Welcome to the Bogleheads Chapter Series. This episode was jointly hosted by the Starting Out and the Pre- and Early Retirement Life States Chapters and recorded October 25th, 2023. The topic was Estate Planning Basics, Taking Care of Your Parents. Open Q&A. Bogleheads are investors who follow John Bogle's philosophy for attaining financial independence.

This recording is for informational purposes only and should not be construed as personalized investment advice. I'll mention Mike Piper's book. So a lot of folks may know of Mike Piper. He's very active with the Bogleheads and he's extremely involved with the Boglehead Center, I'm sorry, John Bogle Center for Financial Literacy, excuse me, even the treasurer for that organization.

So he's got a book on Amazon and the Kindle copy is $4.99, last I checked, and it's called After the Death of Your Spouse, and I'm just going to put it on my screen briefly so that folks have something quasi-tangible to act on. And although the title is After the Death of Your Spouse, I found the first half almost like a checklist in preparing.

So one would benefit from reading this well before what the title implies. So with that, and folks who don't know Mike Piper, he's a CPA and he's very active again on the forums, very accessible, he's humble, he's approachable, he's a phenomenal person. So I'm very comfortable recommending this book.

And more specifically, I'll just cover the table of contents. The book's divided in this way of immediate steps and very practical, almost checklist-oriented what folks would be encountering, but you can read it and in advance know what to plan for. So it covers the roles of the executor and by empowering yourself, and it's very conversationally written, void of jargon, very user-friendly.

So I wholeheartedly recommend at least the first half for the planning stage. And why I distinguish the second half towards the bottom of this table of contents, you see part two, intermediate next steps. This large, and now I'm forwarding to the next part of the table of contents, a lot of this addresses the technical financial aspects of accounts and beneficiaries for IRAs and inherited IRAs, and even deferring an inheritance, which didn't occur to me, and he goes over why one might do that, tax reasons and otherwise.

Something else that I thought was really valuable in the first half of the book was notifying credit bureaus, so the credit reporting agencies like TransUnion, Experian, and Equifax, after the death of your spouse, because there's identity theft. So that hadn't occurred to me. I think a lot of people are versed in subsections of this topic, but there's just a gold mine, a treasure trove of practical insights here.

So again, I'll scroll back to the cover. That's the title, "After the Death of Your Spouse" by Mike Piper. You can find it on Kindle for $4.99 as of today. With that, I will stop sharing my screen. Pause, share. Pause that. Okay. With that, I'll jump into how we'll structure the rest of today's meeting.

So thanks to everyone for joining. We've divided the topical content into these five categories, which I'll read. The first, taking care of an aging parent. Second, elder care planning, including power of attorney. The third, health directives and proxies, as well as living wills. The fourth, guardianships, including custody and handling incapacitation.

And the fifth of five is end of life situations, including prepaid funerals. So with those topics, we'll open it up to the group to share, as Mary mentioned, personal experiences, focused questions. We will aggregate those questions, compile them, consolidate them, present them to Summerfield so that when we reschedule, he can address them in a very focused manner.

So I'll pause for a second. Miriam or team, did I miss anything in terms of how we'll structure what folks can expect in terms of ground rules for the meeting? May I ask, Michelle, did your hand up for a reason? And also there's background noise, so if you're not intending to speak, can you mute, please?

Okay, thank you. Okay. So Alan, Lady Geek, Miriam, did I miss anything in terms of how we intend to structure this since there's a bit of ad hoc going on? No. Okay. So why don't we open it up to the group, taking care of an elder parent. This is an opportunity ideally to share factual, informed insights, guidance, experience, things that you found helpful, specific questions you have.

What we'd like to avoid is too highly opinionated where it could be wrong or where it's not factual and it could lead to mis- or disinformation. So nothing wrong with sharing what you found helpful. It's obviously subjective, but we want to avoid putting out wrong information. So with that, let's open up taking care of an aging parent.

Feel free to raise your hand, put questions in the chat. Does anyone have a specific question about taking care of an aging parent or those who have? So Stu has his or her hand raised. Stu, feel free. Yeah. My mom lives in Florida and we are not in Florida and it seems like she's having issues getting to doctor's appointments.

So she's late 80s and she's been asking her neighbors, but I can tell the neighbors are getting tired of taking mom to her appointments. How far are the doctors and how many? Maybe like 15 to 30 minutes away. And how often does she need to go? Well, I'd say maybe once a month and a half, every month and a half.

Okay. Miriam has her hand up. Yeah. One thing, check her insurance policy. Her health insurance policy to see if there is the health insurance company can pay for a medical van to take her. She's eligible for that. And also our relatives used, well, first of all, there are also private medical vans that she could sign up with.

And sometimes the local counties have medical vans that are available. And we would have to apply with the county to, especially in Florida, to apply with the county, with the agencies that supply the medical vans. But I remember using one for a relative and they actually, the relative was in a wheelchair.

They would put the wheelchair in the van and it would be locked inside the van. So it didn't move. And it was, I could go with our relative in the van also to the doctor's appointment. And the reason I could not take the person is that, first of all, if the person fell out of the wheelchair, I could not pick them up.

And then also it was just so difficult maneuvering the wheelchair and getting the person from the wheelchair into my car. So the medical van was the solution rather than a neighbor who, it comes to a point where the neighbor is not going to be so willing probably. She's got a Blue Cross-Fed program, basic.

I don't think she would want to spend a dollar on any transportation. She'd rather miss her appointment. - What's her mobility like? - She's fine, but late 80s, she's not the best driver anymore. - I was gonna say, I've had to arrange transportation in Florida for my parents on occasion, and when they couldn't get, they're in assisted living and they generally can get rides from the assisted living to their appointments.

But when I've had to arrange a ride, there are some taxi services that cater to the senior population. You might have to search them out, but it may not be available where you want to live, but it might be something to look at. It might be a cheaper option than maybe the full medical transport, which can get kind of expensive.

- Is she in a suburban or urban, or how dense is her environment? - Between Fort Myers and Naples, it's called Estero. Well, it's a suburban. - Okay, and so some of these options like medical van or specialized taxi services, you mentioned her perhaps reluctance to spend. Are you or others covering her costs?

If that were covered, would she be more agreeable to using these services? I don't want to volunteer you, it's perhaps a hypothetical. - I think if we were to spend the money, she would ask how much it costs and then she would get mad at us for spending the money.

What if you told her it was a fraction of what it really costs? - She might find out. That's what I was thinking, maybe like, "Hey, we got a big discount on Uber. We got a 75% coupon and we got a bunch of rides for you, mom." - So Uber has worked for her?

What has been working for you? - No, no, no, no. She hasn't done that yet. She's afraid to do that, but I'm thinking. - Are you going to tell her you're submitting it to insurance for a reimbursement? - Gorey, in the chat, one of the Vogelheads said, Sarah said, "Sometimes organizations for specific diseases, for example, the American Cancer Society may have a ride program through volunteers." - Excellent.

So, Stu, thanks for the question. You definitely want to poll the audience for other topics or questions, but absent that, we can continue on this if it's helpful. I'm not monitoring the chat, so if others have things from the chat that should be shared verbally, Miriam or others, please do.

Stu, was there anything more to your question that you want to share, either what has worked well for you, what may help others, what you learned later that benefited you that could help others early on? - Well, no, but right now, it's just been the neighbors, you know, and I'll be talking about this to my brothers because we need to have...

We can't have her neighbors, like, relying on them. - Okay. Understood. Let's see. Alan has a question. - As I just want to point, I put a link in the chat of a helpful book resource to how to initiate the financial conversation with parents when you're addressing potential future needs or current.

Sometimes they're unwilling and uncomfortable having a conversation with a child about their future needs, and there's a wonderful book. I've heard this author a number of times on some podcasts, Cameron Huddleston, basically about how to approach the conversation. She wrote about her own experience with her mother. The book is titled "Mom and Dad, We Need to Talk," how to have essential conversations with your parents about their finances, which also includes elder care planning and such.

Just wanted to point that out as a good resource. - Great. Thanks, Alan. As far as getting assistance for driving an elderly parent, certainly if they have any religious affiliations, congregations that may be able to offer such services, and just Googling for the local county that she resides in, as well as the city, for assistance.

I know my mother, who also lives in Florida and Clearwater, we've kind of dealt with this a little bit. We've actually found a private driver rather than using Uber, but I found out there is actually a volunteer organization that does provide services for nominal amounts, like $10 round trip within a certain radius of mileage.

Those services might be available. - I found the private driver not to be that expensive, relatively speaking, myself. - Yeah, it depends, yeah. - Okay, very helpful. So a parallel question in the absence of other questions, why don't we quickly pull. If you have a question, please raise your hand or just chime in.

This is super informal, feel free. You won't be interrupting, but in the absence of questions, I'm wondering, folks on this call seem cognitively aware, engaged, conversant, and we might have our own plans to age in place or stay in our homes as long as we're physically able, et cetera, but at some point, we lose objectivity and we're not able to make the same decisions that we thought we committed to earlier.

