Have You Been Told Your Loved One Needs a Guardianship?

We often receive calls from potential clients who have been told that their loved one needs the assistance of a legal guardian. In the most common situation, the person has been living independently, but is showing signs of dementia, and has been doing things that put themselves or others at risk of harm. Examples include leaving the stove burners on, locking themselves out of their home, wandering out of their home and getting lost, and mixing-up their medications. Other times a senior will have a behavioral disturbance, such as striking out at care center staff and fellow residents, and a guardian is needed to consent to psychiatric medical treatment and consent to placement in a secure care facility.

A guardian is person who is appointed by a court to make health care and placement decisions for another person. We start the guardianship process by filing a court petition, explaining the circumstances to the court, and asking the court to appoint a legal guardian. We send out notices to interested persons, including close family members and people serving as trustee, power of attorney, and health care representative. A copy of the legal notice is personally delivered to the person in need of a guardianship (called a "respondent"). The respondent and interested parties have 15 days to object to the appointment of a legal guardian.

During the 15-day waiting period, a trained psychologist or nurse, known as the "court visitor," is appointed by the Judge to interview the respondent and all persons who are knowledgeable about the respondent's circumstances. The court visitor reports his or her findings to the Judge, including the visitor's opinion about whether a guardian should be appointed.

From our first contact, it normally takes 20 to 25 days to obtain a guardianship. Sometimes there is an emergency situation requiring immediate action. The most common example is a respondent with a behavioral disturbance requiring immediate psychiatric treatment. In these situations, we can request a temporary emergency guardianship, which we can normally obtain within 5 or 6 days.

Sometimes the decision to file for guardianship is easy- the respondent's behavior is creating an immediate and serious risk of harm. Other times it is more difficult. For example, we often meet with adult children of aging parents concerned about the parent's ability to live independently, but the parent has "not yet" done anything risky or suffered harm. Filing for guardianship can create real animosity between adult children and aging parents. It is not a decision to be taken lightly. Sometimes the best decision is not to file for guardianship. An experienced elder law attorney can be of tremendous help in weighing the pros and cons, and the timing, of a guardianship petition.

Geoff Bernhardt is an elder law attorney in Portland, Oregon. For more information on
his firm and on guardianships, please visit his website at www.elderlawpdx.com.

Oregon's State Budget is in Trouble: What Does It Mean for Seniors and Long-Term Care?

The economic news has been bleak. A year ago, who would have imagined the federal government taking over large banks and insurance companies? Seemingly every day we see news that things are getting tougher: rising unemployment, plummeting stock and bond markets, and retirement accounts cut in half.

Most recently, we see the economy affecting state budgets. A declining economy leads to reduced tax revenue for the state. Oregon is affected more than other states, since we are so dependent on the income tax. There will be less money available to help people with serious health problems. Make no mistake: state programs that serve seniors will suffer significant cuts. We saw this in the 2002-2003 recession, when 4,500 vulnerable seniors lost their Medicaid long-term care benefits.

What do these economic problems at the national and state level mean for the average senior? What can a retired person on a fixed income do to minimize the impact on him or herself and their families? The answer is that those who have planned in advance will be miles ahead. Recent law changes make it important to establish a long-term care plan well in advance of the need for care, while you are still healthy. Ideally, the plan should be created five years before long-term care may be needed.

If you are a married senior, have you considered what would happen if you or your spouse need long-term care? The average cost of long-term care in Oregon is almost $6,500 per month. Contrary to popular belief, Medicare does not pay for long-term nursing home care. Without proper planning, most of your assets would be spent on the care of the ill spouse. The healthy spouse could be left in poverty.

An unmarried senior must spend all of his or her assets, including the family home, down to $2,000, before qualifying for government assistance. The rules on these programs are complicated. Often, the ill senior will be left with only $30 per month from his or her Social Security to pay for personal needs. Without careful advance planning, this senior is literally out of money and out of options. In situations like these, we see children spending their own savings in support of their parents, leaving them unprepared for their own retirement. A cycle of poverty can be created.

