Downsizing=Stress

I’m pretty good about dealing with the ends of a Bell Curve.  Extreme sadness or medical issue can be dealt with; joy and jubilation can be dealt with.  But this slow stream of having to give up things that have been a part of me is really, really difficult.  Intellectually, I understand that in order to have room for the new, the old needs to be discarded.  But, boy, it is difficult.  I also understand that the less “stuff” one has, the easier it is to clean the space….mentally and materially.

We are moving into a space one half of the current footprint.  When I agreed to move, I didn’t expect to find a new location so quickly and I didn’t expect the experience to be so tumultuous. 

Selling things conjures up feelings of sadness, fun, excitement, and resignation.  To have a house sale or not; to sell pieces individually on Craig’s List or eBay or Facebook Marketplace or not; to donate or not; to locate a consignment shop or not.  And of course, all this while trying to keep the daily routine and responsibilities.  Whenever I think about or utter the word “trying”, I remember a comment by Tony Robbins who said something like “trying” is not doing.  So I will rewrite the above phrase:  all this while keeping the daily routine and responsibilities.  I actually feel better.  Less overwhelm. 

Lessons learned from selling a house: 1) the less cluttered it is, the better it shows; 2) the cleaner it is, the better it shows; 3) the better your paperwork, i.e., the dates, companies, improvements made, the easier the disclosure form can be completed and the more accurate the written description for the house ads becomes; 4) lower expectations for meal prep during the time the house is on the market makes for less stress; 5) every day is a day in which the perfect buyer will see the house so every day the house must look pristine.

I will be speaking to an AARP group later this month about my blog and my mission to encourage people to organize their intentions so that those who inherit the responsibility to deal with the person’s incapacity or death will actually know where things are and what to do. 

Contact me if you have a Pittsburgh group that would be open to having me speak. 

An Organizing Hiatus

I have been working on downsizing my photo collection for about a year.  What I thought would be a 6 month project is, well, much more involved that I imagined.  I think I am about half way and other, more pressing projects are coming up so back on the shelf go the albums and boxes that have been sitting on my work station. 

What has taken so long is the memories the pictures hold.  So I stop and remember and the time flies by.  I have managed to scan photos and old film and have the film transferred to DVD.  I even learned how to make copies so each of my kids will have one.  The photos have been uploaded to photo books and as I write this, I am waiting for slides that I found to be scanned.  These will also be uploaded and described in book form.  My kids will not know the people in the pictures unless I tell them.  They will not know me as a young woman and my grandkids will certainly not know the brown haired girl in the photos as their gray-haired grandmother. 

Reviewing the photos has rekindled my interest in genealogy.  While there’s tons of information available- many resources for free- the search takes an inordinate amount of time. 

If anyone in cyberspace is working on similar projects, let us know how you are faring.  We are works in progress no matter what our age.

The Final Gift

My dear friend was murdered on October 27, 2018 during the attack on the synagogue in Pittsburgh.  People have written much more eloquently than I about the feelings and emotions of this horrific day. This blog is not about my feelings.  This is about decision and action with a topic I feel strongly about.

One of the comforting actions my friend’s wife did was to follow the instructions he left for his funeral and burial.  This family had THE CONVERSATION.  The wife knew which funeral home, which cemetery, and what kind of service her husband wanted.  Certainly he had no way of knowing that someone was going to kill him.  He left home that Saturday morning as he usually did.  Nothing out of the ordinary.  When his wife heard about the shooting, she called him and couldn’t raise him.  Then she knew even before law enforcement showed up at her home.

She also knew that way back they tackled the hard conversation and she knew what he wanted to happen when he died.  They both thought they had many years to live before the actions needed to be carried out.  The challenge is—we don’t know what will happen in the next minute.  THE CONVERSATION IS like an insurance policy- you hope you never need it but when you do, you are glad it’s there.  So have that conversation with your family.  Give your family the opportunity to give you the final gift of carrying out your wishes. 

Let me know your thoughts. Share your experience with others.  While this is not necessarily a cocktail party conversation, it really could give depth to such chit chat.  I find most people either stop me in my tracks and tell me they don’t want to talk about it or they open up with sad stories from their past. Yet getting them to commit to having THE CONVERSATION with their own loved ones is difficult.  The more we talk about it, I hope the easier it will be for people to take action.