So how have folks navigated this kind of less obvious transition of someone in their 50s or 60s saying, "Yes, when it's my time to move to assisted living, I'll voluntarily do that," but when they're 70 and all the things that they, in their younger rational days, they would have said they'd volunteer for, they no longer have that lens.

Making my questions clear, when we lose the objectivity to voluntarily lose the home or seek assistance, leave the home, I mean, or accept assistance, I don't know, there must be people who've experienced this and how do we guard against that for ourselves? So are you saying that a family member would force the parents into an assisted situation?

Is that kind of what you're- Oh no, not at all. So it's entirely hypothetical, but definitely I don't mean to imply anyone being forced or anything. So let's say in my current rational state, or I think I'm rational, I'll say when I need assistance, when I'm no longer independent, when my quality of life has deteriorated significantly, I'll be open to moving to a facility.

That's what I say in my current state, when I have the cognitive ability to say that, and I mean it genuinely with the best of intentions, but fast forward a few decades, I'm no longer able to take care of myself, but I no longer have the objectivity to say, "I agreed to leave my home and accept assistance at this point." So my future self is holding on to distorted self-impressions of, "I'm still independent.

I can exist in my home. I don't need assistance." Even though I previously said, "When the time comes, I will welcome those things." But it's- I think what tends to happen is, I know in my family situation, there was a medical event that triggered, that re-triggered the discussion that my parents should move, and they finally did agree.

They made good plans, but I think they were trying to hold on to their lifestyle at home as long as they could, but they went beyond when they probably should have gone, but the medical events that they were in, I think it takes maybe family members staying engaged, evaluating cognitive, physical conditions, and assess what the options are for family members.

Okay. That helps. A medical event sounds clear. So I see Miriam has her hand up, and then Ellen. Yes. I think this happens all the time, Gorrie. On the Vogelheads Forum, it seems that at every point in time, we have a thread that involves, "My elderly relative refuses to leave the home.

My elderly aunt lives on a farm in the middle of Minnesota, 30 miles from the nearest medical center, and she refuses to leave." We have relatives who will- they are intent on aging in place in the home, even though right now they are basically homebound and bedridden. So it comes to a point, I think, where this is where guardianships come in, I suspect.

And then also, what do you do? You just pick them up or get the sheriff out there and put them into a facility? This is a very, very difficult decision because, as you say, they're not necessarily thinking clearly due to age, or they just don't want to get old, they just don't want to move, they don't want to be in a facility.

It's very, very difficult. There's different components of this, too. I know with my own dad, he loved to drive, but during one of my visits, I knew he shouldn't have been driving, and I had to engage his primary care doctor to- she was going to report him to the state of Florida to have his license revoked.

But before she did that, she asked if he would visit with her to discuss this, and during that visit, he agreed to give up his license. But that was a component of just keeping him safe and keeping other people safe as well. So I see Allen has his hand up.

I'll just ask in the interim, have folks seen something work in this situation? Are people, like in Miriam's example of bedridden, homebound, want to age in place, are they more receptive to conversations with their peers, their close friends, maybe family members who aren't the younger generation who are, you know, encouraging the different facility?

But if they're someone from their own age group who went through something similar, have folks experienced that a bedridden, homebound, age in place, reluctant person is more receptive, more permeable, depending on the source of information? Okay, maybe we can revisit that. There's almost no choice. I mean, it gets to the point where for the elderly relative that I am thinking of in our family, where they will simply have no choice.

Right now, they do not have their medicines on auto refill. They're not taking their medicines. They have a commode next to their bed. They cannot empty the commode. You know, every time we go over, it is a new thing. One more thing. It's embarrassing to say that this is a relative in the family.

But this is what they want to do. They want to age in place. They are serious, they are intent on it. A guardianship, I understand. We've never done it. Nobody, I know in our family, we have a large family, nobody has ever had to have a guardianship. Because eventually it just became so obvious, the family went and said, we have a great place for you.

We have a wonderful place for you. And you need to go there because you're going to lose the home. Or because for some reason, we just simply have to do it. Now is the time. And eventually move them. Find a place that you think that they would feel comfortable with.

Find a place financially that is doable. It's very, very difficult. I don't know how else to explain it, but it would depend on each individual person. Some people qualify for Medicaid. Others do not. Some have financial resources. Others do not. It's a very big area. Mm-hmm. So maybe it takes exposure long before the situation, touring facilities saying, would you ever consider moving here if the situation came to it?

I'll say no. That's a nice thing to do, but they're going to say no. Well, this relative has said no. But I'm saying in the rational decade or two before the event presents, if when folks have objectivity and it's framed hypothetically as if you reached a state where you needed a commode next to your bed, where you couldn't physically perform x, y, z, those daily functions, would you consider this place, this?

They will say no. Because first of all, I will never be in a position to need a commode next to my bed. And also if I do, I will be able to take care of it. Or I will hire a lady to come in and clean. There will be rational in their mind, rational explanations for why they will never need to move to an assisted living facility.

And by the way, I never use with our relative, this relative, the word nursing home. I always call it an assisted living facility. But that and it helps a little bit, but they will, you know, that there will always be a reason on their mind why they don't need it.

And also they will think that they will get better. Today I can't get out of bed, but tomorrow I'll probably be able to. If I take my extra Tylenol, I will be able to get out of bed and I'll be able to push the microwave buttons to make my dinner.

That's how it comes and it doesn't happen. Understood. It comes down to independence. I think that's really people try to, I think, I think the intention is good. Maybe when you're in your fifties or sixties that when you reach that stage that you would consider it. But then when you get there, you've enjoyed the life that you've had and you're just trying to.

But that's my point. Are we those people too? Because we're referring to a different group, but maybe we're all vulnerable to that. So, okay. Why don't we pause that for a second, Alan, you've had your hand up for a while. And then Sarah. Okay. Just to address this last question, I think the problem is even when people are on sound mind and say that I plan on doing X, Y, and Z when cognitive decline kicks in, they probably will no longer recognize or acknowledge that they stated that before.

So it's a hurdle that's hard to overcome, but you can, there are other resources and ways to approach this. For instance, most elderly have a primary care physician nowadays met the Medicare wellness annual wellness exam requires a review of a memory test, cognition questionnaire, and other questions. If you accompany an elderly parent to the primary care annual exam, they will assess and ask for input and the physician may be helpful in determining that it perhaps is time to, as a minimum, get some home healthcare, which could be a transition towards assisted living.

Also, if an elderly parent has either a long-term care policy or indemnity plan that offers some home health care, that's another way to transition towards a more complete care down the road. It's certainly prudent to review if your parents will allow you any of their insurance policies, particularly long-term care policies and reading in detail what the services are.

I had to go through this with my mother who's 92 and battling pancreatic cancer. She had what we thought was a pretty good long-term care policy that turns out now that company out of Pennsylvania is in rehabilitation, long story, I could go on for an hour about that. It does have homemaker benefit, it does have some home healthcare benefit that we've been able to take advantage of, and she wants to continue to remain in her home with assistance as needed.

We may or may not need to have either inpatient hospice care, potentially, or rather in her house. But certainly, looking at those resources from the physician, it's typically going to be a medical event that precipitates this. Multiple calls, falls, other injuries, unfortunately, that make it more of an urgent matter.

But if somebody's hospitalized and sent to rehab, that's one way to transition to another facility down the road. Social worker from the hospital may be able to assist with placement and assessment, at least to assess what their home situation is, and from their professional perspective, that is needed. >> Okay.

Thank you, Alan. Very helpful. Sarah, you had your hand up? >> Yes. Following up on what Alan said, a medical event can be an opportunity. Your loved one, even if they're -- so Medicare only -- Medicare, original Medicare only goes into a skilled nursing facility at their cost if the -- I think it's 48 hours, 72 hours, something like that.

But even if they don't qualify for that, to discharge somebody from the hospital to an assisted living place, because the doctor said, even if that might not be per se what they said, may be a way to get them in the door, and somehow or another, they just never leave that.

There was a story years ago, I think it was on Invisibilia, about how we, as we age, crave the familiar. And so you're asking somebody who's lived in their home maybe 40 or more years to leave the thing that they understand, that they know how to cope with, and when we're looking the most for what is familiar, and that might be something to keep in mind when a relative is pushing back.

You know, one of the reasons to me to moving into a CCRC is that they are a life plan community, is that they are the ones that are going to say, you know what, this just ain't working, it's time to move to the next level. >> And for folks who don't know, what's a CCRC?

>> Pre-McHara Retirement Community, also called a life plan community. And you know, there's usually a big buy-in, they're also considered a financial risk because of that big buy-in, whether or not they will float until you no longer need their services. There's lots of threads on Bogleheads about CCRCs. A care manager, if you were able to recruit a care manager, perhaps they would be able to be the third party that comes in and says, this doesn't work, I wrote another note here, but I can't read that.

