Bogleheads® Chapter Series – Estate Planning Basics – Taking care of your parents

00:00:00.000 | Welcome to the Bogleheads Chapter Series.

00:00:05.600 | This episode was jointly hosted by the Starting Out and the Pre- and Early Retirement Life

00:00:10.240 | States Chapters and recorded October 25th, 2023.

00:00:14.760 | The topic was Estate Planning Basics, Taking Care of Your Parents.

00:00:18.880 | Open Q&A.

00:00:19.880 | Bogleheads are investors who follow John Bogle's philosophy for attaining financial independence.

00:00:25.560 | This recording is for informational purposes only and should not be construed as personalized

00:00:29.600 | investment advice.

00:00:32.520 | I'll mention Mike Piper's book.

00:00:34.640 | So a lot of folks may know of Mike Piper.

00:00:37.280 | He's very active with the Bogleheads and he's extremely involved with the Boglehead Center,

00:00:43.760 | I'm sorry, John Bogle Center for Financial Literacy, excuse me, even the treasurer for

00:00:49.840 | that organization.

00:00:51.920 | So he's got a book on Amazon and the Kindle copy is $4.99, last I checked, and it's called

00:00:58.920 | After the Death of Your Spouse, and I'm just going to put it on my screen briefly so that

00:01:04.880 | folks have something quasi-tangible to act on.

00:01:11.120 | And although the title is After the Death of Your Spouse, I found the first half almost

00:01:16.500 | like a checklist in preparing.

00:01:18.720 | So one would benefit from reading this well before what the title implies.

00:01:25.760 | So with that, and folks who don't know Mike Piper, he's a CPA and he's very active again

00:01:32.880 | on the forums, very accessible, he's humble, he's approachable, he's a phenomenal person.

00:01:38.040 | So I'm very comfortable recommending this book.

00:01:41.080 | And more specifically, I'll just cover the table of contents.

00:01:44.200 | The book's divided in this way of immediate steps and very practical, almost checklist-oriented

00:01:53.440 | what folks would be encountering, but you can read it and in advance know what to plan

00:02:01.160 | for.

00:02:02.160 | So it covers the roles of the executor and by empowering yourself, and it's very conversationally

00:02:10.440 | written, void of jargon, very user-friendly.

00:02:14.520 | So I wholeheartedly recommend at least the first half for the planning stage.

00:02:19.920 | And why I distinguish the second half towards the bottom of this table of contents, you

00:02:24.280 | see part two, intermediate next steps.

00:02:27.740 | This large, and now I'm forwarding to the next part of the table of contents, a lot

00:02:32.200 | of this addresses the technical financial aspects of accounts and beneficiaries for

00:02:40.600 | IRAs and inherited IRAs, and even deferring an inheritance, which didn't occur to me,

00:02:47.160 | and he goes over why one might do that, tax reasons and otherwise.

00:02:51.280 | Something else that I thought was really valuable in the first half of the book was notifying

00:02:58.540 | credit bureaus, so the credit reporting agencies like TransUnion, Experian, and Equifax, after

00:03:05.640 | the death of your spouse, because there's identity theft.

00:03:08.880 | So that hadn't occurred to me.

00:03:10.280 | I think a lot of people are versed in subsections of this topic, but there's just a gold mine,

00:03:17.920 | a treasure trove of practical insights here.

00:03:21.440 | So again, I'll scroll back to the cover.

00:03:26.480 | That's the title, "After the Death of Your Spouse" by Mike Piper.

00:03:29.080 | You can find it on Kindle for $4.99 as of today.

00:03:33.320 | With that, I will stop sharing my screen.

00:03:36.240 | Pause, share.

00:03:39.640 | Pause that.

00:03:42.080 | Okay.

00:03:43.940 | With that, I'll jump into how we'll structure the rest of today's meeting.

00:03:48.120 | So thanks to everyone for joining.

00:03:51.000 | We've divided the topical content into these five categories, which I'll read.

00:03:57.900 | The first, taking care of an aging parent.

00:04:01.800 | Second, elder care planning, including power of attorney.

00:04:06.720 | The third, health directives and proxies, as well as living wills.

00:04:12.640 | The fourth, guardianships, including custody and handling incapacitation.

00:04:19.700 | And the fifth of five is end of life situations, including prepaid funerals.

00:04:26.220 | So with those topics, we'll open it up to the group to share, as Mary mentioned, personal

00:04:31.360 | experiences, focused questions.

00:04:37.040 | We will aggregate those questions, compile them, consolidate them, present them to Summerfield

00:04:43.080 | so that when we reschedule, he can address them in a very focused manner.

00:04:48.200 | So I'll pause for a second.

00:04:50.480 | Miriam or team, did I miss anything in terms of how we'll structure what folks can expect

00:04:56.600 | in terms of ground rules for the meeting?

00:04:59.560 | May I ask, Michelle, did your hand up for a reason?

00:05:06.920 | And also there's background noise, so if you're not intending to speak, can you mute, please?

00:05:11.880 | Okay, thank you.

00:05:13.800 | Okay.

00:05:14.800 | So Alan, Lady Geek, Miriam, did I miss anything in terms of how we intend to structure this

00:05:20.460 | since there's a bit of ad hoc going on?

00:05:23.240 | No.

00:05:24.240 | Okay.

00:05:25.240 | So why don't we open it up to the group, taking care of an elder parent.

00:05:27.840 | This is an opportunity ideally to share factual, informed insights, guidance, experience, things

00:05:34.840 | that you found helpful, specific questions you have.

00:05:38.080 | What we'd like to avoid is too highly opinionated where it could be wrong or where it's not

00:05:47.600 | factual and it could lead to mis- or disinformation.

00:05:52.840 | So nothing wrong with sharing what you found helpful.

00:05:55.480 | It's obviously subjective, but we want to avoid putting out wrong information.

00:06:02.240 | So with that, let's open up taking care of an aging parent.

00:06:08.440 | Feel free to raise your hand, put questions in the chat.

00:06:15.120 | Does anyone have a specific question about taking care of an aging parent or those who

00:06:24.780 | have?

00:06:26.800 | So Stu has his or her hand raised.

00:06:29.920 | Stu, feel free.

00:06:32.640 | Yeah.

00:06:33.640 | My mom lives in Florida and we are not in Florida and it seems like she's having issues

00:06:43.880 | getting to doctor's appointments.

00:06:46.320 | So she's late 80s and she's been asking her neighbors, but I can tell the neighbors are

00:06:54.080 | getting tired of taking mom to her appointments.

00:07:00.480 | How far are the doctors and how many?

00:07:03.080 | Maybe like 15 to 30 minutes away.

00:07:05.640 | And how often does she need to go?

00:07:09.160 | Well, I'd say maybe once a month and a half, every month and a half.

00:07:16.080 | Okay.

00:07:17.080 | Miriam has her hand up.

00:07:20.080 | Yeah.

00:07:21.080 | One thing, check her insurance policy.

00:07:23.720 | Her health insurance policy to see if there is the health insurance company can pay for

00:07:30.840 | a medical van to take her.

00:07:34.000 | She's eligible for that.

00:07:35.900 | And also our relatives used, well, first of all, there are also private medical vans that

00:07:41.960 | she could sign up with.

00:07:44.280 | And sometimes the local counties have medical vans that are available.

00:07:51.120 | And we would have to apply with the county to, especially in Florida, to apply with the

00:07:57.040 | county, with the agencies that supply the medical vans.

00:08:01.480 | But I remember using one for a relative and they actually, the relative was in a wheelchair.

00:08:09.600 | They would put the wheelchair in the van and it would be locked inside the van.

00:08:13.120 | So it didn't move.

00:08:15.040 | And it was, I could go with our relative in the van also to the doctor's appointment.

00:08:22.520 | And the reason I could not take the person is that, first of all, if the person fell

00:08:28.360 | out of the wheelchair, I could not pick them up.

00:08:32.300 | And then also it was just so difficult maneuvering the wheelchair and getting the person from

00:08:38.080 | the wheelchair into my car.

00:08:39.960 | So the medical van was the solution rather than a neighbor who, it comes to a point where

00:08:48.280 | the neighbor is not going to be so willing probably.

00:08:54.440 | She's got a Blue Cross-Fed program, basic.

00:09:00.840 | I don't think she would want to spend a dollar on any transportation.

00:09:09.200 | She'd rather miss her appointment.

00:09:11.420 | - What's her mobility like?

00:09:15.840 | - She's fine, but late 80s, she's not the best driver anymore.

00:09:19.560 | - I was gonna say, I've had to arrange transportation in Florida for my parents on occasion, and

00:09:26.520 | when they couldn't get, they're in assisted living and they generally can get rides from

00:09:31.800 | the assisted living to their appointments.

00:09:34.000 | But when I've had to arrange a ride, there are some taxi services that cater to the senior

00:09:44.720 | population.

00:09:45.720 | You might have to search them out, but it may not be available where you want to live,

00:09:50.960 | but it might be something to look at.

00:09:53.960 | It might be a cheaper option than maybe the full medical transport, which can get kind

00:09:58.280 | of expensive.

00:09:59.280 | - Is she in a suburban or urban, or how dense is her environment?

00:10:08.960 | - Between Fort Myers and Naples, it's called Estero.

00:10:15.440 | Well, it's a suburban.

00:10:20.560 | - Okay, and so some of these options like medical van or specialized taxi services,

00:10:26.480 | you mentioned her perhaps reluctance to spend.

00:10:31.680 | Are you or others covering her costs?

00:10:36.480 | If that were covered, would she be more agreeable to using these services?

00:10:41.680 | I don't want to volunteer you, it's perhaps a hypothetical.

00:10:45.280 | - I think if we were to spend the money, she would ask how much it costs and then she would

00:10:49.600 | get mad at us for spending the money.

00:10:53.620 | What if you told her it was a fraction of what it really costs?

00:10:58.040 | - She might find out.

00:10:59.040 | That's what I was thinking, maybe like, "Hey, we got a big discount on Uber.

00:11:06.880 | We got a 75% coupon and we got a bunch of rides for you, mom."

00:11:12.340 | - So Uber has worked for her?

00:11:14.000 | What has been working for you?

00:11:15.000 | - No, no, no, no.

00:11:16.000 | She hasn't done that yet.

00:11:17.000 | She's afraid to do that, but I'm thinking.

00:11:20.000 | - Are you going to tell her you're submitting it to insurance for a reimbursement?

00:11:25.600 | - Gorey, in the chat, one of the Vogelheads said, Sarah said, "Sometimes organizations

00:11:31.080 | for specific diseases, for example, the American Cancer Society may have a ride program through

00:11:39.760 | volunteers."

00:11:40.760 | - Excellent.

00:11:41.760 | So, Stu, thanks for the question.

00:11:47.040 | You definitely want to poll the audience for other topics or questions, but absent that,

00:11:52.920 | we can continue on this if it's helpful.

00:11:56.000 | I'm not monitoring the chat, so if others have things from the chat that should be shared

00:12:01.920 | verbally, Miriam or others, please do.

00:12:06.680 | Stu, was there anything more to your question that you want to share, either what has worked

00:12:12.000 | well for you, what may help others, what you learned later that benefited you that could

00:12:19.040 | help others early on?

00:12:20.900 | - Well, no, but right now, it's just been the neighbors, you know, and I'll be talking

00:12:30.040 | about this to my brothers because we need to have...

00:12:33.560 | We can't have her neighbors, like, relying on them.

00:12:38.160 | - Okay.

00:12:39.160 | Understood.

00:12:40.160 | Let's see.

00:12:41.160 | Alan has a question.

00:12:42.160 | - As I just want to point, I put a link in the chat of a helpful book resource to how

00:12:49.280 | to initiate the financial conversation with parents when you're addressing potential future

00:12:54.480 | needs or current.

00:12:56.300 | Sometimes they're unwilling and uncomfortable having a conversation with a child about their

00:13:01.760 | future needs, and there's a wonderful book.

00:13:05.040 | I've heard this author a number of times on some podcasts, Cameron Huddleston, basically

00:13:10.540 | about how to approach the conversation.

00:13:13.600 | She wrote about her own experience with her mother.

00:13:16.040 | The book is titled "Mom and Dad, We Need to Talk," how to have essential conversations

00:13:20.080 | with your parents about their finances, which also includes elder care planning and such.

00:13:27.000 | Just wanted to point that out as a good resource.

00:13:30.680 | - Great.

00:13:31.680 | Thanks, Alan.

00:13:32.680 | As far as getting assistance for driving an elderly parent, certainly if they have any

00:13:38.760 | religious affiliations, congregations that may be able to offer such services, and just

00:13:44.440 | Googling for the local county that she resides in, as well as the city, for assistance.

00:13:51.840 | I know my mother, who also lives in Florida and Clearwater, we've kind of dealt with this

00:13:56.800 | a little bit.

00:13:58.400 | We've actually found a private driver rather than using Uber, but I found out there is

00:14:04.520 | actually a volunteer organization that does provide services for nominal amounts, like

00:14:10.240 | $10 round trip within a certain radius of mileage.

00:14:17.400 | Those services might be available.

00:14:18.920 | - I found the private driver not to be that expensive, relatively speaking, myself.

00:14:25.960 | - Yeah, it depends, yeah.

00:14:30.120 | - Okay, very helpful.

00:14:35.360 | So a parallel question in the absence of other questions, why don't we quickly pull.

00:14:39.840 | If you have a question, please raise your hand or just chime in.

00:14:43.800 | This is super informal, feel free.

00:14:46.160 | You won't be interrupting, but in the absence of questions, I'm wondering, folks on this

00:14:52.800 | call seem cognitively aware, engaged, conversant, and we might have our own plans to age in

00:15:03.840 | place or stay in our homes as long as we're physically able, et cetera, but at some point,

00:15:09.080 | we lose objectivity and we're not able to make the same decisions that we thought we

00:15:14.620 | committed to earlier.