None of these things needs to happen, but they do all the time when people fail to plan. An experienced elder law attorney can help create a plan for good quality long-term care and protection of a healthy spouse and disabled children. Don't wait until it's too late - plan today to protect yourself and your family.

Geoff Bernhardt is an elder law attorney in Portland, Oregon. For more information on his firm and on Medicaid planning, please see his website at www.elderlawpdx.com.

The Future of Elder Care: Part 1: Elder Cohousing

In my work with families who are placing a loved one in a care community, I am often asked about the future of long term care. Many people I talk with are uncomfortable with the concept of long term care for themselves but think it's adequate for their parents. I have good news and bad news: There is an alternative to long term care options known as Elder cohousing, but don't expect it to show up in your neighborhood anytime soon.

The cohousing model was adopted from Denmark and migrated to the US in 1988. Initially conceived as multi-generational cohousing, neighbors adopted rules and built structures that allowed them to live supportively with one another, sharing common facilities and incorporating non-hierarchical decision-making, two of the six main characteristics that all cohousing communities share. Now, a similar concept, Elder cohousing, is becoming more popular with the 50 and older crowd in the US. Elder cohousing is an environmentally sustainable alternative to the existing models of housing for boomers and elders alike who yearn for their independence within a supportive community environment.

There are three elder cohousing projects that have been completed in the US. The three lucky states are Virginia, California, and Colorado. To date, there are eight elder cohousing projects actively underway according to Eldercohousing.org. Some communities are spearheaded by a group of friends or neighbors; others are formed by a few members who then recruit other future "neighbors" for investment and participation.

Studies suggest that people remain healthier and may live more independently if they have strong community ties. Cohousing fits this prescription perfectly as each member of a cohousing project has duties and contributions they are expected to provide. In one cohousing community, members' professions included the following:
* Architect and Project Manager
* Technical illustrator/painter/sculptor
* Librarian
* Builder/Developer
* Teacher
* Retired English professor
* Financial planner
* Ombudsman
* Psychotherapist
* Retired businessman
* Social services for youth in prison.

If a member of an elder cohousing project needs care at some point in their journey, they continue to live at the site for as long as possible. Members are expected to help provide for one another; some will hire in-home care or employ caregivers for those who are in need. In the event that a member needs to live in a long term care community, members of the elder cooperative will continue to remain a part of the member's life. This allows members to age in place for as long as possible, decreasing the financial, psychosocial, and health burden of the individual.

If you would like to learn more about elder cohousing, or how to form your own cohousing project, visit www.eldercohousing.org.

Amie Clark, Founder, The Senior List
www.theseniorlist.com

Forget Me Not: November is National Alzheimer's Awareness Month

Dementia is a major issue for older people and their families. According to the Centers for Disease Control and Prevention, 47% of people age 85 and older have some kind of dementia. In my elder law practice, I find it helpful to have a working knowledge of the different types of dementia affecting our clients and their families. The major categories of dementia are as follows:

Mild Cognitive Impairment. This exists when a person has a complaint about memory loss that is corroborated by someone else. Neuropsychological testing will show that these patients have an objective memory impairment when compared to peers of similar age and educational background. At this stage, the person appears to have normal general cognitive function and can perform activities of daily living. Mild cognitive impairment is not in itself a diagnosis of dementia. However, many people diagnosed with mild cognitive impairment will progress to a diagnosis of Alzheimer's Disease.

