Posts Tagged ‘health care power of attorney’

Agent On Power of Attorney is Personally Liable for Legal Fees

MARCH 3, 2014 VOLUME 21 NUMBER 9

Let’s say that Billy signs a power of attorney, naming his friend Joyce as his agent. Later Billy becomes incapacitated, and his agent needs legal advice about her rights and responsibilities. Who will pay for their legal advice?

Generally speaking, you are not supposed to have to spend your own money for things you need to do while acting under a power of attorney, and that includes getting legal advice. But the real world can sometimes get in the way — Billy’s assets may be insufficient to pay legal fees, there may be a dispute about whether his agents are acting in his best interests, or there may be personal interests that they are simultaneously promoting.

This concern is not academic, at least for the people involved in a recent Arizona Court of Appeals decision. “Billy” in that case was Billy Preston, who was sometimes tagged as “the fifth Beatle.” He became seriously ill in 2005, and was admitted to a hospital in Phoenix; he died in June, 2006, after months in a coma.

Billy had signed a medical power of attorney in 2004, naming his friend Joyce Moore as health care agent. Joyce was already his agent — she had represented him as a musician for some years before he signed the health care power of attorney. In March, 2006, while Billy was comatose, his half-sister petitioned the Arizona probate court to be named Billy’s conservator. Although Joyce’s power of attorney put her in charge of medical, not financial, decisions, she felt that she needed legal advice. Joyce hired a Phoenix law firm to represent her; she signed a retainer agreement on March 30, 2006.

Apparently, Joyce and her lawyers did not have the same understanding of their relationship. While Joyce later testified that she thought her lawyers represented her only as health care agent for Billy, her lawyers insisted that they represented her as an individual because of her financial dealings with Billy.

Joyce insisted that her lawyers should submit their bill to Billy’s estate; whether or not that made sense, it was an impractical way to secure payment since the Billy Preston estate had declared bankruptcy. In fact, the estate sought (and recovered) some of the retainer fee Joyce had given to her lawyers, since it had come from Billy’s estate and had not been approved by the bankruptcy court.

Three years after Billy Preston’s death, Joyce’s attorneys sued her personally for about $30,000 in legal fees. Joyce argued that she was not personally liable for the bill; a fee arbitration process found otherwise, and awarded $13,550.86 in legal fees and costs to the law firm. Joyce appealed and set the dispute for trial.

After a three-day trial, an Arizona jury ruled that Joyce personally owed her lawyers $20,000. Joyce appealed the judgment. Last week the Arizona Court of Appeals upheld the award of fees and costs to Joyce’s lawyers, finding that she had not produced sufficient arguments to overcome the jury’s award. Burch & Cracchiolo, P.A. v. Moore, February 27, 2014.

The ruling itself is not actually all that revealing. Joyce represented herself for the appeal, and did not submit transcripts of the trial proceeding; in the absence of those transcripts, the appellate court ruled that she could not show that there had been mistakes in the trial court. The real value of the case, for our purposes, is a chance to explore the authority of agents under powers of attorney to hire lawyers (and other professionals).

There is little doubt that an agent can hire an attorney, accountant, physician or other professional as may be needed in order to discharge their obligations as agent. So, for instance, it would be easy to imagine a circumstance in which there were legitimate legal questions about the agent’s authority, or powers, or duties, and hiring a lawyer might well be necessary and appropriate to help figure out the answers to those questions. That lawyer’s fees would ordinarily be charged against the estate of the principal (the person who signed the power of attorney).

Similarly, it would be easy to imagine that a financial agent might need to hire an accountant to prepare tax returns or accountings, or to investigate past transactions. Those charges should be paid by the estate in most cases, too. Same thing for hiring a doctor, or a social worker, or a case manager, to help oversee care of a person who has signed a health care power of attorney.

Problems can and do arise when the agent also has business dealings with the principal before the power of attorney is signed or used — and such circumstances do happen. After all, it often makes sense to name your business associate to manage your own finances — typically they might know more about your finances than others, even family members. But that can complicate the responsibility to figure out what the attorney (or accountant, or medical professional) is doing for the agent as agent, and what is being done for the agent as an individual.

It’s hard to tease out how much of that might have been going on in Billy’s case, since the appellate record is sparse. But confusion between the lawyers’ view of their role and the client/agent’s view is not that uncommon; it’s why a fee agreement should spell out the precise relationship and who will be responsible for payment.

Typically, a lawyer’s fee agreement might provide that bills will be submitted to the principal’s estate. If they are not paid for any reason (even though that failure or refusal of payment might be challenged), the fee agreement often will provide that the agent is responsible for payment and for seeking reimbursement from the estate. Such a provision might have been in Joyce’s attorney’s fee agreement, but the appellate court did not mention it.

Does all that mean that you should refuse to act as agent because  you might incur personal expenses if things go awry? If you are very skittish about the possibility, you should consider whether it is important enough for you to decline. In the real world, however, disputes like this are rare — and your loved ones need someone to step up and take responsibility for their care if and when they are unable to do it themselves.