00:15:16.880 | So how have folks navigated this kind of less obvious transition of someone in their 50s

00:15:25.760 | or 60s saying, "Yes, when it's my time to move to assisted living, I'll voluntarily

00:15:30.960 | do that," but when they're 70 and all the things that they, in their younger rational

00:15:37.280 | days, they would have said they'd volunteer for, they no longer have that lens.

00:15:46.320 | Making my questions clear, when we lose the objectivity to voluntarily lose the home or

00:15:50.880 | seek assistance, leave the home, I mean, or accept assistance, I don't know, there must

00:16:00.520 | be people who've experienced this and how do we guard against that for ourselves?

00:16:04.160 | So are you saying that a family member would force the parents into an assisted situation?

00:16:18.320 | Is that kind of what you're-

00:16:19.880 | Oh no, not at all.

00:16:20.960 | So it's entirely hypothetical, but definitely I don't mean to imply anyone being forced

00:16:25.320 | or anything.

00:16:26.320 | So let's say in my current rational state, or I think I'm rational, I'll say when I need

00:16:33.640 | assistance, when I'm no longer independent, when my quality of life has deteriorated significantly,

00:16:39.960 | I'll be open to moving to a facility.

00:16:43.400 | That's what I say in my current state, when I have the cognitive ability to say that,

00:16:47.360 | and I mean it genuinely with the best of intentions, but fast forward a few decades, I'm no longer

00:16:53.280 | able to take care of myself, but I no longer have the objectivity to say, "I agreed to

00:16:58.920 | leave my home and accept assistance at this point."

00:17:03.460 | So my future self is holding on to distorted self-impressions of, "I'm still independent.

00:17:11.320 | I can exist in my home.

00:17:12.720 | I don't need assistance."

00:17:15.560 | Even though I previously said, "When the time comes, I will welcome those things."

00:17:19.840 | But it's-

00:17:20.840 | I think what tends to happen is, I know in my family situation, there was a medical event

00:17:29.200 | that triggered, that re-triggered the discussion that my parents should move, and they finally

00:17:40.800 | did agree.

00:17:41.800 | They made good plans, but I think they were trying to hold on to their lifestyle at home

00:17:47.360 | as long as they could, but they went beyond when they probably should have gone, but the

00:17:55.520 | medical events that they were in, I think it takes maybe family members staying engaged,

00:18:05.520 | evaluating cognitive, physical conditions, and assess what the options are for family

00:18:14.880 | members.

00:18:15.880 | Okay.

00:18:16.880 | That helps.

00:18:17.880 | A medical event sounds clear.

00:18:18.880 | So I see Miriam has her hand up, and then Ellen.

00:18:20.560 | Yes.

00:18:21.560 | I think this happens all the time, Gorrie.

00:18:23.680 | On the Vogelheads Forum, it seems that at every point in time, we have a thread that

00:18:29.720 | involves, "My elderly relative refuses to leave the home.

00:18:35.200 | My elderly aunt lives on a farm in the middle of Minnesota, 30 miles from the nearest medical

00:18:42.200 | center, and she refuses to leave."

00:18:45.080 | We have relatives who will- they are intent on aging in place in the home, even though

00:18:52.320 | right now they are basically homebound and bedridden.

00:18:58.720 | So it comes to a point, I think, where this is where guardianships come in, I suspect.

00:19:04.680 | And then also, what do you do?

00:19:05.920 | You just pick them up or get the sheriff out there and put them into a facility?

00:19:11.760 | This is a very, very difficult decision because, as you say, they're not necessarily thinking

00:19:18.000 | clearly due to age, or they just don't want to get old, they just don't want to move,

00:19:28.320 | they don't want to be in a facility.

00:19:31.560 | It's very, very difficult.

00:19:33.360 | There's different components of this, too.

00:19:35.680 | I know with my own dad, he loved to drive, but during one of my visits, I knew he shouldn't

00:19:43.160 | have been driving, and I had to engage his primary care doctor to- she was going to report

00:19:50.920 | him to the state of Florida to have his license revoked.

00:19:56.120 | But before she did that, she asked if he would visit with her to discuss this, and during

00:20:01.840 | that visit, he agreed to give up his license.

00:20:05.040 | But that was a component of just keeping him safe and keeping other people safe as well.

00:20:15.680 | So I see Allen has his hand up.

00:20:18.000 | I'll just ask in the interim, have folks seen something work in this situation?

00:20:27.280 | Are people, like in Miriam's example of bedridden, homebound, want to age in place, are they

00:20:32.840 | more receptive to conversations with their peers, their close friends, maybe family members

00:20:41.600 | who aren't the younger generation who are, you know, encouraging the different facility?

00:20:47.320 | But if they're someone from their own age group who went through something similar,

00:20:52.600 | have folks experienced that a bedridden, homebound, age in place, reluctant person is more receptive,

00:21:00.400 | more permeable, depending on the source of information?

00:21:04.920 | Okay, maybe we can revisit that.

00:21:11.120 | There's almost no choice.

00:21:12.120 | I mean, it gets to the point where for the elderly relative that I am thinking of in

00:21:18.920 | our family, where they will simply have no choice.

00:21:22.640 | Right now, they do not have their medicines on auto refill.

00:21:25.560 | They're not taking their medicines.

00:21:30.200 | They have a commode next to their bed.

00:21:32.520 | They cannot empty the commode.

00:21:36.600 | You know, every time we go over, it is a new thing.

00:21:39.720 | One more thing.

00:21:41.200 | It's embarrassing to say that this is a relative in the family.

00:21:44.920 | But this is what they want to do.

00:21:46.440 | They want to age in place.

00:21:48.280 | They are serious, they are intent on it.

00:21:50.920 | A guardianship, I understand.

00:21:53.800 | We've never done it.

00:21:54.800 | Nobody, I know in our family, we have a large family, nobody has ever had to have a guardianship.

00:22:02.360 | Because eventually it just became so obvious, the family went and said, we have a great

00:22:07.120 | place for you.

00:22:08.520 | We have a wonderful place for you.

00:22:10.640 | And you need to go there because you're going to lose the home.

00:22:13.920 | Or because for some reason, we just simply have to do it.

00:22:18.360 | Now is the time.

00:22:20.040 | And eventually move them.

00:22:21.840 | Find a place that you think that they would feel comfortable with.

00:22:25.800 | Find a place financially that is doable.

00:22:29.200 | It's very, very difficult.

00:22:30.560 | I don't know how else to explain it, but it would depend on each individual person.

00:22:36.080 | Some people qualify for Medicaid.

00:22:38.760 | Others do not.

00:22:40.200 | Some have financial resources.

00:22:42.800 | Others do not.

00:22:44.960 | It's a very big area.

00:22:46.760 | Mm-hmm.

00:22:47.760 | So maybe it takes exposure long before the situation, touring facilities saying, would

00:22:53.960 | you ever consider moving here if the situation came to it?

00:22:57.520 | I'll say no.

00:22:58.520 | That's a nice thing to do, but they're going to say no.

00:23:00.440 | Well, this relative has said no.

00:23:03.560 | But I'm saying in the rational decade or two before the event presents, if when folks have

00:23:10.680 | objectivity and it's framed hypothetically as if you reached a state where you needed

00:23:16.960 | a commode next to your bed, where you couldn't physically perform x, y, z, those daily functions,

00:23:25.600 | would you consider this place, this?

00:23:29.160 | They will say no.

00:23:30.480 | Because first of all, I will never be in a position to need a commode next to my bed.

00:23:36.200 | And also if I do, I will be able to take care of it.

00:23:40.480 | Or I will hire a lady to come in and clean.

00:23:43.620 | There will be rational in their mind, rational explanations for why they will never need

00:23:49.880 | to move to an assisted living facility.

00:23:52.920 | And by the way, I never use with our relative, this relative, the word nursing home.

00:23:58.560 | I always call it an assisted living facility.

00:24:02.400 | But that and it helps a little bit, but they will, you know, that there will always be

00:24:09.800 | a reason on their mind why they don't need it.

00:24:12.320 | And also they will think that they will get better.

00:24:15.160 | Today I can't get out of bed, but tomorrow I'll probably be able to.

00:24:20.200 | If I take my extra Tylenol, I will be able to get out of bed and I'll be able to push

00:24:24.800 | the microwave buttons to make my dinner.

00:24:28.920 | That's how it comes and it doesn't happen.

00:24:33.040 | Understood.

00:24:34.040 | It comes down to independence.

00:24:35.040 | I think that's really people try to, I think, I think the intention is good.

00:24:41.660 | Maybe when you're in your fifties or sixties that when you reach that stage that you would

00:24:47.280 | consider it.

00:24:48.280 | But then when you get there, you've enjoyed the life that you've had and you're just trying

00:24:53.560 | to.

00:24:55.640 | But that's my point.

00:24:56.680 | Are we those people too?

00:24:58.680 | Because we're referring to a different group, but maybe we're all vulnerable to that.

00:25:05.720 | So, okay.

00:25:06.720 | Why don't we pause that for a second, Alan, you've had your hand up for a while.

00:25:09.280 | And then Sarah.

00:25:10.280 | Okay.

00:25:11.280 | Just to address this last question, I think the problem is even when people are on sound

00:25:16.080 | mind and say that I plan on doing X, Y, and Z when cognitive decline kicks in, they probably

00:25:22.040 | will no longer recognize or acknowledge that they stated that before.

00:25:25.880 | So it's a hurdle that's hard to overcome, but you can, there are other resources and

00:25:30.120 | ways to approach this.

00:25:31.460 | For instance, most elderly have a primary care physician nowadays met the Medicare wellness

00:25:38.000 | annual wellness exam requires a review of a memory test, cognition questionnaire, and

00:25:45.040 | other questions.

00:25:46.040 | If you accompany an elderly parent to the primary care annual exam, they will assess

00:25:51.960 | and ask for input and the physician may be helpful in determining that it perhaps is

00:25:57.760 | time to, as a minimum, get some home healthcare, which could be a transition towards assisted

00:26:03.680 | living.

00:26:04.680 | Also, if an elderly parent has either a long-term care policy or indemnity plan that offers

00:26:12.280 | some home health care, that's another way to transition towards a more complete care

00:26:18.240 | down the road.

00:26:20.240 | It's certainly prudent to review if your parents will allow you any of their insurance

00:26:25.360 | policies, particularly long-term care policies and reading in detail what the services are.

00:26:32.600 | I had to go through this with my mother who's 92 and battling pancreatic cancer.

00:26:37.840 | She had what we thought was a pretty good long-term care policy that turns out now that

00:26:42.120 | company out of Pennsylvania is in rehabilitation, long story, I could go on for an hour about

00:26:47.560 | that.

00:26:48.560 | It does have homemaker benefit, it does have some home healthcare benefit that we've been

00:26:53.600 | able to take advantage of, and she wants to continue to remain in her home with assistance

00:26:59.080 | as needed.

00:27:00.080 | We may or may not need to have either inpatient hospice care, potentially, or rather in her

00:27:05.600 | house.

00:27:06.600 | But certainly, looking at those resources from the physician, it's typically going to

00:27:11.160 | be a medical event that precipitates this.

00:27:15.000 | Multiple calls, falls, other injuries, unfortunately, that make it more of an urgent matter.

00:27:21.800 | But if somebody's hospitalized and sent to rehab, that's one way to transition to another

00:27:28.200 | facility down the road.

00:27:30.160 | Social worker from the hospital may be able to assist with placement and assessment, at

00:27:34.640 | least to assess what their home situation is, and from their professional perspective,

00:27:39.680 | that is needed.

00:27:41.520 | >> Okay.

00:27:42.520 | Thank you, Alan.

00:27:45.520 | Very helpful.

00:27:47.640 | Sarah, you had your hand up?

00:27:50.880 | >> Yes.

00:27:51.880 | Following up on what Alan said, a medical event can be an opportunity.

00:28:00.680 | Your loved one, even if they're -- so Medicare only -- Medicare, original Medicare only goes

00:28:07.640 | into a skilled nursing facility at their cost if the -- I think it's 48 hours, 72 hours,

00:28:14.520 | something like that.

00:28:16.160 | But even if they don't qualify for that, to discharge somebody from the hospital to an

00:28:23.240 | assisted living place, because the doctor said, even if that might not be per se what

00:28:28.560 | they said, may be a way to get them in the door, and somehow or another, they just never

00:28:34.100 | leave that.

00:28:36.520 | There was a story years ago, I think it was on Invisibilia, about how we, as we age, crave

00:28:48.060 | the familiar.

00:28:49.920 | And so you're asking somebody who's lived in their home maybe 40 or more years to leave

00:28:57.160 | the thing that they understand, that they know how to cope with, and when we're looking

00:29:04.320 | the most for what is familiar, and that might be something to keep in mind when a relative

00:29:09.880 | is pushing back.

00:29:13.720 | You know, one of the reasons to me to moving into a CCRC is that they are a life plan community,

00:29:20.580 | is that they are the ones that are going to say, you know what, this just ain't working,

00:29:24.720 | it's time to move to the next level.

00:29:27.320 | >> And for folks who don't know, what's a CCRC?

00:29:30.840 | >> Pre-McHara Retirement Community, also called a life plan community.

00:29:36.080 | And you know, there's usually a big buy-in, they're also considered a financial risk because

00:29:41.360 | of that big buy-in, whether or not they will float until you no longer need their services.

00:29:49.240 | There's lots of threads on Bogleheads about CCRCs.

00:29:54.240 | A care manager, if you were able to recruit a care manager, perhaps they would be able

00:30:03.320 | to be the third party that comes in and says, this doesn't work, I wrote another note here,

00:30:11.480 | but I can't read that.