And you know, the other thing that I would be concerned about is whether or not something like Adult Protective Services, that's what we call it in my state, could become involved. Is there the possibility that this would be considered so negligent that family members would be accused of being negligent?

And I don't know, and the home care nurses that I knew that called APS back in the day when I did a little bit of home care, didn't think that in my state APS was very successful in their deeds. So, but definitely to, you know, it ain't easy. It just is not easy.

>> Okay. Thank you, Sarah. Diane? >> I came late to this discussion. So I'm sorry. I'm a boglehead nanny. I'm just adamant about having the discussion as early as possible, if it's your family or if it's someone -- if it's your immediate family or it's someone else, have the discussion.

Start at age 50. Make sure you know. Someone says, I never, ever want to go into a home. Why not? Explore everything that you possibly can. Figure out what the alternatives are. Do not wait. It's -- you write the other thing. Write a letter to yourself. If you think there's a possibility of memory impairment, write a letter to yourself.

Do not -- and it does not come on suddenly. There can be suspect -- in terms of the Medicare wellness, it's pretty easy to avoid that. But if it does not come on suddenly, you know, your loved ones know, write a letter to yourself. Be absolutely positive of what you do and don't want.

And if you have a family member that says, I'm going to stay in my home no matter what, then figure out what the scenarios are. List them out. What if this happens? What if this happens? If they say no, you have to figure out where your boundaries are and what you can do for them.

>> Okay. Thank you. Very helpful. So I want to also add to the way you said write a letter to yourself, I wonder if people can record videos to themselves. And that way, you know, someone said earlier, they will deny having felt that or said that. But reading something can also be -- I didn't write that, but maybe seeing a video of oneself can be more convincing.

And something also came to mind, a lot of long-term care plans can pay family members to be the caretaker. I don't know if folks have familiarity with that. But where a family member serves the elderly person in their own home so that you don't need to hire necessarily an external home health aide.

So I think that's normal or at least not atypical. So I want to remind folks of the other topics and in the interest of time, we can -- some of these segue equally into each other. So the next one on the list is elder care planning, including power of attorney.

So certainly our first portion included a lot of elder care planning. But under this umbrella, are there any other additional comments or questions or experiences? >> About the first topic? >> So taking care of an aging parent was the first, then we're moving to the second, elder care planning, including power of attorney.

>> One thing I would add to this topic was it was helpful for me getting my parents to consider moving to assisted living several years ago was while my mom was hospitalized, the case manager mentioned that there were agencies that would help you discern appropriate places for placement based on financial resources.

And that process was so invaluable to getting my parents to open their eyes to what was available to them in their community and that they could afford it. >> It sounds like a great resource. >> Those agencies are free. >> Okay. I see Miriam has her hand up, but very briefly, Stu, how does one find such an agency?

Is it as simple as Googling agencies to help find assisted living? >> Probably. >> Okay. Thank you. Miriam? >> Yes. On powers of attorney, Gary, we did have a question coming in from the RSVP list, and it had to do with the difference between financial powers of attorney and health directive powers of attorney, whether to have separate documents or one document.

And one of the reasons they asked is that they find that medical places, hospitals and nursing homes do not necessarily even ask for the powers of attorney, the power of attorney, but the banks will. And then also, well, that was that part of the question. So I know, for example, our power of attorney for my husband's elderly sisters is 27 pages long, and that's Times New Roman 12 point or 14 point, the regular document point.

Now, you know, why wasn't -- when I take it with me to their doctors, they don't even want to see it. I pull it out, and they think I'm serving them a subpoena or something. It's just huge. But on the other hand, you need the power of attorney. You need that for medical decisions, and for -- you need the power of attorney.

How do people handle the power of attorney, and what has been their experiences in hospitals and nursing homes with the powers of attorney? >> I have experience with it, if you want me to comment. >> Pardon me? >> I have experience with it. I'm currently using one for my father in Florida.

I've used it for four years. He had set up a durable power of attorney with his family lawyer several years ago, and that's good for financial as well as medical. His medical providers have asked for it for me to talk to them, so it's usually very easily sent over.

I just -- I've scanned it into a PDF document and emailed it to them when they needed it. Occasionally, I'll have to fax one in, but it's not 27 pages. I think it might be five or six pages, I think, but it's a standard durable -- it's called a durable power of attorney.

It wouldn't allow me to probably transact, say, real estate transactions, although I say that, and I was able to sell my father's house several years ago with it, but I don't know if I'd be able to take out loans against the real estate with it, but I haven't attempted to do that either.

So that's -- >> Right. So I see Diane and then Lady Geek, and just a quick comment. The way Miriam mentioned, banks will ask for the power of attorney. I think folks in this crowd know banks often have their own specific power of attorney, so you'd want to get a copy of that.

>> Yeah. I was a banker in my career, and we would usually want a power of attorney specific for the transaction if you were borrowing money. >> Got it. Okay. Diane and then Lady Geek, and then Deanna. >> It's two totally, totally different things, and what are you trying to accomplish?

If you're trying to deal with the finances, you need a regular power of attorney, but if you're trying to deal with healthcare, you need a durable power of attorney for healthcare, and that needs to be ironclad. You need to 100% know what your patient wants you to advocate for, and you need to be really, really clear, but I'm not sure why there's a confusion between the two separate things, because a healthcare provider, in my experience, only wants to know that you have the healthcare power of attorney, and they will recognize that.

>> Okay. Miriam, do you want to reiterate if there was confusion? Do you want to clarify that question? When we say healthcare power of attorney, is that different from healthcare proxy? >> Yes. >> Okay. >> No. >> Well, yes, no, no, no, no, it's not different from a healthcare proxy.

I think it has to do with whether or not you have two separate documents. I think that's what the question was, whether there are two separate documents, whether you can walk in with a, have your power of attorney, just a health power of attorney, healthcare power of attorney, I guess the healthcare proxy, but for example, our power of attorney has healthcare in it as one subsection.

It has real estate, it has financial, it even has virtual currency in it, meaning every new possible clause that an attorney can put into a power of attorney is there, including the latest Florida legislative, legislative law from Florida that if the bank won't accept your power of attorney, then you can sue them.

Even that is in this power of attorney, it has everything, it has the whole kitchen sink in it, and that's what I say, it's 27 pages long, but I think the question had to do with having a short power of attorney for healthcare versus putting in all the financial stuff in the power of attorney, because the question says that they find that the medical places, hospitals and nursing homes, don't even want to look at it, they just say, do you have it?

And then they accept it. Yeah. My experience at Durable has worked for the medical community, when they've asked for it, I've sent it in, and it was like magic, they started talking to me, so it's good. Okay. Diane, your hand is still up. Do you have additional comments? No.

Okay. Lady Geek. Okay. Hello. Okay. Diane, I'll lower your hand then. Okay. So the difference, there's three different things that get confused, not with my mom, but when my husband was alive, there is a, I had a, it was a standby, a power of attorney for legal financial things, and then there's a medical power of attorney, but there's also when he was a frequent flyer to the hospital ER, they really don't care about POA.

As a spouse, I have automatic legal rights, or actually I didn't even, I don't believe I, they actually said, do you have power of attorney, yeah, and I brought it in, and all they did was copy Xerox, the nurse on staff or the physician on staff would just take my POA, run it in through the copier, staple it and hand it back to me, he says, okay, you're good.

Nobody reads that, but as a spouse, I have, I do have legal rights to admit him, and I was doing that, well, maybe I did show it, but either way, I was doing that, but medical directives. In Pennsylvania, there's a standard form called the Pennsylvania Order for Life Sustaining Treatment, the PULSE form, I believe that's standard in many states, it is a doctor's order, you can change it as many times as you want, nobody reads a legal document, these are doctor's orders, you sit down with the case manager, with the nurse, with the physician, you sit down one-on-one and say, what do you want, what do you want to do with your husband?

They go, DNR, do this, do that, oh, by the way, never do feeding tubes, that is inhumane, but the, so, yeah, I've seen it done, I was pissed. So the, so what he's saying, it's just separate out the process, if, when you need a medical thing, you're in a hospital, or a doctor's office or something, they, you fill out the PULSE form, the order, a doctor order for life-sustaining treatment, then you tell the person what do you want to do, you're done, they don't care anything about the legal documents, they might ask for POA later on, that's about it, so just be clear that when you fill out, when you're, when you pay a lawyer to fill out these documents, at least the person who's going to need to use them can read them, and then take care of it for you under their own POA, so that, that's what I wanted to mention from, from doing this many times.

