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An "advance health care directive" lets your physician, family and friends
know your health care preferences, including the types of special treatment you
want or don't want at the end of life, your desire for diagnostic testing,
surgical procedures, cardiopulmonary resuscitation and organ donation.
By considering your options early, you can ensure the quality of life that is
important to you and avoid having your family "guess" your wishes or having to
make critical medical care decisions for you under stress or in emotional
turmoil.
ADVANCE HEALTH CARE DIRECTIVE CHECKLIST
The material prepared for this checklist is intended as informational only
and not as legal advice. "If you are unsure of your options or have questions,
we suggest that you talk with your physician, your lawyer and other trusted
advisors."
- GATHER INFORMATION FOR DECISION-MAKING. Your
physician is a good place to start for understanding your options on health
care treatment at the end of life. In addition, many organizations have
information that may be useful.
- DISCUSS YOUR END-OF-LIFE DECISIONS WITH KEY PEOPLE.
Talk about your decisions with your family, physician and others who are
close to you. Some questions to consider for discussion:
- What is important to you when you are dying?
- Are there specific medical treatments you especially want or do not
want?
- When you are dying, do you want to be in a nursing home, hospital or
at home?
- What are the options in
Palliative Care/Pain Management and Hospice
Care?
- PREPARE YOUR ADVANCE CARE DIRECTIVE FORM.
Under state law, you have a legal right to express your health care wishes
and to have them considered in situations when you are unable to make these
decisions yourself. California consolidated various earlier forms used to
indicate health care preferences into one Advance Care Directive. All valid
health care directives executed before July 1, 2000 can remain in effect
under California Probate Code section 4701. Earlier forms included Natural
Death Act Declaration, Directive to Physicians and Durable Power of Attorney
for Health Care.
A wide array of resources are available on advance health care directives,
including FAQs provided by health and hospice care providers.
- DESIGNATE PERSON TO CARRY OUT WISHES. Select
who should handle your health care choices and discuss the matter with them.
You could name a spouse, relative or other agent.
- INFORM KEY PEOPLE OF YOUR PREFERENCES. Notify
your doctor, family and close friends about your end-of-life preferences.
Keep a copy of your signed and completed advance health care directive safe
and accessible. This will help ensure that your wishes will be known at the
critical time and carried out. Give a copy of your form to:
- The person you appoint as your agent and any alternate designated
agents
- Your physician
- Your health care providers
- The health care institution that is providing your care
- Family members
- Other responsible person who is likely to be called if there is a
medical emergency
RESOURCES
Note: This listing is intended as a starting
point and provided for informational purposes only. There are many other
resources available that you may wish to research. Listing here is not an
endorsement of the organization or its web page content. If you have questions,
please consult with your physician, lawyer, accountant or other appropriate
person.
 Being
in pain at the end of life can be more terrifying than death itself. Modern
health care focuses attention on this concern through pain management and
palliative care.
In California, all hospitals and nursing homes are required to assess a
patient's pain condition as a fifth vital sign - along with the patient's pulse,
temperature, respiration and blood pressure. California also is taking a leading
role by requiring all medical schools in the state to train physicians on pain
management and end-of-life care.
Palliative care is given to patients who face serious illness for which there
is not a cure. Often called "hospice-type care," palliative care seeks to make
the patient's life as comfortable as possible by controlling pain and symptoms,
by easing the patient's concerns over daily living needs, and by helping the
patient and family address psychological and spiritual needs. Respect for the
patient's culture, beliefs and values are essential components of palliative
care.
Ensuring Good Pain Management
- Since different types of illnesses will require different approaches,
ask your doctor how he/she will manage pain that can result from your
illness. Your doctor should see that you have access to appropriate pain
specialists.
- Consider how much pain you may be able to endure in exchange for other
quality-of-life factors such as alertness and physical ability.
- Easing your pain is a priority so let your caregivers know when you are
experiencing pain.
- Be as specific and thorough as possible in describing your pain. Alert
your doctor when you are unable to do specific things and when the pain is
better or worse. Consider indicating your pain using a scale of 1 to 10.
- Once you create a personal pain management plan, be sure to use it to
avoid physical discomfort.
RESOURCES
Note: This listing is intended as a starting
point and provided for informational purposes only. There are many other
resources available that you may wish to research. Listing here is not an
endorsement of the organization or its web page content. If you have questions,
please consult with your physician, lawyer, accountant or other appropriate
person.