More Definitions for Estate Planning Terms

FEBRUARY 10, 2014 VOLUME 21 NUMBER 6

Last week we gave you short definitions of some common estate planning terms, like “will” (and “pourover will”), “trust” (including both “living” and “testamentary” trust), “grantor trust” and more. This week we want to continue that project with another batch of common terms:

Durable power of attorney — sometimes called a “financial” or “general” power of attorney. The key is that the power of attorney continues (or becomes effective) even if you become incapacitated. This is simultaneously the most important and most dangerous document that most people will sign with their estate planning. Why dangerous? Because it gives such broad, mostly unchecked power to someone else to handle your finances.

Living will — a document by which you give directions about how you would like to be cared for (or what care you would prefer not to have) at the end of life. That’s not the only time the living will is effective (or important), of course, but that’s what people usually think of. This is the document you might sign to direct that you not receive artificially-supplied food and fluids at a time when you are no longer able to make decisions yourself. OR you might direct that you DO want food and fluids (and/or other care) provided in such a situation.

Health care power of attorney — you can designate someone else to make medical decisions for you if you become unable to make or communicate decisions yourself. That person is called your “agent” or “attorney-in-fact,” and the document that names them is your health care power of attorney. That’s the term usually used in Arizona, by the way — other states might use different terms for the same concept.

Advance directive — any document by which you provide for medical decision-making in the event that you become incapable is called an advance directive. The most common advance directives are health care powers of attorney and living wills, but there are others. In Arizona, for instance, you might have an advance directive about mental health care decisions, or rejecting resuscitation measures, or even giving someone authority to decide when you should stop driving. These are a little bit more specialized, and you should talk with your attorney about them.

UTMA accounts — UTMA stands for “Uniform Transfers to Minors Act”, and it refers to a law that has been adopted in some form in every American state. It amounts to a simple sort of mini-trust set out in the law — rather than pay to have a trust set up for a minor, you can simply make a gift to a UTMA account. That makes it easy and inexpensive. It also means that you are stuck with the terms of that legislative trust, but it’s one way to make gifts to children and grandchildren.

529 plans — as long as we’re writing about children and grandchildren, we should mention these popular methods of making gifts. “529″ refers to the section of the Internal Revenue Code which both permits and governs these accounts. Once again, it is a simple and inexpensive way to make a gift to your child or grandchild, provided that the primary purpose of your gift is to pay for future educational costs. Ask your attorney (and also your accountant and financial planner) for more information and direction if this idea seems appealing.

“Crummey” trusts — sometimes called “irrevocable life insurance trusts” (or abbreviated as ILITs), these trusts are a method of transferring assets (often, but not always, life insurance) to future generations without making the gift outright and absolute. The nutshell version: you make a gift of less than the annual exclusion amount (see below) to a trustee, and the trustee notifies the beneficiary that they can take out the gift. When they don’t remove the gift, for tax purposes the transfer is treated as having been made by the beneficiary, so the gift is deemed to have been completed. These trusts are often used to allow gifts of the annual premium amount for life insurance, or to make gifts without giving the beneficiary a chance to misspend the gift.

Annual gift tax exclusion amount — there is a tremendous amount of misunderstanding about this concept. In 2014 you can make a gift of up to $14,000 to any person without having to explain yourself to the Internal Revenue Service or anyone in the federal government. Your spouse can do the same thing — even if it is your money that funds the gift. You (and your spouse, if he or she participates) can do the same thing for as many individuals as you’d like. Here’s the misunderstanding part, though: if you give, say, $20,000 to one person, that doesn’t mean you pay an gift tax, or you have to get government approval. It just means you have to file a gift tax return — and if the amount you total up from all of those returns over your lifetime gets to $5,000,000 (it’s actually more than that, but we’re trying to make this simple) then you might have to pay a gift tax. This $14,000 figure, by the way, has absolutely nothing to do with Medicaid eligibility (yes, you can make a $14,000 gift — but it might make you ineligible for Medicaid even though it’s blessed by the IRS).

And, finally, this perennially popular concept/term:

EINs — “Employer Identification Numbers” are issued by the Internal Revenue Service for probate estates, trusts, and other entities that might have to file income tax returns. When someone asks for your “TIN” they mean that they want either your individual Social Security Number or the appropriate EIN. Even if the trust or estate does not have employees (and even if it never will) it still gets an Employer Identification Number (EIN). Does your trust need to have an EIN issued? That is an enduringly popular question, which we have addressed several times before (and undoubtedly will again).

Are You an Organ Donor? Are You Sure?

JULY 15, 2013 VOLUME 20 NUMBER 26

Do you have strong feelings about being an organ donor? It is a topic that too often goes undiscussed while preparing your estate plan. That’s one time to consider whether you want to be an organ donor — particularly if you have meant to address it but haven’t gotten around to the topic.

You probably remember the last trip you took to update your driver’s license, but maybe you cannot remember if you ever registered to be an organ donor. Or perhaps, you’re a registered donor, but have not had a conversation with your friends and family about your decision to donate. Maybe you feel strongly that you do not want to donate your organs. In each of those circumstances, it is important to make your wishes clear and to talk with your family and your attorney about the topic.

