S E N I O R   S M A R T S

••••• November 2019 Issue •••••

The Importance of Advance Care Planning


Plans to submit an article by August deadline were interrupted. I was told to go to the Emergency Room on August 12 because of symptoms and was hospitalized until August 15. I had to go to the Emergency Room again on August 30. Thus the title for this article.


Every year I assume the role of Advocate for National Healthcare Decisions Day (nhdd.org) regarding advance care planning.


To quote nhdd.org: “It always seems too early until it’s too late.”


When you are being put on a gurney or have to call for a taxi to drive you to the emergency room because your doctor tells you to “go to the emergency room,” it is not the time.


Emergency Contact


It is extremely important to have emergency contact information in your health records.


If your primary care physician is unable to contact you with an urgent message related to your care, the emergency contact will be contacted.


Likewise, this information is needed by your nurse when you are admitted to the unit.


Words of Wisdom


Fortunately, I had provided emergency contact information to my primary care physician.


I had recently arranged an advance care planning meeting with my representative. During the hospitalization, I was able to answer the doctor’s questions related to CPR, etc.


If at anytime during my hospitalization, I was unable to verbally answer questions I had a copy of my handwritten draft (what I refer to as a Memorandum of Understanding between me and my health care representative) of my customized Advance Health Care Directive with me.


I suggest updating information monthly for your emergency contact (health care agent).


Example: When recently thinking about the estate plan I had previously completed and a query regarding current contact information for my designee, I learned that my designee as personal executor had been deceased for 10 years.


In addition to discussing and completing your Advance Directive, you need to have an emergency fund to cover: taxi fare, public transit, ambulance service (if necessary); copayment for: emergency room, hospitalization, primary care physician appointments, ancillary services (physical therapy, occupational therapy, speech therapy), prescriptions, durable medical equipment; groceries (dietary orders), meal delivery until you can go to the supermarket.


Preparing for hospitalization:


  • Leave prescription medications at home. (Your nurse will give you your medications ordered during your stay.)
  • Wear casual clothing that you do not care if they get lint from a blanket.
  • Bring cell phone charger.
  • Do not expect a private room (unless medically indicated). Your roommate will be determined by the next admission and available bed.
  • Do not expect uninterrupted sleep. You will be monitored for vital signs, electrocardiogram, and blood draws for lab tests.
  • Aftercare Appointments:
  • Arrive early to complete forms.
  • Read all forms. Make necessary corrections.
  • Know when the symptoms occurred.
  • Know what medications you are taking.
  • Know your medication allergies.
  • Know your diagnosis.




When choosing your health care agent consider the following guidelines:


  • Someone whom you have known for years.
  • Someone who is amenable to assuming the responsibilities and duties expected.
  • Interview the potential agent as you would an employee or contractor.
  • What is the current condition of their life? (e.g., personal relationships, employment, financial). NB: Someone experiencing difficulties may not be the appropriate choice. They will be distracted by events in their life.
  • A willingness to schedule meetings to discuss the four parts of advance care planning: health care decisions, financial, obituary, funeral.
  • Availability when needed (e.g., hospitalization and discharge conference with hospitalist).
  • You work well as a team.
  • Willing to accompany you on this chapter in life’s journey.




Care companion. Goes on the convalescence journey with you. Provides words of encouragement. Provides words of consolation.


Health care agent. A person you allow to make decisions for you in case you cannot make them yourself. [attorney-in-fact, health care proxy, representative, surrogate]


Health care proxy. A document that names someone you trust as your proxy, or agent, to express your wishes and make health care decisions for you if you are unable to speak for yourself. [durable medical power of attorney, health care agent, health care surrogate.] NB: If you become incapacitated and have not appointed a proxy, state law determines who makes decisions on your behalf.



