Advanced Planning For Healthcare And Financial Decisions
Advanced Planning for Healthcare Decisions
Durable Power of Attorney for Health Care Decisions
A Power of Attorney is a written document that you sign in which you authorize another person to act as your agent to make healthcare decisions for you.
There may be circumstances when you are hospitalized, but are not terminally ill, and unable to make your own decisions. In order for a power of attorney to be valid if you become disabled, you must create what is known as a “durable” power of attorney. A durable power of attorney states that it will be valid even if you become disabled. If it does not contain that language, your agent will not be able to use the power of attorney if you become disabled.
You can appoint someone to make healthcare decisions for you in a Durable Power of Attorney for Healthcare Decisions (DPAHC). An advantage of a DPAHC is that it may prevent the need for a formal guardianship. If you do not have a DPAHC and become unable to make your own decisions, someone may have to go to court to have you declared incompetent to be able to make decisions for you. Such a process is costly, time consuming and burdensome.
A DPAHC only becomes effective immediately, unless you state otherwise. However, so long as you can give informed consent, you can make your own medical decisions.
Please note, you must execute (or sign) the DPAHC before you are mentally incapacitated because it will not be valid unless you understand the nature and significance of it.
The DPAHC only lasts as long as you are living. Therefore, when you die, the DPAHC dies with you. You can also terminate it at any time by revoking it or by executing a new one.
Your Power of Attorney for Health Care can include an advanced healthcare directive, discussed below.
The Nevada Legislature created forms for powers of attorney for health care decisions located at Nevada Revised Statutes Chapter (NRS) 162A. See NRS 162A.860. A special Health Care Power of Attorney Form for adults with intellectual disabilities can also be found at NRS 162A.865 and adults with dementia at NRS 162A.870. This form uses language meant to be easily understood by those adults with intellectual disabilities and other cognitive disorders.
Advanced Healthcare Directive
An advanced healthcare directive is a declaration directing your physician to withhold or withdraw life-sustaining treatment if you have an incurable or irreversible condition. It will only go into effect if you are unable to communicate your desires, if you are in a coma for example.
One common question asked regarding the Advanced Directive is whether or not a doctor is allowed to provide any sort of pain relief or other comfort measures if such a document is executed. Nevada law specifically provides that even though you sign an Advanced Directive, the doctor or other provider of health care of the responsibility will give you pain medication and comfort measures.
In order to sign a living will, you must be of sound mind and eighteen years or older. The Advanced Directive must be signed by the creator and either attested to by two competent witnesses or a notary public.
An Advanced Directive is different than a DPAHC. The Advanced Directive is a limited document because it only covers the medical circumstances mentioned and does not designate a decision maker for the creator.
The 2015 Legislature created a form for end-of-life decision for adults with intellectual disabilities and adults with dementia. This form explains those decisions in an easy format so the adult with intellectual disabilities can understand what they are signing. See NRS 162A.865 and NRS 162A.870.
Physician’s Order for Life Sustaining Treatment (POLST) and Do Not Resuscitate Order (DNR)
A POLST is a legal document containing a physician’s order about medical interventions for the very frail elderly or those near the end of a progressive or terminal illness. The document expresses a patient’s wishes about very specific medical interventions that the patient may or may not desire. For example, the POLST can specify whether or not the patient wants CPR, feeding tubes, antibiotics, etc.
The POLST form must be signed and dated by your doctor and by you or your legal representative. It is important that you make the decisions on a POLST in conjunction with your medical provider.
The POLST should remain with the patient wherever they receive treatment. If at home, the patient can keep the POST on their refrigerator or next to their bed, locations emergency responders are trained to look.
The POLST can be used in conjunction with other legal documents such as DPAHC or Advanced Directive; however, if there is a conflict among the documents, the POLST will govern. You can obtain a POLST form at http://dpbh.nv.gov/Reg/DNR-POLST/EMS_-_DNR_POLST_Forms/.
Patients who are terminally ill may also qualify to obtain a Do Not Resuscitate Identification (DNR), which instructs pre-hospital emergency medical services personnel to withhold life resuscitating treatment in the event of cardiac or respiratory arrest.