The National Conference of Commissioners on Uniform State Laws adopted The Uniform Anatomical Gift Act in 1968 and went on to revise the Act most recently in 2006.  Arizona is one among over forty states that adopted the newer version of the Act. Arizona Revised Statutes §§36-841 (and the 20-or-so following statutory sections), lays out the groundwork for making an organ donation in the state. Arizona is unique in that it is one state where a donor may register and select what specific organs he or she wishes to donate.

But how do you become an organ donor in Arizona? If you are 18 years or older, you can become a donor by registering with Donate Arizona, or including written instructions in your will. Additionally, you can include language in your power of attorney that authorizes your Agent to consent to donation. Even if you never register, you can still become a donor if you include language in your will or power of attorney providing your agent with authorization to donate on your behalf. It is never too late to sit down and make your wishes clear.

Kris Patterson, with the Donor Network of Arizona, encourages people to do three important things if they wish to donate: register with a local network; talk to your family and friends about your desire to become a donor; and let your doctors determine whether you are a good candidate to donate.  She explained that people frequently assume that they are too old to donate, or rule out registering to become a donor because they have a bad heart or bum hip. When it comes down to it, there is no litmus test that identifies whose organs can be used.

The Act lists people in order of priority who may provide consent upon your death to become (or not become) a donor. The person who you appoint as your Agent under your power of attorney is first in line. If you do not appoint an Agent, the Act provides that a family member, a guardian, or friend, and in certain cases, even a domestic partner can share your decisions about organ donation with medical personnel after your death. As a last resort, you can always include instructions about organ donation in your will.

So, take a moment to think, have you made a decisions about organ donation? If so, does your family know? Have you been thinking about making an appointment to update your old will or power of attorney? If so, when you come in to see us, let’s talk about organ donation and make sure that your documents reflect your decisions.

Executive summary:

Want to make sure you are an organ donor? If you are an Arizona resident, do these three things:

  1. Fill out the Arizona donor registration form. Include any special provisions (like approval or refusal for individual organs, preference for transplant over research or the reverse, or anything else you feel strongly about).
  2. Include a provision authorizing organ donation in your health care power of attorney.
  3. Talk with your family — especially the agent on your health care power of attorney AND any family member who might not approve of organ donation.

Want to make sure you are NOT an organ donor? Do these two things:

  1. Make your wishes clear in your health care power of attorney (and maybe in your will as well).
  2. Talk with your family — especially the agent on your health care power of attorney AND any family member you think might really want to approve organ donation.

 

 

Privacy and Medical Records: A Few Words About HIPAA

JUNE 3, 2013 VOLUME 20 NUMBER 22
A delightful, intelligent and witty client of ours (nearly all our clients are delightful, intelligent and witty) visited her podiatrist’s office. Our client has always battled problems with her weight, so when an assistant insisted that she step onto an office scale she declined. I’m pretty sure, she said, that my podiatrist doesn’t really need to know my weight, and I just don’t like scales. The podiatrist’s assistant smiled understandingly but insisted. “I’m sorry,” she said, “but we have to take your weight on each visit. It’s required by HIPAA.”

Experienced elder law attorneys and people working in the medical field will likely have laughed out loud at that story. It is a good illustration of just how misunderstood HIPAA really is.

HIPAA, for those less familiar with acronym-speak, is the Health Insurance Portability and Accountability Act of 1996. As the name of the law indicates, it has been around for nearly twenty years, though it came to more prominence in 2003, when the first round of regulations implementing the law became effective. HIPAA has since been blamed for all manner of silliness — including the mandatory weigh-in at our client’s podiatry office, the “please stand behind this line” sign at your local pharmacy counter, and (our personal favorite) the sign-in sheet at your doctor’s office that variously requires either your first (only) or last (only) name — apparently on the theory that your privacy is better protected when the receptionist shouts out “Mr. Johnson?” or, in another office, “Dave?”

What does HIPAA actually provide? It mandates that your health care providers — pretty much all of them — keep your records and data confidential. It is an attempt to prevent sale and recirculation of identifiable data. You would probably not want your name added to a list of people diagnosed with a given condition, and then sold to an insurance company, or a medical supplier. HIPAA is on your side.

But here’s the more difficult part. HIPAA doesn’t mandate that doctor’s offices treat you like (or actually issue you) a number to hide your name. It doesn’t require that you weigh in at your podiatrist’s. It doesn’t prevent the hospital where you are being treated from communicating with your doctor’s office or your pharmacy. It also doesn’t give you the right to sue your doctor, hospital or pharmacist for violating your privacy.

What does get prosecuted under HIPAA? Not much. Last year, according to the US Department of Health and Human Services, there were about 10,000 HIPAA complaints received. About two-thirds of those were dealt with summarily, and another large segment are deemed to involve no violation at all. That leaves about a quarter of all cases in which some sort of corrective action is mandated — which does not mean fines, or criminal prosecution, or even public disclosure of offending offices or providers.