00:30:14.160 | And you know, the other thing that I would be concerned about is whether or not something

00:30:21.040 | like Adult Protective Services, that's what we call it in my state, could become involved.

00:30:28.000 | Is there the possibility that this would be considered so negligent that family members

00:30:33.880 | would be accused of being negligent?

00:30:38.120 | And I don't know, and the home care nurses that I knew that called APS back in the day

00:30:45.200 | when I did a little bit of home care, didn't think that in my state APS was very successful

00:30:52.920 | in their deeds.

00:30:55.120 | So, but definitely to, you know, it ain't easy.

00:31:00.760 | It just is not easy.

00:31:03.680 | >> Okay.

00:31:06.200 | Thank you, Sarah.

00:31:07.200 | Diane?

00:31:08.200 | >> I came late to this discussion.

00:31:14.920 | So I'm sorry.

00:31:16.080 | I'm a boglehead nanny.

00:31:21.000 | I'm just adamant about having the discussion as early as possible, if it's your family

00:31:28.640 | or if it's someone -- if it's your immediate family or it's someone else, have the discussion.

00:31:35.440 | Start at age 50.

00:31:37.280 | Make sure you know.

00:31:39.760 | Someone says, I never, ever want to go into a home.

00:31:45.960 | Why not?

00:31:47.720 | Explore everything that you possibly can.

00:31:51.380 | Figure out what the alternatives are.

00:31:53.640 | Do not wait.

00:31:55.280 | It's -- you write the other thing.

00:32:00.360 | Write a letter to yourself.

00:32:02.120 | If you think there's a possibility of memory impairment, write a letter to yourself.

00:32:10.880 | Do not -- and it does not come on suddenly.

00:32:15.320 | There can be suspect -- in terms of the Medicare wellness, it's pretty easy to avoid that.

00:32:27.640 | But if it does not come on suddenly, you know, your loved ones know, write a letter to yourself.

00:32:36.040 | Be absolutely positive of what you do and don't want.

00:32:40.960 | And if you have a family member that says, I'm going to stay in my home no matter what,

00:32:47.120 | then figure out what the scenarios are.

00:32:49.360 | List them out.

00:32:50.800 | What if this happens?

00:32:51.800 | What if this happens?

00:32:52.800 | If they say no, you have to figure out where your boundaries are and what you can do for

00:33:00.840 | them.

00:33:01.840 | >> Okay.

00:33:02.840 | Thank you.

00:33:03.840 | Very helpful.

00:33:04.840 | So I want to also add to the way you said write a letter to yourself, I wonder if people

00:33:10.160 | can record videos to themselves.

00:33:12.920 | And that way, you know, someone said earlier, they will deny having felt that or said that.

00:33:18.920 | But reading something can also be -- I didn't write that, but maybe seeing a video of oneself

00:33:24.000 | can be more convincing.

00:33:25.920 | And something also came to mind, a lot of long-term care plans can pay family members

00:33:34.600 | to be the caretaker.

00:33:37.800 | I don't know if folks have familiarity with that.

00:33:40.560 | But where a family member serves the elderly person in their own home so that you don't

00:33:48.040 | need to hire necessarily an external home health aide.

00:33:52.360 | So I think that's normal or at least not atypical.

00:33:59.400 | So I want to remind folks of the other topics and in the interest of time, we can -- some

00:34:06.160 | of these segue equally into each other.

00:34:09.280 | So the next one on the list is elder care planning, including power of attorney.

00:34:15.240 | So certainly our first portion included a lot of elder care planning.

00:34:20.000 | But under this umbrella, are there any other additional comments or questions or experiences?

00:34:27.200 | >> About the first topic?

00:34:31.900 | >> So taking care of an aging parent was the first, then we're moving to the second, elder

00:34:36.040 | care planning, including power of attorney.

00:34:38.200 | >> One thing I would add to this topic was it was helpful for me getting my parents to

00:34:45.920 | consider moving to assisted living several years ago was while my mom was hospitalized,

00:34:52.240 | the case manager mentioned that there were agencies that would help you discern appropriate

00:35:01.520 | places for placement based on financial resources.

00:35:08.000 | And that process was so invaluable to getting my parents to open their eyes to what was

00:35:15.540 | available to them in their community and that they could afford it.

00:35:22.620 | >> It sounds like a great resource.

00:35:24.000 | >> Those agencies are free.

00:35:26.640 | >> Okay.

00:35:27.640 | I see Miriam has her hand up, but very briefly, Stu, how does one find such an agency?

00:35:33.800 | Is it as simple as Googling agencies to help find assisted living?

00:35:38.880 | >> Probably.

00:35:40.760 | >> Okay.

00:35:43.000 | Thank you.

00:35:44.000 | Miriam?

00:35:45.000 | >> Yes.

00:35:46.000 | On powers of attorney, Gary, we did have a question coming in from the RSVP list, and

00:35:51.280 | it had to do with the difference between financial powers of attorney and health directive powers

00:35:58.680 | of attorney, whether to have separate documents or one document.

00:36:06.200 | And one of the reasons they asked is that they find that medical places, hospitals and

00:36:14.320 | nursing homes do not necessarily even ask for the powers of attorney, the power of attorney,

00:36:22.560 | but the banks will.

00:36:25.920 | And then also, well, that was that part of the question.

00:36:32.760 | So I know, for example, our power of attorney for my husband's elderly sisters is 27 pages

00:36:39.720 | long, and that's Times New Roman 12 point or 14 point, the regular document point.

00:36:47.080 | Now, you know, why wasn't -- when I take it with me to their doctors, they don't even

00:36:54.320 | want to see it.

00:36:55.320 | I pull it out, and they think I'm serving them a subpoena or something.

00:36:59.840 | It's just huge.

00:37:02.160 | But on the other hand, you need the power of attorney.

00:37:05.880 | You need that for medical decisions, and for -- you need the power of attorney.

00:37:12.720 | How do people handle the power of attorney, and what has been their experiences in hospitals

00:37:16.840 | and nursing homes with the powers of attorney?

00:37:19.360 | >> I have experience with it, if you want me to comment.

00:37:23.360 | >> Pardon me?

00:37:24.360 | >> I have experience with it.

00:37:25.360 | I'm currently using one for my father in Florida.

00:37:28.960 | I've used it for four years.

00:37:32.080 | He had set up a durable power of attorney with his family lawyer several years ago,

00:37:37.200 | and that's good for financial as well as medical.

00:37:40.480 | His medical providers have asked for it for me to talk to them, so it's usually very easily

00:37:46.080 | sent over.

00:37:47.080 | I just -- I've scanned it into a PDF document and emailed it to them when they needed it.

00:37:52.880 | Occasionally, I'll have to fax one in, but it's not 27 pages.

00:37:57.960 | I think it might be five or six pages, I think, but it's a standard durable -- it's called

00:38:02.640 | a durable power of attorney.

00:38:04.480 | It wouldn't allow me to probably transact, say, real estate transactions, although I

00:38:13.440 | say that, and I was able to sell my father's house several years ago with it, but I don't

00:38:20.960 | know if I'd be able to take out loans against the real estate with it, but I haven't attempted

00:38:28.800 | to do that either.

00:38:29.800 | So that's --

00:38:30.800 | >> Right.

00:38:31.800 | So I see Diane and then Lady Geek, and just a quick comment.

00:38:38.120 | The way Miriam mentioned, banks will ask for the power of attorney.

00:38:42.000 | I think folks in this crowd know banks often have their own specific power of attorney,

00:38:47.640 | so you'd want to get a copy of that.

00:38:49.280 | >> Yeah.

00:38:50.280 | I was a banker in my career, and we would usually want a power of attorney specific

00:38:55.960 | for the transaction if you were borrowing money.

00:38:59.120 | >> Got it.

00:39:00.120 | Okay.

00:39:01.120 | Diane and then Lady Geek, and then Deanna.

00:39:03.920 | >> It's two totally, totally different things, and what are you trying to accomplish?

00:39:08.640 | If you're trying to deal with the finances, you need a regular power of attorney, but

00:39:15.080 | if you're trying to deal with healthcare, you need a durable power of attorney for healthcare,

00:39:22.280 | and that needs to be ironclad.

00:39:25.920 | You need to 100% know what your patient wants you to advocate for, and you need to be really,

00:39:37.520 | really clear, but I'm not sure why there's a confusion between the two separate things,

00:39:44.720 | because a healthcare provider, in my experience, only wants to know that you have the healthcare

00:39:52.400 | power of attorney, and they will recognize that.

00:39:56.560 | >> Okay.

00:39:58.080 | Miriam, do you want to reiterate if there was confusion?

00:40:03.200 | Do you want to clarify that question?

00:40:06.160 | When we say healthcare power of attorney, is that different from healthcare proxy?

00:40:10.760 | >> Yes.

00:40:11.760 | >> Okay.

00:40:12.760 | >> No.

00:40:13.760 | >> Well, yes, no, no, no, no, it's not different from a healthcare proxy.

00:40:17.760 | I think it has to do with whether or not you have two separate documents.

00:40:22.360 | I think that's what the question was, whether there are two separate documents, whether

00:40:26.960 | you can walk in with a, have your power of attorney, just a health power of attorney,

00:40:33.920 | healthcare power of attorney, I guess the healthcare proxy, but for example, our power

00:40:38.920 | of attorney has healthcare in it as one subsection.

00:40:44.520 | It has real estate, it has financial, it even has virtual currency in it, meaning every

00:40:54.080 | new possible clause that an attorney can put into a power of attorney is there, including

00:41:00.120 | the latest Florida legislative, legislative law from Florida that if the bank won't accept

00:41:10.280 | your power of attorney, then you can sue them.

00:41:12.480 | Even that is in this power of attorney, it has everything, it has the whole kitchen sink

00:41:16.320 | in it, and that's what I say, it's 27 pages long, but I think the question had to do with

00:41:21.040 | having a short power of attorney for healthcare versus putting in all the financial stuff

00:41:28.280 | in the power of attorney, because the question says that they find that the medical places,

00:41:33.840 | hospitals and nursing homes, don't even want to look at it, they just say, do you have

00:41:37.960 | it?

00:41:38.960 | And then they accept it.

00:41:39.960 | Yeah.

00:41:40.960 | My experience at Durable has worked for the medical community, when they've asked for

00:41:47.720 | it, I've sent it in, and it was like magic, they started talking to me, so it's good.

00:41:55.000 | Okay.

00:41:56.000 | Diane, your hand is still up.

00:41:57.000 | Do you have additional comments?

00:41:58.680 | No.

00:41:59.680 | Okay.

00:42:00.680 | Lady Geek.

00:42:01.680 | Okay.

00:42:02.680 | Hello.

00:42:03.680 | Okay.

00:42:04.680 | Diane, I'll lower your hand then.

00:42:08.440 | Okay.

00:42:09.720 | So the difference, there's three different things that get confused, not with my mom,

00:42:16.440 | but when my husband was alive, there is a, I had a, it was a standby, a power of attorney

00:42:24.200 | for legal financial things, and then there's a medical power of attorney, but there's also

00:42:30.040 | when he was a frequent flyer to the hospital ER, they really don't care about POA.

00:42:37.320 | As a spouse, I have automatic legal rights, or actually I didn't even, I don't believe

00:42:47.320 | I, they actually said, do you have power of attorney, yeah, and I brought it in, and all

00:42:50.520 | they did was copy Xerox, the nurse on staff or the physician on staff would just take

00:42:55.840 | my POA, run it in through the copier, staple it and hand it back to me, he says, okay,

00:43:01.600 | you're good.

00:43:02.600 | Nobody reads that, but as a spouse, I have, I do have legal rights to admit him, and I

00:43:09.560 | was doing that, well, maybe I did show it, but either way, I was doing that, but medical

00:43:14.640 | directives.

00:43:16.600 | In Pennsylvania, there's a standard form called the Pennsylvania Order for Life Sustaining

00:43:21.400 | Treatment, the PULSE form, I believe that's standard in many states, it is a doctor's

00:43:26.360 | order, you can change it as many times as you want, nobody reads a legal document, these

00:43:31.440 | are doctor's orders, you sit down with the case manager, with the nurse, with the physician,

00:43:35.720 | you sit down one-on-one and say, what do you want, what do you want to do with your husband?

00:43:40.080 | They go, DNR, do this, do that, oh, by the way, never do feeding tubes, that is inhumane,

00:43:46.320 | but the, so, yeah, I've seen it done, I was pissed.

00:43:52.720 | So the, so what he's saying, it's just separate out the process, if, when you need a medical

00:43:59.080 | thing, you're in a hospital, or a doctor's office or something, they, you fill out the

00:44:04.220 | PULSE form, the order, a doctor order for life-sustaining treatment, then you tell the

00:44:08.240 | person what do you want to do, you're done, they don't care anything about the legal documents,

00:44:13.360 | they might ask for POA later on, that's about it, so just be clear that when you fill out,

00:44:19.240 | when you're, when you pay a lawyer to fill out these documents, at least the person who's

00:44:23.920 | going to need to use them can read them, and then take care of it for you under their own

00:44:28.560 | POA, so that, that's what I wanted to mention from, from doing this many times.

