Let’s Talk About End-of-Life Issues. Maybe?

By Karen Cifala

As I got ready to write this article in my normal systematic and informative style, I got derailed by participation in several cultural events which unexpectedly redirected the way I felt about this topic. Having recently participated in a Passover Seder, a beautiful blessing of the new building for a Thai restaurant complete with Buddhist monks and chanting, plus a heartfelt Easter service, I realize how natural and special cultural beliefs are in our everyday lives—as well as in our end-of-life experiences. So to get the most important things out of the way first: Talk to your loved ones about these issues.

The will

In the United States and within each state, we have laws that regulate what happens to our belongings after we die—our investments, our homes, and our personal property—through a legal document called a will. A will dictates to the state how you would like your assets to be disbursed. If you die without a legal will, your estate (whatever that may be) is divided in probate court where a judge decides who gets the assets.

This can take months and thousands of dollars. Umm . . . you need a will. If you have a simple estate (no property, few or no investments), you can use DIY (Do-It-Yourself) software like www.Nolo.com and use the Quicken Will Maker. Or you can hire an attorney to draw up a will for you. I highly recommend this route, because the legal professional may cover some beneficial areas that you haven’t thought about. You will need to know who you will name as beneficiaries and designated executor.

The Advance Healthcare Directive

This legal form includes a living will (which gives written instructions on the degree of life-sustaining measures that should be taken), a health proxy (someone appointed to make health-related decisions in the event you can’t), and a HIPAA release (which allows someone to access your medical records) which is useful with the insurance claims. This form varies by state; however, it is simple to download the specific one you need at the National Hospice and Palliative Care Organization’s website www.caringinfo.org.

Yeah, it might be a good idea to start this conversation with your loved ones before a crisis hits, or you could just wait until you are on your way to the ER in the ambulance (not) to do this. Make sure you ask permission if you want to appoint your sister as the health proxy—I surprised mine years ago when I sent mine to her out of the blue.  Good news is that she accepted, but someone else might not feel comfortable with that responsibility.

Authorized User on Bank and Investment Accounts

To keep your money from being tied up in probate court, name a trusted friend or family member to be a co-owner of investments and/or bank accounts. If you should become incompetent through illness (we all feel that way sometimes, right?), you will still need to have your bills paid. Ask permission of someone you trust and name that person to take on the responsibility of Power of Attorney to access funds, investments, or insurance policies. I know most banks and investment firms will have their own documents that must be in place before they can release funds. And, if one co-owner dies, the other owner is usually entitled to the balance through the “right of survivorship.”


So back to the redirection of my article: It occurred to me that I, in my mind, was thinking about end-of-life issues with loved ones from a Christian-based background, and that I have some cultural assumptions about beliefs, accepted behaviors, rituals, and social heritage that would come into play, and that not everyone feels or believes the same way I do.  In the 1990s, the Federal Patient Self-Determination Act was created which emphasized patient-informed consent.  In general, western society encourages and promotes individualism and independence, and in healthcare, patient autonomy is valued and supported, with great emphasis on individual wishes.  However, some cultures might have different views on the decision-making process. Perhaps in some cultures the patient might have little or no input regarding treatment.

Perhaps a particular culture has a high regard for authority, so that a patient would look to the expertise of the healthcare team to make their end-of-life medical decisions (instead of having an advanced medical directive).  I believe I read that not more than 25 percent of the general population has an advance directive, and I wonder if differences in culture might play a role in this.  End-of-life decisions supporting cultural values and beliefs is just as  important when you are having this family discussion, and adhering to cultural practices while trying to follow federal regulations can be a balancing act, but is probably well worth making the effort before there is a crisis.

Even if you think you’ve got it together for that distressing moment when something terrible happens, make sure you at least have these legal issues taken care of. Then you can say “the rest is up to a higher power”, or in my case, my sister.  My mom always said that actions speak louder than words, and in this case, where your actions in preparing so that a stressful time can be made much simpler for your loved ones, you know she is right, as always!

Karen Cifala is a senior real estate specialist with Remax Roots in Berryville.  To reach her you can call her at (303)817-9374 or email her at kcifala@gmail.com.  Join her April 16 at  Appleland Sports Center from 3-5 for a Free Open Forum discussion with Professionals Working 4Seniors on Finding the Right Home Care.