From time to time there are serious fines levied. Just last month, for instance, Idaho State University paid a $400,000 settlement for disabling its firewall protection on servers housing patient data on almost 20,000 individuals cared for in its clinics. And just a few months earlier, Hospice of Northern Idaho agreed to pay $50,000 to resolve violations centering on the theft of an unencrypted laptop containing records of 441 hospice patients. The Hospice of Northern Idaho case was a landmark, according to the Department of Health and Human Services: it was the first time the agency had entered into a settlement involving security breaches involving fewer than 500 patients.

Obviously, the privacy regulations governing health care providers have a big impact on the provision of services and on patients. But what does this have to do with lawyers — especially since lawyers can not file lawsuits on behalf of clients who believe that their HIPAA privacy rights have been violated? It is the doctrine of unintended consequences writ large: lawyers who draft estate planning documents for clients want to be sure that they will be effective at a later time when the client may not be able to give consent. But there is concern that doctors, hospitals and other health care providers will not deal with family members, even if they have been named as agent in a properly drawn power of attorney.

We should not have to worry. The Department of Health and Human Services has made clear that it permissible for medical providers — including doctors, pharmacists, nurses and social workers — to talk with family members unless the patient has expressly forbidden such conversations. Among the frequently asked questions prominently listed on the DHHS website is this one:

“If I do not object, can my health care provider share or discuss my health information with my family, friends, or others involved in my care or payment for my care?”

The answer, in a word, is “yes.” Read the DHHS answer for more detail.

Much of the hyperbole about the reach of HIPAA, and the difficulty in complying, is just silly. Your doctor is supposed to have a plan for protecting your health records, and not to share them inappropriately. That should not preclude talking with either your family or your other health providers (hospital, pharmacist, social worker). But to be safe, your health care power of attorney, your financial power of attorney and even your revocable living trust could include a provision expressly authorizing your agent and trustee to talk with your doctor when it is necessary to get updated medical information.

And our client with the anxiety about stepping on the podiatrist’s scale? We explained the law to her. “That’s just silly,” we said. “HIPAA doesn’t mandate that they weigh you at every visit. That’s the Patriot Act.”

Driving, Aging and Dealing With Family Dynamics

APRIL 1, 2013 VOLUME 20 NUMBER 13
Driving. It’s an issue for seniors. And their families.

According to the Centers for Disease Control, drivers over age 75 are at particular risk for fatal accidents, and that risk continues to grow as those older drivers age. The CDC is candid: it’s hard to tell how much of that is related to increased frailty and susceptibility to injury, and how much is the result of worsening vision and slower reaction times. Ultimately, though, it doesn’t really matter: fatality rates are much higher for older drivers (on a per-mile-driven basis) than even for brand-new drivers under age 20.

When is it time to stop driving, and who is best able to tell the time has arrived? Or are those even the right questions to be asking? If you have an older family member, or you are aging yourself (yes, we know that that includes every reader), then you should be concerned about the issue. Fortunately, there is some help available.

First, let’s wrestle with what may be the biggest problems in encouraging a senior to drive less, or to stop driving: there is plenty of emotion and psychology involved, and there are too-few alternatives. It is seldom good enough to just insist on your parent or spouse giving up the car keys. You need to consider the problem from their perspective.

In our modern American culture, we tend to identify with our automobiles. I may favor a flashy, brightly-colored muscle car; you may prefer a solid, responsible and reliable set of wheels. My brother, on the other hand, might be a nut about saving gas. All three of us are making statements about our interests, preferences and personalities when we pick out a car. There is little else which says so much about us and simultaneously provides so much freedom.

So if you think I ought to stop driving, I am going to be very resistant. At root, my objections might be very practical — it’s too hard to get errands done, I don’t want to rely on anyone else, I’m not really driving that much any more anyway — but those objections will be more forceful because you are getting too close to my sense of self.

Before you tackle restricting the driving of an aging family member, it would be wise to review the arguments, prepare some strategies, and figure out what has worked for others. The good news: there are several good resources to help you with that project.

Let’s start with the AARP, which has done extensive work on driver safety and education. The AARP’s focus on aging drivers is unsurprising, but you may be surprised at how well they have analyzed the issue and how much material is available. Start with the online seminar called “We Need to Talk.” It will take about an hour (a little more if you stop along the way to scratch out questions or approaches, or if you re-review some sections). You may be surprised at how well it helps prepare you for your talk with a family member about your concerns.

Maybe what you really want is a review of driving skills, or a refresher course with emphasis on abilities that change over time. The AARP has some help there, too — it offers a link to driver safety courses for seniors. A quick check as we wrote this found three courses within a few miles of the Fleming & Curti, PLC, offices scheduled in the next month. Plus there’s an online version of the course, too.

Maybe you’re past this point with your family member. Can you disable the vehicle, force a review of their driving ability, or take stronger action? Yes, but first look at two publications produced by AARP, MIT’s AgeLab and The Hartford Insurance Company. One, “We Need to Talk,” is the basis for the AARP seminar described above. You can also order printed copies if you want to leave one lying around, or share with siblings or other family members. Copies are free, and you’ll get them in the mail in just a couple of days. While you’re online, you might also download or order “At the Crossroads,” another excellent resource offered by the same consortium.

