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Really good advice to get a Will + DNR. This can be performed by a law firm that specializes in "elder law". Another reason for visiting with an elder law firm

Really good advice to get a Will + DNR. This can be performed by a law firm that specializes in "elder law". Another reason for visiting with an elder law firm is that there are serious financial implications when someone ends up in a skilled nursing facility for the rest of their life. Private pay is, not joking, more than $10K per month. If you want to use medical assistance (medicaid) you will have to "spend down" your savings until you qualify. Elders who want to give their assets/money to their children need to do so 5 years before they enter a facility. If they transfer assets and enter a nursing facility in less than 5 years, the children who received those assets will need to cover the cost until the "spend down" is done. This look-back period used to be 2 years, but because of the "Deficit Reduction Act of 2005" signed by George "Dubya" Bush, it is now 5 years. This is the kind of trap that wipes out the finances of entire middle class families-- how's that for reducing the deficit with cruelty? To avoid this trap, the family needs to handle transfer of assets like property and savings very carefully under the advice of lawyers who specialize in this field.

throwaway5752 7y ago
Thank you so much for giving the fuller explanation. I figured anyone that would look into it would be advised of those considerations. You might even run into issues staying in a preferred facility for your entire life based on your ability to pay privately vs medicaid/medicare. You could literally be not lucid, be repeatedly resuscitated (when you might otherwise might want to die a natural death), and have that all happening while burning through your entire life savings or financially harming your loved ones if you did not specify this beforehand.
- dfsegoat 7y ago
  If you don't word it right, it seems to me you could also be facing a short-term reversible condition - someone elses mistake even - and they would be legally bound to let you go. Which would be equally devastating to my family: >"...Upon transfer to the ward, the patient was inadvertently given hydromorphone instead of morphine. Shortly thereafter she was found not breathing. Resuscitation was not performed because of a do-not-resuscitate order on her medical record." [1] ... A narcan dose would reverse the above in about 20 seconds, but instead the patient died. ... this is why I asked GP about how these things are drawn up - I have to imagine it is scenario based? 1- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3986316/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3986316/
  - throwaway5752 7y ago
    Okay, let's get the full quote: "A 90-year-old woman lived independently, despite a history of stroke, congestive heart failure, emphysema, osteoporosis and hypothyroidism. After a fall in her residence during the winter, she presented to the emergency department of her local hospital where she was given long-acting morphine orally to control pain in her chest wall. With a diagnosis of pneumonia and renal failure, the patient was transferred to a ward, where the morphine was discontinued and hydromorphone was ordered in its place. Unfortunately, the patient received both analgesics. Two days after admission to the ward, she was found unrousable. Narcotic overdose was considered. After a single bolus dose of naloxone intravenously, the patient became alert; however, left alone for a few minutes, she was then found without vital signs. No further attempt at resuscitation was attempted because a do-not-resuscitate order had been previously entered in her chart at her request." It isn't a simple case of an otherwise healthy person not given narcan because of a DNR. They were very ill, injured, and coded after an inital nalaxone treatment. Honestly, if it were me, I might want to shake the hand of the person that gave accidental overdose. Regardless, that is great link and both cases are very ethically complicated. You should look into it more yourself, but for example, one might want to withdraw life sustaining treatment (food/water) if they are in a persistent vegetative state for a certain period of time. Based on other circumstances they might want a hard DNR. It is important and people should educate themselves about end of live decisions and options. edit: I just realized you were referring to case #2. That is also complicated ethically.
dfsegoat 7y ago
>"Really good advice to get a Will + DNR" I'm curious about two things: 1) are you advocating getting a flat out DNR order in your advanced directives / living will (do not ressus, period)? or just having advanced medical directives which say when you should be a DNR case? If the former then I think that is a more nuanced discussion than just "good advice", considering you might be facing a reversible drug overdose for instance [2]. 2) Do these the law firms typically walk through all the hypothetical scenarios to say under which one you should be DNR? The reversible overdose etc. case is one which I would be interested in vs. long-term vegetative state, etc. - I would understandably want to clarify there. 1 - https://en.wikipedia.org/wiki/Do_not_resuscitate#Risks https://en.wikipedia.org/wiki/Do_not_resuscitate#Risks 2 - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3986316/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3986316/
- crispyambulance 7y ago
  1) DNR "rules" are covered (in my family's case) in a document called "Health Care Directives". It has a number of options and the options are selected by initialing. YMMV depending, I think, on state laws. 2) The firm I used had a meeting where the family members sat down and discussed everything with a lawyer. We were able to ask detailed questions and get answers. It was helpful and very worth the expense, because we used that knowledge later on to transfer property "the right way" so that it would stay in the family rather than being used entirely for medical-assistance spend-down.