I did it for my mom, I believe, as her daughter, but, and again, I brought in my POA, which was actually a, was not adorable, it was a standby POA, with the condition that she have two medical, signed medical statements from her doctors saying she was incompetent for financial decisions, I got, I easily got those, that's when she was admitted to memory care, I admitted her under that POA, they, that became, it becomes durable when that happened, I forget they call it springing POA or whatever, but, so that's what I wanted to say about POAs, there's, there's legal things, and there's practical things, oh, sorry, about the bank POAs, I actually did have a bank form years ago, when I signed one for my mom when she first moved into her CCRC, at the local bank, I went back as, you know, trying to modify her accounts, and they refused that, and they wanted, now they said they don't, they no longer use bank POAs, they want the real POA, Xeroxed it, copied it, and then they sent off to their, whatever the bank's legal guys say, and they turn around, they said, yeah, you're good, fill it in, so I'm good to go, so I don't think banks are using their own forms anymore, okay, that's all I had to say.

Okay, thank you, Lady Geek, Tiana, you may be muted, you appear muted. I'm the person that Miriam had read the note about, banks accept the POAs, and the medical people don't care, so the reason I said that was last year, I have one sister that has a POA, and I have the POA for my mom, who's 100 now, and my other sister does not have a POA, so the other sister took my mom from the hospital to a nursing home, and put her in a nursing home, and then signed it as, she said, I have a POA, so she signed it, and it wasn't like the medical part, it was the, are you the person responsible for paying bills if she can't, so it was, you know, they should have asked for the copy of the power of attorney, and in their document, they say, we will ask within 24 hours for a copy of your POA, but they never did, so there's my mom in the nursing home, and we didn't have what you call the medical power of attorney, so in that case, my mom would be the person that has the full authority to make her own medical decisions, so everything went wrong in that case, and I don't know if anyone has any comments.

Regarding the contract, I know when I put my parents into assisted living, I didn't have to have a power of attorney to sign the contract for them to enter the facility, I just took on the financial responsibility for them, so I don't know if you need the POA necessarily for that.

Deanna, has the nursing home followed up to obtain a copy? No, that was last year, and she was there for like three weeks, I think. The thing that Bill said, I forgot, what did you say, Bill? I think you mentioned your sister signed the contract for the nursing home.

But in this part of their contract, it specifically said, are you signing this as power of attorney, so you could sign it as the person taking on the responsibility, you would sign it on a different line, but if you sign it as power of attorney, then they're supposed to ask you a document, so basically, you're hoping that just an average person couldn't just throw your mom in a nursing home, but they can.

And we didn't know if we could get her out again very easily, because we didn't have the medical power of attorney, so it was like, someone can do something, but we can't undo it very easily. If we had the medical power of attorney, my other sister or I probably could have gotten her out immediately.

But because of that, we had to go through like a three-week process to get her back out again, so yeah. Wow. Any other questions or comments regarding what we've covered so far? Allen. Yeah, I was just going to say, for many of us, our elderly parents may have had a durable power of attorney and healthcare surrogate, and all these documents completed many, many years ago, even over decades ago, so it's certainly worth reviewing in advance.

There may be newer formats and state legislation that requires additional content, as Miriam said, and it's prudent to review that on a regular basis. I know recently, when my mother took ill, I contacted her attorney, and we in fact updated her powers of attorney and everything, in addition to her will, but he said that what we had was really totally outdated and had just been sitting in a lockbox all these years, so that's something else to be proactive with.

Do you recall the material differences? In our case, there was some language that the state of Florida wanted in the more current version. I don't recall the specifics. I know it was probably a couple of pages longer than the original one. I didn't compare the two, but he reassured me that what we have is current, and I will ultimately have power.

I already have durable power of attorney for her. Haven't had any issues as yet, but I haven't had to do much with it as yet. Okay. Miriam. Thank you, Alan. Yes. I wanted to ask Lady Geek, on the POLST, the Provider Orders for Life-Sustaining Treatment, how does that differ from the living will?

Nobody looks at the living will? Well, what is the living will, first of all? The living will is your life-sustaining treatment, what you wish for life-sustaining treatment. What you wish. It's called an advanced healthcare directive. Right. And you sign that. The elderly person signs that ahead of time, and it is then notarized, I guess, whatever the state requires.

But how does that differ, then, from the POLST? The POLST is a doctor order they must follow. The advanced healthcare directive is a legal document that somebody looks at and interprets. So the doctor's orders is immediate, it's effective, everybody knows what to do, and they will follow it. You can update that as many times as you want, while that person stays there, but I've never been asked for the advanced healthcare directive, because I've always filled out that form, and they were very clear, it's a one-on-one interaction, they explain everything, and I sign it.

I think I sign it as patient representative, or I sign my name Lady Geek POA, or something like that. And then, of course, they have the copy of the actual POA that people never read. But they say being a spouse, or being a daughter, immediate family, goes a long way.

If it was a friend, an unmarried partner, you'd have a lot more to prove, I would think. Or more disrelevance. Okay. Thank you, Lady Geek. Diane, and then Sarah. A POST is very different, in my experience, from a power of attorney, a medical power of attorney. A medical power of attorney can be very explicit, talking about what you want, in any number of circumstances, and you can evoke it.

A POST, you have three choices. I want full care, I want intermediate care, maybe if this happens, I want to do this, or I do not want any resuscitation. A POST is absolutely 100% clear about what you want. And a durable power of attorney is like, these are your wishes.

And so, I've heard it said that you don't need a POST until you get older. I think because of the fact that you can choose, I want full code, I want everything, that people should have a POST. I know, I'm older, I live in a facility where ambulances may come once or twice a week.

They always want to see the POST. Some people feel as though when they're younger, they don't need a POST. I don't understand the downside of having one, but it is much more direct and explicit and covers the situation. So I would 100% recommend a POST. Okay, thank you, Diane.

So maybe something for the crowd to noodle on is downsides to a POST, as Diane mentioned, not knowing what the downsides are. So if folks have an experience with the downside, they can share it later. So Sarah, and then Beverly and Tim. So, yes, advanced directives are often expressing your wishes, but they are not physician's orders or providers or licensed independent practitioners orders.

And the medical world works off of protocols and orders. So you can go into a hospital and somebody will read your advanced directives and say, is the DNR all right? And they'll say yes, and they write the order for the DNR. And that ceases to exist when you go out, when you're discharged from the hospital.

Physician's order for life-sustaining treatment is so long as you can present it to a provider, then they need to follow that order. And so when the EMTs arrive at your house, the paramedics, and they're going to work off a protocol and you say, here's the POST, absolutely positively do not do chest compressions, they go, okay.

No, they don't. Well, yes, let me rephrase. That's what they're supposed to do. If it's a physician's order for life-sustaining treatment, but not if it's an advanced directive. Because otherwise, if it's an advanced directive, they're working off of their protocols and their protocols are to intervene. There's actually a fairly good thread on this in Bogleheads recently, yeah.

Is that Taylor's thread on pros and cons of do not resuscitate? I think so. There was also another one, but I think that may be the one you're talking about. Yeah. Lady Geek, it's topic 412455. If you can put that on the chat, perhaps. So Jim Dolly, who is an emergency room physician, was also one of the people who made comments about that.

And he's talked about, well, when you have somebody in the emergency room, and it's pretty clear that resuscitation has been requested not to happen, they'll back off. But the problem is really more like if you're in the field and there's no physician around, they're working off of protocols. Or those advanced directives don't follow the patient, like my mom went from a hospital setting where the advanced directives were there, they knew what not to do chest compressions or try to resuscitate, but then she went to rehab and for some reason, those directives didn't follow her there, and they did initially do take resuscitation measures.

So that's something to just think about. Okay. Thank you, Bill. Diane, your hand is still up. I don't know if that's intended. It wasn't intended, but let me say something. There are a lot of questions about end-of-life and DNR, and do you or do you not call 911 if you have a post order?

Do they have to, if you call them because you're in distress, but maybe you're not critical from the condition, each emergency service operates in a different way, and it's something I think that people really need to think about. And all of these things, until you're older, until you've experienced them, you don't think about them.

And there's always little, for instance, one of the things, if you go to what they call drive-by surgery, if you're doing outpatient surgery, they do not have to follow, in almost every case, your DNR, because it's a short term, they don't have resuscitated capacity, and so they will not follow your DNR.

If you go into surgery, you have a DNR, you have to, in most cases as a condition of surgery, you have to stop that. No physician wants to go into surgery and says, if you go into heart failure, I'm just going to let you die. It's so complex, and so all I can say is investigate, investigate, investigate, and talk to your family members, talk to your loved ones, figure out what it is they need, figure out what you can do to advocate for them.

I recently had an experience with my best friend. I was absolutely 100% sure she was 100% sure of what she needed, what she wanted, major teaching hospital, major city. I had four days of doctors calling me and saying, we want surgery, and other doctors saying, I don't think she's competent.

I actually had to call in and threaten a lawyer. Just investigate, talk to your loved ones, figure out everything that's going on. It's so complex. Make sure you know what you want and what your loved ones want. >> Okay. Thank you, Diane. Beverly and Tim? >> Hi. I want to make a few comments because I used to work in healthcare, and I can tell you that I never read anybody's advance directive, and I never really got documentation.