Arizona drivers’ licenses are valid until age 65 without retesting (you do have to have your picture taken at least every twelve years or so). After 65 a driver has to take a vision test at least every five years, but there is no automatic retest for driving ability.

There is, however, one way to get a family member retested: any one who is concerned about driving ability can request a review for a family member, neighbor, patient or client (many of the requests are filed by doctors and other medical and social service professionals). You can initiate a review by filing a form 96-0469 with the Motor Vehicle Division; after looking at your description, MVD may require a doctor’s report and/or a driving test.

Are you worried about the possibility that you might cause this kind of concern, and force your own children to take similar steps? We have one suggestion for you to head off a similar scenario for your own future: talk to your family, and maybe even consider signing an agreement with your family about driving. You can give someone — perhaps the same person you name as agent on a health care power of attorney, perhaps someone else — instructions to tell you when you need to stop driving, and the power to take steps to stop you from putting yourself and others at risk.

The reality: such an agreement probably has no legal validity. But it could give your chosen family member the moral and psychological power they need to tackle a very difficult problem when you are unable to make the decision for yourself. At Fleming & Curti, PLC, we include such a power in most of our health care powers of attorney; if you would like to sign an agreement on your own, there’s one in the back of the “At the Crossroads” booklet described above. There is also a separate copy of such an agreement on The Hartford’s website; you can download it, review it and sign it on your own. But we really favor talking with your family about it.

A final thought: at least once a week or so, we have a client tell us “I’ll be the first to know when I need help.” Sadly, that has not been borne out by our experience at all.

Can a Person with Dementia Sign Legal Documents? (Part 2)

MARCH 4, 2013 VOLUME 20 NUMBER 9
Last week we posed the question, and then mostly wrote about competence (or capacity) to sign a will. We promised to explain more about the level of competence required to sign other documents. So let us now tackle that concept.

A person with a diagnosis of dementia may well be able to sign legal documents, at least in Arizona. We suspect that the answer should be pretty much the same in other states, but if you are curious about your own state you should check with a local attorney about how competence is determined.

Generally speaking, competence or capacity is usually analyzed situationally. That is, the question will be answered differently depending on the nature of the document and the circumstances of the signing. The general rule: the signer has to have sufficient understanding to know what the document is, and the effect of the signing.

What kinds of documents might be involved? There are a variety of contexts in which capacity can be difficult to assess, including (but not limited to):

  • Ability to sign a contract — say to buy a car, or build a home.
  • Understanding of a power of attorney, which might give the authority to another person to sign future documents.
  • Competence to sign a trust, which might have elements of agency (like a power of attorney) and testamentary effect (like a will).
  • Capacity to get married (which is, after all, a specialized kind of contract).
  • Ability to make medical decisions — including refusing medication, or either seeking or declining mental health treatment.

Each of those situations, and the dozens of others that might arise, will be judged differently, because the nature and effect of the act will be different. But we can generalize about several of the important rules that cut across types of documents:

  • Minority is presumptive incapacity. That is, a person under age 18 does not have the legal ability to enter into a contract, get married, sign a trust (or will), or make medical decisions for themselves. There are, however, exceptions — a contract for “necessaries” (food, shelter, etc.) may be enforceable if signed by a minor. An “emancipated” minor may be able to do some things that an unemancipated minor can not.
  • It may not be necessary to have capacity to do the underlying thing before giving the authority to someone else. What? Let us explain: a person who might not have the capacity to enter into a complicated contract might still have sufficient capacity to sign a power of attorney giving someone else the power to sign the contract.
  • Arizona’s legislature has decided that the capacity level required to sign a trust should be the same as testamentary capacity, as we described last week. That may mean that someone who does not have sufficient capacity to sign a power of attorney could nonetheless sign a trust, which gives even broader authority to the trustee. Odd result, but mostly theoretical, as it’s hard to find someone in just that circumstance.
  • Generally speaking, most observers think that the capacity to sign a will is a lower level of competence than contractual or other forms of capacity. But it might not be that hard to describe someone who adequately understands the nature of a power of attorney but does not have an understanding at the level of testamentary capacity.
  • There are few legal ways to determine capacity in advance. Challenges to capacity are almost always initiated after the signing is completed — and often after the signer has died, or become completely and undeniably incompetent. That means that evidence of capacity (or lack of capacity) is often being reconstructed well after the fact.

It’s also important to remember that we are writing here about competence/capacity, and not necessarily about the validity of documents signed by someone with dementia. In response to our article last week, one reader wrote to us:

“You covered dementia issues very clearly. Thank you! But what about the issue of undue influence in the presence of known dementia where, in principle, the demented person otherwise possesses testamentary capacity? How does the mix of those two aspects play out?”

It’s a very good point. There is a difference between capacity (or competence) on the one hand, and undue influence on the other. Dementia might make a given signer incapable of signing a document, or their competence may be sufficient to sign. But that same person might be made more susceptible to undue influence because of their dementia.

