May 14–Though the COVID-19 pandemic carries on, claiming thousands of lives, infecting thousands more and altering social and economic landscapes, the number of people planning ahead with health care instructions doesn’t seem to have changed.
Local attorneys, whose practices include estate planning and wills, said they hadn’t really seen big increases in demand for creating advance directives for health care. They spoke anecdotally about a month into Indiana’s stay-at-home order and travel restrictions.
The attorneys and doctors recommend having such documents in place, at any age, in case of a situation or emergency where a patient can’t articulate medical treatment choices for themselves. The directives can also state who a patient wants making health care decisions for them.
“Usually in the medical situations, it’s important to have an advocate — somebody who’s willing to be proactive, contacting doctors and nurses and whoever they can, and to find out what the situation is and what the options are,” said attorney Loraine Troyer. “It’s like anything else, there’s just options on what to do. And that’s what a health care directive does: it appoints somebody to help choose those options.”
Troyer provides wills, estate planning and bankruptcy services from her office in Goshen. She said she hadn’t seen much of an uptick in calls for advance directives. Neither had attorney James Kolbus, of Barkes, Kolbus, Rife & Shuler law firm in Goshen.
Randall Jacobs, an attorney with the firm Yoder Ainlay Ulmer & Buckingham, on the other hand, believed he’d seen a slight bump in requests for such services.
Troyer and Kolbus speculated demand for advance directives probably hasn’t risen because residents have had to address more immediate concerns, including, for many, employment and financial issues.
“‘Am I employed? Can I pay for groceries this week? Can I pay rent?’ That type of thing. It’s probably further down, they just haven’t thought about it,” Kolbus said.
A certain level of fear might also play into it. Some might not want to risk a face-to-face meeting. Others might have a more innate superstition about confronting death.
“One of the problems with doing a will is people don’t want to think about that, and so they don’t really want to get prepared,” Troyer said. “And the more scared they are, the less they want to do something because they think they’re like tempting fate or something.”
Jacobs agreed. He advocated for planning ahead for unforeseen situations, as well as one’s mortality, but it’s a subject many people don’t want to focus heavily on.
“Nobody, even now, people don’t think they’re going to die from COVID-19, just like you don’t think you’re going to die next week in an automobile accident. But, things happen, and you should do appropriate planning to address those risks,” Jacobs said. “And with regard to health care decisions and powers of attorney and those kinds of things, people don’t want to think about being a situation where they are incapacitated.”
But attorneys will accommodate needs for social distancing during the planning process, from appointments to signing documents.
Kolbus and Troyer both said they work with video conferencing tech, such as Zoom, to speak with clients remotely. They’ll also wear masks and keep a physical distance during any in-person meetings or signings.
Jacobs generally held off doing face-to-face meetings, unless the situation was an emergency, during the stay-at-home order. In some situations where he spoke with clients in person, like for a last will and testament, they met outdoors.
“I’ve actually done some outside, like on people’s back porches, or back on their picnic tables, and we’ve worn masks and gloves, and signed things outside,” Jacobs said.
He pointed out state law requires witnesses to be present in person for the signing of last wills; they can’t appear remotely for those.
Troyer and Kolbus noted the Indiana Supreme Court is allowing witnesses in certain conditions to appear via video for the signing of other documents, such as medical directives, during the COVID-19 emergency. Those arrangements also have to comply with several rules.
But the key, the attorneys and doctors agree, is to first discuss arrangements in advance directives with loved ones chosen to serve as a patient’s health care representatives — those appointed to make decisions for medical care and carry out wishes if the patient is unable.
“The thing I tell people that’s really important with that is to really talk to your family and your loved ones about what your wishes and what your goals are,” said Dr. Max Mertz, a Goshen Health physician. “It’s really important that you have conversations with whoever would make those decisions — family, loved ones, whoever you designate.”
Having such a plan in place, naming a health care power of attorney, now can save on future legal or family headaches if a patient is unable to speak for themselves, according to Mertz and Kolbus. Without a directive, state law takes over with a general list of who’s in charge of making decisions, which can become murky or lead to family disputes.
“You’d be subject to whatever the statute says. And that dictates who in priority can make medical decisions for you,” Kolbus said. “It’s good to have, especially in these times that we have.”
The directives also provide a road map for health care providers. They get a clearer understanding of patient goals in end-of-life situations, such as, according to Mertz, whether one would want to go on dialysis or feeding tubes, or even whether one wants nothing done.
Mertz, the medical director for Goshen Home Care and Hospice, outlined a few key types of directives. One is the health care power of attorney, which lets a patient appoint a representative to speak for them in situations where they can’t.
“I think that’s equally, if not more important, because that way, the person you designate would be able to speak for you, even in settings where you’re not at the end of your life,” Mertz said.
Living wills is another route for patients with terminal illnesses and facing death soon. Mertz said the documents are limited to end-of-life care decisions.
“It’s a fairly limited document, but at least it does help people to know that they’ve thought about that,” he said.
A third type is a Physican Ordered for Scope of Treatment, or POST, document. They’re also more limited to patients who are elderly or with life-limiting or terminal illnesses, allowing them to specify certain treatments, according to Mertz.
For those who have already put together health care or estate plans, or those who are getting ready to, Jacobs pointed out keeping them current is also important.
“It’s very critical for people, when they’re thinking about estate planning to make sure their beneficiary forms are up to date,” Jacobs said. “It’s a process I think all adult people should go through regardless of the threat of a pandemic.”
In end-of-life planning, he put priorities on setting up advance directives and guardian provisions for parents of minor children, keeping beneficiary designations updated on documents like 401(k) plans, retirement accounts and life insurance. He also advised naming a health care power of attorney and keeping any wills or living trusts up to date.
For those who don’t want to hire an attorney for advance directive planning, Mertz said patients can also complete paperwork at his office or at the hospital. The forms do have to be witnessed appropriately, and the patient has to be mentally competent.
Goshen Health’s website, GoshenHealth.com, has further information and resources on advance directives.
Aimee Ambrose can be reached at [email protected] or 574-533-2151, ext. 240316. Follow her on Twitter at @aambrose_TGN.
Aimee Ambrose can be reached at [email protected] or 574-533-2151, ext. 240316. Follow her on Twitter at @aambrose_TGN.
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