Communication is the key

We are in the final stages of completing our workshops on Personal Planning, including Advanced Directives, Representation Agreements, Advanced Care Planning, Power of Attorney and Wills. I have been taking the lead on the information on these topics and working with a very effective team that keeps me focused and on track. This is a big topic and one that is important for all of us.

As I have looked at all of the issues surrounding this topic, one fact jumps out at me over and over again. Communications with your loved one are the key to making your wishes known.

As you prepare the legal and informal documents, I think it is your responsibility to make sure that your loved ones understand what you want. Don’t just give them your representation agreement or your advance directive. Talk to them. Just because they have copies of your advance directives doesn’t mean they will understand what you want for every possible scenario.

No one knows what tomorrow will bring. My wife had a brain aneurysm three years ago and was given a 15% chance of survival. I had to make some very serious health care decisions for her, and I did. She fully recovered, not because of anything I did, but because of the excellent health care in Australia, specifically the Alfred Hospitals in Melbourne. So I know from personal experience that a serious accident or illness can result in you being incapable of making your own health care decisions at the time care is needed.

  

An advance care plan allows for such a possibility. It provides family or close friends and health care providers with a guide to your care and treatment, based on your wishes. An advance care plan can answer:

•      Who do you want to make your health care decisions for you?

•      What health care treatment(s) do you agree to or refuse if a health care provider recommends them?

•      Would you accept or refuse life support and life-prolonging medical interventions for certain conditions?

•      What are your preferences should you need residential care and not be able to be cared for at home?

•      Do you want to be buried, cremated or use some method of body donation? Do you want to donate organs or tissues?

•      Do you want to receive fluid intravenously (IV) or nutrition with a feeding tube if you can’t drink or eat on your own? If you will never again be able to drink or eat on your own, at what point do you want to stop intubation?

•      How do you feel about the use of equipment if your kidneys or other organs shut down or you can’t breathe on your own and the condition could be long-term?

•      If your breathing or heart stops, do you want paddles or CPR used to bring those functions back?

•      What if you have a serious illness like Alzheimer’s, cancer, chronic obstructive pulmonary disease (COPD), congestive heart failure, kidney disease or Parkinson’s? Would you want palliative care to help relieve pain and keep you comfortable?

If you’re the agent named to make medical decisions for a senior loved one, it’s crucial for your loved one to communicate personal preferences with other family members.

Everyone in the immediate family orbit needs to know what your wishes are. Advance care planning is about having conversations with your close family, friends and health care provider(s) so that they know the health care treatment you wish to have or refuse if you become incapable of expressing your own decisions.

Writing down your beliefs, values and wishes for future health care is an advance care plan. Your advance care plan may also include additional legal documents.

In British Columbia, health care providers are expected to respect an adult’s wishes for health care that they expressed while capable. Whether you have expressed your wishes in an advance care plan or not, health care providers will make medically appropriate treatment recommendations for you.

Making an advance care plan lets others know the decisions you would make for yourself and will give your family and friends the knowledge and tools they need for the future. An advance care plan is a choice. It is a choice that will help alleviate some of the stress your family and friends could face if they are asked to make important health care decisions for you.

There is no way to know what someone might want in every possible situation, but a frank discussion now with your parent or senior loved one can reveal information that could help you with weighty health care decisions later.

Just like the three rules of real estate are location, location, location, the three keys to successfully advocating the health care wishes of your loved one are communication, communication, communication, starting on the day you are first appointed to carry out those future wishes, when not if you are in that situation.

How long will your hip replacement last?

I had a hip replacement and I asked when I had it done, how long should it last, the doctor was vague on his response. So, I think are most specialist but there is no need, a study called How long does a hip replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up by Jonathan T Evans, MRCS, Jonathan P Evans, MSc, Robert W Walker, MRCS, Prof Ashley W Blom, PhD, Michael R Whitehouse, PhD, Adrian Sayers, MSc released in February 2019 has an answer to the question, how long will my hip replacement last?

My Hip replacement was not easy and my goal is to not have to have another one, which is also the aim of the medical professionals. However, all hip replacements will eventually fail because of processes such as infection, fracture, or a combination of normal processes, such as loosening and wear.

For doctors to counsel patients accurately and appropriately, it is important to know how long a total hip replacement might last. Life expectancy is rising and thus the long-term survivorship of the total hip replacement is increasingly relevant

The ultimate aim, that all hip replacements provide a normal pain-free function for the rest of the recipient's lives, has not been achieved as of yet. In the UK, the National Institute of Health and Care Excellence set a benchmark in 2014, that individual components making up a total hip replacement are only recommended for people with end-stage arthritis if they have 10-year revision rates of 5% or lower.

The typical patient who had a hip replacement in the UK in 2016 was 69·8 years old if female or 67·6 years old if male, and had a BMI of 28·8. 90% of hip replacements were done for osteoarthritis and 60% of recipients were female.