throwaway5752 7y ago

Thank you so much for giving the fuller explanation. I figured anyone that would look into it would be advised of those considerations. You might even run into issues staying in a preferred facility for your entire life based on your ability to pay privately vs medicaid/medicare. You could literally be not lucid, be repeatedly resuscitated (when you might otherwise might want to die a natural death), and have that all happening while burning through your entire life savings or financially harming your loved ones if you did not specify this beforehand.

dfsegoat 7y ago
If you don't word it right, it seems to me you could also be facing a short-term reversible condition - someone elses mistake even - and they would be legally bound to let you go. Which would be equally devastating to my family: >"...Upon transfer to the ward, the patient was inadvertently given hydromorphone instead of morphine. Shortly thereafter she was found not breathing. Resuscitation was not performed because of a do-not-resuscitate order on her medical record." [1] ... A narcan dose would reverse the above in about 20 seconds, but instead the patient died. ... this is why I asked GP about how these things are drawn up - I have to imagine it is scenario based? 1- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3986316/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3986316/
- throwaway5752 7y ago
  Okay, let's get the full quote: "A 90-year-old woman lived independently, despite a history of stroke, congestive heart failure, emphysema, osteoporosis and hypothyroidism. After a fall in her residence during the winter, she presented to the emergency department of her local hospital where she was given long-acting morphine orally to control pain in her chest wall. With a diagnosis of pneumonia and renal failure, the patient was transferred to a ward, where the morphine was discontinued and hydromorphone was ordered in its place. Unfortunately, the patient received both analgesics. Two days after admission to the ward, she was found unrousable. Narcotic overdose was considered. After a single bolus dose of naloxone intravenously, the patient became alert; however, left alone for a few minutes, she was then found without vital signs. No further attempt at resuscitation was attempted because a do-not-resuscitate order had been previously entered in her chart at her request." It isn't a simple case of an otherwise healthy person not given narcan because of a DNR. They were very ill, injured, and coded after an inital nalaxone treatment. Honestly, if it were me, I might want to shake the hand of the person that gave accidental overdose. Regardless, that is great link and both cases are very ethically complicated. You should look into it more yourself, but for example, one might want to withdraw life sustaining treatment (food/water) if they are in a persistent vegetative state for a certain period of time. Based on other circumstances they might want a hard DNR. It is important and people should educate themselves about end of live decisions and options. edit: I just realized you were referring to case #2. That is also complicated ethically.

dfsegoat 7y ago

>"Really good advice to get a Will + DNR" I'm curious about two things: 1) are you advocating getting a flat out DNR order in your advanced directives / living will (do not ressus, period)? or just having advanced medical directives which say when you should be a DNR case? If the former then I think that is a more nuanced discussion than just "good advice", considering you might be facing a reversible drug overdose for instance [2]. 2) Do these the law firms typically walk through all the hypothetical scenarios to say under which one you should be DNR? The reversible overdose etc. case is one which I would be interested in vs. long-term vegetative state, etc. - I would understandably want to clarify there. 1 - https://en.wikipedia.org/wiki/Do_not_resuscitate#Risks https://en.wikipedia.org/wiki/Do_not_resuscitate#Risks 2 - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3986316/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3986316/

crispyambulance 7y ago
1) DNR "rules" are covered (in my family's case) in a document called "Health Care Directives". It has a number of options and the options are selected by initialing. YMMV depending, I think, on state laws. 2) The firm I used had a meeting where the family members sat down and discussed everything with a lawyer. We were able to ask detailed questions and get answers. It was helpful and very worth the expense, because we used that knowledge later on to transfer property "the right way" so that it would stay in the family rather than being used entirely for medical-assistance spend-down.