Legal & Retirement Planning

Objectives

Upon completion of this session, you will:

• Understand the importance of, and how to draft advance directives

• Understand your legal rights in the workplace, and in insurance

What if you temporarily lost the ability to make or communicate

decisions because you were knocked unconscious in a car

accident or had a stroke?

What if it was a long term or permanent loss caused by a

condition that gets progressively worse over time such as

Alzheimer's Disease?

Who will decide what’s best for you and your family?

Advance Directive

What is it?

An advance directive is a written document that tells doctors what kind of care you want

if you are unable to speak for yourself, or gives another person the power to make

decisions on your behalf.

Advance DirectiveWhat is it?

There are two kinds of advance directives:

1. Living Will – describes the kind of medical or life-sustaining treatments you want if seriously or terminally ill.

2. Durable Power of Attorney for Healthcare – states whom you have chosen to make healthcare decisions for you.

Advance Directive

Why do I need one?

Communication is the single most important step

in health care planning

Advance DirectiveWhy do I need one?

• Your wishes cannot be followed if no one knows them

• It makes your preferences known before you become seriously ill

• It spares your loved ones the stress of making decisions for you

• It helps have decisions about your treatment guided by your religious beliefs or spiritual values

Advance Directive

Where do I start?

Advance DirectiveWhere do I start?

• Legal requirements and names of documents vary state to state

• If you live in more than one state, make sure you have the appropriate documents for each location

• Forms are available from…• your doctor, hospital or nursing home• your state’s Department of Health or Medical Society• www.caringinfo.org

Advance DirectiveWhere do I start?

Ask Yourself…. • Do I want all measures taken to prolong my life, regardless of the quality of that life?

• Or, just what is necessary for my comfort, but nothing further?

• Do I have certain wishes about the use of specific medical procedures?

• What else?

Choosing a Power of AttorneyIn addition to being willing to speak on your behalf,

make sure he/she meets these criteria:

• legal criteria in your state

• understands what’s important to you

• could travel to be at your side if necessary

• available long into the future

• what else?

Advance DirectiveWhere do I start?

Re-examine your health care wishes whenever one of the Five D’s occur:

Decade – when you start each new decade of your lifeDeath – whenever you experience the death of a loved oneDivorce – when you experience a divorce or other major family changeDiagnosis – when you are diagnosed with a serious health conditionDecline – when you experience a significant decline in health or you are no longer able to live independently

Advance Directive

How do I draft one?

A few things to remember…

• Be careful about giving too many specific instructions; don’t unintentionally restrict your agent’s power to act.

• You and two witnesses must sign the document ; the person you appoint as your agent cannot be a witness.

Know your state – guidelines and laws vary. Examples:• some require that the document be notarized• some automatically revoke a spouse’s proxy in the event of divorce• some will not honor a pregnant person’s advance directive

Advance DirectivesHow do I draft one?

I, ________________________________________________, write this document as a directive regarding my medical care.

PART 1. My Durable Power of Attorney for Health CareI appoint this person to make decisions about my medical care if there ever comes a time when I cannot make those decisions myself. I wan

the person I have appointed, my doctors, my family and others to be guided by the decisions I have made in the parts of the form that follow.Name:Home telephone:Work telephone:Address: If the person above cannot or will not make decisions for me, I appoint this person:Name:Home telephone:Work telephone:Address: I have not appointed anyone to make health care decisions for me in this or any other document.

PART 2. My Living WillThese are my wishes for my future medical care if there ever comes a time when I can't make these decisions for myself.

A. These are my wishes if I have a terminal condition

Life-sustaining treatments______I do not want life-sustaining treatment (including CPR) started. If life-sustaining treatments are started, I want them stopped.______I want the life-sustaining treatments that my doctors think are best for me.Other wishes:________________________________________________________________________________________________________________________________________________________________________________________________________________

Advance Directive - Sample

Advance Directive - Sample

Artificial nutrition and hydration______I do not want artificial nutrition and hydration started if they would be the main treatments keeping me alive. If artificial nutrition and hydration are started, I want them stopped.______I want artificial nutrition and hydration even if they are the main treatments keeping me alive.Other wishes:____________________________________________________________________________________________________________________________________________________________________________________________________________________

Comfort care______I want to be kept as comfortable and free of pain as possible, even if such care prolongs my dying or shortens my life.Other wishes:____________________________________________________________________________________________________________________________________________________________________________________________________________________