What do we mean? Let’s give an example — drawn from our considerable experience with the distinction. An elderly widower, living alone, has a diagnosis of dementia. He is nonetheless charming, witty and perfectly able to discuss his wishes. He can recall the names of his three children, and of his seven grandchildren. He can report their ages, the cities they live in and their careers (or status as students) — and he is mostly correct, though sometimes his information is two or three years out of date.

This gentleman’s daughter lives in the same city, and is the one who oversees his living arrangements and care. She does his shopping, hires people to check on him daily, takes him to doctors’ appointments, writes out his checks (he still signs them) and otherwise helps out. She also talks to him endlessly about how his other two children don’t deserve to end up with his house and bank accounts, how she really ought to be the one who benefits from his estate, and how his late wife (her mother) always wanted her to inherit everything. Eventually he agrees to sign a new will and trust, mostly to stop her constant harangues.

Was he competent to sign the new estate planning documents? On the facts as we’ve given them here, probably yes. Was he unduly influenced? Very likely. Was that influence facilitated (and the proof made easier) because of his dementia? Absolutely.

When did the daughter’s behavior cross the line? The legal system isn’t actually very helpful, since the answer is defined in a circular fashion. Her influence was “undue” when it resulted in her wishes being substituted for his. It was not necessarily objectionable (at least not legally) when she told him what she wished he would do, what her mother had wanted, or what was fair. But at some point she may well have turned ordinary familial influence into “undue” influence.

We hope that helps explain this complicated and nuanced area of the law. But we want to leave you with a completely unrelated, but important, note: Kieran Hartley York joined the Fleming & Curti family (literally) on Sunday, March 3. We are delighted to have met the little guy, and look forward to great things from him in the future.

The Difference Between Powers of Attorney and Guardianship

JULY 18, 2011 VOLUME 18 NUMBER 26
“Elder law” (what we practice here at Fleming & Curti, PLC) can be a fairly broad practice area. We work in estate planning, long-term care planning, guardianship and conservatorship, trust administration and probate — and each of those areas encompasses a number of other topics as well. But some variation of the question below is one of the most common questions potential new clients ask us. We want to take a moment to explain the difference between two poorly-understood legal concepts: powers of attorney and guardianship/conservatorship.

Here’s the question, distilled to its essence: We had to put dad into a nursing home. The staff there are telling us we need to get a power of attorney. Can you prepare a power of attorney for us?

Seems like a simple enough question. A power of attorney is, after all, a fairly straightforward document. You can download a form from the internet, and many seniors have already signed one. Turns out that the question is usually much harder to answer than it appears, however.

Different kinds of powers of attorney

The first issue: there are different kinds of documents that are all called “powers of attorney.” As if that wasn’t confusing enough, some states (and some practitioners) use different terms — “health care proxy,” or “patient advocate designation,” or “durable power of attorney,” for example — for what are essentially the same things.

In general terms, there are two well-recognized kinds of power-of-attorney document. One kind designates some one else who can make decisions about the signer’s health care — medical authorization, placement decisions and the like. The other names some one to handle financial matters — check signing, sale of property, transfers of assets into a living trust, even gift-giving (in some cases).

When the nursing home tells you that you need a power of attorney for your recently-admitted father, they are probably most concerned about the health care power of attorney. They want someone to be able to approve medications and treatments, to make decisions about hospitalization (or declining hospitalization) and to notify about your father’s condition and progress. They may also be interested in making sure you have power to handle his finances, especially to pay his nursing home bills — but that may not be their primary focus.

Distinguish guardianship and conservatorship

Contrast the power of attorney with the guardianship/conservatorship process. If you have to secure a guardianship or conservatorship with regard to your father, that means you will have to file a court proceeding and go through a number of mandated procedures.

You will probably be hiring a lawyer to represent you; in Arizona, a lawyer will certainly be appointed to represent your father (unless he already has his own lawyer). There will also be a medical report, and a court investigator. A process server will have to physically hand (or read) the court papers to your father. A hearing will be held at the courthouse. Once you are appointed, you will have annual reports to file with the court. If you have been appointed as conservator, you will also have to file a “surety bond” — an insurance company’s guarantee that your father’s estate will be made whole in the event that you misspend his money or otherwise behave inappropriately.

Wait — what’s the difference between guardianship and conservatorship (you ask)?

It’s a good question. Be careful about generalizing here — different states use different versions of these terms to mean different things (and sometimes they have the opposite meaning in other states). But in Arizona, guardianship is the court process to secure control over an incapacitated person’s health care and placement decisions. Conservatorship is the court process to secure control over the finances of a person who needs protection.

Roughly speaking, a guardian (in Arizona) has the same kind of authority that a health care agent might have. Meanwhile, an Arizona conservator has the same kind of powers and responsibilities that an agent under a financial power of attorney might be given.

So which do I want — power of attorney or guardianship/conservatorship?

It’s not really which one you want so much as which one you can get. A power of attorney requires a competent signer, willing to give the power (health, financial or both) to you. A guardianship or conservatorship requires the court to find that your father is not able to make his own decisions — in essence, not able to sign his own power of attorney. So our first question to you will be: what does his doctor say about his competence? What do you think: will he understand the nature of a power of attorney, and be willing to give you that authority?