If somebody said I'm the husband or the wife or the mother or the father, I just believed them because it wasn't my job to really vet them. I think that an advance directive is vague, to say I don't want to be resuscitated is not that meaningful, whereas a POST, which I'm from New Jersey, and POST started here, so the Physician's Order of Life Sustaining Treatment, is a legal document in a hospital.

Even if you get discharged in that hospital system, and now there's not just one hospital, but there are a lot of hospitals in a conglomerate, right? Every time you sign in, that document pops up first. If you say I don't want to be resuscitated, does that mean you don't want chest compressions?

Does that mean you don't want a ventilator? There's a lot of things that that could mean. The POST is specific, because for my own mother, she said, "If I get pneumonia, I don't want to be on a ventilator." Okay, but do you want oxygen if it'll make you feel comfortable?

Yes, I don't want a feeding tube. Okay, so there are various things that you can agree to or not agree to, and you can say why, and you can be very specific. I'd encourage people to get a POST because then you have more power, and if you are at a surgery center, it doesn't matter if you're in an emergency room.

If you're in a nursing home, it carries weight and credibility with the medical staff, and they do need to follow that, whereas an advanced directive, it's kind of wishy-washy whether or not, and nobody has the time ... In a crisis, nobody's going to read it anyway. They do the best they can in a crisis, but an order is an order, so it's a good thing to have that on record, and put down exactly what you want it to say and why.

I always tell patients, "You can change your mind at any point. We can rewrite this. Tomorrow, if you decide that you don't want oxygen, we'll write it." I think you should feel comfortable if you have that in your medical record. Thank you, Beverly and Tim. Alan? Yes. I put a link in the chat, at least for the state of Florida, and I suspect many others.

The state has an official DNR document signed by a physician, especially for individuals that are still living at home, perhaps with terminal illnesses, and it's printed out on yellow paper. I actually have one here that I have already printed out for my mother, who's terminally ill, and it's supposed to be filled out, signed by the physician, and taped to the refrigerator in a common area where it can be found quickly if paramedics are called to the home or another caregiver has to intervene and sees that the patient is unresponsive, so it's quite clear what their advanced directives and do not resuscitate wishes are.

That's something to look into for each of your individual states. That can be certainly helpful when somebody wishes to remain at home. Alan, is the DNR order the same thing as the PULST? I'm not familiar with the PULST, but I presume it's the same thing. I'm sorry. The PULST comes from the doctor, is that right, Beverly?

That's correct. You sit down with your physician, you sign that, so DNR is not that meaningful, because do not resuscitate could mean not shocking somebody, not giving them compressions, there's a whole range of things. If you have one DNR while you're hospitalized, when you're discharged, it goes away. If you have a PULST, it continues on.

Like I say, it's always on file for you. Every time you sign into that hospital system, or even if you call paramedics, when they type in your name and social security number, bam, that thing pops up. That's the first thing that they see, what they can and can't do for you.

That may be state specific, because I know my experience in Florida, I had submitted when my mother first went to the hospital a couple of years ago, I submitted her advanced directives and so forth, and when she was most recently admitted, they asked me if we had such a document.

I said, "Yes, it's been submitted." They did not have any record of it. We had to start all over again. Then once you went to another facility within the same system, they did not have a copy of what we had just submitted two weeks previously. No, only the PULST, because if it's a do not resuscitate order, the minute you're out of that system, the minute you're discharged, it goes away.

Even if you are, there's certain facilities have, it's only good for 72 hours or whatever. It has to be renewed periodically. Is this something universal to all states, or is that something more specific to yours? I've never heard of it. I'm a retired physician. No, PULST, P-U-L-S-T. It started in New Jersey, but I recently spoke with, it's in Pennsylvania and other states as well.

That's a doctor's order. I believe it is in Florida. The DNR is also an order, but it's only specific to that hospitalization. One thing is that the DNR you create when you do your estate planning or your elder care planning, along with the health directives, it's like the living will.

You do that with an attorney and it may be signed with notaries, but it sounds to me like the PULST is a medical paper that is done in the hospital with the attorneys when you are in the hospital for some reason. Would that be correct to say that? No, the PULST is not just when you're in the hospital.

The PULST in my community, you put it in a place for medical text. The problem is if you have a PULST that says DNR and you call 911, you are at the mercy of the person that shows up. They can or cannot decide. You can have, they will say, why did you call 911?

What is it that you want? Your loved one that is standing there is going to say, what are they going to say? I call 911, I don't want you to do procedures. I want you to do X, Y, and Z. It's a very controversial area and people need to figure out exactly what they need.

And if they have a PULST that in effect says do not resuscitate, why call 911? You need to figure this out. But a PULST is not something you create with your attorney and have it notarized along with your living will, your power of attorney, your financial powers of attorney when you're in the document creating and signing session with your attorney.

The PULST is not done then, is that correct? I have never seen a PULST in that realm. It's something that your physician initiates or you initiate with your physician. I have not seen any legal or lawyer ramifications. Beverly? No, the DNR, while it's a legal document, it doesn't have to be, it can't be recognized in the hospital until a physician writes a DNR order with the family or the patient.

The PULST is a medical order and it must be recognized and it must be recognized by EMS, emergency, wherever you are. It's a physician's order as opposed to a legal document that says this is what I wish. But that's one step. If you're alert and awake and when you get to the hospital, you can say I'd like to sign, I'd like my physician to write a DNR order that will be recognized by the hospital.

But a DNR that you write in an attorney's office is not the same as a medical person would. So you bring in a DNR and then the doctor signs it with his order. Ideally, it must be recognized. But what I'm saying, and this may be just true in California, when you call 911 and you have a DNR and a PULST, they're going to say, why did you call me?

And it's between your loved one and the EMTs what they're going to do. And, you know, you can, so you need to understand if you have do not resuscitate PULST, should you call 911. It's very difficult because you may have a terminal condition, but you also may have a short term condition that you need relief for.

It takes a lot of thought. Ideally all of this should function legally, but it always does not. The hospital should recognize your power of attorney, your medical power of attorney. They should recognize as an advocate, your PULST. I just recently had an experience as a large major teaching hospital, took me five days in a threatening an attorney to get them to honor my friend's PULST.

Not as smooth as it should be, educate yourselves. I just Googled and the PULST exists at some level in 50 states and Washington DC. So yes, it is valid with some tweaks in all of the states. I just found, I just posted the one, I just Googled it real quick and found the one for Florida.

I'll give you an example. I spoke to the social worker when my mother was first hospitalized and diagnosed with terminal cancer and they referred me to the yellow sheet for the do not resuscitate to hang on the fridge at home. Never mentioned PULST. I never even heard of it until this evening, but in fact it does exist for Florida as well and I found it and I'm going to follow up and have her fill that out.

It goes into more detail with more options than does the standard basic DNR. Yeah. Yeah. If you have any questions, Miriam knows how to contact me, so PM me, it's fine and good luck with everything. Thank you, Diane, Beverly, Alan, Miriam and did I miss someone? So going back to, I think all of these things as Lady Geek mentioned, kind of work in parallel.

So I'll just go over the categories again to fuel the discussion for any other comments or questions. So taking care of an aging parent, we started with, we segued into elder care planning, including power of attorney. We certainly discussed health directives and proxies as well as living wills. I'm not sure we use that term, so we can revisit it if it helps.

And then the last two categories, guardianships, which was mentioned but not discussed, custody and handling incapacitation, and the last category, end of life situations, including prepaid funeral. So we're at a quarter after nine and if folks have questions or experiences or guidance or helpful thoughts on any of these topics, feel free to chime in.

I would like to say one thing that I previously was not aware of, you can have all of these documents in place, you or your loved one can require surgery, your surgeon most likely will say, we need to suspend your DNR, we need to suspend your post, I will not go into surgery with the edict that I cannot revive you.

My friend had a do not intubate. She went into surgery, they intubated her. It allowed her to survive the surgery. But then she deteriorated. So you need to -- what you need to do is understand every single ramification. You need to understand you can have all of these things in place, but your surgery.

Do you want to say if my heart stops on the table? Don't resuscitate me. I'm not sure any surgeon would go ahead and perform the surgery. So again, it's just education, education, figure out as much as you can ahead of time for you and for your loved ones. >> Okay.

Lady geek has her hand up. Thank you, Diane. >> Funerals, prepaying. Let me post a link to what happened when my husband died. It's happened the first time. Okay. Yeah. Okay. Yeah. It explains the story in the first post of what happened. When my husband was passing, right before he died, he said time to make funeral arrangements.

And because of prior -- I heard from people that they can increase -- you pay a fixed price, but they can charge you with the cost increase, which they can do. So first experience, which I posted about the -- I posted the link in the chat, was where I purchased an insurance contract that they will cover all the additional costs.

So it turns out he passed away about a month or so later. And the guy who sold it to me was an insurance salesman. I asked him, how much money are you making on this? He says 30 bucks. But what happened was that when my husband passed, the cost of the value of the contract -- I mean, it was only a couple months.