00:44:38.040 | I did it for my mom, I believe, as her daughter, but, and again, I brought in my POA, which

00:44:46.160 | was actually a, was not adorable, it was a standby POA, with the condition that she have

00:44:52.120 | two medical, signed medical statements from her doctors saying she was incompetent for

00:44:56.780 | financial decisions, I got, I easily got those, that's when she was admitted to memory care,

00:45:01.120 | I admitted her under that POA, they, that became, it becomes durable when that happened,

00:45:05.680 | I forget they call it springing POA or whatever, but, so that's what I wanted to say about

00:45:11.480 | POAs, there's, there's legal things, and there's practical things, oh, sorry, about the bank

00:45:17.720 | POAs, I actually did have a bank form years ago, when I signed one for my mom when she

00:45:23.080 | first moved into her CCRC, at the local bank, I went back as, you know, trying to modify

00:45:31.040 | her accounts, and they refused that, and they wanted, now they said they don't, they no

00:45:35.160 | longer use bank POAs, they want the real POA, Xeroxed it, copied it, and then they sent

00:45:42.240 | off to their, whatever the bank's legal guys say, and they turn around, they said, yeah,

00:45:46.680 | you're good, fill it in, so I'm good to go, so I don't think banks are using their own

00:45:51.080 | forms anymore, okay, that's all I had to say.

00:45:53.880 | Okay, thank you, Lady Geek, Tiana, you may be muted, you appear muted.

00:46:03.000 | I'm the person that Miriam had read the note about, banks accept the POAs, and the medical

00:46:11.040 | people don't care, so the reason I said that was last year, I have one sister that has

00:46:18.540 | a POA, and I have the POA for my mom, who's 100 now, and my other sister does not have

00:46:25.320 | a POA, so the other sister took my mom from the hospital to a nursing home, and put her

00:46:32.400 | in a nursing home, and then signed it as, she said, I have a POA, so she signed it,

00:46:40.360 | and it wasn't like the medical part, it was the, are you the person responsible for paying

00:46:47.160 | bills if she can't, so it was, you know, they should have asked for the copy of the power

00:46:56.200 | of attorney, and in their document, they say, we will ask within 24 hours for a copy of

00:47:01.880 | your POA, but they never did, so there's my mom in the nursing home, and we didn't have

00:47:09.800 | what you call the medical power of attorney, so in that case, my mom would be the person

00:47:16.540 | that has the full authority to make her own medical decisions, so everything went wrong

00:47:22.360 | in that case, and I don't know if anyone has any comments.

00:47:26.840 | Regarding the contract, I know when I put my parents into assisted living, I didn't

00:47:42.420 | have to have a power of attorney to sign the contract for them to enter the facility, I

00:47:48.200 | just took on the financial responsibility for them, so I don't know if you need the

00:47:53.320 | POA necessarily for that.

00:47:57.320 | Deanna, has the nursing home followed up to obtain a copy?

00:48:04.240 | No, that was last year, and she was there for like three weeks, I think.

00:48:09.880 | The thing that Bill said, I forgot, what did you say, Bill?

00:48:16.740 | I think you mentioned your sister signed the contract for the nursing home.

00:48:23.220 | But in this part of their contract, it specifically said, are you signing this as power of attorney,

00:48:30.540 | so you could sign it as the person taking on the responsibility, you would sign it on

00:48:34.100 | a different line, but if you sign it as power of attorney, then they're supposed to ask

00:48:37.820 | you a document, so basically, you're hoping that just an average person couldn't just

00:48:44.660 | throw your mom in a nursing home, but they can.

00:48:51.140 | And we didn't know if we could get her out again very easily, because we didn't have

00:48:56.140 | the medical power of attorney, so it was like, someone can do something, but we can't undo

00:49:03.220 | it very easily.

00:49:05.320 | If we had the medical power of attorney, my other sister or I probably could have gotten

00:49:09.260 | her out immediately.

00:49:11.980 | But because of that, we had to go through like a three-week process to get her back

00:49:16.620 | out again, so yeah.

00:49:21.420 | Wow.

00:49:24.460 | Any other questions or comments regarding what we've covered so far?

00:49:30.380 | Allen.

00:49:31.380 | Yeah, I was just going to say, for many of us, our elderly parents may have had a durable

00:49:39.940 | power of attorney and healthcare surrogate, and all these documents completed many, many

00:49:45.040 | years ago, even over decades ago, so it's certainly worth reviewing in advance.

00:49:50.080 | There may be newer formats and state legislation that requires additional content, as Miriam

00:49:56.360 | said, and it's prudent to review that on a regular basis.

00:50:00.920 | I know recently, when my mother took ill, I contacted her attorney, and we in fact updated

00:50:08.200 | her powers of attorney and everything, in addition to her will, but he said that what

00:50:13.960 | we had was really totally outdated and had just been sitting in a lockbox all these years,

00:50:19.460 | so that's something else to be proactive with.

00:50:26.060 | Do you recall the material differences?

00:50:30.320 | In our case, there was some language that the state of Florida wanted in the more current

00:50:35.880 | version.

00:50:36.880 | I don't recall the specifics.

00:50:37.880 | I know it was probably a couple of pages longer than the original one.

00:50:43.400 | I didn't compare the two, but he reassured me that what we have is current, and I will

00:50:48.660 | ultimately have power.

00:50:50.160 | I already have durable power of attorney for her.

00:50:53.940 | Haven't had any issues as yet, but I haven't had to do much with it as yet.

00:50:57.720 | Okay.

00:50:58.720 | Miriam.

00:50:59.720 | Thank you, Alan.

00:51:00.720 | Yes.

00:51:01.720 | I wanted to ask Lady Geek, on the POLST, the Provider Orders for Life-Sustaining Treatment,

00:51:09.420 | how does that differ from the living will?

00:51:12.920 | Nobody looks at the living will?

00:51:14.720 | Well, what is the living will, first of all?

00:51:18.320 | The living will is your life-sustaining treatment, what you wish for life-sustaining treatment.

00:51:26.320 | What you wish.

00:51:27.320 | It's called an advanced healthcare directive.

00:51:29.000 | Right.

00:51:30.000 | And you sign that.

00:51:31.000 | The elderly person signs that ahead of time, and it is then notarized, I guess, whatever

00:51:38.200 | the state requires.

00:51:39.720 | But how does that differ, then, from the POLST?

00:51:42.440 | The POLST is a doctor order they must follow.

00:51:48.840 | The advanced healthcare directive is a legal document that somebody looks at and interprets.

00:51:53.960 | So the doctor's orders is immediate, it's effective, everybody knows what to do, and

00:51:58.600 | they will follow it.

00:51:59.600 | You can update that as many times as you want, while that person stays there, but I've never

00:52:05.080 | been asked for the advanced healthcare directive, because I've always filled out that form,

00:52:10.000 | and they were very clear, it's a one-on-one interaction, they explain everything, and

00:52:14.560 | I sign it.

00:52:15.560 | I think I sign it as patient representative, or I sign my name Lady Geek POA, or something

00:52:21.960 | like that.

00:52:23.760 | And then, of course, they have the copy of the actual POA that people never read.

00:52:30.520 | But they say being a spouse, or being a daughter, immediate family, goes a long way.

00:52:36.520 | If it was a friend, an unmarried partner, you'd have a lot more to prove, I would think.

00:52:45.080 | Or more disrelevance.

00:52:46.680 | Okay.

00:52:47.800 | Thank you, Lady Geek.

00:52:48.800 | Diane, and then Sarah.

00:52:52.160 | A POST is very different, in my experience, from a power of attorney, a medical power

00:52:59.320 | of attorney.

00:53:00.320 | A medical power of attorney can be very explicit, talking about what you want, in any number

00:53:06.080 | of circumstances, and you can evoke it.

00:53:10.280 | A POST, you have three choices.

00:53:13.320 | I want full care, I want intermediate care, maybe if this happens, I want to do this,

00:53:21.640 | or I do not want any resuscitation.

00:53:26.120 | A POST is absolutely 100% clear about what you want.

00:53:34.960 | And a durable power of attorney is like, these are your wishes.

00:53:38.840 | And so, I've heard it said that you don't need a POST until you get older.

00:53:45.040 | I think because of the fact that you can choose, I want full code, I want everything, that

00:53:53.280 | people should have a POST.

00:53:54.840 | I know, I'm older, I live in a facility where ambulances may come once or twice a week.

00:54:04.560 | They always want to see the POST.

00:54:10.280 | Some people feel as though when they're younger, they don't need a POST.

00:54:14.960 | I don't understand the downside of having one, but it is much more direct and explicit

00:54:23.280 | and covers the situation.

00:54:28.360 | So I would 100% recommend a POST.

00:54:32.560 | Okay, thank you, Diane.

00:54:35.660 | So maybe something for the crowd to noodle on is downsides to a POST, as Diane mentioned,

00:54:43.960 | not knowing what the downsides are.

00:54:46.120 | So if folks have an experience with the downside, they can share it later.

00:54:50.200 | So Sarah, and then Beverly and Tim.

00:54:54.120 | So, yes, advanced directives are often expressing your wishes, but they are not physician's

00:55:03.280 | orders or providers or licensed independent practitioners orders.

00:55:08.940 | And the medical world works off of protocols and orders.

00:55:14.680 | So you can go into a hospital and somebody will read your advanced directives and say,

00:55:19.760 | is the DNR all right?

00:55:21.320 | And they'll say yes, and they write the order for the DNR.

00:55:23.780 | And that ceases to exist when you go out, when you're discharged from the hospital.

00:55:29.200 | Physician's order for life-sustaining treatment is so long as you can present it to a provider,

00:55:34.980 | then they need to follow that order.

00:55:37.080 | And so when the EMTs arrive at your house, the paramedics, and they're going to work

00:55:42.320 | off a protocol and you say, here's the POST, absolutely positively do not do chest compressions,

00:55:48.280 | they go, okay.

00:55:49.280 | No, they don't.

00:55:50.280 | Well, yes, let me rephrase.

00:55:51.280 | That's what they're supposed to do.

00:55:58.640 | If it's a physician's order for life-sustaining treatment, but not if it's an advanced directive.

00:56:05.700 | Because otherwise, if it's an advanced directive, they're working off of their protocols and

00:56:09.060 | their protocols are to intervene.

00:56:12.320 | There's actually a fairly good thread on this in Bogleheads recently, yeah.

00:56:20.520 | Is that Taylor's thread on pros and cons of do not resuscitate?

00:56:27.080 | I think so.

00:56:28.920 | There was also another one, but I think that may be the one you're talking about.

00:56:32.800 | Yeah.

00:56:33.800 | Lady Geek, it's topic 412455.

00:56:37.480 | If you can put that on the chat, perhaps.

00:56:45.200 | So Jim Dolly, who is an emergency room physician, was also one of the people who made comments

00:56:52.580 | about that.

00:56:53.580 | And he's talked about, well, when you have somebody in the emergency room, and it's pretty

00:57:03.180 | clear that resuscitation has been requested not to happen, they'll back off.

00:57:08.860 | But the problem is really more like if you're in the field and there's no physician around,

00:57:14.420 | they're working off of protocols.

00:57:16.820 | Or those advanced directives don't follow the patient, like my mom went from a hospital

00:57:25.660 | setting where the advanced directives were there, they knew what not to do chest compressions

00:57:33.900 | or try to resuscitate, but then she went to rehab and for some reason, those directives

00:57:41.580 | didn't follow her there, and they did initially do take resuscitation measures.

00:57:53.380 | So that's something to just think about.

00:57:55.580 | Okay.

00:57:56.580 | Thank you, Bill.

00:57:57.580 | Diane, your hand is still up.

00:57:58.820 | I don't know if that's intended.

00:58:02.260 | It wasn't intended, but let me say something.

00:58:06.580 | There are a lot of questions about end-of-life and DNR, and do you or do you not call 911

00:58:18.300 | if you have a post order?

00:58:22.920 | Do they have to, if you call them because you're in distress, but maybe you're not critical

00:58:30.420 | from the condition, each emergency service operates in a different way, and it's something

00:58:40.540 | I think that people really need to think about.

00:58:44.180 | And all of these things, until you're older, until you've experienced them, you don't think

00:58:50.740 | about them.

00:58:51.740 | And there's always little, for instance, one of the things, if you go to what they call

00:58:58.180 | drive-by surgery, if you're doing outpatient surgery, they do not have to follow, in almost

00:59:06.620 | every case, your DNR, because it's a short term, they don't have resuscitated capacity,

00:59:15.920 | and so they will not follow your DNR.

00:59:19.700 | If you go into surgery, you have a DNR, you have to, in most cases as a condition of surgery,

00:59:29.460 | you have to stop that.

00:59:32.720 | No physician wants to go into surgery and says, if you go into heart failure, I'm just

00:59:37.820 | going to let you die.

00:59:40.820 | It's so complex, and so all I can say is investigate, investigate, investigate, and talk to your

00:59:49.860 | family members, talk to your loved ones, figure out what it is they need, figure out what

00:59:58.180 | you can do to advocate for them.

01:00:01.940 | I recently had an experience with my best friend.

01:00:05.980 | I was absolutely 100% sure she was 100% sure of what she needed, what she wanted, major

01:00:13.980 | teaching hospital, major city.

01:00:17.740 | I had four days of doctors calling me and saying, we want surgery, and other doctors

01:00:24.260 | saying, I don't think she's competent.

01:00:26.980 | I actually had to call in and threaten a lawyer.

01:00:32.780 | Just investigate, talk to your loved ones, figure out everything that's going on.

01:00:40.340 | It's so complex.

01:00:42.620 | Make sure you know what you want and what your loved ones want.

01:00:46.980 | >> Okay.

01:00:47.980 | Thank you, Diane.

01:00:48.980 | Beverly and Tim?

01:00:51.980 | >> Hi.

01:00:53.660 | I want to make a few comments because I used to work in healthcare, and I can tell you

01:00:57.460 | that I never read anybody's advance directive, and I never really got documentation.

01:01:02.900 | If somebody said I'm the husband or the wife or the mother or the father, I just believed

01:01:06.420 | them because it wasn't my job to really vet them.

01:01:11.860 | I think that an advance directive is vague, to say I don't want to be resuscitated is

01:01:16.700 | not that meaningful, whereas a POST, which I'm from New Jersey, and POST started here,

01:01:22.100 | so the Physician's Order of Life Sustaining Treatment, is a legal document in a hospital.