Hospice care is designed to comfort and support patients and their families
when the patient can no longer benefit from cure-oriented medical treatment. The
typical hospice patient has a life expectancy of six months or less. While
hospice often is understood to be a "place to go when you are dying," it more
typically allows a dying patient to receive care at home surrounded by family
and friends.
Hospice services are provided by a team of trained professionals -
physicians, nurses, counselors, therapists, social workers, aides and volunteers
-- who provide medical care and support services not only to the patient, but to
the patient's family and loved ones. The care addresses the emotional, social
and spiritual impact of the disease on the patient and the patient's family.
As the primary health insurer for people age 65 and older, the Medicare
program in the Social Security Administration offers certain hospice benefits
for end-of-life care. Check with the federal Social Security Administration and
your health insurance plan.
RESOURCES
Note: This listing is intended as a starting
point and provided for informational purposes only. There are many other
resources available that you may wish to research. Listing here is not an
endorsement of the organization or its web page content. If you have questions,
please consult with your physician, lawyer, accountant or other appropriate
person.
Your Important Papers,
What to Keep and Where
by Marsha
Goetting, PhD, CFP®, CFCS,
Professor and MSU Extension Family Economics Specialist
The beginning of each new stage or change in your life calls for a fresh look
at the types of records and papers you should be keeping. Whether you are a
student, married, divorced, widowed, or setting up your first apartment or
house, new roles and responsibilities call for new ways of thinking about
keeping personal records.
Households should be viewed as mini-businesses since many of the functions of
planning, purchasing and record keeping are the same as they are for any other
type of business, large or small. You will find financial records becoming a
vital part of your life. They are a key to your credit standing, are essential
to help you save money on taxes, and provide a continuing indication of your
financial progress.
A systematic plan for keeping track of important papers which come into your
home can save hours of anxious searching, can help preserve peace and harmony
and make it easier to cope with emergency situations.
Record-keeping, however, is more than merely a matter of neatness and order.
Legal and safety factors enter in as well. Many records and papers can be kept
in a home file for ready access, while others should be left with your attorney
or placed in a safe-deposit box. A good rule to follow is to keep the item at
home unless it is a legal document or is difficult to replace or duplicate. Then
it should be kept in a safe-deposit box or possibly left with your attorney.
Plan and evaluate the need for storage of all papers to determine which
should be discarded and which should be stored and where. Make the decision and
file each paper accordingly. Do not just stack papers and plan to return to them
later. This is the way things become lost and cause you to waste valuable time
in searching for or replacing them.
A home filing system with a space provided for the important things is the
key to managing the mass of family papers. Items to be kept at home do not call
for fancy filing cabinets or for special "offices." A "business corner" can be
set up in any room in the house. A cardboard drawer or metal box can serve
adequately for storage of bills and family papers. Filing systems must be
planned to meet your needs. You may not need detailed files at the present time.
But remember, every type of important paper should be assigned a certain space
and kept there until needed.
The following guide to record-keeping will help you work out a personalized
and efficient system for preserving and safeguarding important family papers.
Moreover, it will provide a handy reference for deciding what items to keep, why
you need to keep them, how long to keep them and where they should be kept.
You will note that duplicate copies of many family papers should be kept at
home for immediate reference. Important reasons for storing some family papers
at certain locations are explained beside each category. However, you must make
the final decision about where you will store your documents.
Records to Keep at Home
Most records discussed here should be kept for long periods of time.
Before you decide to toss any out,
look them over carefully to see if any are permanent or semi-permanent
records.
What to Keep Why and How to Keep
FAMILY RECORDS
Education & employment-- List education and job experiences. Evidences
of qualifications for certain work, reliability and tenure. Keep to determine
retirement benefits.
Family advisors-- List of names, addresses and telephone number of
each. Ready reference when medical, legal, etc.) need arises.
Insurance Policies-- List information for each policy. Review yearly.
- Automobile-- Reference for coverage. Keep until car sold or
policy expires.
- Personal liability-- Reference for coverage. Keep until
policy expires.
- Property-- Reference for coverage. Keep until property sold
or policy expires.
- Life-- Reference for coverage. Keep until policy expires or is
redeemed.
- Health-- Reference for coverage. Keep until policy expires.
Health records Physicians' names and addresses who have record of each
family member.
Licenses to practice-- Usually displayed. Keep copy in a safe place.
PROPERTY RECORDS
- Automobile-- Certificate of title and bills of sale. Keep until
you dispose of car. Essential for transfer to new owner when car is sold.
- Guarantees and warranties-- For proof of date of purchase; to determine
service and parts guaranteed. Keep until no longer valid.