The cost of the contract was -- he made basically a $50 profit. So I negotiated with him for extra copies of the death certificates. So I mean, here I am, my husband passes away, and I'm negotiating with the funeral director for death certificates over the cost. And hey, I'm a global ed, but I don't know.

I think he -- I don't know whether he was insulted or laughing hysterically at someone who would do this. So I got the death certificates. The second time, the prepaid for my mom was done like 10 or -- oh, 1997? Way back. And looking at the cost, and I went to the same funeral home, and yes, they can pay -- so the difference was for the religious service person, and it was an extra $600.

So I just paid it, and very nice service. So that's my experience with prepaying. So yes, they can charge, and they do charge a cost above and beyond the contract. And actually when I read, I actually had a copy of my mom's -- my parents' original documents for the funeral home and for the cemetery, and it said prices -- there was a print in there that said prices valid through the end of December 1998 or whatever.

It was that old, 2000-something. So they can charge. So I say I have an option if you guys are really -- this insurance contract, which I linked to in the chat, or just suck it up and pay the difference when the time arises. >> Okay. Thank you, Lady Geek.

Any other questions or comments, insights, personal situations to share that others may learn from? Personal situations to share that you want to ask a question about? Alan? >> Yes. One of the things to consider also, assuming if an elderly parent or certainly when they're approaching end of life, if you have power of attorney, both financial and otherwise, in reviewing all their finances, maybe they have a trust in place, certainly there will, one must also plan to ensure that there's going to be enough sufficient cash on hand to take care of final expenses and how that's going to be handled.

For instance, in my case, my mother had POD or TOD beneficiaries on all of her accounts, and that would have been problematic if upon her death, all the money is immediately -- the accounts are all frozen and distributed accordingly with basically the beneficiaries would have to pony up money on their own to cover final expenses down the road, assuming that all the siblings or beneficiaries are willing to do so.

So that's a consideration to think about when you're reviewing end of life care and financial planning. The funny thing is, I spoke to her estate planning attorney for some guidance, and he basically said, "I can't advise you on the financial aspect on the accounts. You need to talk to a financial advisor or a CPA," in spite of him having drafted her will and so forth.

So we're in the process of doing that. But just one consideration that may fall through the cracks if you don't think about it. >> Well, Alan, why would a POD take a long time? I know the accounts are frozen immediately, but for my sister's-in-law, if you go in immediately, they can unfreeze them within a day.

>> Well, in my mother's case, she has a number of grandchildren and great-grandchildren that she wants monies distributed to. She doesn't have a trust, but myself and my two siblings are all the POD/TOD, so there's no money available to make that distribution. We'd have to basically all pony up the money on our own, as well as how to cover her final expenses.

She has a minimal amount in her checking account, and we need to basically reserve enough money to take her final expenses, as well as distributions for her wishes to her grandchildren and great-grandchildren. Whatever is left will then be divvied up amongst our siblings. >> Okay. Thank you, Alan. Jim, and then Deanna, and then Diane.

>> I just wanted to mention my father-in-law passed away last year, and he was a veteran and wanted a military burial, and I'm going to share the screen here. We ended up, the Abraham Lincoln National Cemetery, which looks like this, the pictures, handles everything. I mean, you can show up with a casket or cremains, and they can do above ground or in these things.

I forget what these things are called. >> Crypts. >> Crypts. Very nice. And they have an honor guard, a military attachment comes over, does a very nice honor guard. Honorable ceremony, and they actually did a gun salute, and they gave us the shell casings, which was nice. Really nice.

So, anyway, if you have a veteran and they would want to do this, these cemeteries are located all over the country. >> Thank you, Jim. Deanna. >> This is based on what Alan just said. So, yesterday I went to one of my mom's banks, and the woman there has been helping me with some of the power of attorney stuff and processes for my mom to be able to keep getting access to her accounts.

And so she suggested that my mom might want to put me on as like the secondary owner of the checking account so that it would -- it sounds like that would fix the problem that Alan was talking about, that suddenly everything's frozen and no one has any money, so that I probably should then use that as what happens in that circumstance.

And I don't know what you mean by enough money in there, Alan, but -- >> Yeah, we actually did that. I'm now a joint -- named jointly on her checking account, but it's not sufficiently funded currently, and we're going to address that, how to get it sufficiently funded to cover all the needs.

>> And can you give me more specifics? What does it mean specifically, or sufficiently funded? What would you guess? >> Well, in her case, she wants -- the money is distributed for her -- some of her heirs that would be over $100,000. So I need to have that available to take care of as the executor of her estate, whereas all of her investment accounts are TOD or POD for myself and two siblings.

So we need to basically reserve sufficient funds to cover her other wishes for distribution to heirs. And the question would be, for instance, if she passes, prior to my telling Fidelity, for instance, where her accounts are at, prior to saying, could I transfer money -- because I have power of attorney -- could I transfer money from her account to her checking account prior to telling them that she has passed?

That could be one option, just the day that she passes, to make a massive transfer or initiate a massive transfer. I don't know ethically and legally if that's okay, and I'm not sure if that would even work. But that was one option. >> Yeah. >> Well, then, are you also considering the, like, say, medical bills that are built up or something?

>> That, too. Any additional costs. She has a long-term care policy, but we're paying out of pocket and getting 80% of it reimbursed, so there will be ongoing expenses where the estate is responsible for. >> Okay. Thanks. >> Deanna, we are doing this now for my sister-in-law, and one thing to be careful about is that we have found that the different banks do have different rules.

For example, my sister-in-law banks at a credit union. There there are -- she -- my sister-in-law is the -- what they call the primary on the account. There are three joints. But as soon as the sister-in-law dies, the credit union says they are notified immediately by Social Security, Medicare, the hospital, the bank.

The big brother tells them immediately that she has passed away. The account is immediately frozen, and one of the joints has to come in with their identification to open up the account. Then the account is unfrozen for 60 days, and any of the joints can take money out, and you can use the money then to pay for things.

At that point, the account will be permanently frozen, and the joints have to go put their money somewhere else in a different account. However, what do you need the money for? In her case, it would be to pay the mortgage, because if the account is frozen, the mortgage on her house comes out automatically from her account, so it wouldn't be open to pay that.

How about Florida Power and Light, you know, the Internet? There are bills that come directly out of her account, so that is why we would need to get it opened immediately. Meanwhile, we bank at Chase, and there it is different. There we're like, Alan, the joints -- the account will not be frozen immediately.

The joint can just go in. The joint can go in and take the money out of the account. >> I'll just ask -- I'll ask her what the situation is at that bank. >> Yeah. >> Okay. Thank you, Miriam, Alan, and Deanna. Diane, your hand is up. You're muted.

Diane, you appear muted. >> I posted a couple of resources for nonprofit funeral consumer associates. These are generally associations locally you can join. They survey the funeral directors in the area and will give you costs for cremation and all of the other funeral options. It's -- again, I always would prefer nonprofit, and so when your loved one dies, you contact them or you know ahead of time the services and what they will cost in your area.

The other link I provided was whole body donations. This is a somewhat fraught field. Lots of people leave their body to a medical facility. There's also a lot of commercial organizations out there. It can be a somewhat murky area. There are -- there's information about how much money can be made from selling body parts.

So I guess what I would say is these organizations can provide a very valuable resource. Try to look for a nonprofit organization. And again, all I can say is do your research ahead of time. Talk to your loved ones. Know exactly what you want. Know exactly what your resources are.

Plan ahead. Know what your resources are. >> Okay. Thank you, Diane. In the absence of other questions or comments, I'll share a quick -- folks probably know of Charlie Munger, so Warren Buffett's right hand. He turns 100 in January and he's still going strong. He often quips that the only thing he wants to know is where he's going to die so that he doesn't go there.

Along the lines of what folks are saying, what do folks think in terms of practical actionable takeaways from this sort of meeting? And I love how it's going. I was just feeling grateful that folks' comments are focused and concise and pointed and helpful. Are there -- you know, whether it's physical activity, we all know, you know, eat healthy and exercise.

In terms of cognitive decline or just staying healthy, how to put off all of these things that we're talking about as long as possible. What have -- what has worked for folks? What have they seen work for their friends and loved ones? >> Best thing is to be born with good genes, but you have no control over that.

>> Okay. >> I live in an area where there's a lot of retirees. I'm on the younger end of the spectrum, but I know several folks in their 80s, into their 90s, and they're still quite active, and it's a common trait I see amongst them all is that they stay physically engaged almost every day of the week, or -- and socially engaged, so I think that's just something I observed, anecdotally.

>> Okay. So in addition to the physicality of it, also community. >> Yeah. >> And also, not only is Charlie Munger turning 100, but in January, Taylor Laramore, who began the Vogelheads in 1998, is turning 100 years old on January 25, and we are already planning his 100th birthday party.