01:01:28.020 | Even if you get discharged in that hospital system, and now there's not just one hospital,

01:01:33.780 | but there are a lot of hospitals in a conglomerate, right?

01:01:36.900 | Every time you sign in, that document pops up first.

01:01:41.380 | If you say I don't want to be resuscitated, does that mean you don't want chest compressions?

01:01:46.340 | Does that mean you don't want a ventilator?

01:01:49.060 | There's a lot of things that that could mean.

01:01:51.140 | The POST is specific, because for my own mother, she said, "If I get pneumonia, I don't want

01:01:56.540 | to be on a ventilator."

01:01:57.780 | Okay, but do you want oxygen if it'll make you feel comfortable?

01:02:01.420 | Yes, I don't want a feeding tube.

01:02:03.780 | Okay, so there are various things that you can agree to or not agree to, and you can

01:02:09.860 | say why, and you can be very specific.

01:02:13.980 | I'd encourage people to get a POST because then you have more power, and if you are at

01:02:18.700 | a surgery center, it doesn't matter if you're in an emergency room.

01:02:22.540 | If you're in a nursing home, it carries weight and credibility with the medical staff, and

01:02:27.140 | they do need to follow that, whereas an advanced directive, it's kind of wishy-washy whether

01:02:33.220 | or not, and nobody has the time ... In a crisis, nobody's going to read it anyway.

01:02:38.780 | They do the best they can in a crisis, but an order is an order, so it's a good thing

01:02:44.740 | to have that on record, and put down exactly what you want it to say and why.

01:02:50.340 | I always tell patients, "You can change your mind at any point.

01:02:53.660 | We can rewrite this.

01:02:54.940 | Tomorrow, if you decide that you don't want oxygen, we'll write it."

01:03:00.500 | I think you should feel comfortable if you have that in your medical record.

01:03:05.300 | Thank you, Beverly and Tim.

01:03:10.060 | Alan?

01:03:11.060 | Yes.

01:03:12.060 | I put a link in the chat, at least for the state of Florida, and I suspect many others.

01:03:18.100 | The state has an official DNR document signed by a physician, especially for individuals

01:03:24.460 | that are still living at home, perhaps with terminal illnesses, and it's printed out on

01:03:32.180 | yellow paper.

01:03:33.180 | I actually have one here that I have already printed out for my mother, who's terminally

01:03:37.660 | ill, and it's supposed to be filled out, signed by the physician, and taped to the refrigerator

01:03:43.580 | in a common area where it can be found quickly if paramedics are called to the home or another

01:03:48.780 | caregiver has to intervene and sees that the patient is unresponsive, so it's quite clear

01:03:55.580 | what their advanced directives and do not resuscitate wishes are.

01:04:01.060 | That's something to look into for each of your individual states.

01:04:05.780 | That can be certainly helpful when somebody wishes to remain at home.

01:04:08.940 | Alan, is the DNR order the same thing as the PULST?

01:04:15.140 | I'm not familiar with the PULST, but I presume it's the same thing.

01:04:20.940 | I'm sorry.

01:04:22.540 | The PULST comes from the doctor, is that right, Beverly?

01:04:28.140 | That's correct.

01:04:29.180 | You sit down with your physician, you sign that, so DNR is not that meaningful, because

01:04:35.060 | do not resuscitate could mean not shocking somebody, not giving them compressions, there's

01:04:39.860 | a whole range of things.

01:04:43.960 | If you have one DNR while you're hospitalized, when you're discharged, it goes away.

01:04:49.180 | If you have a PULST, it continues on.

01:04:52.740 | Like I say, it's always on file for you.

01:04:56.700 | Every time you sign into that hospital system, or even if you call paramedics, when they

01:05:01.880 | type in your name and social security number, bam, that thing pops up.

01:05:05.380 | That's the first thing that they see, what they can and can't do for you.

01:05:09.260 | That may be state specific, because I know my experience in Florida, I had submitted

01:05:14.420 | when my mother first went to the hospital a couple of years ago, I submitted her advanced

01:05:17.940 | directives and so forth, and when she was most recently admitted, they asked me if we

01:05:22.100 | had such a document.

01:05:24.140 | I said, "Yes, it's been submitted."

01:05:25.580 | They did not have any record of it.

01:05:26.860 | We had to start all over again.

01:05:28.060 | Then once you went to another facility within the same system, they did not have a copy

01:05:32.980 | of what we had just submitted two weeks previously.

01:05:35.440 | No, only the PULST, because if it's a do not resuscitate order, the minute you're out of

01:05:41.120 | that system, the minute you're discharged, it goes away.

01:05:44.480 | Even if you are, there's certain facilities have, it's only good for 72 hours or whatever.

01:05:49.680 | It has to be renewed periodically.

01:05:51.600 | Is this something universal to all states, or is that something more specific to yours?

01:05:57.440 | I've never heard of it.

01:05:58.440 | I'm a retired physician.

01:05:59.440 | No, PULST, P-U-L-S-T.

01:06:00.440 | It started in New Jersey, but I recently spoke with, it's in Pennsylvania and other states

01:06:05.960 | as well.

01:06:06.960 | That's a doctor's order.

01:06:07.960 | I believe it is in Florida.

01:06:08.960 | The DNR is also an order, but it's only specific to that hospitalization.

01:06:15.560 | One thing is that the DNR you create when you do your estate planning or your elder

01:06:21.800 | care planning, along with the health directives, it's like the living will.

01:06:27.520 | You do that with an attorney and it may be signed with notaries, but it sounds to me

01:06:32.900 | like the PULST is a medical paper that is done in the hospital with the attorneys when

01:06:40.160 | you are in the hospital for some reason.

01:06:42.200 | Would that be correct to say that?

01:06:44.360 | No, the PULST is not just when you're in the hospital.

01:06:49.320 | The PULST in my community, you put it in a place for medical text.

01:06:56.080 | The problem is if you have a PULST that says DNR and you call 911, you are at the mercy

01:07:04.120 | of the person that shows up.

01:07:06.640 | They can or cannot decide.

01:07:11.080 | You can have, they will say, why did you call 911?

01:07:15.160 | What is it that you want?

01:07:16.520 | Your loved one that is standing there is going to say, what are they going to say?

01:07:20.360 | I call 911, I don't want you to do procedures.

01:07:24.560 | I want you to do X, Y, and Z.

01:07:26.720 | It's a very controversial area and people need to figure out exactly what they need.

01:07:34.400 | And if they have a PULST that in effect says do not resuscitate, why call 911?

01:07:42.520 | You need to figure this out.

01:07:44.200 | But a PULST is not something you create with your attorney and have it notarized along

01:07:49.240 | with your living will, your power of attorney, your financial powers of attorney when you're

01:07:53.800 | in the document creating and signing session with your attorney.

01:07:59.880 | The PULST is not done then, is that correct?

01:08:02.520 | I have never seen a PULST in that realm.

01:08:05.900 | It's something that your physician initiates or you initiate with your physician.

01:08:11.120 | I have not seen any legal or lawyer ramifications.

01:08:15.000 | Beverly?

01:08:16.000 | No, the DNR, while it's a legal document, it doesn't have to be, it can't be recognized

01:08:22.400 | in the hospital until a physician writes a DNR order with the family or the patient.

01:08:28.320 | The PULST is a medical order and it must be recognized and it must be recognized by EMS,

01:08:34.480 | emergency, wherever you are.

01:08:36.800 | It's a physician's order as opposed to a legal document that says this is what I wish.

01:08:43.440 | But that's one step.

01:08:45.680 | If you're alert and awake and when you get to the hospital, you can say I'd like to sign,

01:08:50.000 | I'd like my physician to write a DNR order that will be recognized by the hospital.

01:08:54.280 | But a DNR that you write in an attorney's office is not the same as a medical person

01:08:59.040 | would.

01:09:00.040 | So you bring in a DNR and then the doctor signs it with his order.

01:09:03.640 | Ideally, it must be recognized.

01:09:06.520 | But what I'm saying, and this may be just true in California, when you call 911 and

01:09:14.560 | you have a DNR and a PULST, they're going to say, why did you call me?

01:09:21.840 | And it's between your loved one and the EMTs what they're going to do.

01:09:27.640 | And, you know, you can, so you need to understand if you have do not resuscitate PULST, should

01:09:36.720 | you call 911.

01:09:39.520 | It's very difficult because you may have a terminal condition, but you also may have

01:09:46.160 | a short term condition that you need relief for.

01:09:49.680 | It takes a lot of thought.

01:09:55.160 | Ideally all of this should function legally, but it always does not.

01:10:00.500 | The hospital should recognize your power of attorney, your medical power of attorney.

01:10:06.920 | They should recognize as an advocate, your PULST.

01:10:13.200 | I just recently had an experience as a large major teaching hospital, took me five days

01:10:21.160 | in a threatening an attorney to get them to honor my friend's PULST.

01:10:29.820 | Not as smooth as it should be, educate yourselves.

01:10:36.040 | I just Googled and the PULST exists at some level in 50 states and Washington DC.

01:10:43.520 | So yes, it is valid with some tweaks in all of the states.

01:10:49.040 | I just found, I just posted the one, I just Googled it real quick and found the one for

01:10:53.000 | Florida.

01:10:54.000 | I'll give you an example.

01:10:55.000 | I spoke to the social worker when my mother was first hospitalized and diagnosed with

01:10:58.560 | terminal cancer and they referred me to the yellow sheet for the do not resuscitate to

01:11:03.560 | hang on the fridge at home.

01:11:05.000 | Never mentioned PULST.

01:11:06.000 | I never even heard of it until this evening, but in fact it does exist for Florida as well

01:11:10.960 | and I found it and I'm going to follow up and have her fill that out.

01:11:14.960 | It goes into more detail with more options than does the standard basic DNR.

01:11:19.680 | Yeah.

01:11:20.680 | Yeah.

01:11:21.680 | If you have any questions, Miriam knows how to contact me, so PM me, it's fine and good

01:11:29.920 | luck with everything.

01:11:30.920 | Thank you, Diane, Beverly, Alan, Miriam and did I miss someone?

01:11:39.200 | So going back to, I think all of these things as Lady Geek mentioned, kind of work in parallel.

01:11:44.920 | So I'll just go over the categories again to fuel the discussion for any other comments

01:11:52.720 | or questions.

01:11:54.080 | So taking care of an aging parent, we started with, we segued into elder care planning,

01:11:59.080 | including power of attorney.

01:12:01.000 | We certainly discussed health directives and proxies as well as living wills.

01:12:06.480 | I'm not sure we use that term, so we can revisit it if it helps.

01:12:10.760 | And then the last two categories, guardianships, which was mentioned but not discussed, custody

01:12:16.920 | and handling incapacitation, and the last category, end of life situations, including

01:12:23.640 | prepaid funeral.

01:12:25.480 | So we're at a quarter after nine and if folks have questions or experiences or guidance

01:12:33.240 | or helpful thoughts on any of these topics, feel free to chime in.

01:12:42.460 | I would like to say one thing that I previously was not aware of, you can have all of these

01:12:48.840 | documents in place, you or your loved one can require surgery, your surgeon most likely

01:12:57.600 | will say, we need to suspend your DNR, we need to suspend your post, I will not go into

01:13:05.560 | surgery with the edict that I cannot revive you.

01:13:11.400 | My friend had a do not intubate.

01:13:16.480 | She went into surgery, they intubated her.

01:13:19.960 | It allowed her to survive the surgery.

01:13:24.840 | But then she deteriorated.

01:13:27.160 | So you need to -- what you need to do is understand every single ramification.

01:13:36.640 | You need to understand you can have all of these things in place, but your surgery.

01:13:43.900 | Do you want to say if my heart stops on the table?

01:13:49.680 | Don't resuscitate me.

01:13:50.680 | I'm not sure any surgeon would go ahead and perform the surgery.

01:13:55.340 | So again, it's just education, education, figure out as much as you can ahead of time

01:14:04.680 | for you and for your loved ones.

01:14:06.680 | >> Okay.

01:14:07.680 | Lady geek has her hand up.

01:14:09.880 | Thank you, Diane.

01:14:12.880 | >> Funerals, prepaying.

01:14:19.980 | Let me post a link to what happened when my husband died.

01:14:25.840 | It's happened the first time.

01:14:36.160 | Okay.

01:14:37.160 | Yeah.

01:14:38.160 | Okay.

01:14:39.160 | Yeah.

01:14:40.160 | It explains the story in the first post of what happened.

01:14:41.160 | When my husband was passing, right before he died, he said time to make funeral arrangements.

01:14:47.680 | And because of prior -- I heard from people that they can increase -- you pay a fixed

01:14:54.500 | price, but they can charge you with the cost increase, which they can do.

01:15:01.220 | So first experience, which I posted about the -- I posted the link in the chat, was

01:15:08.960 | where I purchased an insurance contract that they will cover all the additional costs.

01:15:15.000 | So it turns out he passed away about a month or so later.

01:15:19.180 | And the guy who sold it to me was an insurance salesman.

01:15:22.020 | I asked him, how much money are you making on this?

01:15:24.200 | He says 30 bucks.

01:15:27.260 | But what happened was that when my husband passed, the cost of the value of the contract

01:15:34.140 | -- I mean, it was only a couple months.

01:15:35.340 | The cost of the contract was -- he made basically a $50 profit.

01:15:39.780 | So I negotiated with him for extra copies of the death certificates.

01:15:44.620 | So I mean, here I am, my husband passes away, and I'm negotiating with the funeral director

01:15:49.680 | for death certificates over the cost.

01:15:53.320 | And hey, I'm a global ed, but I don't know.