Alzheimer's Disease. This may start with a loss of short-term memory. As it progresses, the patient will experience an impairment in executive function (the ability to make and carry out a plan) and judgment. He or she will have difficulty making appropriate choices. Social skills may be lost. Next, the patient may experience aphasia, or language impairment. Initially, this manifests as difficulty making word choices. As the illness progresses, the patient's verbal communication is very difficult to understand, and in late stages, the patient may not speak at all. Another symptom is called apraxia, which is motor memory impairment. This is where the person has difficulty with activities of daily living, such as bathing and dressing. The person may easily become disoriented as to time and place, and is at risk of getting lost. Finally, the person may experience symptoms of agnosia, which is the inability to recognize the purpose of an object. He or she may not know what to do with a toothbrush, or may take a cup of coffee and pour it on the floor. Approximately 10% of Alzheimer's Disease cases are so-called "early onset," with diagnosis prior to age 65. These cases tend to progress faster than "late onset" Alzheimer's Disease.

Vascular Dementia. This is a decline in cognitive ability that is usually the result of a stroke. It is the second leading cause of dementia. It occurs when brain tissue is damaged because of reduced flow of blood to the brain. The brain cells have difficulty working together to process information. Executive function is often affected, but memory impairment may be less severe than with Alzheimer's Disease.

Lewy Body Dementia. This is a progressive dementia characterized by a significant fluctuation in the person's cognitive impairment. There will be periods of acute confusion, and recurrent, detailed visual hallucinations. The person may show motor symptoms similar to Parkinson's Disease, such as changes in gait. He or she may shuffle or walk stiffly. There may be frequent falls. People with Lewy Body dementia are very sensitive to anti-psychotic medications, which can worsen cognition and motor control issues, and increase hallucinations. For this reason, it is very important that proper diagnosis is made and health care providers are educated about this form of dementia.

Frontal-Temporal Dementias. These are dementias of behavior rather than memory. The onset is more rapid than with Alzheimer's Disease. Symptoms include early and severe changes in personality, judgment, planning, and social function. Pick's Disease is an example of a frontal-temporal dementia.

One of the most important things a person with mild cognitive impairment or early
dementia/Alzheimer's can do is to develop a plan to insure good care and quality of life, and to make sure their legal affairs are in order. Alzheimer's Disease and Dementia Planning is one of our specialties. If you know someone affected by Alzheimer's Disease, please give him or her a copy of this article.

Geoff Bernhardt is an elder law attorney in Portland, Oregon. For more information on
his firm and on Medicaid planning, please see his website at www.elderlawpdx.com.

Understanding Compulsive Hoarding

We have all heard stories about compulsive hoarders. Maybe you have been to someone's house and had to navigate via "goat trails" in and out of the person's accumulated possessions. I have always thought of this as simply an eccentric behavior. But recently I read a story that caused me to think more deeply about this problem.

A man had been married to his wife for over 50 years. She was a compulsive hoarder. They had separate rooms in their home. His was meticulously clean; hers was absolutely jam-packed with junk. He took care of his wife when her health went into decline. As she was dying, her last words were not something like "I love you", instead, her last words were "please don't touch my stuff".

Hoarding is defined as the acquisition of, and inability to discard items, even though they appear to others to have no value. People with compulsive hoarding syndrome have immense difficultly throwing things away, even items of little or no value such as old newspapers, bits of string, worn-out clothes, and junk mail.

A person who is a compulsive hoarder has a variety of thoughts going through his or her mind. Items may be perceived to have sentimental value, and "If I throw it away, I am throwing away part of myself." Hoarders have a difficult time making decisions. They fear making the wrong decision, so they will save an item to avoid making a "bad choice" of getting rid of it. Hoarders may feel responsible for those around them, so they will save items "just in case I or my loved ones need them".

Hoarders also have control issues. They may feel that the moment they throw something away, they are no longer in control, and what happens to this item is in the hands of others. Hoarders are also afraid of forgetting what something looked like, or its content, and fear that "once the item is gone, it's gone forever." There is also a fear of "letting go." For example, a hoarder may fear that once she has thrown something away, that part of her life, no matter how insignificant, is gone forever.

Hoarding also creates safety issues. Excessive clutter causes fire and tripping/fall hazards. People have trapped themselves in homes and apartments, and floors have collapsed due to the weight of hoarded materials.