B. These are my wishes if I am ever in a persistent vegetative state

Life-sustaining treatments______I do not want life-sustaining treatment (including CPR) started. If life-sustaining treatments are started, I want them stopped.______I want the life-sustaining treatments that my doctors think are best for me.Other wishes:____________________________________________________________________________________________________________________________________________________________________________________________________________________

Artificial nutrition and hydration______I do not want artificial nutrition and hydration started if they would be the main treatments keeping me alive. If artificial nutrition and hydration are started, I want them stopped.______I want artificial nutrition and hydration even if they are the main treatments keeping me alive.Other wishes:____________________________________________________________________________________________________________________________________________________________________________________________________________________

Comfort care______I want to be kept as comfortable and free of pain as possible, even if such care prolongs my dying or shortens my life.Other wishes:________________________________________________________________________________________________________________________________________________________________________________________________________________________________

C. Other directionsYou have the right to be involved in all decisions about your medical care, even those not dealing with terminal conditions or persistent vegetative states. If you have wishes not covered in other parts of this document, please indicate them below.

 PART 3. Other WishesA. Organ donation______I do not wish to donate any of my organs or tissues.______I want to donate all of my organs and tissues.______I only want to donate these organs and tissues:______________________________________________________________________Other wishes:____________________________________________________________________________________________________________________________________________________________________________________________________________________________________

B. Autopsy______I do not want an autopsy.______I agree to an autopsy if my doctors wish it.Other wishes:____________________________________________________________________________________________________________________________________________________________________________________________________________________________________

C. Other statements about your medical careIf you wish to say more about any of the choices you have made or if you have any other statements to make about your medical care, you may do so on

aseparate piece of paper. If you do so, put here the number of pages you are adding: _________

 

Advance Directive - Sample

PART 4. SignaturesYou and two witnesses must sign this document before it will be legal.

A. Your signatureBy my signature below, I show that I understand the purpose and the effect of this document.Signature:Date:Address:

B. Your witnesses' signaturesI believe the person who has signed this advance directive to be of sound mind, that he/she signed or acknowledged this advance directive in my presence and that he/she appears not to be acting under pressure, duress, fraud or undue influence. I am not related to the person making this advance directive by blood, marriage or adoption nor, to the best of my knowledge, am I named in his/her will. I am not the person appointed in this advance directive. I am not a health care provider or an employee of a health care provider who is now, or has been in the past, responsible for the care of the person making this advance directive.

Witness #1Signature:Date:Address:

Witness #2Signature:Date:Address:

Adapted with permission from the District of Columbia Hospital Association1250 Eye, N.W., Suite 700, Washington, DC 20005; telephone: 202-682-1581; fax: 202-371-8151.

Advance Directive - Sample

Questions?

Understanding Your Legal Rightsin the Workplace and in Insurance

What basic job rights are you entitled to?

• Over time pay• Minimum wage• Workers’ Compensation• Unemployment insurance• Protection against discrimination• Union protection• Employer contribution to social security

The right to contest discharge without just cause?

Private Sector Employees• in most states, the law presumes you are employed “at will”

Government Employees• terminations frequently related to constitutional rights • governmental employer may establish work rules that limit speech or conduct

Union Employees• rights determined by collective bargaining agreement• employees usually not “at will”

Part Time Workers• no law about when you are considered full or part-time• bosses can treat groups of workers differently regardless of hours• some laws only cover workers after they work a certain number of hours

Independent Contractors• not an employee – most federal and state laws do not apply• lose many advantages and protections

Americans with Disabilities Act of 1990 (ADA)

• prohibits discrimination in recruitment, hiring, promotions, training, pay, social activities, other privileges of employment

• restricts questions that can be asked about an applicant’s disability before a job offer is made

• does not require an applicant to disclose a disability to a prospective employer

ADAWhat does it do?

ADAWhat does it do?

Applies to employers with 15 or more employees, including:

• private employers• state and local governments• employment agencies• labor unions

Genetic Information Nondiscrimination Act of 2008

(GINA)

• prohibits group health plans and health insurers from denying coverage to a healthy individual based solely on a genetic predisposition to developing a disease in the future

• prohibits them from charging that person higher premiums

• bars employers from using individuals’ genetic information when making hiring, firing, job placement, or promotion decisions

GINAWhat does it do?

