The Other Bucket List

1. The Other Bucket List An unvarnished perspective on aging, and the urgent need for planning There’s the “wanna-do” bucket list of people, places, things we want to achieve in this life. Then, there’s the “have-to-do” list to protect ourselves, our families, our earnings, those things, those memories we value most to preserve and protect our legacy and the footprint we leave behind. Planning for the last trip you’ll ever take. c. Elaine M. Northcutt, 2013

2. The Other Bucket ListPlanning for the last stages of life: Aging, Dying and Death. “Magical Thinking” • Magical thinking sounds like this: • I’ll be dead, it’s not my problem • “What?– me worry” • “I don’t own anything of value” • “ don’t like lawyers” • “It’s too complicated” • “I plan to live forever”, (no joke). c. Elaine M. Northcutt, 2013

3. “Reality” • What reality looks like: • Clueless in the emergency room at 3AM • Stressed out • Acute awareness of the fragility of life • Up a creek without a paddle • Family conflict; life and death decisions have to be made. Are you prepared? c. Elaine M. Northcutt, 2013

4. Why Aging? Why Dying? and Why Death? • Aging is an active stage of human development. It’s called the aging continuum. • Dying is a “stop” sign. Dying is a stage where the mind or body or the mind and body simply reach a state of “shutting down”. It is a time where no there is no more medical intervention to “cure”– to fix. Quality-of-Life will not be improved with an intervention. This is stage of life is unique for each and every one of us. • Death is the moment life ceases– and yet it is– part of the living experience. It is a “life event”– the same as a birth. c. Elaine M. Northcutt, 2013

5. While we have no control over our birth, we have almost complete control over how we leave this world. c. Elaine M. Northcutt, 2013

6. The purpose of this workshop is to orient you to effective planning for your peace of mind and quality of life. c. Elaine M. Northcutt, 2013

7. OUTLINE Sharea few stories to illustrate the problems, issues and dangers of a failure to plan or inadequate planning. DefineQuality of Life. It is the measurement. It is a collection of conditions that impact how we live and especially with respect to how we age. Discuss complex and fragmented systems that do no work and explore a new integrated multi-disciplinary system that does work. Describethe Seven Domains of Quality-of-Life: health and healthcare; insurance and benefits; financial resources and planning; law– and estate planning; social constructs and family dynamics; life care planning and incapacity; end-of-life care. 4. CompleteQuestionnaire. This will be a guided exercise, it is for your use only and to take home. Examine a cost-benefit analysis worksheet and a personal “bucket” list for you take with you and assess and consider. c. Elaine M. Northcutt, 2013

8. A failure to plan and inadequate planning. • Three stories that will get your attention. > Bob’s Story. > Diana’s story. > Carolyn’s story. • How and why this happened. > Denial, complacency > Consumers are poorly informed, functional literacies > Complex and fragmented aging services > Discrimination against seniors and the elderly. > Cultural systems > Values and Belief systems > Mental Illness • Failing bodies and failing systems. > complexity, communication, technology, human burden c. Elaine M. Northcutt, 2013

9. Quality-of-Life Paradigm. • Definition: a set of conditions that preserve the safety, social welfare, health, resources and dignity of an aging individual • Seven Domains of Quality-of-Life > Health and healthcare > Insurance and Benefits > Financial Resources Management > Estate Planning > Social Relationships > Life Care Planning. (physical and cognitive impairment plan). > End-of-Life Care Plan c. Elaine M. Northcutt, 2013

10. Achieving and Maintaining Quality-of-Life • > Developing literacy and competency • # healthcare literacy • # healthcare insurance literacy • # financial literacy • # Estate Planning literacy • # Understanding social relationships • # Understanding the aging process, acceptance. • # Understanding mental illness, mental health. c. Elaine M. Northcutt, 2013

11. > Seeking competent professional guidance # Establishing a relationships with primary care physician # Establishing relationship with insurance professional # Guidance from certified financial planners # Establishing a relationship with estate planning attorneys # Consulting with social workers and geriatric care managers # Seeking guidance from psychotherapists about social relationships. # Access to palliative and hospice care treatment teams. # Access to chaplains and grief counselors. c. Elaine M. Northcutt, 2013

12. > Implementation Plan # There is no substitute for legal protection. NONE. # Open conversations with family and friends. Regularly. # Organization skills: filing systems, computer file system. # Project Mgt. skills: managing each task to is completion. # Communication Skills: with family, professionals, aging parent. # Keeping a Log– a narrative: medications, history, # Transparency where ever possible. # Support systems c. Elaine M. Northcutt, 2013

13. How do these domains impact quality of life? Healthcare Poor: Arrive at the ER at 3A with a parent with no medication list. Better: Printed list of medications or box of medications in hand. Great: Copy of advance directive, insurance, medical history, description of chief symptoms or onset of present situation, name or primary care physician. Established relationship with primary care physician, organization skills, healthcare navigation, medical protocols, “instantly” improve the quality of care and quality of life. The patient feels at some level reassured because their family or their agent are at hand. Narrative informs the diagnostic and prognostic process. Reduces stress and adversarial nature with physicians c. Elaine M. Northcutt, 2013