01:15:56.540 | I think he -- I don't know whether he was insulted or laughing hysterically at someone

01:16:01.360 | who would do this.

01:16:02.360 | So I got the death certificates.

01:16:04.500 | The second time, the prepaid for my mom was done like 10 or -- oh, 1997?

01:16:14.780 | Way back.

01:16:16.500 | And looking at the cost, and I went to the same funeral home, and yes, they can pay -- so

01:16:23.640 | the difference was for the religious service person, and it was an extra $600.

01:16:30.400 | So I just paid it, and very nice service.

01:16:33.480 | So that's my experience with prepaying.

01:16:37.000 | So yes, they can charge, and they do charge a cost above and beyond the contract.

01:16:42.980 | And actually when I read, I actually had a copy of my mom's -- my parents' original documents

01:16:48.500 | for the funeral home and for the cemetery, and it said prices -- there was a print in

01:16:53.320 | there that said prices valid through the end of December 1998 or whatever.

01:16:57.920 | It was that old, 2000-something.

01:17:01.220 | So they can charge.

01:17:03.620 | So I say I have an option if you guys are really -- this insurance contract, which I

01:17:09.000 | linked to in the chat, or just suck it up and pay the difference when the time arises.

01:17:17.180 | >> Okay.

01:17:18.180 | Thank you, Lady Geek.

01:17:21.460 | Any other questions or comments, insights, personal situations to share that others may

01:17:27.380 | learn from?

01:17:30.340 | Personal situations to share that you want to ask a question about?

01:17:34.500 | Alan?

01:17:35.500 | >> Yes.

01:17:36.500 | One of the things to consider also, assuming if an elderly parent or certainly when they're

01:17:44.100 | approaching end of life, if you have power of attorney, both financial and otherwise,

01:17:49.180 | in reviewing all their finances, maybe they have a trust in place, certainly there will,

01:17:54.080 | one must also plan to ensure that there's going to be enough sufficient cash on hand

01:17:58.620 | to take care of final expenses and how that's going to be handled.

01:18:02.520 | For instance, in my case, my mother had POD or TOD beneficiaries on all of her accounts,

01:18:11.040 | and that would have been problematic if upon her death, all the money is immediately -- the

01:18:16.500 | accounts are all frozen and distributed accordingly with basically the beneficiaries would have

01:18:23.680 | to pony up money on their own to cover final expenses down the road, assuming that all

01:18:28.520 | the siblings or beneficiaries are willing to do so.

01:18:31.400 | So that's a consideration to think about when you're reviewing end of life care and financial

01:18:37.640 | planning.

01:18:38.840 | The funny thing is, I spoke to her estate planning attorney for some guidance, and he

01:18:45.040 | basically said, "I can't advise you on the financial aspect on the accounts.

01:18:49.440 | You need to talk to a financial advisor or a CPA," in spite of him having drafted her

01:18:56.100 | will and so forth.

01:18:57.760 | So we're in the process of doing that.

01:19:00.440 | But just one consideration that may fall through the cracks if you don't think about it.

01:19:03.720 | >> Well, Alan, why would a POD take a long time?

01:19:10.560 | I know the accounts are frozen immediately, but for my sister's-in-law, if you go in immediately,

01:19:19.320 | they can unfreeze them within a day.

01:19:22.400 | >> Well, in my mother's case, she has a number of grandchildren and great-grandchildren that

01:19:27.920 | she wants monies distributed to.

01:19:30.600 | She doesn't have a trust, but myself and my two siblings are all the POD/TOD, so there's

01:19:39.640 | no money available to make that distribution.

01:19:42.400 | We'd have to basically all pony up the money on our own, as well as how to cover her final

01:19:47.840 | expenses.

01:19:48.840 | She has a minimal amount in her checking account, and we need to basically reserve enough money

01:19:54.400 | to take her final expenses, as well as distributions for her wishes to her grandchildren and great-grandchildren.

01:20:03.480 | Whatever is left will then be divvied up amongst our siblings.

01:20:08.040 | >> Okay.

01:20:09.800 | Thank you, Alan.

01:20:10.800 | Jim, and then Deanna, and then Diane.

01:20:13.080 | >> I just wanted to mention my father-in-law passed away last year, and he was a veteran

01:20:18.080 | and wanted a military burial, and I'm going to share the screen here.

01:20:22.200 | We ended up, the Abraham Lincoln National Cemetery, which looks like this, the pictures,

01:20:30.520 | handles everything.

01:20:31.520 | I mean, you can show up with a casket or cremains, and they can do above ground or in these things.

01:20:38.080 | I forget what these things are called.

01:20:40.120 | >> Crypts.

01:20:41.120 | >> Crypts.

01:20:42.120 | Very nice.

01:20:43.120 | And they have an honor guard, a military attachment comes over, does a very nice honor guard.

01:20:48.040 | Honorable ceremony, and they actually did a gun salute, and they gave us the shell casings,

01:20:53.520 | which was nice.

01:20:54.520 | Really nice.

01:20:55.520 | So, anyway, if you have a veteran and they would want to do this, these cemeteries are

01:20:59.280 | located all over the country.

01:21:01.680 | >> Thank you, Jim.

01:21:07.080 | Deanna.

01:21:09.480 | >> This is based on what Alan just said.

01:21:12.520 | So, yesterday I went to one of my mom's banks, and the woman there has been helping me with

01:21:19.760 | some of the power of attorney stuff and processes for my mom to be able to keep getting access

01:21:27.080 | to her accounts.

01:21:29.560 | And so she suggested that my mom might want to put me on as like the secondary owner of

01:21:36.720 | the checking account so that it would -- it sounds like that would fix the problem that

01:21:43.080 | Alan was talking about, that suddenly everything's frozen and no one has any money, so that I

01:21:49.940 | probably should then use that as what happens in that circumstance.

01:21:55.520 | And I don't know what you mean by enough money in there, Alan, but --

01:21:58.940 | >> Yeah, we actually did that.

01:22:02.080 | I'm now a joint -- named jointly on her checking account, but it's not sufficiently funded

01:22:09.880 | currently, and we're going to address that, how to get it sufficiently funded to cover

01:22:13.240 | all the needs.

01:22:14.240 | >> And can you give me more specifics?

01:22:17.880 | What does it mean specifically, or sufficiently funded?

01:22:22.960 | What would you guess?

01:22:23.960 | >> Well, in her case, she wants -- the money is distributed for her -- some of her heirs

01:22:30.760 | that would be over $100,000.

01:22:34.200 | So I need to have that available to take care of as the executor of her estate, whereas

01:22:40.160 | all of her investment accounts are TOD or POD for myself and two siblings.

01:22:48.280 | So we need to basically reserve sufficient funds to cover her other wishes for distribution

01:22:55.520 | to heirs.

01:22:57.840 | And the question would be, for instance, if she passes, prior to my telling Fidelity,

01:23:03.280 | for instance, where her accounts are at, prior to saying, could I transfer money -- because

01:23:07.800 | I have power of attorney -- could I transfer money from her account to her checking account

01:23:12.520 | prior to telling them that she has passed?

01:23:15.720 | That could be one option, just the day that she passes, to make a massive transfer or

01:23:20.520 | initiate a massive transfer.

01:23:22.560 | I don't know ethically and legally if that's okay, and I'm not sure if that would even

01:23:27.120 | work.

01:23:28.120 | But that was one option.

01:23:29.120 | >> Yeah.

01:23:30.120 | >> Well, then, are you also considering the, like, say, medical bills that are built up

01:23:35.920 | or something?

01:23:36.920 | >> That, too.

01:23:37.920 | Any additional costs.

01:23:39.680 | She has a long-term care policy, but we're paying out of pocket and getting 80% of it

01:23:43.840 | reimbursed, so there will be ongoing expenses where the estate is responsible for.

01:23:48.800 | >> Okay.

01:23:49.800 | Thanks.

01:23:50.800 | >> Deanna, we are doing this now for my sister-in-law, and one thing to be careful about is that

01:23:55.680 | we have found that the different banks do have different rules.

01:23:59.760 | For example, my sister-in-law banks at a credit union.

01:24:04.800 | There there are -- she -- my sister-in-law is the -- what they call the primary on the

01:24:10.240 | account.

01:24:11.240 | There are three joints.

01:24:14.720 | But as soon as the sister-in-law dies, the credit union says they are notified immediately

01:24:21.160 | by Social Security, Medicare, the hospital, the bank.

01:24:24.880 | The big brother tells them immediately that she has passed away.

01:24:29.040 | The account is immediately frozen, and one of the joints has to come in with their identification

01:24:39.040 | to open up the account.

01:24:40.440 | Then the account is unfrozen for 60 days, and any of the joints can take money out,

01:24:46.520 | and you can use the money then to pay for things.

01:24:49.480 | At that point, the account will be permanently frozen, and the joints have to go put their

01:24:54.880 | money somewhere else in a different account.

01:24:58.120 | However, what do you need the money for?

01:25:01.600 | In her case, it would be to pay the mortgage, because if the account is frozen, the mortgage

01:25:07.100 | on her house comes out automatically from her account, so it wouldn't be open to pay

01:25:13.200 | that.

01:25:14.200 | How about Florida Power and Light, you know, the Internet?

01:25:18.920 | There are bills that come directly out of her account, so that is why we would need

01:25:22.560 | to get it opened immediately.

01:25:24.800 | Meanwhile, we bank at Chase, and there it is different.

01:25:29.200 | There we're like, Alan, the joints -- the account will not be frozen immediately.

01:25:35.800 | The joint can just go in.

01:25:40.140 | The joint can go in and take the money out of the account.

01:25:45.100 | >> I'll just ask -- I'll ask her what the situation is at that bank.

01:25:49.300 | >> Yeah.

01:25:50.300 | >> Okay.

01:25:51.300 | Thank you, Miriam, Alan, and Deanna.

01:25:54.780 | Diane, your hand is up.

01:25:57.540 | You're muted.

01:26:00.580 | Diane, you appear muted.

01:26:05.980 | >> I posted a couple of resources for nonprofit funeral consumer associates.

01:26:13.420 | These are generally associations locally you can join.

01:26:20.020 | They survey the funeral directors in the area and will give you costs for cremation and

01:26:28.380 | all of the other funeral options.

01:26:32.460 | It's -- again, I always would prefer nonprofit, and so when your loved one dies, you contact

01:26:42.380 | them or you know ahead of time the services and what they will cost in your area.

01:26:48.860 | The other link I provided was whole body donations.

01:26:53.260 | This is a somewhat fraught field.

01:26:57.340 | Lots of people leave their body to a medical facility.

01:27:00.780 | There's also a lot of commercial organizations out there.

01:27:08.780 | It can be a somewhat murky area.

01:27:13.380 | There are -- there's information about how much money can be made from selling body parts.

01:27:20.300 | So I guess what I would say is these organizations can provide a very valuable resource.

01:27:28.740 | Try to look for a nonprofit organization.

01:27:34.660 | And again, all I can say is do your research ahead of time.

01:27:40.420 | Talk to your loved ones.

01:27:42.380 | Know exactly what you want.

01:27:46.820 | Know exactly what your resources are.

01:27:50.500 | Plan ahead.

01:27:52.140 | Know what your resources are.

01:27:55.700 | >> Okay.

01:27:56.700 | Thank you, Diane.

01:27:59.740 | In the absence of other questions or comments, I'll share a quick -- folks probably know

01:28:06.220 | of Charlie Munger, so Warren Buffett's right hand.

01:28:09.940 | He turns 100 in January and he's still going strong.

01:28:14.300 | He often quips that the only thing he wants to know is where he's going to die so that

01:28:21.100 | he doesn't go there.

01:28:25.860 | Along the lines of what folks are saying, what do folks think in terms of practical

01:28:34.340 | actionable takeaways from this sort of meeting?

01:28:37.780 | And I love how it's going.

01:28:38.780 | I was just feeling grateful that folks' comments are focused and concise and pointed and helpful.

01:28:46.500 | Are there -- you know, whether it's physical activity, we all know, you know, eat healthy

01:28:51.460 | and exercise.

01:28:53.180 | In terms of cognitive decline or just staying healthy, how to put off all of these things

01:28:58.400 | that we're talking about as long as possible.

01:29:01.500 | What have -- what has worked for folks?

01:29:04.060 | What have they seen work for their friends and loved ones?

01:29:07.380 | >> Best thing is to be born with good genes, but you have no control over that.

01:29:15.500 | >> Okay.

01:29:16.500 | >> I live in an area where there's a lot of retirees.

01:29:24.460 | I'm on the younger end of the spectrum, but I know several folks in their 80s, into their

01:29:30.260 | 90s, and they're still quite active, and it's a common trait I see amongst them all is that

01:29:37.020 | they stay physically engaged almost every day of the week, or -- and socially engaged,

01:29:46.100 | so I think that's just something I observed, anecdotally.

01:29:51.940 | >> Okay.

01:29:52.940 | So in addition to the physicality of it, also community.

01:29:57.820 | >> Yeah.

01:29:59.900 | >> And also, not only is Charlie Munger turning 100, but in January, Taylor Laramore, who

01:30:06.620 | began the Vogelheads in 1998, is turning 100 years old on January 25, and we are already

01:30:14.100 | planning his 100th birthday party.

01:30:17.860 | >> Fantastic.

01:30:20.060 | >> What keeps Taylor going?

01:30:22.300 | >> He once told me, he said, "I often wonder why I made it to the," you know, at that time

01:30:30.500 | he told me he was about 97, "How did I make it to 97?"

01:30:35.420 | And he said, "I think it was because after working, after being in World War II, after

01:30:41.540 | being in a foxhole in Belgium for several weeks in the middle of winter in World War

01:30:51.100 | II, watching people die, I came home and realized that little things don't matter, not to get

01:31:00.220 | upset about little things in life."

