● Advance Care Planning is a discussion around a patient & their loved ones' treatment preferences, identifying a surrogate, and identifying goals of care.

● The advance directive legally documents the patient/loved one decisions around advanced care planning

● Advance directive document accomplishes 2 main things: 1) documents big picture decisions around healthcare choices in treatment & goals of care 2) Names a surrogate medical decision maker, ie who makes MEDICAL decisions when the patient is unable to (physically or cognitively)

● Different terms used for this surrogate medical decision maker are DPOA (durable power of attorney), Medical Power of Attorney (POA), Health Care Proxy, Health Care Agent, surrogate medical decision maker! and more

● Living will is a lay term used for an advance directive. Often a patient will have a living will done at the time they do estate planning & this is often done with an attorney. The advance directive includes the same information included in a living will PLUS names the Medical POA.

● Families can use ANY template for the advance directive though there is some variation by state

● An advance directive DOES NOT need to involve a lawyer. It can be done for FREE

● The document needs to be signed by a witness (FREE) OR can be notarized (cost)

● The advance directive template & Step-by-step guide that Hōtto uses is & has templates by state: https://prepareforyourcare.org/en/advance-directive-state/ca

● A POLST form (Physician Orders for Life Sustaining Treatment) is a SEPARATE form/process used when someone is at the very END of their life. Consider completion of this form when someone is at a stage for palliative care/hospice

● The Medical power of attorney is different from the financial decision maker. It can be the same person or different.

● Different terms used for financial decision maker include fiduciary, guardian, trustee, financial power of attorney and other terms

● The financial power of attorney is the person who makes financial decisions around paying for hired caregivers, assisted living/personal care home costs, medical expenses, etc.

● Sometimes there can be disagreements and conflicts of interest within a family when it comes to using a person's funds for care & who benefits from those funds after that person passes. In extreme cases, financial abuse is present - ie misuse of the PLWD's money.

● Getting a financial power of attorney identified EARLY and while the PLWD has decision making capacity can avoid

● The ideal is a Medical POA and Financial POA (can be the same or different people) that is named WHEN the PLWD has decision making capacity, is someone the PLWD trusts (ie this person has previously demonstrated they had the PLWD's best interest at heart), and is someone that willingly wants and is capable of caring out the responsibility.

● Can have multiple people act as power of attorney for finances and also consider a fiduciary advisor hire for decision on financial investments on top of the power of attorney decision making.

● If there is no family/friends that can act as a financial fiduciary, some banks or attorneys will offer a service to act as a financial fiduciary. "Exchange Bank" is an example of a California Bank that provides this service.

● If there is no family/friends that can act for medical decision making, a legal team, prior physician, or an independent organization can be appointed. The fiduciary of the trust including the legal team that manages can do this also. A previous physician that is not currently part of your medical team can provide. Organization that can act as a care manager/medical POA: Sageeldercare.com, enAble Age Gracefully, Seniors at Home

● Estate planning includes setting up wills, trusts to manage property, other financial assets and to name beneficiaries. There are various components of estate planning that are usually done with an attorney but can also be done independently using standardized legal forms with sites like RocketLawyer, depending on complexity. If the PLWD's financial assets are complex, we recommend referring to a knowledgeable estate planning lawyer.

● Transferring property and other financial assets to a trust is an important part of planning prior to assisted living (assisted living waiver) or nursing home placement and considerations for health insurance coverage eligibility for MediCal. For example, the nursing home will take almost all of the social security income, however if you file for financial hardship, then half of social security gets reserved for the spouse.

Version: YT 1/2025