PLEASE NOTE: To obtain a DNR, patients must fill out an application with the State and provide a certification from their physician that they are terminally ill and otherwise meet the requirements. The application is available at http://dpbh.nv.gov/Reg/DNR-POLST/EMS_-_DNR_POLST_Forms/.
These patients may be able to obtain bracelet or medallion to identify their DNR status.
Secretary of State’s Living Will Lockbox
A DPAHC, Advanced Directive, or POLST provides very specific instructions for end-of-life care and is an opportunity to tell health care professionals and family members what you want as far as life sustaining or other treatment. When healthcare professionals and others do not have access to such a document even though you have created one, they will not know your wishes in an emergency.
The Living Will Lockbox is a secure, virtual lock box in which Nevadans can file certain directives, including advanced directives, powers of attorney, and “do not resuscitate” (DNR) orders for access by designated health care professionals, and family when medical treatment decisions must be made.
There is no cost to file with the Lockbox.
Once you have a directive document, you can register it with the Lockbox online at File Advance Directive | Nevada Secretary of State (nvsos.gov).
Seven to ten days after filing your directive with the Lockbox, you will receive a letter confirming that the documents have been securely filed. You will also receive a registration number on a wallet-size card and instructions for accessing the Lockbox, viewing the documents and making changes.
Advanced Planning for Financial Decisions
Power of Attorney for Financial Decisions
A power of attorney is a written legal document that gives another person the right and authority to act on your behalf. The reason most people sign a power of attorney is to enable another person to manage their affairs if they become disabled and cannot manage their own affairs.
The scope of a power of attorney for financial decisions can be limited or broad. For example, you can authorize your agent to simply pay your bills or you can give your agent the power to handle nearly all your financial affairs.
In order for a power of attorney to be valid if you become disabled, you must create what is known as a “durable” power of attorney. A durable power of attorney states that it will be valid even if you become disabled. If it does not contain that language, your agent will not be able to use the power of attorney if you become disabled.
When you sign a Power of Attorney for Financial Decisions, you can make it effective now or make it effective only if you become disabled in the future. If you power of attorney becomes effective upon disability, you agent will not be able to do anything until and unless you become disabled. The power of attorney will usually require a doctor’s certification of disability in order for your agent to act. If you make it effective now, your agent will have the ability to handle your affairs immediately. One of the benefits of a power of attorney that is effective immediately is that your agent does not have to produce a certification of disability from a doctor every time he needs to use the power of attorney.
Some people do not want to sign a power of attorney that is effective immediately because they are afraid that they will be giving up control to someone else. The act of signing a power of attorney does not mean you need to stop handling your own affairs. If your intent is that it only be used in the future if it is needed, then that needs to be clearly communicated to your agent.
You should be absolutely certain that your chosen agent is both capable and trustworthy. Some people do not want to sign a power of attorney that is effective immediately because they do not really trust the person and want to retain control as long as possible. If you do not trust the person you are appointing, then you should not appoint them as your agent at all.
Please note, the Power of Attorney has to be executed before the principal is mentally incapacitated because it will not be valid unless the principal understands the nature and significance of the power of attorney.
A Power of Attorney only lasts as long as you are living. Therefore, when you die, the power of attorney dies with you. You can also terminate a power of attorney at anytime by revoking it or by executing a new power of attorney.
If you sign a Power of Attorney for Financial Decisions, it is a good idea to check with your bank and other financial institutions to make sure they will honor it. Some banks have their own forms they want you to fill out and will not honor a power of attorney that has been done elsewhere. Because a power of attorney does not have the same effect as a court order, a third party, such as a bank, does not have to honor it.
A representative payee is a person, agency, organization or institution that is selected by Social Security to manage the recipients funds when they are unable to do so themselves. The job of the representative payee is only to help the beneficiary with money management. Before a payee is appointed, Social Security will evaluate medical and other types of evidence in order to determine whether a recipient can manage their benefits on their own.
Please note, a power of attorney does not give someone the authority to act as your representative payee.
To apply to become a representative payee, you should visit the Social Security website at http://www.ssa.gov/payee/.