If your father is already too far into the dementia process to sign a power of attorney, you may have no choice but to seek guardianship and/or conservatorship. If he is mentally pretty alert, and able to understand (and explain) the reasons why he might sign a power of attorney, it might well be appropriate to talk with him about that choice.

What are the relative costs?

Once again, it is hard to generalize. Getting your father to talk with a lawyer, discuss powers of attorney (and, probably, estate planning generally) and getting him to sign after he has agreed to the documents should probably cost a few hundred dollars — more, if it takes multiple meetings, he has unusual estate issues or wishes, or there is family discord to deal with. Guardianship and/or conservatorship will probably cost ten times as much, and assure continuing legal involvement as future accountings and reports have to be prepared and filed.

OK — I think dad will understand the power of attorney and be willing to sign it. Can you please come to the nursing home with one and get him to sign?

Would that it were that easy. A good lawyer will want to meet with your father more than once. While many make home (or nursing home) visits, they will probably charge more. And a key element of representation of your father requires that he be the client — that may mean that after we have talked about his situation extensively, we are uncomfortable being the ones who prepare his documents.

In that case, we are likely to refer him to another lawyer. We will probably suggest one geographically close to him, and give you some advice about how to make the initial contact. Basically, we want to make sure that (even if you make the call and set up the appointment) there is no question in your father’s mind that his lawyer is in fact his lawyer. You may be absolutely certain that you and he are on the same page — but we sometimes see situations where that turns out not to be the case, and we all want to make sure his wishes are paramount.

Do I really have to do any of this?

You might not, actually. In Arizona (this is not true in every state) there is a mechanism for family members to make health care decisions for someone who never got around to signing a health care power of attorney. There is a priority checklist (starting with spouses and working through family friends) for who can make decisions. One limitation: the person named in the checklist can not make a decision to withhold or withdraw life-sustaining artificially-provided food and fluids.

There is no similar mechanism for financial decisions. If your father has only his name on his bank accounts (or brokerage accounts, car title or deed to his house) then it will require either a power of attorney or a conservatorship to get authority to liquidate assets, pay bills or even request annual minimum distributions from his IRA. Quick — go look to see if he didn’t sign a power of attorney years ago.

This is all so complicated. Can’t I just get the power of attorney form, fill it out and get him to sign it?

Yes, and it will probably work just fine. If it doesn’t, you could look like you were trying to take advantage of him. If someone later decides your form is inadequate, or not properly signed, or has some other defect, you might not find out about it until after he is clearly incapacitated and unable to sign a new power of attorney. But candidly, those are not the most likely outcomes. What we offer is professional counsel, answers to complicated and personal questions, and peace of mind. We’re pretty comfortable that our services are worth what we charge.

We hope that helps. Good luck with your father, whether we see you or not. We know that this is a difficult time, filled with anxiety and unexpected challenges. There are also a number of rewards along the way, but no one should minimize the work you have undertaken.

Oh, by the way — if it’s your mother, your aunt, your son or your sister you are caring for, the answers are mostly the same.

Advice On Making Health Care Decisions For Someone Else

AUGUST 10, 2009  VOLUME 16, NUMBER 50 

When you name someone as your health care agent, you literally entrust them with life-and-death decisions. When you are the agent the job can sometimes seem overwhelming.

Sometimes health care decisions must be made by someone who was not even designated in a power of attorney. A “surrogate” decision-maker (usually, but not always, the closest family member) is often empowered by state law to act when the patient has not made a specific choice. Few patients have had specific discussions with their agents about their health care wishes, and those who have not gotten around to signing advance directives are even less likely to have given any direction.

Although thousands upon thousands of people make health care decisions for someone else every year, there is little help or direction available for the agent or surrogate. Lawyers may be familiar with end-of-life care and decisions, but they seldom get involved — and may be an expensive way to facilitate decisions even if they are available.

We can offer some general advice and a pair of printed resources for those making health care decisions for someone else. First, a few suggestions:

  • Talk to the person who has named you as agent about his or her wishes. Sooner is better than later, but even a seriously ill, demented or incapacitated patient might be able to give some direction.
  • If you know you have been named as health care agent, ask for a copy of the power of attorney. It might include provisions that surprise you, or that you need clarified.
  • When you have to begin using the health care power of attorney, make sure you get all the information you need. Talk to doctors, nurses and caretakers. Explain why you need to have your questions answered, and insist that you get them answered.
  • If you do not fully understand the medical issues involved in a given procedure or test, tell the providers you need more information. Do not hesitate to get a second opinion when you are uncertain what you should be doing.
  • Remember that you are not applying your own standards to the decision, but those of the person for whom you are acting. This can be the most difficult part of handling a health care power of attorney or surrogacy. The law recognizes — and favors — what it calls “substituted judgment.” That means that you are expected to substitute the patient’s judgment for your own, not the other way around.