01:31:04.500 | And as we know, he, during -- on the Vogelheads Forum, he is cordial, decent, kind, helpful,

01:31:13.620 | you know, somebody can explode in front of him with negative comments about him, and

01:31:20.900 | he takes it in stride and tries to make -- tries to say something nice.

01:31:28.460 | Plus, he's extremely helpful with his financial information.

01:31:33.060 | >> Wonderful.

01:31:34.700 | Thank you for sharing.

01:31:37.260 | >> He also does not even use a cane.

01:31:40.300 | He's almost -- he's 99 years old and nine months.

01:31:44.900 | He doesn't use a wheelchair.

01:31:46.220 | He doesn't use a cane.

01:31:47.580 | He doesn't use a walker.

01:31:50.140 | He's still 6 feet tall.

01:31:52.140 | He's had four bouts of cancer, which he has dealt with.

01:31:56.860 | He does credit good medical doctors.

01:32:02.460 | And by the way, his son has told me that he's very pushy with his doctors.

01:32:06.020 | You know, he doesn't want to be in that office longer than he has to be, and he wants to

01:32:10.620 | be seen on time.

01:32:11.620 | He's very, you know, time-oriented.

01:32:14.460 | But he does follow his doctor's orders.

01:32:17.540 | He goes to chemotherapy.

01:32:18.540 | I don't remember if it's once a week or once a month, but he still goes after his latest

01:32:24.060 | bout of cancer, which was hip cancer, about five years ago.

01:32:31.420 | He did lose his voice to lung cancer -- not lung cancer, throat cancer, maybe 20 years

01:32:38.820 | ago now, maybe 15 years ago.

01:32:42.820 | He has been through -- he's been through a lot, and he still has a good attitude, and

01:32:48.780 | that's what he attributes his long life to.

01:32:51.980 | >> Wonderful.

01:32:52.980 | Thanks for sharing, Maryam.

01:32:54.260 | It gives new meaning to stay the course.

01:32:57.420 | Diane, your hand is up.

01:33:04.820 | You're muted.

01:33:10.320 | Diane, why don't we start by unmuting, and then let us know if your raised hand is intended

01:33:19.220 | and if you have a comment.

01:33:21.020 | Okay.

01:33:22.020 | Well, we're figuring that out.

01:33:26.540 | So any other thoughts?

01:33:28.220 | It's clear physical activity, community interaction.

01:33:32.820 | What else have folks seen work for the folks who are active into their 80s, 90s, haven't

01:33:44.180 | physically or cognitively declined as much as we've seen others?

01:33:52.540 | >> I imagine there's some studies somewhere that suggest that those individuals who are

01:33:56.500 | financially secure, perhaps because of less stress, perhaps will theoretically live longer

01:34:04.460 | or are able to get better healthcare and utilize the resources from a life of living below

01:34:10.900 | their means.

01:34:11.900 | I haven't seen studies, per se, but one would expect they exist.

01:34:16.620 | So maybe Bogle has, as a group, have a little better longevity and fewer cognitive issues

01:34:24.260 | down the road.

01:34:27.580 | >> It's a great idea.

01:34:28.580 | >> I also know, Gauri, that a life insurance salesman, life insurance person in life insurance

01:34:35.340 | once mentioned that the policies are more expensive for people who are more likely to

01:34:40.460 | die early, and one of the factors is your job, your employment.

01:34:46.520 | Are you working in a heavy construction zone as a person, you know, moving big barrels

01:34:56.520 | of concrete around or cranes, you're up on one of those big cranes hoisting large concrete

01:35:04.560 | barriers, or are you an attorney or an accountant sitting at a desk?

01:35:11.400 | >> Great point.

01:35:14.320 | Thank you, Miriam.

01:35:17.880 | Any other questions or comments?

01:35:20.520 | The floor is open, and feel free to go beyond topics we've stated.

01:35:26.040 | Deanna?

01:35:27.040 | >> I know.

01:35:28.040 | I have another question.

01:35:33.600 | Lately I've been going to different banks, giving them the power of attorney papers,

01:35:38.560 | and then sometimes they'll say you have power of attorney over the checking and savings

01:35:44.040 | but not CDs, or you have to sign this additionally or a bunch of different things.

01:35:51.360 | So has anybody, or are there any books to read or something that would help me through

01:35:58.720 | this process, because each of the four banks is different, each of them counts, they don't

01:36:05.720 | just say you have power of attorney, you can do anything.

01:36:09.080 | They are kind of like, they're almost like getting in the way of I have to do one thing

01:36:14.000 | at a time or something.

01:36:16.760 | Now I have the checking account, but I don't have access to the CDs or things like that.

01:36:22.520 | Do you guys have any tips?

01:36:30.000 | >> I think you simply have to go to each bank, ask them the very direct questions, and write

01:36:35.860 | it down.

01:36:36.860 | >> Yeah.

01:36:37.860 | >> If they have, ask them do you have forms for that, get a copy of the form.

01:36:43.040 | Are these banks that you can walk into, or are these online banks?

01:36:46.800 | >> Yeah, I can walk into them, although one's like 40 or 50 miles away, but I got to the

01:36:54.840 | point where walking into the banks was a lot better than calling them on the phone.

01:36:59.080 | >> Yeah.

01:37:00.080 | >> And then just keep separate notes for each bank, but put yourself as a joint if possible

01:37:06.320 | so you have all access to the money.

01:37:10.040 | But again, it depends if it's your mother, correct?

01:37:13.320 | >> Yeah.

01:37:14.320 | >> And she's 100 also.

01:37:15.320 | >> Yeah.

01:37:16.320 | >> Third person tonight going to be 100.

01:37:17.320 | >> She's already 100.

01:37:18.320 | >> Already 100.

01:37:19.320 | She'll be 101.

01:37:20.320 | >> She beat the whatever guy to 100, yeah.

01:37:21.320 | >> She beat Taylor and Charlie Munger.

01:37:22.320 | >> Charlie Munger.

01:37:23.320 | >> Yeah.

01:37:24.320 | >> Yeah.

01:37:25.320 | Each bank is different, so just you have to write it, if each bank is, you have to write

01:37:35.320 | it down specifically.

01:37:36.320 | >> Right.

01:37:37.320 | You're sort of making a grid, like what does this bank need, what does this one need, what

01:37:44.920 | do I, what counts for this one and what counts for that one?

01:37:48.360 | >> And also, if they have a brochure or a book, I did find, for example, Ally Bank,

01:37:56.040 | which is an online bank, when you open an account at Ally, they do give you a booklet

01:38:01.200 | that they send to you, like the old days, in the mail.

01:38:04.120 | Well, that was interesting because in that booklet, it specifically lays out what to

01:38:09.040 | do and what happens when a person dies, if the account is joint, if it's TOD, Ally does

01:38:16.480 | allow TOD accounts, even for joint accounts, you can still have beneficiaries.

01:38:22.160 | So that was very helpful because I saw it in writing.

01:38:26.400 | So if you go to the bank and they say, Ally's online, but if you go to an online bank, I

01:38:32.120 | mean, to a physical bank, and they say, oh, no, this does not happen, you can't do this,

01:38:38.640 | you show them the paper.

01:38:39.640 | >> Right.

01:38:40.640 | >> And you say, well, this is the official Chase paper, it says I can do it.

01:38:44.560 | >> Yeah.

01:38:45.560 | >> Or maybe the officer you're speaking to is not well-trained or doesn't know.

01:38:53.160 | >> That happens.

01:38:54.160 | Thanks.

01:38:55.160 | >> Very helpful.

01:38:56.160 | Thank you.

01:38:57.160 | So some of these comments remind me of the importance, and this is both obvious but perhaps

01:39:04.280 | often overlooked, is the importance of having a thorough inventory of where these accounts

01:39:10.880 | are, contact people, just so that whoever needs to navigate the process is equipped

01:39:18.240 | and not unearthing things blindly.

01:39:24.680 | So Miriam, I know some other questions may have been submitted via the RSVP.

01:39:32.480 | Anything we want to cover there?

01:39:34.240 | >> Another thing we didn't cover, which was submitted, had to do with guardianships.

01:39:38.920 | They said when is an elderly guardianship appropriate?

01:39:43.960 | Has anybody here done guardianships?

01:39:46.480 | Have any of their relatives been in guardianships?

01:39:50.600 | My understanding is that nobody in our family has that I know of, but it's when a person

01:39:58.760 | perhaps does not have relatives, you might need to appoint a guardian, but to do -- my

01:40:09.400 | understanding is that a guardianship in Florida especially, it involves the court system.

01:40:15.440 | So you are bringing in the court system, and a guardian will need to be appointed.

01:40:20.480 | It can be a relative, but still, before you can do anything, you do have to file paperwork

01:40:26.760 | with the court system.

01:40:28.920 | Sometimes things need to be approved by a judge.

01:40:32.040 | So it is not easy to do that, to do a guardianship, in the sense that it involves a whole other

01:40:39.280 | level of administration.

01:40:43.840 | But I guess if you have to do it, there's no other way.

01:40:47.600 | >> Okay.

01:40:50.120 | Thank you.

01:40:51.120 | I've not been monitoring the chat, but I did notice this question, and it has a few answers,

01:40:55.840 | so maybe we can build on those if there's more to add.

01:40:59.000 | So the question is, how long does it take for a trustee to access the cash in a bank

01:41:04.520 | or brokerage account when the trust owner is suddenly incapacitated, assuming the trustee

01:41:11.560 | is named for the situation?

01:41:13.960 | I'll paraphrase some of the responses in that it doesn't take long, and one maintains access.

01:41:22.800 | But folks should feel free to build on known responses or situations.

01:41:33.200 | Have trustees experienced barriers, or what would make it easier for the next trustee

01:41:38.720 | who finds themselves in that situation?

01:41:42.440 | Excuse me.

01:41:44.960 | Bill, I see you commented in response.

01:41:50.320 | Do you want to elaborate on your response for the benefit of the group?

01:41:54.080 | >> Yeah.

01:41:55.080 | So I saw some questions about trustees.

01:41:57.640 | My parents had trusts set up, and they were trustees for their trusts until they moved

01:42:09.960 | into assisted living at that time.

01:42:11.640 | They agreed to have me take over their financial affairs, and they resigned as trustee, and

01:42:18.360 | I was appointed trustee.

01:42:20.680 | There was some documentation that had to be done with a lawyer for that to facilitate

01:42:25.480 | that, but it was fairly smooth.

01:42:29.400 | And once I did that, working with financial institutions, working with their existing

01:42:38.120 | institution, it was challenging.

01:42:40.520 | It was during the early days of COVID, and it was challenging, and I heard Miriam talk

01:42:47.880 | about Ally Bank, and I do have relationships there, and my parents didn't at the time,

01:42:54.800 | but they worked pretty well with trusts, so I just opened a new account, and my parents'

01:43:01.760 | names are online, and they were very easy to work with, and along the way, my mom passed

01:43:12.080 | away last year, and her accounts didn't get frozen.

01:43:18.120 | We just continued to pay bills out of that account as needed until probate was settled

01:43:26.840 | this year.

01:43:28.440 | >> Okay.

01:43:29.440 | Thank you, Bill.

01:43:32.040 | In the absence of other questions or comments, I'll raise one that I'm curious about.

01:43:39.040 | Having heard about CCRCs on this call, or retirement communities, or assisted living,

01:43:45.600 | are these places that when we're at our cognitive best rational objective that folks can move

01:43:53.600 | into, and then as cognitive abilities may decline, and we reach that form of person

01:44:02.240 | that is less agreeable, but needing or wanting to age in place, are these communities designed

01:44:09.700 | to age in place, can accommodate memory care, so that there's a middle ground that someone

01:44:16.440 | isn't forced to leave their situation, and can be cared for while aging in place voluntarily

01:44:25.580 | in a place that they've chosen?

01:44:27.460 | Is that part of how these are premised?

01:44:32.220 | And I see, Sarah, your hand is up.

01:44:33.900 | I don't know if it's in response to this or something new, but feel free.

01:44:37.900 | >> Yes, in response to this.

01:44:40.060 | So I'll post the link.

01:44:42.700 | There is an organization called CARF, C-A-R-F, carf.org, that provides voluntary certification

01:44:52.180 | for life plan CCRC communities.

01:44:58.180 | So a lot of it is just going to depend on the community and the state you live in.

01:45:05.940 | You know, I had a friend who had her mother in Las Cruces, New Mexico, in a CCRC way back

01:45:11.540 | when, and the CCRC called up one day and said, "You know, it's time we talk about your mother

01:45:19.460 | moving to memory care."

01:45:21.660 | So I've got --

01:45:22.660 | >> Within that facility, Sarah?

01:45:23.660 | Sorry to interrupt.

01:45:24.660 | >> Yes.

01:45:25.660 | >> Okay.

01:45:26.660 | >> Yes.

01:45:27.660 | So, and, you know, I'm pursuing a CCRC, but it's in a different location, which is just

01:45:37.140 | in a whole other bag of worms.

01:45:39.740 | And the original facility has independent assisted living, memory care, and a skilled

01:45:46.380 | nursing facility, but they have built a sister facility, which is totally separate, except

01:45:53.020 | for the highest level, and it has all of that except for the skilled nursing facility.

01:45:58.980 | And they think that's okay, and that's the way the future is.

01:46:03.700 | In my city, there is a new for-profit, not CARF-certified facility that is all four,

01:46:15.260 | but they make me really nervous.

01:46:17.020 | And I can also -- I keep posting on Bogleheads the thread about -- the article about you

01:46:23.580 | should worry about -- it's not titled this, but the basic premise is you should worry

01:46:27.460 | about your CCRC going bankrupt.