>> Fantastic. >> What keeps Taylor going? >> He once told me, he said, "I often wonder why I made it to the," you know, at that time he told me he was about 97, "How did I make it to 97?" And he said, "I think it was because after working, after being in World War II, after being in a foxhole in Belgium for several weeks in the middle of winter in World War II, watching people die, I came home and realized that little things don't matter, not to get upset about little things in life." And as we know, he, during -- on the Vogelheads Forum, he is cordial, decent, kind, helpful, you know, somebody can explode in front of him with negative comments about him, and he takes it in stride and tries to make -- tries to say something nice.

Plus, he's extremely helpful with his financial information. >> Wonderful. Thank you for sharing. >> He also does not even use a cane. He's almost -- he's 99 years old and nine months. He doesn't use a wheelchair. He doesn't use a cane. He doesn't use a walker. He's still 6 feet tall.

He's had four bouts of cancer, which he has dealt with. He does credit good medical doctors. And by the way, his son has told me that he's very pushy with his doctors. You know, he doesn't want to be in that office longer than he has to be, and he wants to be seen on time.

He's very, you know, time-oriented. But he does follow his doctor's orders. He goes to chemotherapy. I don't remember if it's once a week or once a month, but he still goes after his latest bout of cancer, which was hip cancer, about five years ago. He did lose his voice to lung cancer -- not lung cancer, throat cancer, maybe 20 years ago now, maybe 15 years ago.

He has been through -- he's been through a lot, and he still has a good attitude, and that's what he attributes his long life to. >> Wonderful. Thanks for sharing, Maryam. It gives new meaning to stay the course. Diane, your hand is up. You're muted. Diane, why don't we start by unmuting, and then let us know if your raised hand is intended and if you have a comment.

Okay. Well, we're figuring that out. So any other thoughts? It's clear physical activity, community interaction. What else have folks seen work for the folks who are active into their 80s, 90s, haven't physically or cognitively declined as much as we've seen others? >> I imagine there's some studies somewhere that suggest that those individuals who are financially secure, perhaps because of less stress, perhaps will theoretically live longer or are able to get better healthcare and utilize the resources from a life of living below their means.

I haven't seen studies, per se, but one would expect they exist. So maybe Bogle has, as a group, have a little better longevity and fewer cognitive issues down the road. >> It's a great idea. >> I also know, Gauri, that a life insurance salesman, life insurance person in life insurance once mentioned that the policies are more expensive for people who are more likely to die early, and one of the factors is your job, your employment.

Are you working in a heavy construction zone as a person, you know, moving big barrels of concrete around or cranes, you're up on one of those big cranes hoisting large concrete barriers, or are you an attorney or an accountant sitting at a desk? >> Great point. Thank you, Miriam.

Any other questions or comments? The floor is open, and feel free to go beyond topics we've stated. Deanna? >> I know. I have another question. Lately I've been going to different banks, giving them the power of attorney papers, and then sometimes they'll say you have power of attorney over the checking and savings but not CDs, or you have to sign this additionally or a bunch of different things.

So has anybody, or are there any books to read or something that would help me through this process, because each of the four banks is different, each of them counts, they don't just say you have power of attorney, you can do anything. They are kind of like, they're almost like getting in the way of I have to do one thing at a time or something.

Now I have the checking account, but I don't have access to the CDs or things like that. Do you guys have any tips? >> I think you simply have to go to each bank, ask them the very direct questions, and write it down. >> Yeah. >> If they have, ask them do you have forms for that, get a copy of the form.

Are these banks that you can walk into, or are these online banks? >> Yeah, I can walk into them, although one's like 40 or 50 miles away, but I got to the point where walking into the banks was a lot better than calling them on the phone. >> Yeah.

>> And then just keep separate notes for each bank, but put yourself as a joint if possible so you have all access to the money. But again, it depends if it's your mother, correct? >> Yeah. >> And she's 100 also. >> Yeah. >> Third person tonight going to be 100.

>> She's already 100. >> Already 100. She'll be 101. >> She beat the whatever guy to 100, yeah. >> She beat Taylor and Charlie Munger. >> Charlie Munger. >> Yeah. >> Yeah. Each bank is different, so just you have to write it, if each bank is, you have to write it down specifically.

>> Right. You're sort of making a grid, like what does this bank need, what does this one need, what do I, what counts for this one and what counts for that one? >> And also, if they have a brochure or a book, I did find, for example, Ally Bank, which is an online bank, when you open an account at Ally, they do give you a booklet that they send to you, like the old days, in the mail.

Well, that was interesting because in that booklet, it specifically lays out what to do and what happens when a person dies, if the account is joint, if it's TOD, Ally does allow TOD accounts, even for joint accounts, you can still have beneficiaries. So that was very helpful because I saw it in writing.

So if you go to the bank and they say, Ally's online, but if you go to an online bank, I mean, to a physical bank, and they say, oh, no, this does not happen, you can't do this, you show them the paper. >> Right. >> And you say, well, this is the official Chase paper, it says I can do it.

>> Yeah. >> Or maybe the officer you're speaking to is not well-trained or doesn't know. >> That happens. Thanks. >> Very helpful. Thank you. So some of these comments remind me of the importance, and this is both obvious but perhaps often overlooked, is the importance of having a thorough inventory of where these accounts are, contact people, just so that whoever needs to navigate the process is equipped and not unearthing things blindly.

So Miriam, I know some other questions may have been submitted via the RSVP. Anything we want to cover there? >> Another thing we didn't cover, which was submitted, had to do with guardianships. They said when is an elderly guardianship appropriate? Has anybody here done guardianships? Have any of their relatives been in guardianships?

My understanding is that nobody in our family has that I know of, but it's when a person perhaps does not have relatives, you might need to appoint a guardian, but to do -- my understanding is that a guardianship in Florida especially, it involves the court system. So you are bringing in the court system, and a guardian will need to be appointed.

It can be a relative, but still, before you can do anything, you do have to file paperwork with the court system. Sometimes things need to be approved by a judge. So it is not easy to do that, to do a guardianship, in the sense that it involves a whole other level of administration.

But I guess if you have to do it, there's no other way. >> Okay. Thank you. I've not been monitoring the chat, but I did notice this question, and it has a few answers, so maybe we can build on those if there's more to add. So the question is, how long does it take for a trustee to access the cash in a bank or brokerage account when the trust owner is suddenly incapacitated, assuming the trustee is named for the situation?

I'll paraphrase some of the responses in that it doesn't take long, and one maintains access. But folks should feel free to build on known responses or situations. Have trustees experienced barriers, or what would make it easier for the next trustee who finds themselves in that situation? Excuse me. Bill, I see you commented in response.

Do you want to elaborate on your response for the benefit of the group? >> Yeah. So I saw some questions about trustees. My parents had trusts set up, and they were trustees for their trusts until they moved into assisted living at that time. They agreed to have me take over their financial affairs, and they resigned as trustee, and I was appointed trustee.

There was some documentation that had to be done with a lawyer for that to facilitate that, but it was fairly smooth. And once I did that, working with financial institutions, working with their existing institution, it was challenging. It was during the early days of COVID, and it was challenging, and I heard Miriam talk about Ally Bank, and I do have relationships there, and my parents didn't at the time, but they worked pretty well with trusts, so I just opened a new account, and my parents' names are online, and they were very easy to work with, and along the way, my mom passed away last year, and her accounts didn't get frozen.

We just continued to pay bills out of that account as needed until probate was settled this year. >> Okay. Thank you, Bill. In the absence of other questions or comments, I'll raise one that I'm curious about. Having heard about CCRCs on this call, or retirement communities, or assisted living, are these places that when we're at our cognitive best rational objective that folks can move into, and then as cognitive abilities may decline, and we reach that form of person that is less agreeable, but needing or wanting to age in place, are these communities designed to age in place, can accommodate memory care, so that there's a middle ground that someone isn't forced to leave their situation, and can be cared for while aging in place voluntarily in a place that they've chosen?

Is that part of how these are premised? And I see, Sarah, your hand is up. I don't know if it's in response to this or something new, but feel free. >> Yes, in response to this. So I'll post the link. There is an organization called CARF, C-A-R-F, carf.org, that provides voluntary certification for life plan CCRC communities.

So a lot of it is just going to depend on the community and the state you live in. You know, I had a friend who had her mother in Las Cruces, New Mexico, in a CCRC way back when, and the CCRC called up one day and said, "You know, it's time we talk about your mother moving to memory care." So I've got -- >> Within that facility, Sarah?

Sorry to interrupt. >> Yes. >> Okay. >> Yes. So, and, you know, I'm pursuing a CCRC, but it's in a different location, which is just in a whole other bag of worms. And the original facility has independent assisted living, memory care, and a skilled nursing facility, but they have built a sister facility, which is totally separate, except for the highest level, and it has all of that except for the skilled nursing facility.

And they think that's okay, and that's the way the future is. In my city, there is a new for-profit, not CARF-certified facility that is all four, but they make me really nervous. And I can also -- I keep posting on Bogleheads the thread about -- the article about you should worry about -- it's not titled this, but the basic premise is you should worry about your CCRC going bankrupt.