  • 1: Doctors who are specialists in the care of patients in the hospital.
  • 2: Physicians that organize the communication between different doctors caring for a patient, and serve as the point of contact for other doctors and nurses for questions, updates, and delineating a comprehensive plan of care.
  • 3: Main physician for family members to contact for updates on a loved one.
  • 4: COMMUNICATION between the primary care doctor and the hospitalist takes place at least twice during a hospitalization and again prior to discharge from the hospital.
  • 5: CARE may include:
  • a) ordering and reviewing diagnostic tests in order to make a diagnosis;
  • b) develop treatment plans;
  • c) teach patients about their conditions;
  • d) consult with other physicians in various specialties to determine the best care for their patients.
  • 6: ORDER medications, treatments and services (e.g., physical or respiratory therapy).
  • 7: BOARD CERTIFICATION in hospital medicine is offered through the American Board of Physician Specialties after completion of a written exam.
  • HISTORY: This movement was initiated about a decade ago and has evolved due to many factors: convenience, efficiency, financial strains on primary care doctors, patient safety, cost-effectiveness for hospitals, and need for more specialized and coordinated care for hospitalized patients.




The period of recovery after a disease or an operation. Involves rest, diet, exercise.


Quiet rest periods are important. Rest. allows the body to do its job in recovering from the disease.


After a serious illness it takes time for the body to readjust to your previous routine or performing tasks (e.g., effect on extremities). To reduce the risk of recurrence gradually increase activity times (e.g., set 2-hour limit for completing any/all tasks each day). Ask and accept help. Delegate tasks.




A summary of the day’s events, condition changes, appointments, thoughts, feeling, goals, daily activities, progress or setbacks, skin assessment. Can be private or shared with loved one(s) or care companion. Can be used to create a summary when preparing for an appointment with the primary care physician and specialists.




While convalescing you can communicate with your loved one(s) by: telephone – discuss the best day and time to schedule a call, be punctual, be respectful of the other person’s time when it is time to conclude the call; text message – text at the same time when sending so that the recipient can be available to reply; Dub – A Google app for simple video calling. Works with iOS and Android devices.




Diet. A prescribed allowance of food adapted for a particular state of health or disease. It is also known as a strategy for eating or an eating plan; to drink or eat sparingly in accordance with prescribed rules.




Exercise. A physical or mental activity performed to maintain, restore or increase normal capacity. Physical exercise involves activities that maintain or increase muscle tone and strength, especially to improve physical fitness or to manage a handicap or disability.


Daily physical activity for a minimum of 35 minutes will increase exercise capacity and the ability to use oxygen to derive energy for work, decrease myocardial demands for the same level of work, favorably alter lipid and carbohydrate metabolism, prevent cardiovascular disease and help to control body weight and composition.


Mental exercise. Involves activities that maintain or increase cognitive facilities. Daily intellectual stimulation improves concentration, integration, and application of concepts and principles; enhances problem-solving abilities; promotes self-esteem; facilitates self-actualization; counteracts depression associated with social isolation and boredom; and enhances the quality of one’s life.


Activity intolerance. Inadequate mental or physical energy to accomplish daily activities. Risk factors include debilitating physical conditions such as anemia, obesity, musculoskeletal disorders, neurological deficits (such as those following a stroke), severe heart disease, chronic pulmonary disease, metabolic disorders, and sedentary lifestyle.


Activity intolerance (risk for). A state in which an individual is at risk of experiencing insufficient physiological or psychological energy to endure or complete required or desired daily activities.




Depending on the diagnosis and prognosis, you may experience grief over the inability to maintain your previous lifestyle and the effects of the disease on your body (e.g., the ability to perform certain tasks).




There may be a day when you feel grumpy and express: “this is becoming a hell I never asked for” when you drop objects or have to grasp an object several times before you are able to pick it up (e.g., safety pin) due to weakness of an upper extremity.


It is important to share your frustration and remember that the day before you were able to grasp and pick up objects and tomorrow will be different.


Discuss the incidents with your doctor. You may be referred for physical therapy or occupational therapy.




To progress during convalescence is acknowledging required lifestyle changes and your limitations. You are not the same person you were before becoming ill and the diagnosis.