- Household inventories-- Keep list up-to-date as you dispose of or
add household items. Record item, cost and date of purchase or sale. For
insurance claims to establish values; net worth statements. Pictures of
items very helpful when making claims. Make a copy also for safe-deposit
box.
- Instruction books-- For reference on use and care. Keep until
sold or discarded.
FINANCIAL RECORDS
- Account books-- Record of income and expenditures. For reference and
comparison. Useful to determine net worth.
- Bank statement --As documents of proof for income tax.
- Canceled checks Sort them and save those needed for income tax
deductions; proof of important payments. Keep checks for tax purposes at
least five years.
- Credit cards --Keep a list of names and addresses of issuing company,
plus card number, if any. In case of loss or theft notify nearest office of
company immediately by telephone or telegraph. Give your name, address,
number of card, where and when you think it was lost or stolen--and whether
you reported loss to police. Follow up with a letter giving same
information.
- Home improvement records --Retain all records for at least 3
years after report of sale of house is made on tax return.
- Receipts and receipted bills-- Proof of payment. For charge
accounts until that are tax deductible. May also be useful in filing
insurance claims to prove value.
- Safe-deposit box item list-- Revise list annually. For the information
of family members.
- Savings-- Pass books or statements. List of accounts and numbers
should be in safe-deposit box.
- Tax returns-- Keep copies of every federal, state and local tax
return. Keep vouchers and accompanying papers accessible for at least five
years.
LEGAL RECORDS
Living will-- Copy at home. Also with medical records.
Will (copy)-- Unsigned copy for home reference should questions arise.
Durable power of attorney-- Gives others the power to make health care or
business decisions when you are no longer able to make decisions on your own.
Permanent and Semi-Permanent Records
Keep in a safe deposit box, with a list of contents of box in file at home.
What to Keep Why and How to Keep (Keep indefinitely unless otherwise noted.)
FAMILY RECORDS Keep a copy of inventory of important family records
also in home file.
- Adoption paper(s) and A copy may be
kept at home. To prove ages to start to school; for obtaining birth
certificates some jobs; to obtain driver's license; for marriage license;
for registering to vote; to qualify for Social Security benefits; to obtain
passports; to determine estate heirs.
- Church-- Baptismal and confirmation
certificates. Acceptable evidence of birth date when obtaining a delayed
birth certificate. Copies may be kept in home files.
- Citizenship-- To obtain
certain types of jobs; to obtain passports; prove eligibility to vote.
- Copyrights and patents-- Proof of
ownership rights.
- Death certificates-- Proof of death
for social security benefits, estate settlement.
- Divorce decree-- To clear legal
requirements for remarriage.
- Employment record-- To obtain
retirement and other job benefits. Proof of spouse earnings may be necessary
for estate tax saving.
- List of insurance policies-- List of
policy numbers, name of each insured, beneficiary, company, agent. Reference
for kinds and amounts of coverage. Keep until collected or expires. Records
of payments and premiums. Location of policy. Record of claims. Duplicate
policies can be obtained. Policies should be kept in home file.
- Marriage records-- For proof of
marriage to collect insurance. To collect social security. To settle estate,
veteran's federal benefit pension compensations.
- Military records-- Order to active
and inactive duty, commissions, medical treatment or disability, papers
connected with claims for benefit. Some authorities recommend that discharge
certificates be recorded by county or city clerk to create additional
official record in case the original is lost. Include all documents
connected with the G.I. Bill for education. Necessary to qualify for
veteran's benefits.
- Passport-- Required for most travel
outside the country. Hold on to your expired passport, which could be used
to satisfy some application requirements for a new one.
- Social Security card-- Keep copy of
card or number from card. Will be needed when you apply for benefits.
- Wills (copy)-- Copy may be kept in
box for reference. Essential for settlement of estate. Original can be kept
with attorney or clerk of court.
PROPERTY RECORDS
- Abstract for real estate-- Keep
until property is sold. To prove clear title.
- Automobile title, bill of sale--
Proof of ownership.
- Burial lot deed-- Note on it the
number of plots. Proof of ownership.
- Deeds and mortgages-- Include title
policy; property insurance policy; mortgage; receipts for payments on
mortgage. Keep records of improvement to compute capital gains or losses.
Record day, month and year you acquire or sell property; gross sale price;
depreciation; legal fees and expense of sale. For income tax and estate tax
purposes.
FINANCIAL RECORDS
- Contracts, notes, debts-- Includes
promissory notes, mortgages, installment contracts, liens, and chattels
either collectable or payable and evidence of status for estate settlement.