There are at least two good printed resources for a health care decision-maker to consult. Both are online and free. We regularly recommend these to our clients (and their families):

Some Advice About Selecting Fiduciaries For Your Estate Plan

APRIL 20, 2009  VOLUME 16, NUMBER 37

When it comes time to complete estate planning, our clients usually have clear ideas about who should receive their property, what health care decisions they would want made — even how they feel about cremation, burial, organ donation and most of the other issues that must be addressed. What stumps more clients than any other issue? Who to name as trustee, personal representative (what we used to call an “executor”), and agent under health care and financial powers of attorney.

Some of the common questions we hear from clients about whom to select:

Is it acceptable to name a child who lives out of state? Yes, at least in Arizona, which does not require in-state residency for any of the various fiduciary roles. With e-mail, fax machines, overnight delivery and other modern communications options, there is usually little difficulty for your son on the east coast (or even your daughter in Japan) to communicate. In fact, we frequently observe that we may have an easier time communicating with your the Iowa sister you named as agent than your nephew who lives on the east side of Tucson.

There is one small exception to that rule, and it is more practical than legal. We generally counsel that the ideal health care agent should live near you. Reviewing medical records, talking to doctors and caretakers, and developing a clear picture of your condition is much easier for someone nearby.

Can I name several, or all, of my children as co-agents, co-trustees, etc.? Yes, though we may try to discourage you from naming multiple fiduciaries. To the extent that you are trying to avoid family disputes, it is our experience that giving everyone equal authority tends to encourage disagreements. We will probably suggest that you might want to name your daughter (the banker) as financial agent, and your son (the nurse practitioner) as health care agent — and each as back-up to the other. If you really want to give them joint authority, though, there is no legal reason not to do so.

Speaking of which, is it better to name different people to health and financial roles, or give the same person authority over everything? There is no clearly correct answer. You know your family (and their strengths and weaknesses) much better than we do. If there is one person who is capable in all areas, by all means give that person authority as health care agent, financial agent, personal representative and trustee. You can segregate the roles as a means of providing checks and balances, or to give everyone reassurance that you value their input.

Do I have to tell everyone involved who will have which authority? No. But as a practical matter, we encourage you to do so. We want your daughter to realize, for instance, that she is the one who needs to make arrangements if something should happen to you. We hate to see someone show up, ready to act — and then find out they have no role. That creates confusion, and obviously can engender hard feelings.

We hope that you will share your estate planning documents with all your family (and any non-family members named as trustee, agent, or personal representative). There is no legal requirement that you do so, but it does increase the likelihood that any problems can be worked out while you are still alive, competent and in charge of your own decisions.

What Have We Learned From The Tragedy of Terri Schiavo?

APRIL 4, 2005  VOLUME 12, NUMBER 40

By most reports Terri Schiavo was a shy and quiet woman, and she might well have been distressed if she had anticipated that the process of her dying would become such a public spectacle. Much has been written about her, her family, her wishes, her condition, and the political and religious factions aligned on one side or the other. In fact, too much has been written already—but we are compelled to seek some greater meaning for the public in her very private tragedy.

Regardless of individual reactions to the long death of Terri Schiavo, there are practical lessons for consideration. First among those, of course, is the importance of executing medical directives while still able to do so.

Every adult, regardless of age, should designate an individual (and one or more alternates) to make medical decisions in the event of incapacity. Whether the document is called a health care power of attorney, a health proxy designation or something else, it is important to designate a surrogate. Do not put it off because you do not think you are at risk. Terri Schiavo was 27 when she collapsed suddenly. Nancy Beth Cruzan was 25 when an auto accident left her brain-injured and catapulted her case into national headlines in the mid-1980s. A decade earlier, 21-year-old Karen Ann Quinlan’s injuries from a night of mixing alcohol and valium first focused public attention on legal, ethical and moral issues surrounding the end of life.

In addition to nomination of a surrogate to make personal and medical decisions, most individuals should also sign a statement indicating their wishes. The unfortunately-named “living will” can express a wish not to be treated in some circumstances, or to receive full treatment in any event, or any other variation imaginable. Under Arizona law, any statement describing your wishes can qualify as a living will—write it, sign it and have it witnessed (usually by two people) and you have made a significant contribution to your own peace of mind.

Arizona law provides a form for health care powers of attorney and living wills, but permits other options. Lawyers usually prepare the documents in connection with general estate planning, but a lawyer is not required. Forms are available from hospitals, area agencies on aging, and advocacy groups. A number of perfectly acceptable variations can be found online, including those at the Arizona Attorney General’s website.

Another option: the National Right to Life’s “Will to Live” directs provision of medical care under nearly all circumstances. It also expresses the view that tube feedings are not medical care, and should be continued in most circumstances.

Arizona law also recognizes advance directives authorizing mental health treatment, and directing withholding of CPR and resuscitative efforts. Those forms are not as important for most people but can be essential in some cases. For more information about the options in Arizona (including both mental health powers and the “orange form” governing out-of-hospital resuscitation) check into our Question and Answer section on advance directives.

Whatever documents you do sign, it is also important to circulate them widely. Encourage discussion of your wishes while you are still able to participate and you will increase the likelihood that those wishes will be honored.

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