F ocus on the F utur e - COCHRA NE SUPPORT SERV I CES JUNE 2021 Volume 7 Issue 5 NINE THINGS TOKNOWABOUT PLANNING FOR YOUR FUTURE By Lori Cochrane, Principal Professional Fiduciary Cochrane Support Services You wouldn?t undertake a major project or move to a new area without first doing some research and learning about your options, right? Educating yourself about how to manage things as you decline is no different. Familiarizing yourself with terminology, learning about tools and resources, and what types of challenges you might encounter will make it easier for you to create a plan. Things either go as planned or they go forward in a chaotic fashion. For important matters like ensuring others are aware of your preferences for handling a health crisis, or preserving your estate for your beneficiaries, a plan is the answer. Planning helps to ensure you use appropriate resources effectively and helps keep you in control, as well as bringing you peace of mind. We have compiled this list of terminology you may encounter to help you focus on your future. Plan like a pro by reviewing this list and learning more. 1.) Pr edictable Challenges of Aging Aging in Place - What type of support might you need to age at home? Plan for the right kind of help based on your situation, medical conditions, and financial resources. Avoidable Hospital Conditions - Are you fully aware of what ails you? Following-up with recommended medical care, appointments, treatment, and addressing suspicious problems head-on will help you avoid a hospitalization. Community Support - Have you tapped into local resources to become informed about various services available? Take advantage of locally offered educational opportunities about age related issues. Elder Fraud and Undue Influence - Have you received a call from someone offering a service in exchange for gift cards? Or, maybe someone you know is constantly borrowing money without paying it back. Don?t be ashamed if you?ve fallen prey. Scammers are savvy. Contact the police department if you or someone you know has been the victim of a scam. 2.) Navigating a M edical Event Hospital Discharge Coordination - A stay in the hospital after a medical event can seem like just a blip on the radar. Discharge often happens abruptly even though a slower plan was agreed upon. The hospital is focused on getting you to the next location for a variety of reasons. To help coordinate the safety and necessity for discharge, the hospital SHOULD provide a consulting nurse who will talk with you or those advocating for you to discuss options and formulate a plan. However, they don?t always do this. Involve your advocate right away - patients are often discharged to home with little warning. Info@CochraneCSS.com | (916) 705-7309 | www.CochraneCSS.com Navigating a M edical Event, continued... Rehabilitation Services, or ?Rehab? - Delivered in a variety of settings, these services, ordered by a physician, can include Physical Therapy, Occupational Therapy, Speech Therapy, and others. These are put in place in order to improve your functionality after an illness or temporary disability. Skilled Nursing Facility - Here is where you can receive medical care supervised by a physician, in a less acute environment. You may receive services or treatment from a licensed practitioner such as a Registered Nurse, or a Licensed Vocational Nurse, Certified Nursing Assistant, Physical Therapist, Occupational Therapist, etc. The care you receive in these facilities is disappointing. The non-medical care provided is extremely lacking in personal attention. Nursing Home / Convalescent Facility / Long Term Care Facility - These can be part of a Skilled Nursing Facility, but typically are less focused on skilled services, and more focused on caring for your long term needs. Some patients remain living here for the long term. Discharging to Home - With an assessment of your level of need matched with the level of care providers needed, discharging to your home may be a feasible option for you. 3.) Car e Provider s Advocate / Care Manager - Picture Lori Cochrane, Licensed Professional Fiduciary. This service can be provided in a variety of ways. The purpose of advocating or managing your care is to give clarity to a confusing situation, and give strength to the level of communication necessary to understand and organize information that informs your choices. Private Duty Nursing - Typically not covered by Medicare or insurance; paid for privately. Find out if the nurse is licensed and insured, and whether they are supervised by a physician. They may not perform direct medical care, but may provide medication dispensing and management. Hiring this service from an agency is advisable to ensure proper licensing and supervision. Home ?H e a l t h? Care [Medical] - Clinical services covered by Medicare and ordered by a physician. A Home Health Agency can provide rehabilitative and other direct medical services in your home from licensed and qualified practitioners. Home Health is not personal care, but care for specific therapeutic purposes, on their schedule, and once you have reached your best functionality the services stop. Home ?C a r e? Agency [Custodial] - These agencies employ caregivers who come to your home and provide in-home custodial care assisting with your activities of daily living, such as meal preparation, or light housework. They also provide help transferring to a wheelchair or toilet, and personal care such as bathing assistance, grooming, up to and including personal care required for someone who is bedridden. Caregivers from a Home Care Agency are not licensed or permitted to perform any direct medical care. Medical Care vs Custodial Care Medical care is usually covered by Medicare or private health insurance, and is provided by a licensed practitioner, such as a physician, a nurse, or a therapist, and the professionals who come to your home who were ordered by a physician, who work for a Home Health Agency (see above). Custodial care is not covered by Medicare or private health insurance, and is provided by non-licensed caregivers to assist with your activities of daily living. Custodial care is what the caregivers from a Home Care Agency (see above) provide you with. 4.) L evels of Need ADLs (Activities of Daily Living) - As part of an assessment while planning for the amount of care you require, these activities are necessities of life. Are you able to do the following independently? If not, what level of assistance might you need to accomplish the following each day: - Personal hygiene, including bathing, grooming, taking care of oral health, and more. Dressing, choosing appropriate clothing, and undressing yourself. Eating and feeding yourself. Toileting, getting on and off the toilet, cleaning properly, and your level of continence. Mobility, standing from a seated position, walking from point A to point B independently, and getting in and out of bed. Info@CochraneCSS.com | (916) 705-7309 | www.CochraneCSS.com L evels of Need, continued... IADLs (Instrumental Activities of Daily Living) - All of the activities above require some logistical considerations, which are instrumental. An assessment for the level assistance you might need includes IADLs such as: - Communication--whether you can use all the tools necessary for you to communicate your needs and wants regarding the ADLs listed above. This includes how well you function using a telephone or smartphone. Transportation--either driving oneself or arranging for a ride. Meal preparation--planning, clean-up, safe handling of equipment, and food safety management. Shopping for food and clothing, and choosing appropriately. Housework, laundry, and maintaining a clean place to live. Medication Management, organizing dosing, taking the proper amount at the right time, and avoiding skipped doses. Personal financial management, paying bills on time, staying within a budget, and avoiding scams. 