01:46:30.780 | So it is -- I mean, you're putting in a big chunk of change, and in exchange for that

01:46:38.220 | and whatever you pay the monthly, you're looking for them to take care of you until you no

01:46:41.860 | longer need care, and sometimes it doesn't work out that way.

01:46:49.100 | >> Okay.

01:46:50.100 | Thank you, Sara.

01:46:51.100 | That's very informative.

01:46:52.220 | Just a quick question, and then we'll go to Lady Geek.

01:46:55.420 | When you say the risk of them going bankrupt, how does one mitigate for that?

01:47:00.980 | Are there larger companies that are more financially stable?

01:47:04.700 | I know some of the REITs are in the healthcare and assisted living space, or are these large

01:47:11.700 | financially independent, smaller, where you just have to wonder?

01:47:15.860 | >> So, again, I'll post the link to CARF, and although it's pretty simple, carf.org.

01:47:22.060 | And I think -- I'll double-check.

01:47:24.380 | And they do have articles in there.

01:47:28.020 | And one of the things that is desirable is to investigate financially what they can do.

01:47:35.420 | I mean, it's sort of a -- like a pyramid scheme, frankly.

01:47:43.860 | And you want your car, your CCRC, it's like a lot of things.

01:47:50.660 | You want it 90-plus percent, preferably more like 95% continuous occupancy.

01:47:59.020 | You want to see a long waiting list so they can maintain that occupancy rate.

01:48:05.980 | There are people who feel that your best bet is to go with a not-for-profit.

01:48:12.980 | It's not easy.

01:48:15.140 | And so they're -- so the comment in the chat, do all CCRCs require a buy-in fee?

01:48:22.380 | So they are divided by categories, usually just A, B, C, and I think D. A, I think, was

01:48:31.340 | the original model where you paid a big chunk in and you didn't get anything back.

01:48:38.380 | But that was to end of life, regardless of what happened.

01:48:43.980 | And then there are various other plans, but, you know, if you're getting money back, that's

01:48:49.700 | still a problem if your company goes bankrupt because they don't have anything to give you

01:48:55.500 | and you're low on the totem pole for getting -- the investors get money back first, which

01:49:00.860 | is what's worrying me about mine here in town.

01:49:04.060 | >> Thank you.

01:49:05.060 | And I'll close out the question and then to Lady Geek.

01:49:08.060 | Are there -- what's the incidence or frequency of these going bankrupt?

01:49:13.180 | Is it clearly a legitimate concern, but remote in terms of probabilities thus far?

01:49:21.140 | Or it's been happening a lot?

01:49:23.620 | Or with what frequency are they going bankrupt?

01:49:26.340 | >> I don't have a frequency for you.

01:49:28.780 | I do use a fee-only financial planner.

01:49:32.580 | She was quite concerned when she realized I was talking about doing a CCRC.

01:49:39.460 | The article that I'll post that she gave me also mentions, yeah, I mean, it's a risk.

01:49:48.900 | >> Okay.

01:49:49.900 | Thank you, Sarah.

01:49:51.540 | Lady Geek.

01:49:54.860 | >> Let's talk about getting the entrance deposit refunded, which is what I'm doing right now

01:50:01.260 | with my mom.

01:50:03.500 | First, when I helped my mom transfer into -- well, my dad died, and actually he was

01:50:12.060 | one of the people who said, "I'm never moving."

01:50:14.380 | And my mom -- I was killing my mom because she was taking care of him.

01:50:17.700 | She is this very, very social person.

01:50:19.900 | I was killing her just to -- because she had to stay there.

01:50:22.700 | I said, "Mom, you would love this retirement community."

01:50:25.260 | And she absolutely wanted to go there.

01:50:27.300 | But it took a while -- as soon as my dad passed, me and my sibling just -- she was there.

01:50:33.700 | During the admission -- while she was going through the admission process into the community

01:50:38.980 | or purchasing her unit, one of the forms on the entrance deposit was how would you like

01:50:44.860 | it refunded to the estate, to beneficiaries directly, or to a charity or something.

01:50:52.820 | So we filled out the form to -- she filled out the form that the refund would go to beneficiaries,

01:51:00.540 | which includes me.

01:51:02.500 | So my mom passes.

01:51:05.180 | I close out everything with the CCRC.

01:51:11.500 | And the entrance deposit is interesting.

01:51:14.140 | Because in my situation, my mom's situation, there's no -- I do not -- she has no estate.

01:51:20.660 | She has TOD/POD accounts, which are not part of the estate probate process.

01:51:26.580 | So there's no money in there to pay anything due.

01:51:29.860 | So what the CCRC realizes is that this happens all the time.

01:51:34.860 | What they are doing is any balance due, her rent, credit or debit, refund or payment,

01:51:44.620 | will be adjusted on the return of the entrance deposit.

01:51:48.060 | So if she owes one month of expenses, or actually she's getting a credit for like three weeks,

01:51:55.060 | they will add that to the entrance deposit.

01:51:57.180 | So that way the beneficiaries will get paid that amount.

01:52:00.900 | So what they're doing is -- it's the category where you give them the money and they give

01:52:07.820 | you 90% back.

01:52:10.100 | That's the category she's going in.

01:52:11.300 | There's different categories.

01:52:12.300 | Now, how do I get that back?

01:52:14.420 | Well, they obviously know she passed, because it's their skilled nursing center.

01:52:20.020 | I did not need to supply that certificate.

01:52:24.380 | So what -- I read it, and I worked with the rep.

01:52:28.820 | You'll get it back in 90 days.

01:52:31.100 | Excuse me?

01:52:32.100 | Apparently those entrance deposits, I guess they're like escrow accounts.

01:52:36.140 | It's a pool of cash.

01:52:38.600 | They take the -- they give their profits, goes to the general community expenses.

01:52:42.860 | But what they do -- it's like a bank with a -- that can do whatever they want.

01:52:49.020 | They will wait until they have enough money to pay you back in that cash reserve.

01:52:55.100 | So if everybody dies and everybody gets paid, everybody leaves, they're not going to refund

01:53:01.780 | anyone until they get a new person coming in and giving them an entrance deposit.

01:53:05.940 | They will wait.

01:53:06.940 | So they depend on turnover.

01:53:08.420 | They depend on capacity.

01:53:10.300 | So I have to -- so first of all, they're waiting 30 days for the transactions to sell.

01:53:15.060 | That just happened.

01:53:16.540 | So now I have to wait another 60 days to be assigned a number in the queue to get the

01:53:22.300 | refund.

01:53:23.300 | And they say, well, typically that's about 90 days.

01:53:26.660 | Could be less.

01:53:29.020 | But it really depends on their turnover and occupancy rate.

01:53:33.780 | Last year they said it was running close to 90 days.

01:53:36.340 | They said this year it's looking a little shorter.

01:53:38.700 | So I'm now in a waiting game.

01:53:41.540 | And so I just find it interesting -- I guess it's like a bank where the depositor comes

01:53:46.180 | in and demands their money back.

01:53:49.180 | They can say, no, you have to wait.

01:53:51.260 | It is -- so if you read the residence care agreement very carefully about that entrance

01:53:56.420 | deposit, it's clearly stated there, but you don't realize what it is until you actually

01:54:01.180 | need to read that paragraph.

01:54:03.300 | So but it was an interesting form that they will adjust -- because this happens all the

01:54:07.540 | time with the state accounts, I don't have an estate account.

01:54:10.100 | They will just adjust balance due or give you a refund to the entrance deposit, the

01:54:15.020 | money you get back.

01:54:16.020 | So I thought that was really cool.

01:54:17.020 | I'll just get it.

01:54:18.540 | Now as for dying in Pennsylvania about TOD/POD accounts, I'm pushing out a link to the forum

01:54:25.700 | thread I created for this.

01:54:28.100 | Don't die in Pennsylvania.

01:54:29.100 | Transfer on death -- pay on death accounts are taxable as an inheritance tax.

01:54:35.540 | This is very, very different than an estate tax.

01:54:38.100 | My mom's estate tax is zero because there's nothing there to probate.

01:54:42.940 | The TOD/POD accounts will be taxed at 4.5%.

01:54:47.060 | The lineal inheritance rate in New Jersey, I understand the inheritance -- the tax for

01:54:51.460 | the descendants is zero for immediate descents, but in Pennsylvania, it's 4.5%.

01:54:57.200 | So within nine months, I must file for a Pennsylvania REV 1500, an inheritance tax form.

01:55:08.640 | I'll do it for my mom.

01:55:09.960 | The nice thing with this is that there is -- because this happens with -- like I have

01:55:14.640 | siblings.

01:55:15.640 | They're split across several accounts, including the Fidelity account.

01:55:19.280 | So the nice thing is there's a little check box in the Pennsylvania inheritance form that

01:55:23.180 | says send me a bill.

01:55:24.800 | I give the name and address of each of the beneficiaries.

01:55:28.080 | I don't have to worry about a brother or sister paying me -- I don't have to foot the bill

01:55:32.220 | for them.

01:55:33.360 | So I pay my fair share of the inheritance.

01:55:36.500 | They pay their fair share.

01:55:37.500 | I just check the box.

01:55:39.460 | Not my circus, not my monkey.

01:55:41.560 | Family drama.

01:55:42.760 | Let the state deal with it.

01:55:44.440 | And if either of the siblings fail to pay, the state is free to file a lien against their

01:55:51.000 | property.

01:55:52.760 | Not my concern.

01:55:53.760 | So I posted a thread -- I posted a link to my thread in there.

01:55:59.520 | And apparently the Pennsylvania inheritance -- you have to notify the state of investment

01:56:04.880 | accounts.

01:56:06.200 | You do not have to notify the state for bank and savings and cash accounts.

01:56:09.680 | But you still have to pay the taxes, which I intend to do.

01:56:13.240 | So -- and of course, that is filed with the county of the register of wills, with two

01:56:18.640 | copies.

01:56:19.640 | They'll send a copy to the state.

01:56:20.640 | So okay.

01:56:21.640 | We're out of time.

01:56:22.640 | We've been two hours.

01:56:23.640 | But I just want to say it's a very interesting adventure on the entrance deposit refunds.

01:56:31.420 | And also a more fun adventure with the state of Pennsylvania.

01:56:35.520 | So I'm getting my taxpayer dollars' worth -- they're getting mine.

01:56:39.400 | So okay.

01:56:40.400 | That's all I had to say.

01:56:41.400 | >> Great.

01:56:42.400 | Thank you, Lady Geek.

01:56:43.440 | So as Lady Geek mentioned, we're two minutes after the hour.

01:56:46.640 | I think the quote of the evening will be Lady Geek saying, "Not my circus, not my monkey."

01:56:55.840 | And before we wrap, are there any closing comments or questions?

01:57:01.120 | Again, we're happy to take specific questions to Summerfield so that he can address them

01:57:07.800 | in a focused way when we reschedule.

01:57:13.360 | If not, thanks again to everyone for participating.

01:57:16.320 | >> Gloria, I want to mention three upcoming meetings.

01:57:21.120 | >> Great.

01:57:22.120 | >> Okay.

01:57:23.120 | On November 8th, there is a meeting that Chicago is organizing with Grandma Sylvia.

01:57:30.720 | And Grandma Sylvia will be here, and the topic is "Surviving the Loss of a Spouse and Her

01:57:39.280 | Financial Journey to Financial" -- I think -- it doesn't say here, but financial -- "Her

01:57:47.720 | Ability to Handle Her Own Finances After Her Husband Handled All the Finances and Then

01:57:53.640 | Passed Away."

01:57:55.320 | That's Grandma Sylvia, November 8th.

01:57:58.320 | On November 15th, Chicago is presenting the "Health Care, ACA, COBRA, and Other Options

01:58:06.160 | for Pre- and Early Retirees," pre-Medicare, November 15th.

01:58:14.800 | And then on December 13th, Chicago is hosting Lonnie Thibodeau on Medicare.

01:58:23.080 | He has spoken before at a meeting on Medicare.

01:58:26.440 | He's really great.

01:58:27.440 | He knows Medicare inside and out.

01:58:29.640 | And so that is December 13th.

01:58:33.240 | And then January, possibly the "Mad Scientist" will be back.

01:58:40.200 | And --

01:58:41.200 | >> To discuss his life as a recent homeowner and recent dad.

01:58:45.160 | >> Uh-huh.

01:58:46.160 | And Taylor's birthday party, 100th birthday party.

01:58:51.960 | >> Excellent.

01:58:53.320 | And we can also say the 2024 location for the Bogleheads Conference was announced.

01:58:59.760 | It will be Minneapolis.

01:59:03.040 | Probably in the October range.

01:59:05.000 | I'm not certain of that, but Minneapolis is certain.

01:59:07.760 | They have a huge active volunteer chapter.

01:59:12.280 | So if folks are considering, that's where it'll be.

01:59:19.280 | I want to reiterate how grateful I am for this community.

01:59:22.760 | I find folks inspiring, just how folks help one another.

01:59:27.920 | And I'll say it as straight as it is, because it comes up over and over.

01:59:33.040 | Let's each, you know, remain active, engage in whatever exercise we can, eating healthily.

01:59:40.580 | I think walking keeps coming up in so many different, like, helpful things, whether it's

01:59:48.280 | clearing your head or sharing time with someone.

01:59:50.840 | The co-op community where I live is 1,000 units.

01:59:53.560 | A lot of people do age in place here.

01:59:56.480 | There's a group that does Tai Chi every morning.

01:59:59.360 | They're just groups of people who go walking together.

02:00:04.040 | And a lot of folks in their 90s who are cognitively strong and physically independent.

02:00:10.860 | So I think we all know these things.

02:00:14.280 | Let's just maybe... [music]

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Bogleheads® Chapter Series – Estate Planning Basics – Taking care of your parents – Open Q&A