Consolidated Omnibus Budget Reconciliation Act

(COBRA)

• protects your group health insurance coverage when employment is terminated or if you lose coverage for another reason

• extends coverage for 18 months, but you have to pay for it

• prevents denial of coverage for pre-existing conditions

COBRAWhat does it do?

COBRAWho is eligible?

Group Health Plans • 20 or more employees• both full- and part-time employees are counted

Qualified Beneficiaries• someone covered by a group health plan on the day before a qualifying event.• includes: "covered employee" (active & terminated employees, retirees); a covered employee's spouse and dependent children; agents; self-employed individuals; independent contractors and their employees; directors; political appointees; and elected officials.

Qualifying Events • voluntary or involuntary termination of employment for any reason other than "gross misconduct"• reduction in the number of hours of employment

In addition, for spouses & children:• covered employee becoming entitled to Medicare• divorce or legal separation of the covered employee• death of the covered employee

COBRAWho is eligible?

• Employer must report qualifying event within 30 days• Plan participant or beneficiary must report within 60 days

• COBRA election notice generally sent within 14 days• Participant/beneficiary has 60 days to decide• Has 45 days after electing coverage to pay first premium

COBRAWho initiates it?

COBRAWhat if you can’t afford it?

• you have 30 days of special enrollment rights to sign up on spouse’s or partner’s plan

• find out about state plans for people who can’t afford individual insurance. Try to cover children through State Children’s Health Insurance Program (SCHIP)

• wait until the deadline to tell the plan or your boss that you are not going to sign up for COBRA – you may need it retroactively

• get as much medical care (annual check-ups, tests, procedures, eye exams, fill prescriptions) as possible before coverage ends

Resources

• Patient Services, Inc. (PSI) Contact: 800-366-7741 www.uneedpsi.org

• Bleeding Disorders Legal Hotline Contact: 800-520-6154

• Other resources you can share?

COBRAWhat if you can’t afford it?

Health Insurance Portability and Accountability Act of 1996

(HIPAA)

HIPAAWhat does it do?

• prevents you from being denied group health insurance because of health factors

• prevents you from paying higher premiums than other similarly-situated employees

• limits the ability of a group health plan to exclude coverage for a pre-existing condition

• provides additional opportunities to enroll in a group health plan

HIPAAWhat does it do?

The Privacy RuleGives you rights over your health information and sets rules and

limits on who can look at and receive your health information

Who must follow these laws:• health plans• most health care providers• health care clearinghouses

Who is not required to follow these laws:• life insurers• many schools and school districts• many state agencies like child protective services• many law enforcement agencies and municipal offices

Questions?

Resources

1. Consumer’s Tool Kit for Health Care Advance Planning, Second Edition. Washington, DC: ABA Commission on Law and Aging; 2005

2. Advance Directives. Medline Plus web site. www.nlm.gov/medlineplus/advancedirectives.html3. Advance Directives and Do No Resuscitate Orders. Family Doctor.org web site.

www.familydoctor.org/online/famdocen/home/pat-advocacy/endoflife/003.html4. Planning Ahead. Caring Connections web site. www.caringinfo.org/PlanningAhead.html5. Advance Directives – What you need to know. AARP web site

www.aarp.org/relationships/caregiving/info-09-2010/legal_faq_women_long_term_care.html 6. Your Rights - Worker type. Work Place Fairness web site. www.workplacefairness.org/whatkind 7. Worker types. Can my boss do that web site. http://canmybossdothat.com/category.php?id=34 8. Facts About the Americans with Disabilities Act. U.S. Equal Employment Opportunity Commission web site.

http://www.eeoc.gov/facts/fs-ada.html 9. A Guide to the Genetic Information Non-discrimination Act. Coalition for Genetic Fairness web site.

http://www.geneticfairness.org/ginaresource.html 10. Continuation of Health Coverage – COBRA. U.S. Department of Labor web site.

http://www.dol.gov/dol/topic/health-plans/cobra.htm 11. Understanding Health Information Privacy. U.S. Department of Health and Human Services web site.

http://www.hhs.gov/ocr/privacy/hipaa/understanding/index.html 12. FAQs About Portability of Health Coverage and HIPAA. U.S. Department of Labor web site.

http://www.dol.gov/ebsa/faqs/faq_consumer_hipaa.html 13. HIPAA Basics – Medical Privacy in the Electronic Age. Privacy Rights Clearing House web site.

http://www.privacyrights.org/fs/fs8a-hipaa.htm

THANK YOU!