Hoarding also creates a stress for family members, who may feel embarrassed, frustrated, or resentful of the hoarding behavior. They are ashamed of the clutter, but are forced to live amidst chaos. Family members often resort to "self-help" methods by attempting to clean or organize without the consent of the hoarder, which leads to arguments and fights.

Compulsive hoarding is considered to be a form of obsessive-compulsive disorder (OCD). There are two forms of treatment: medications and behavioral techniques. People working with compulsive hoarders should encourage them to find a psychiatrist or therapist who is experienced in the treatment of OCD who can prescribe appropriate medications and help teach the person to gradually begin to discard items.

Geoff Bernhardt is an elder law attorney in Portland, Oregon. For more information on elder law issues, check out his website at www.elderlawpdx.com.

The How, When and What-If's of Talking to your Parents About Aging Issues

If you're reading this you've probably reached a point where your parents have gotten old. You see them struggling to do day-to-day things like cooking or cleaning. You start to wonder about talking with them because you worry about their health and wellbeing. Yet you also wonder what to say to them and whether they'll listen.

In the following pages, I've provided some tips and tools for talking with your aging parents about concerns you have for them. There's also information to help you determine if your parent's safety is at issue. In the event your mother or father doesn't want to talk about the safety issues you see, there are several ideas for ways to handle the situation. Finally, there is a list of the many care options available to your parents along with a brief description and the pros and cons of each option in my opinion.

HOW TO TALK WITH YOUR AGING PARENTS ABOUT CONCERNS YOU HAVE FOR THEM
Give some thought to the emotional response your concerns may bring up. Often, when
adult children with aging parents are scared or worried they begin to make demands. They tell their parents what to do.

I encourage you to step back from your emotions and identify your concerns. This increases the chance of a having a successful conversation with your parent(s). I suggest you write down what's going through your head when you think about the situation and what you think needs to be done. Then write these reasons down, starting with the word, "because."
My concern Because...
You can't live alone anymore.
I'm afraid you're going to start a fire because you can't see as well as you used once did.
I'd never forgive myself if you got hurt.
I worry that you'll fall and won't be found for days.
You can't drive anymore. I'm afraid you'll get in a wreck and be seriously hurt or die.
I'm worried you'll hurt yourself or someone else.

The "because" column is how you want to start the conversation with your parent(s). Notice the language in the first column compared to the second column. You vs. I. Generally the reaction to the word "you" is defensiveness. When that happens conversations turn into a battle of wills. So speaking from your own perspective, using "I," reduces defensiveness. It also comes from a place of caring and concern. Your parent is more likely to respond when they know you're concerned and care about them. Parents usually don't want their kids to suffer. Ask for their input. Do they worry about falling? Have they thought about getting into a car accident? Older adults are painfully aware of how aging is affecting their bodies though they may not talk about it. So chances are that they've given some thought to what might need to change.

Ask them how they'd solve the problem. Include your parents in the solution. Too often, as people age, they are ignored or overlooked. It's a societal problem. It's also extremely frustrating and if your parent(s) think they don't have a choice, or their opinions don't matter, they're more likely to dig in their heels. But, more importantly, it is their life you're talking about. They should have the power to choose their destiny and will be more likely to be happier with the decisions.
Be aware that your parent is afraid of losing their independence. Chances are, you're both on the same page where their independence is concerned. Discussing your concerns sooner rather than later decreases the chances they'll harm themselves or come to any harm. By recognizing that they may be afraid of losing their rights, their ability to choose and control over their own lives, you'll better understand why they may say or react they way they do. You'll be better able to talk with them and relate to what they're going through and more likely to be successful in talking with them.