- Government bonds-- Keep written
record at home of issuing date; complete serial number; denomination;
co-owner, if any; and after redemption amount received. Needed for (1)
income tax; (2) for gift tax report
if you give it away; (3) for ease of replacement in case of loss; (4) for
ease of settlement of your estate.
- Household inventory-- A description
of article, date purchased and purchase price. Keep up to date as you
dispose of or add new items.
- Investments-- List of saving
accounts, location and numbers. Keep a list in safe-deposit box and at home
of stocks, bonds and real estate investments, together with all pertinent
details. May leave stocks, bonds or other securities with broker. Needed for
evaluation of estate and income tax.
- Pension and profit sharing-- Records
should note dates and amount of employer and employee contributions plans
and payments and benefits received or payable.
Papers To Carry With You (Make a list of these for your
home file)
Item and Suggested Uses:
Credit cards: Identification. To charge
purchases.
Driver's license: Identification and
evidence of legal eligibility to drive.
Uniform donor card: To donate body
organs. To donate body to medical school or training program for use in medical
education or research.
Identifications:
Blood type: Emergency treatment.
Place note in household files for ready reference in case of loss.
Diabetic: Emergency treatment.
Epileptic: Emergency treatment.
Medicare or insurance card: For
identification to receive benefits when admitted to hospital.
Personal ID: Name, address and
telephone for yourself and of person or persons to be notified in case of
emergency.
Doctor preferred: Name, address
and telephone numbers in case of need of emergency treatment.
Organization
membership: Identification and proof of membership.
Social Security card: Identification.
Number should be listed among papers at home together with address of national
headquarters, in case you need to make inquiry about status of account or card
is lost. Keep a copy of card in safe-deposit box.
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Feeling tired all the time?
You’re not alone. In fact, fatigue is one of the most
common complaints that bring adults to doctors’ offices.
Numerous studies indicate that people who see their doctor
about fatigue have generally experienced it for a
considerable length of time — anywhere from six months to
several years!
Fatigue can be due to numerous causes, such as medical
conditions like congestive heart failure, hypothyroidism or
diabetes. It can also be a result of sleep disturbances
brought on by menopause, or by physical changes that
accompany aging. But while fatigue may be an inescapable
part of life, there’s no need to take it lying down. Your
body is geared toward generating energy as well as expending
it. And there are numerous strategies to help regain the
physical and mental energy needed to enjoy life to its
fullest.
Eat for energy
The tried-and-true advice
for healthful eating also applies to keeping your energy
level high:
• Eat a balanced
diet that includes a variety of carbohydrates,
proteins, and fats with an emphasis on vegetables, whole
grains, and healthy oils. Taking a daily multivitamin will
ensure that you get the vitamins and minerals you need, but
taking extra amounts of individual nutrients won’t give you
more energy.
• Eating certain
types of foods in particular amounts can help
prevent fatigue. Because different kinds of foods are
converted to energy at different rates, some — such as candy
and other simple sugars — can give you a quick lift, while
others — such as whole grains and healthy unsaturated fats —
supply the reserves you’ll need to draw on throughout the
day.
• Eat small,
frequent meals. Where energy is the issue, it’s
better to eat small meals and snacks every few hours than
three large meals a day. This approach can reduce your
perception of fatigue because your brain, which has very few
energy reserves of its own, needs a steady supply.
Reduce stress
The most common cause of
persistent fatigue is stress and the emotional response to
it. People who feel fatigued most of the time don’t
necessarily have more stress in their lives than other
people, but they may be more sensitive to its effects.
Stress-induced emotions consume huge amounts of energy.
Relaxation therapy can be an effective tool for reducing
stress and naturally boosting your energy, particularly when
used in combination with cognitive behavioral therapy.
Meditation, self-hypnosis, yoga, and tai chi are all
relaxation techniques. One of the easiest techniques to use
is progressive muscle relaxation, which involves
systematically tightening and releasing sets of muscles,
beginning with your toes and progressing up your legs,
torso, hands, and arms. You might also consider other
relaxation therapies, including aromatherapy and massage.
No
matter what age you are, there are things that you can do to
feel more energetic. Harvard Health Publications’
Boosting Your Energy report will help you take the
first steps toward discovering the causes of your fatigue.
This Special Health Report provides you with the latest
information about fatigue and offers strategies to help you
regain your physical and mental energy. The report discusses
medical conditions that may be the cause of your fatigue as
well as ways to naturally boost your energy.
Reprinted from Boosting Your Energy
— A Special Health Report from Harvard Medical School,
Copyright © 2007 by the President and Fellows of Harvard
College. All rights reserved. |
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