Similar demographics are reported by the national registries in Scandinavia, Australia, and the Netherlands.

There is hope however, hip replacements are getting better and lasting longer. Here is some of what they have to say in their research.

“In conclusion, although there is not enough information yet available to calculate exactly how long a hip replacement will last, using available arthroplasty registry data, we estimate that about three-quarters of hip replacements last 15–20 years and just over half of hip replacements last 25 years in patients with osteoarthritis.“

They did a systematic review and meta-analysis with a search of MEDLINE and Embase from the start of records to Sept 12, 2017. They included articles reporting 15-year survival of primary, conventional total hip replacement constructs in patients with osteoarthritis. They were very thorough as they reviewed implant data and reports of national joint replacement registries, after all of their research they said “assuming that estimates from national registries are less likely to be biased, patients and surgeons can expect a hip replacement to last 25 years in around 58% of patients

Total hip replacement is one of the most common and effective forms of surgery, resulting in generally excellent outcomes and it is getting better.

Pay close attention to personal finances when retiring

 Longer life expectancies and employers’ shift away from defined-benefit pensions has brought into focus the need for personal retirement planning. Yet many people, particularly women, may not be adequately preparing for the financial challenges that lie ahead. Accumulating the assets necessary to live comfortably beyond one’s working years requires planning. Decisions earlier in life that may seem unrelated to retirement security can have a significant impact later in life. This article focuses on the decisions many women make that affect retirement security and suggests how advisors can help female clients build plans that accommodate current circumstances as well as the long term. 

Planning for the long term is critical to ensuring financial security through retirement. Most importantly, women need to recognize the unique financial challenges they face and take great care when making decisions that can impact retirement security. The following advice is from a report called Women and Retirement Security written by Nevenka Vrdoljak and Anna Rappaport and released in Sept 2018.

STARTING OFF IN THE WORKFORCE

·       Saving early is critical.

·       Carefully consider investment options.

·       When making career and job choices, consider employment benefits.

·       If switching jobs, consider the benefits that may be lost or gained.

·       Consider saving in an employer-sponsored retirement plan, an individual retirement account (IR), and perhaps after-tax accounts.

RELATIONSHIPS AND FAMILY

·       Pay close attention to personal finances and seek to balance short- and long-term goals.

·       For couples, each spouse should be actively involved in making financial decisions.

·       Married couples need a financial plan that works for them today and for each spouse in the event of separation.

·       Safeguard your own needs before deciding to help other family members financially.

·       Both spouses need financial protection, including life and disability insurance; both need to consider funding IRs.

HOME OWNERSHIP AND DEBT

·       Spend what you can afford—or less—on housing.

·       Don’t forego retirement saving in order to spend more on housing.

·       void credit card balances or other expensive debt such as payday loans.

·       Keep debt to affordable levels.

·       Establish a debt repayment plan and stick to it.

CAREGIVING

·       Think carefully before assuming caregiving obligations that could make continuing in your job impossible.

·       Do the math to understand how your decision may affect your future financial security.

·       If you scale back or leave your job, focus on how to preserve your long-term financial security through alternative means.

NEARING AND IN RETIREMENT

·       Plan for a long retirement.

·       Carefully consider when to retire.

·       Carefully time your claim to Social Security; spouses

·       should coordinate their decisions.

·       Long-term care insurance is particularly important for women.

·       Remember that things change during retirement.

·       Understand how you are going to receive health Insurance in retirement.

Its not the path but the destination

What holds us back, sometimes inertia stops us from doing what we want to do. Sometimes it is fear that stops forward progress. As we get older, fear and inertia become bigger enemies. I have a friend who has been diagnosed with vascular dementia and he has been told that he has about 2 to 3 years before he starts to forget. He is taking this well, now but as he becomes more forgetful my hope is that he will realize that it is best to live in the moment.

When my wife was recovering from her brain aneurysm for the first two weeks she lived moment to moment, because she had no long term or short term memory and as she recovered she was able to extend those moments. Remember as we get older it is not the day we have to manage,  but each moment in that day.  

We all have fears that hold us back. When I was younger I dreamed of slaying many dragons and righting many wrongs, as I grew older, not wiser I sought out those dragons and found they were easier to slay then I thought. But now that I am older and I hope wiser I realized that it was not only the dragon I had to slay,  I had to slay the fear of the dragon first. Once I slayed the fear, the dragon could be killed or tamed, which I did more than I killed. 

We have all in our lives set goals, big goals, small goals, and many of us over the years have spent time learning how to set those goals, make them SMART goals so we could achieve our goals, or dreams. As I think about the wonder of life, I realize that there are many paths to achieve our goals and many of us spend too much time worrying about the path, when we should focus on the destination.  What a relief, huh?