WHAT IF I THINK MY PARENT IS UNSAFE AT HOME?
If you feel your parents may be putting themselves or someone else at risk it's important to address it as soon as possible. Most older adults have one primary fear: that their independence will be taken away. Contrary to how they often see it, reducing their chances of getting hurt is the best way to maintain their independence. An obvious safety concern is driving. If you suspect, or know, your parents are unsafe behind the wheel then it's probably necessary to intervene. You may have noticed how often there's news coverage of an older motorist hitting someone or something. Some of these accidents have injured, or even killed, the older adult or other people. Admittedly, this is a tricky area to discuss with your parents, which I'll explain later, so it's a common issue that children with aging parents avoid. Doing so, however, keeps your parent and others at risk. Another concern is safety in the home. Poor balance, strokes that affect your parents ability to get around, overmedication, and the need to go up and down stairs daily are some common things that increase a person's risk for falls. Poor eyesight or an inability to think clearly or react quickly [due to a stroke, reduced oxygen to the brain, overmedication, or the beginning stages of dementia] can create a situation where your mother or father aren't able to prevent a fire from starting if a hot pad falls onto a burner or a candle tips over, for example.

H*#@ NO, I WON'T GO
Even though you feel you feel your parents are unsafe, they may not agree. I suggest to clients that they give their parents several choices and a deadline for deciding. A script for this:
"I know you don't want to discuss leaving your home; however, the reality is you can't stay here unless you accept in-home help or, you have the option of moving to assisted living. You'll have to decide by [give them a specific deadline]. I know this isn't easy for you and I'm sorry about that."

Your parent may continue to object and you may need to continue repeating some version of what I've outlined above. Showing compassion yet being firm can move many parents who dig their heels in, but not all. Despite all your efforts your parent may continue to live in an unsafe environment until something serious happens that makes it impossible for them to return home. Depending on the issue that prevents them from moving home, they may have few options.
It's not unusual for assisted living facilities to have waiting lists. Depending on your parent's health situation he/she may have to skip assisted living entirely and go to a skilled nursing facility. The best you may be able to do is talk with facilities near you, or near your parent's home, and ask to be put on a waiting list. This gives you some control over circumstances if you have to make quick decisions about your parent's living situation later on. Facilities will check with you if your name is getting near the top of their move-in list as apartments become available. If circumstances haven't changed for you, most facilities will move your name to the
end of the list.

CARE OPTIONS
There are many types of care options and each has its pros and cons.

Living with Adult Children
This option is not for everyone. I ask clients who are considering this if they've sat down and discussed it with their parents. It's not uncommon for adult children to feel it's their duty to move their parents into their home and care for them. However, when they talk with their mother or father about this they're often surprised their parent doesn't want this. Likewise, some elderly parents expect their kids to make a place for them in their home when they can no longer care for themselves. This often isn't realistic. Adult children may literally not have space for their mother or father to move in; money to pay for things their parent needs as
they age [or to move to a bigger home]; be able to afford to work less hours or take time off to provide the help their parent needs or, may not have the fortitude to be with their parents that much. Unless adult children and their mother or father have established a relationship as adults that allows for each other's differences, throwing parents and children together after years of being apart can create a lot of stress for both parties. Even if the parent/child relationship is strong and both sides are respectful of each other's time, space and lifestyle, adding a parent to your household can be hard on significant others and grandchildren. This decision takes careful consideration for everyone involved, you, your parent, your kids, your significant other, your siblings, because it impacts all of them in some way.
Pros...

• an opportunity to give back to your mother or father for all they've done for you

Cons...

• if the above benefit sounds rosey it's because it usually is. Rarely does the dream match reality.
• high stress simply because your parent's needs will increase the older they get.
  

In-Home Care
There are companies that provide caregivers that will come to your parent's home. Services vary but generally they provide light housekeeping, prepare meals, write letters, provide socialization (visit with your family member), transport to appointments, help bathing and dressing and medication reminders. These companies may, or may not, provide nursing services (described below).
Pros...

• your parent can continue to live in their home
• may be less expensive than assisted living
• covered by long-term care insurance
  

Cons...