5.) L evels of Car e Care Plan / Plan of Care - Often a requirement of any care entity, based on an assessment of your needs for medical care and personal care. Person-Centered Care - The concept that your input and experience is the guide for anyone involved in planning for your care. Your wishes and goals are at the heart of your plan. Palliative Care - Focused on your comfort, but also providing treatment, palliative care is helpful when someone has a serious illness. Quality of life is important as you balance your comfort with how aggressively you want to be treated for an illness. Hospice Care - When approaching the end of life, hospice care focuses on care, comfort, and quality of life. With hospice care, you no longer receive treatment for your illness, but you do receive treatments that relieve symptoms. Respite Care - A break for your primary caregiver is necessary for their own self-care. Arrangements can be made where a substitute caregiver takes over for a time, or the patient can go to a facility for a period of time. There are many options. 6.) Capacity and Self-deter mination Competence - Exhibiting knowledge, judgment, skill or strength. Cognitive Impairment - On a spectrum of ability, cognitive impairment is evidenced by difficulty remembering, learning new things, concentrating, or making decisions. Losing Capacity - Capacity is a question of whether you are able to understand the benefits, risks, and effects of a decision you are making. Capacity is on a spectrum, where if someone is losing their capacity it means they may be able to make some decisions reasonably, but they lack the capacity to make complicated or serious decisions. Self-determination - Although a person may lack capacity to make important decisions, self-determination is when we respect that other people have control of their own lives. It becomes necessary and important for those making decisions to learn as much as possible about what the person would have wanted for themselves. 7.) Wher e will you r eside? Your Home - This may be where your heart is, or where you are living. Residential Care Facilities for the Elderly (RCFE) - These facilities are licensed and provide a room, meals, care, and have common areas for residents to gather. Board and Care Home - Usually in a residential area, Board and Cares are RCFEs for a small number of residents. Continuing Care Retirement Community - Taking into consideration the need for a wide range of care levels, since care needs typically rise as we age, these communities offer independent living, assisted living, and some offer care as extensive as Memory Care, and/or Skilled Nursing. Info@CochraneCSS.com | (916) 705-7309 | www.CochraneCSS.com Wher e will you r eside, continued... Independent Living Community - Here, you can take advantage of amenities in a community where additional assistance is available, but you don?t necessarily need it yet. Assisted Living Community - Here, you have the same amenities as independent living, but with some additional assistance per need, such as housekeeping, or medication management, and more. Memory Care Community - Usually within Assisted Living Communities, the memory care unit is a place where you may live if you have significant memory impairment, to the degree where the egresses of the area are monitored, and you receive specialized care for dementia. Placement Agent - Someone who may help you select an appropriate place to live, and align you with locations that fit within your needs and budget. Agents are no cost to you, but typically receive a form of payment from the facility you choose. Cochrane Support Services may offer support for selection of placement, but we DO NOT accept gifts of any kind from the facility you choose. 8.) Pr e-planning To relieve those remaining from the challenge of making funeral or burial arrangements during a mournful and stressful time, pre-planning can be done ahead of time. Some choose the service based on what type of burial one desires. There are more and more options for handling your remains than in previous years. Whichever option you choose, a package that handles all needs can be arranged for and purchased in advance. 9.) End of L ife Planning - Keeping Control POLST (Physician?s Orders for Life Sustaining Treatment) - The documentation of your care preferences is vital to those caring for you. With a POLST, you and your physician discuss and choose intervention options you want to ease the end of your life. You sign it, and the physician signs it, providing you with an established order from a physician directing care providers with orders in case of an emergency. * Advance Healthcare Directive / Living Will - This is a legally executed document that goes into effect either when you become incapacitated or if you specify you want it effective immediately. This allows you to document your wishes in regard to end of life care, and is the document in which you name an agent with power of attorney for healthcare decision making, in case you are not able to speak for yourself. * Power of Attorney Agent, Proxy - This is a person whom you assign to serve as your surrogate decision maker, if you are not able. Under certain circumstances, the person will have the authority to act on your behalf, as if they are in your shoes. An agent can be assigned for health care decisions, and an agent can be assigned for financial decisions. * Executor and Will - The Executor is a person you have selected to settle your remaining financial obligations, and distribute your remaining assets that are not held in a trust. * Revocable / Irrevocable Trust - This is a legally executed document that goes into effect immediately upon signing, and is the entity where you can have a detailed plan to distribute your assets at your death. Please ask an attorney for advice about which type of trust might be right for you. * It is important to consult with an attorney if you have questions. This is not intended as legal advice. Cochrane Support Services provides specialized fiduciary services in the Placer County area and throughout the region. We are Professional Fiduciaries with specialized skill sets. Info@CochraneCSS.com | (916) 705-7309 | www.CochraneCSS.com 200 Gateway Drive #855, Lincoln, CA 95648