So it is -- I mean, you're putting in a big chunk of change, and in exchange for that and whatever you pay the monthly, you're looking for them to take care of you until you no longer need care, and sometimes it doesn't work out that way. >> Okay. Thank you, Sara.

That's very informative. Just a quick question, and then we'll go to Lady Geek. When you say the risk of them going bankrupt, how does one mitigate for that? Are there larger companies that are more financially stable? I know some of the REITs are in the healthcare and assisted living space, or are these large financially independent, smaller, where you just have to wonder?

>> So, again, I'll post the link to CARF, and although it's pretty simple, carf.org. And I think -- I'll double-check. And they do have articles in there. And one of the things that is desirable is to investigate financially what they can do. I mean, it's sort of a -- like a pyramid scheme, frankly.

And you want your car, your CCRC, it's like a lot of things. You want it 90-plus percent, preferably more like 95% continuous occupancy. You want to see a long waiting list so they can maintain that occupancy rate. There are people who feel that your best bet is to go with a not-for-profit.

It's not easy. And so they're -- so the comment in the chat, do all CCRCs require a buy-in fee? So they are divided by categories, usually just A, B, C, and I think D. A, I think, was the original model where you paid a big chunk in and you didn't get anything back.

But that was to end of life, regardless of what happened. And then there are various other plans, but, you know, if you're getting money back, that's still a problem if your company goes bankrupt because they don't have anything to give you and you're low on the totem pole for getting -- the investors get money back first, which is what's worrying me about mine here in town.

>> Thank you. And I'll close out the question and then to Lady Geek. Are there -- what's the incidence or frequency of these going bankrupt? Is it clearly a legitimate concern, but remote in terms of probabilities thus far? Or it's been happening a lot? Or with what frequency are they going bankrupt?

>> I don't have a frequency for you. I do use a fee-only financial planner. She was quite concerned when she realized I was talking about doing a CCRC. The article that I'll post that she gave me also mentions, yeah, I mean, it's a risk. >> Okay. Thank you, Sarah.

Lady Geek. >> Let's talk about getting the entrance deposit refunded, which is what I'm doing right now with my mom. First, when I helped my mom transfer into -- well, my dad died, and actually he was one of the people who said, "I'm never moving." And my mom -- I was killing my mom because she was taking care of him.

She is this very, very social person. I was killing her just to -- because she had to stay there. I said, "Mom, you would love this retirement community." And she absolutely wanted to go there. But it took a while -- as soon as my dad passed, me and my sibling just -- she was there.

During the admission -- while she was going through the admission process into the community or purchasing her unit, one of the forms on the entrance deposit was how would you like it refunded to the estate, to beneficiaries directly, or to a charity or something. So we filled out the form to -- she filled out the form that the refund would go to beneficiaries, which includes me.

So my mom passes. I close out everything with the CCRC. And the entrance deposit is interesting. Because in my situation, my mom's situation, there's no -- I do not -- she has no estate. She has TOD/POD accounts, which are not part of the estate probate process. So there's no money in there to pay anything due.

So what the CCRC realizes is that this happens all the time. What they are doing is any balance due, her rent, credit or debit, refund or payment, will be adjusted on the return of the entrance deposit. So if she owes one month of expenses, or actually she's getting a credit for like three weeks, they will add that to the entrance deposit.

So that way the beneficiaries will get paid that amount. So what they're doing is -- it's the category where you give them the money and they give you 90% back. That's the category she's going in. There's different categories. Now, how do I get that back? Well, they obviously know she passed, because it's their skilled nursing center.

I did not need to supply that certificate. So what -- I read it, and I worked with the rep. You'll get it back in 90 days. Excuse me? Apparently those entrance deposits, I guess they're like escrow accounts. It's a pool of cash. They take the -- they give their profits, goes to the general community expenses.

But what they do -- it's like a bank with a -- that can do whatever they want. They will wait until they have enough money to pay you back in that cash reserve. So if everybody dies and everybody gets paid, everybody leaves, they're not going to refund anyone until they get a new person coming in and giving them an entrance deposit.

They will wait. So they depend on turnover. They depend on capacity. So I have to -- so first of all, they're waiting 30 days for the transactions to sell. That just happened. So now I have to wait another 60 days to be assigned a number in the queue to get the refund.

And they say, well, typically that's about 90 days. Could be less. But it really depends on their turnover and occupancy rate. Last year they said it was running close to 90 days. They said this year it's looking a little shorter. So I'm now in a waiting game. And so I just find it interesting -- I guess it's like a bank where the depositor comes in and demands their money back.

They can say, no, you have to wait. It is -- so if you read the residence care agreement very carefully about that entrance deposit, it's clearly stated there, but you don't realize what it is until you actually need to read that paragraph. So but it was an interesting form that they will adjust -- because this happens all the time with the state accounts, I don't have an estate account.

They will just adjust balance due or give you a refund to the entrance deposit, the money you get back. So I thought that was really cool. I'll just get it. Now as for dying in Pennsylvania about TOD/POD accounts, I'm pushing out a link to the forum thread I created for this.

Don't die in Pennsylvania. Transfer on death -- pay on death accounts are taxable as an inheritance tax. This is very, very different than an estate tax. My mom's estate tax is zero because there's nothing there to probate. The TOD/POD accounts will be taxed at 4.5%. The lineal inheritance rate in New Jersey, I understand the inheritance -- the tax for the descendants is zero for immediate descents, but in Pennsylvania, it's 4.5%.

So within nine months, I must file for a Pennsylvania REV 1500, an inheritance tax form. I'll do it for my mom. The nice thing with this is that there is -- because this happens with -- like I have siblings. They're split across several accounts, including the Fidelity account. So the nice thing is there's a little check box in the Pennsylvania inheritance form that says send me a bill.

I give the name and address of each of the beneficiaries. I don't have to worry about a brother or sister paying me -- I don't have to foot the bill for them. So I pay my fair share of the inheritance. They pay their fair share. I just check the box.

Not my circus, not my monkey. Family drama. Let the state deal with it. And if either of the siblings fail to pay, the state is free to file a lien against their property. Not my concern. So I posted a thread -- I posted a link to my thread in there.

And apparently the Pennsylvania inheritance -- you have to notify the state of investment accounts. You do not have to notify the state for bank and savings and cash accounts. But you still have to pay the taxes, which I intend to do. So -- and of course, that is filed with the county of the register of wills, with two copies.

They'll send a copy to the state. So okay. We're out of time. We've been two hours. But I just want to say it's a very interesting adventure on the entrance deposit refunds. And also a more fun adventure with the state of Pennsylvania. So I'm getting my taxpayer dollars' worth -- they're getting mine.

So okay. That's all I had to say. >> Great. Thank you, Lady Geek. So as Lady Geek mentioned, we're two minutes after the hour. I think the quote of the evening will be Lady Geek saying, "Not my circus, not my monkey." And before we wrap, are there any closing comments or questions?

Again, we're happy to take specific questions to Summerfield so that he can address them in a focused way when we reschedule. If not, thanks again to everyone for participating. >> Gloria, I want to mention three upcoming meetings. >> Great. >> Okay. On November 8th, there is a meeting that Chicago is organizing with Grandma Sylvia.

And Grandma Sylvia will be here, and the topic is "Surviving the Loss of a Spouse and Her Financial Journey to Financial" -- I think -- it doesn't say here, but financial -- "Her Ability to Handle Her Own Finances After Her Husband Handled All the Finances and Then Passed Away." That's Grandma Sylvia, November 8th.

On November 15th, Chicago is presenting the "Health Care, ACA, COBRA, and Other Options for Pre- and Early Retirees," pre-Medicare, November 15th. And then on December 13th, Chicago is hosting Lonnie Thibodeau on Medicare. He has spoken before at a meeting on Medicare. He's really great. He knows Medicare inside and out.

And so that is December 13th. And then January, possibly the "Mad Scientist" will be back. And -- >> To discuss his life as a recent homeowner and recent dad. >> Uh-huh. And Taylor's birthday party, 100th birthday party. >> Excellent. And we can also say the 2024 location for the Bogleheads Conference was announced.

It will be Minneapolis. Probably in the October range. I'm not certain of that, but Minneapolis is certain. They have a huge active volunteer chapter. So if folks are considering, that's where it'll be. I want to reiterate how grateful I am for this community. I find folks inspiring, just how folks help one another.

And I'll say it as straight as it is, because it comes up over and over. Let's each, you know, remain active, engage in whatever exercise we can, eating healthily. I think walking keeps coming up in so many different, like, helpful things, whether it's clearing your head or sharing time with someone.

The co-op community where I live is 1,000 units. A lot of people do age in place here. There's a group that does Tai Chi every morning. They're just groups of people who go walking together. And a lot of folks in their 90s who are cognitively strong and physically independent.

So I think we all know these things. Let's just maybe...