14. Insurance Poor: No insurance; inability to interpret, compare, analyze insurance information. Better: Limited public benefits with share of costs are better than nothing Great: Knowledge of what your insurance covers. Knowing what you have reduces stress in an emergency. Knowing the kinds of insurance that is available that meet your specific needs is vitally important. Solving these in an emergency rooms does not help quality-of-care or quality of life. There are other kinds of insurance to consider other Than you just health insurance. These can improve the quality of your life. c. Elaine M. Northcutt, 2013

15. Financial Poor: Outright negligenceto attend to basic money management responsibilities. Better: Awareness of personal responsibility, vigilance, oversight. Great: Effective financial management controls. Financial Resources MGT impacts quality-of-life. There are some amazing public benefit programs out there, other resources and services at little or no cost. It’s not about the wealth you have. It’s about knowing where to look when you have limited resources and managing those resources– and those with greater means, the ability to adequately protect and effectively use those funds for your personal care and welfare as you age. c. Elaine M. Northcutt, 2013

16. Estate Planning Poor: Believing that you are safe without an estate plan. Better: A Will, Durable Power of Attorney for health care, Durable power of attorney for financial decisions. Great: Consultation with an estate planning attorney, a properly prepared, properly executed– and have a clear understanding of the legal instruments and documents. An Estate Plan is the centerpiece and essential component for your Quality-of-Life. It is an investment for the protection of your person, your social welfare, and financial resources among other considerations. There is no other available mechanism within our society to protect you. Nothing. NOTE: This opinion is a general statement about estate planning. It in no way should be construed as advice or recommendation. Please seek professional advice for specific c. Elaine M. Northcutt, 2013

17. Social Relationships Poor: The absence of social relationships with family, friends, community. Rejection, pride, isolation dehumanizes us. Better: Developing healthy attitudes about aging, hobbies, and physical, cognitive exercises and pursuits. Nurturing and fostering new relationships. Great: Vigilance, awareness, to maintain strong, healthy connections to family. This is a lifetime responsibility. Aging and social constructs is an overlooked component of aging. We tend to make assumptions about our family bonds; positive and negative; for the right reasons and sometimes for the wrong reasons. More than an estate plan your social relationships profoundly impact your quality of life. c. Elaine M. Northcutt, 2013

18. Life Care Plan, (perspective) • Although incapacity planning is built into an estate plan, it usually is expressed in general terms. It assumes that a physician will recognize there is a change and will “automatically” make a diagnosis and put in writing that the patient no longer has capacity, (cognitive). The estate plan does not take into account that fact that physicians are, as a general rule, very reluctant make such a determination because it means that person can no longer make decisions and loses his or her constitutional right to self-determination. • Only a qualified clinician or a court have the authority to determine whether a person no longer has capacity either physical or cognitive. • It is especially vital that a separate life care plan be developed with your attorney that covers possible contingencies. Review, discuss with family, laugh about. Be vigilant for changes in behavior, mood, personality– in aging family members. • This is a critical component of Quality of Life. c. Elaine M. Northcutt, 2013

19. Life Care Plan, (scenario) Poor: Daddy decides to run off with the help at 92; runs off or spends family estate. A mother goes on a cruise and is taken in by a suave Casanova spends the estate and leaves her in Cabo. A favored adult child caring for you is abusive, has a criminal record; you overlook their shortcomings and pay the price. “Dumping” the parent at assisted living or skilled nursing. Better: Advocacy! Filial responsibility. Be hawkish. Assume nothing! Engagement. Parenting the parent. Listening, compassion, negotiation, understanding, agreement. Great: Avoid crisis situations. Vigilance, awareness, to maintain strong, healthy connections to family. This is a lifetime responsibility. A life care plan that incorporates the measures or means of protecting a frail and vulnerable elderly person ahead of time, will be considered by a court of law more favorably if a person needs to be placed in a conservatorship or other legal protection. Trying to remedy a situation after the damage is done is costly and while it may provide some protection--- the trauma, stress, expense of going through the legal system at that late stage of life is absolutely notthe quality of life you want for yourself or the burden you would be placing on your family. c. Elaine M. Northcutt, 2013

20. End-of-Life Care, (perspective) • Without prior planning, your agent for healthcare decisions may not necessarily be making an end-of-life decision based on your wishes. • The dying stage of life brings out the best and the worst in people. Plan it carefully and thoughtfully with as much detail as you can so that whatever decisions need to be made can be made without conflict or ambiguity. • Sharing the end-stage of life can be a beautiful experience. It is a privilege, an extraordinary privilege. Plan well. c. Elaine M. Northcutt, 2013

21. My folks on their 60th Wedding Anniversary. c. Elaine M. Northcutt, 2013