• Depending on the cost your parent may still be home alone much of the time. Having a device like Lifeline is one solution. You might remember the ads on television, "Help, I've fallen and I can't get up." Your parent wears a device around his/her neck and if something happens and they need help they push this button. When your mom or dad activates the device, several things may happen: some devices allow your parent to talk to a person who assesses what's needed and/or talks to your parent until help arrives; other types of devices alert a dispatcher at the company who works from a list of contacts provided by the family, if they are unable to reach anyone or, after a certain period of time, 911 is called. The main challenge with these types of devices is getting your parent to wear it ALL the time.
  
• Your mom or dad may be limited in where they can go, or when they can schedule appointments if they have to be within the hours the caregiver is present. This is one of the biggest obstacles older adults face if they stay in their home. It's one of the main reasons they continue to drive when they shouldn't. Imagine what it would be like to always have to rely on someone else to take you where you want to go. Most U.S. lack a good public transportation system so there are many places, besides rural areas, where public transportation is not available.
• Parents can be uncomfortable having caregivers do things for them so they may use the time for visiting or encourage them to leave before they've completed their chores. Asking the staff of the home care company how they address these issues before you hire them is one way to deal with this problem. Continuing to ask the company for caregiver feedback is another. Asking your parent what things the caregiver is doing for them may also give you a feel for what's being done, or not being done.
  

In-Home Skilled Nursing
Companies that offer this service may provide many of the same services in-home care providers do but they also provide nursing services such as: giving medications, reporting conditions and changes to your parent's doctor, taking vitals, drawing blood, giving injections, setting up medications and physical and occupational therapy.
Pros & Cons are similar to those of in home care above.

Retirement Communities
Generally these are independent living communities of people 55 and older. The living quarters can be homes or apartments, depending on the community, and residents may have the option to buy or to rent. Retirement communities are much like independent living but some services may be provided and residents are usually 55 years of age and above.
Pros:

• Less upkeep than a home- Generally the dues or rent include services for grounds keeping; house cleaning services may be offered; a dining room or other type of meal service may be available and other amenities may be offered.
• Less likelihood your parents will be isolated. There are often activities, excursions, etc. offered in these communities and residents tend to reach out to one another.
  

Cons:

• Potential for narrowed thinking- While your parent may not be isolated from others, residents are primarily spending time with their own age group. Their experiences outside of the community may also be limited. These factors create the potential for them to view the world more narrowly.
  

Assisted Living
These facilities have apartments with kitchenettes. Generally they provide three meals a day that are part of the monthly rent. Most only serve meals in the facility's dining room. There is a nurse on staff and nursing aides who administer medications (some facilities will let residents who are cognitively able manage their own medications). Most facilities offer outings throughout the month for residents. Housekeeping is provided.
Pros:

• Your parent will be less isolated
• They can get their care needs met less expensively than with in-home care
  

Cons:

• Facilities can be fairly regimented- It's less expensive and more convenient for the facility to provide meals and some services to residents on a schedule. This can be fairly frustrating since this is another area older adults lose control over basic things: when to eat; bathe, etc.
• Your parents daily needs may not be met quickly- A focus on turning a profit and a lack of employee commitment to the work (usually due to low wages) often means facilities are understaffed
  

Skilled nursing facility (a.k.a. nursing homes)
This is the type of facility that was available for your parents' parents. Most confuse assisted living with this type of facility. Nursing homes have become skilled nursing facilities (SNF pronounced like sniff) because medical insurers can save costs by moving patients here who need rehabilitation or a longer recovery period after their hospital procedure. It is not true, as your parents may believe, that you never get out of a SNF. It depends on why someone is there. Usually people stay long term if their needs are more than an assisted living facility can provide. (This would be similar to in-home skilled nursing services; the needs are greater than "basic" service: wheelchair bound; need helping getting in and out of bed, chairs, etc. can't walk without assistance, etc.) Some people on Medicaid may be in a SNF because they can't find an assisted living facility that will take Medicaid. Some people may not have enough money for assisted living but have too much for Medicaid. There may be a unique reason a person would stay in a nursing home long term besides those I've mentioned.
Pros:

• Staff have the training to take care of extensive medical needs
• It is less expensive than in-home care
  

Cons:

• Facilities are often understaffed and employees are usually overworked
• Privacy is often at a minimum
• Your parent has little control over their environment
  

Continuing Care Retirement Communities (Three in One)
Some senior housing options have a retirement community, assisted living and skilled nursing (or only the last two) all in the same place.
Pros:

• Your parent can get the level of care they need without having to leave familiar surroundings and friends
  

Cons

• Any of the cons I've mentioned above

I hope this report helps you feel more confident in dealing with the issues that come up as your parent's age, in talking with them about your concerns and in helping them make the right decisions for their health and wellbeing.

Lynne Coon, MS
Counseling and Resources for Adults with Aging Parents
www.lynnecooncounseling.com

Understanding Life Sustaining Measures

You have decided to follow your doctor's advice and complete an Advance Directive for Health Care thus providing a clear understanding of your wishes as they relate to life sustaining measures. You understand the significance of having an Advance Directive, but as you research the process, you are confronted with a lack of understanding regarding what life sustaining measures encompass.

Life sustaining measures can be defined as, "Any medical treatment in which the primary goal is to prolong life rather than treat the underlying condition." In such cases an individual's own body is not capable of sustaining proper functioning on its own without medical intervention. Some examples of life sustaining measures are:

Artificial nutrition and hydration are utilized when an individual is not receiving the nutrients necessary for health and well being. Artificial nutrition (tube feeding) requires a tube be placed into the stomach or the upper intestine. Hydration (fluid replacement) involves tube placement intravenously (IV) via a needle.

Cardiopulmonary resuscitation (CPR) is used when an individual's heart beat and/or breathing has stopped. CPR includes treatments such as mouth-to-mouth resuscitation, chest compressions, electric shock and/or drugs to restart the heart. CPR can be life saving, however, there is a risk of broken or cracked ribs, punctured lungs and death.

Mechanical ventilation supports a person's breathing when they can no longer breath on their own. In this situation a machine called a ventilator forces air into the lungs via tubing in the mouth or nose.

Dialysis is the artificial process by which waste products and excess water are removed from the blood. It is used when the kidneys are no longer able to do this adequately.

These examples of life sustaining treatments are just a few of the more common measures taken to continue life when one or more body systems are not working properly. Deciding what, if any, treatments are right for you should depend on several factors:

Does the treatment relieve suffering, restore functioning, or enhance the quality of life? If so, these would be some of the benefits of treatment. Conversely, a treatment may be considered problematic if it is painful, prolongs the dying process or negatively effects the quality of life. Other questions to ask yourself might be: What are my values as they relate to life prolonging measures? Who will carry out my wishes should I become incapacitated? If I start treatment and it does not improve my status will I want to continue that treatment? If so, when? (It should be noted that it is ethically and legally acceptable to discontinue a treatment that is no longer of benefit. It is the disease not the withdrawal of treatment that causes death.)

How you choose to complete your Advance Directive and what measures you choose to take are up to you. Talk to your doctor and don't be afraid to ask questions if you find the terminology confusing or you simply don't understand. Ultimately understanding your Advance Directive and the medical terminology associated with it will enable you to communicate your wishes to those providing your health care and increase the likelihood that your wishes will be honored.

Finally, understand that completing an Advance Directive for Health Care is a gift to your loved ones. Instead of guessing about what your wishes might be, they have a clear, written, and legally binding expression of your wishes, enabling them to serve as your advocate.

Geoff Bernhardt is an elder law attorney in Portland, Oregon. For more information on his firm and on Medicaid planning, please see his website at www.elderlawpdx.com.