As the coronavirus pandemic continues to escalate, doctors around the U.S. are joining lawyers and financial advisors in urging Americans to create essential documents that can help medical providers better coordinate their care. One form is an advanced directive, or living will, which states your wishes for medical care. Another legal document, a health-care proxy or power of attorney, names someone to carry out your wishes and make medical decisions if you become incapacitated and are unable to do so.
"Covid-19 can affect anyone. No one is spared or immune," said Dr. Sarah Norris, who heads palliative care at the Children's Hospital of Montefiore in the Bronx. Her pediatric hospital now mostly cares for adult patients with the coronavirus, due to the overwhelming local need in that county, which has nearly 35,000 confirmed cases.
When a patient first arrives, "I ask them who they would want to speak for them if they are unable to speak for themselves," Dr. Norris said. However, about 1 in 4 Covid-19 patients at her hospital suffer from such severe breathing issues they cannot answer. "We all need to sit back and think about how someone can respect our life and maintain our personal set of values in the hospital when we are provided with care. We want to hear your voice through your health-care proxy and living will."
Very few Americans have these estate-planning documents. Only about 23% of U.S. adults have a will, and just 6% have an advanced health-care directive, according to the 2020 estate-planning survey by Caring.com.
Many people point to a lack of assets as the reason they have not created a will or estate plan. However, you can get some estate-planning documents for free or at a low cost online. Many lawyers also are offering reduced rates for estate-planning services.
"Getting proper documents and making sure the people will actually carry out your wishes and not what they think is right" is critical, said attorney Bernard Krooks of Littman Krooks and a fellow with the American College of Estate and Trust Counsel.
As the death toll and confirmed cases of Covid-19 rises, online companies, such as Trust & Will, as well as lawyers say they've seen a sharp rise in people of all ages seeking estate-planning services in the last few weeks. "Power of attorney and health-care directives are big right now," said Trust & Will founder and CEO Cody Barbo. "People want to make decisions around who can access their medical and financial records and who can make decisions on their behalf if something were to happen to them."
Source: Caring.com 2020 Estate Planning Survey
Planning ahead can make all the difference. If you don't have these essential documents in order, here's what you should do now.
Complete comprehensive advance directive and power-of-attorney forms. A living will states the type of medical treatments you do or do not want, such as intubation and resuscitation. A health-care power of attorney names someone you trust to be your health-care agent. This person will follow your medical wishes and make medical decisions if you are unable to do so.
Some states combine a living will and power of attorney for health care or health-care agent/proxy into a single advance directive form. You can also designate a durable power of attorney to make financial and legal decisions if you become incapacitated, including being in charge of handling payments for rent, mortgage and monthly bills, as well as medical expenses.
Find a trusted resource to help you create these documents. "Ideally, you should meet with an attorney to have a living will drafted that conforms to your state's law — and to have other essential estate planning documents such as a will and power of attorney drafted," said Bowling Green, Kentucky-based personal finance writer Cameron Huddleston, author of "Mom and Dad, We Need To Talk." Setting up a comprehensive estate plan with an attorney could cost over $1,000 or several hundred dollars at some online companies.
"If you can't afford to meet with an attorney or you're in a pinch, this is a time when getting a document online is acceptable," Huddleston said. That's what her sister Robin Bartee, who lives in Albuquerque, New Mexico, did earlier this month after learning that her partner came in contact with a co-worker who'd tested positive for Covid-19.
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Bartee, who has no symptoms, found a free, fill-in-the blank document online that allowed her to name Cameron as her health-care agent. She contacted a friend who is a notary to finalize the document. "It had to be notarized in person so we all wore masks, we stayed in the car — we passed the documents through the window of my car, and we didn't interact at all," Bartee said. "It took a half an hour at most."
You can download a free advance directive for your state from the National Hospice and Palliative Care Organization. The forms generally will need to be signed in front of witnesses or a notary to be valid, but you may be able to do that online as well.
Find witnesses or a notary public — in person or virtually. States vary in their requirements for finalizing these documents. In most cases, you must sign the form yourself and have it signed by one or more witnesses and/or notaries. With residents now anxious to complete these documents, Barbo said many states — including New York and Pennsylvania — are taking action to make it easier to put a plan in place by permitting remote online notarization or witnessing. You can go to the American College of Trust and Estate Counsel's website for a guide to laws and accommodations in every state.
Make sure to follow these rules closely, especially if you use a do-it-yourself form. "If you have no other option, online website forms are better than nothing. However, I have represented a number of clients and have had to clean up a lot of messes from online legal-form services," said San Antonio, Texas-based attorney Shann Chaudhry. "The law varies from state to state, so if the form doesn't meet state requirements, it could be held as invalid or the courts may choose not to follow it."
Have a conversation with loved ones about your medical wishes. While having a living will and power-of-attorney documents on hand is advisable, doctors and estate-planning attorneys agree that having a conversation with your loved ones about your medical wishes is the first step.
At the very least, write down what you want and who you want in charge of making medical decisions if you become hospitalized and cannot speak for yourself. Share that information with your family and loved ones now because you never know if and when this knowledge will be needed.
Doctors say this is especially true for many Covid-19 patients. "There are a group of people who come in unable to complete a full sentence and can't think clearly because they haven't had enough oxygen for a while," Dr. Norris said. "It's important to speak at home, because your last chance might not be in the emergency room."
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