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Making Healthcare Decisions as a Blended Family

Healthcare decisions are never easy. Sometimes tough choices have to be made and many times someone is left hurting because they were not involved in the process or they did not agree with the choice that was made. How do you make healthcare decisions in a blended family and keep the conflict amongst family members to a minimum?

Take Elizabeth. I met her during my time in the Probate Court. She was 72-years-old and the second wife of her late husband James who had died 13 years earlier. Elizabeth had been an art dealer during her working years. She managed to amass a small fortune, but had not done any planning. She was at the point of incapacitation and in need of more extensive care. Her court hearing was to appoint a Guardian to assist with healthcare decisions.

If you have ever been through the courts for a guardianship hearing, you know that it is an arduous, costly, and lengthy process. Elizabeth was in the position to where she could no longer make decisions for herself and the court basically had to step in and appoint someone to do this for her. Since she had not done any planning, she would likely also need to have someone appointed to handle her financial affairs as well. That is a different process called a conservatorship.

Elizabeth and James had two biological daughters Amy and Amber.  James also had two sons with his first wife James Jr and Richard (Elizabeth’s step sons). All of them felt as though they had a stake in what happened to her. Elizabeth was estranged from her two step sons since her husband’s death over 13 years ago, but they sure as hell showed up for her guardianship hearing to check the state of her affairs. They knew that she had an art collection worth over $1M as well as the house that all of the children were raised in also worth over $1M. Furthermore her step sons had their eye on their father’s hunting gear, his antique cars, and what was left of his retirement savings.

Elizabeth’s daughters were concerned about their mother’s failing health, but they also wondered what would happen to all of the things that she and their late father had collected over the years. To Elizabeth’s surprise, the court room was full of hungry wolves sniffing around trying to see if there was anything for them to gain. In fact at one point during the hearing, Elizabeth turned around looking at the crowd and said “all of these people are here for my money.” These were people that she had not seen in years and even people she did not know learning all about her personal life. Guardianship and conservatorship hearings are open to the public, so anyone can attend.

The court ended up appointing a Guardian for Elizabeth who was outside of the family. The judge felt like there was too much discord amongst the children and that there was the possibility of decisions being made that were not in Elizabeth’s best interest. All four of the children were upset since this took control from them and put it in the hands of a total stranger. The judge also decided to appoint a Conservator to handle Elizabeth’s financial affairs.

Elizabeth could have avoided all of this by making some very important decisions about her care when she still had the capacity to do so. She could have created a Healthcare Directive outlining who should make decisions in the event of her incapacity. She could have also created a Power of Attorney to outline who should make financial decisions in the event of her incapacity. This can be different people or the same person. While she had capacity, it would have been totally up to her to decide. Once the judge is brought in to make a decision on her mental capacity, she and her family lose control, lose privacy, and lose some level of dignity.

Here are a few things that blended families can do to empower themselves to make the best choices for their families:

  1. Have a conversation with the family about your healthcare and financial wishes. Make sure that the people you love understand what you want. This is one of the most critical steps because when there are remarriages, step children, and biological children involved it can get difficult for people to figure out your wishes if the time ever comes when you are unable to communicate that to them. Imagine getting into a car accident and being unconscious. Maybe your spouse feels like they should be making the medical decisions on your behalf. Perhaps your biological children also feel like they should be making those decisions, or even your step children. What if the decision comes up about whether or not to resuscitate or to perform a life-saving surgery? Who would you trust with your very life?

  2. Be sure to document and notarize your wishes. It is not enough to just talk about those wishes, you must put them in writing and have them notarized in order for them to have any legal effect. A Healthcare Directive including a HIPAA release form, a Living Will (for life saving treatment decisions), as well as a financial Power of Attorney are critical documents.

  3. Check your short-term and long-term disability plans at work to make sure they are adequate in the event of a lingering medical emergency that takes you out of work for an extended period of time. If these plans are not available at work, check with private insurers for rates.

  4. Make sure that your Will or Trust is up-to-date and has all of the right decision makers and beneficiaries for your current situation.

  5. Check your long-term care policy and make sure that you understand what it does and does not cover. It is important to note that not all long-term care policies are created equally and coverage can vary widely amongst the different plans.

  6. Be certain that your emergency fund is adequate enough to cover several months of expenses if you ever happen to face a medical emergency.

Elizabeth was still alive when I left the Probate Court but fully incapacitated. Her daughters and step sons were still fighting amongst themselves and fighting in court to get access to her assets and for the authority to make healthcare decisions. This is not what she would have wanted for herself or for her family. The guardianship and conservatorship court proceedings cost thousands of unnecessary dollars that did not need to be spent, opened up her private affairs to the public, and threw her family into disarray.

Taking the above steps can keep your family out of court and out of conflict during an already stressful time. It can also help to insure that your wishes are carried out without court costs, delays, or intervention.

Join my Facebook group DMV Happy Blended Family Network for more content related to financial and estate planning for blended families, and overall blended family support and information.

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