Form 3-1 Advance Healthcare Directive (Advance Directive Addendum). California Hospital Association. Download


Sectarian Health Care Directive. My Healthcare Directive. Download


••••• December 2019 Issue •••••

Celebrating the Holidays



During the holiday season the elderly or ill, family members, friends and caregivers will experience a more hectic schedule.


When I decided to write the Elder Caregivers NEWSLETTER to help with holiday planning, I asked health care professionals for suggestions to help with caring for your loved ones.






The tips of assistive devices are well maintained and in good condition.


Have someone with you for transferring to car and buildings.


Wear good safe shoes.


Get plenty of rest before and after the so that you will not become fatigues.


Have a wheelchair when needed.


Use safety ramps and access, if possible.


Watch floors for wet spots.


Choose a time that is not peak hours for shopping.


Have someone with you.


Have an emergency system to call for help (e.g.,cell phone).


Keep Oxygen safe, transportable. Check the equipment. Make sure you have enough oxygen.





Can a step stool be handled safely.


Packages under the Christmas tree are not in walkways.


Other options for placing packages: a table in another room.


Allow room for turning, if in a wheelchair.


Adhesive backing on throw rugs and doormats.




Call ahead for airline assistance on and off plane.


Let public transportation services know that they will have an individual that needs special assistance.


Use an alternative to public transportation (e.g., Ready Wheels).


©Suggestions provided by Sharol, Physical Therapist.




Wear shoes that are appropriate for weather conditions, comfortable, and with the appropriate heel height, if doing a lot of walking.


Caregivers, family members and friends may want to consider a fanny pack or backpack to carry necessary items so that your hands are free if pushing a wheelchair or providing ambulatory assistance. Raincoat and rain boots in lieu of an umbrella.





Strategies to Handle Holiday Eating


Try not to overeat.


Eating should not be “all or nothing.”


Eat low-fat tasty snacks in lieu of holiday candy.


Try to prevent yourself from gaining a lot of weight by trying to balance special treats with lower fat foods to maintain weight.


Be careful when prioritize--do not overdue. Have treat on Christmas not the day before or the day after. (Prioritize--choosing the foods that are important to you and choosing these items as your “treats” for the event.)


Do not just take one of everything--you will get extra fat and calories you do not even care about.





Party Tips: Attending a Party


Never go hungry—eat a snack before you go to the party to prevent being too hungry.


Take one, but not one of everything on the table.


Watch the portion size.


Do not overeat. Try to eat slowly and move away from the food so that you do not get too tempted by “seconds” that you do not need.


Do not rush up to the food and start eating—chat with family and friends first.


Fill up on the low fat items such as salads, fruit, fresh vegetables, etc.


If you like to drink, try alternating each drink with a mineral water or drink Spritzers that have only small amounts of wine.



Party Tips: Hosting a Party


Prepare both low fat choices and high fat treats.


Do not prepare lots of extra, potentially left-over food.


Make sure you eat properly yourself on the day of the party so that you will not overdo it while chatting with your guests.


Try to modify your own traditional recipes to be lower in fat without sacrificing the taste: substitute some fat; eliminate some fat; reduce the amount of fat called for.


©Suggestions provided by Judith Levine, RD, MS, Registered Dietitian, Nutritionist, National Heart Association.




While enjoying the holidays remember to follow dietary regimen prescribed by your primary care physician and other health care professionals involved in your treatment plan. If you are taking medications, remember to follow the instructions on the prescription.




Corn or cream corn.


Sweet potato pie with marshmallows.


What dentures can tolerate.


Offer choices.


Cook dishes that both (elderly, ill or caregiver, guests) can enjoy (e.g., chicken pot pie).


©Suggestions provided by Barbara, Occupational Therapist.





Family Involvement


The holidays are stressful and tends to fatigue one party or the other. The key to managing: Planning. Anticipate where conflict can evolve.




Plan to get needs met by someone else (e.g., a facility).


Plan festivity around the patient’s best time of day when (he/she) is able to participate, then the family have their own festivities.


Caregiver’s family


Plan to make it as much as possible not to seem an additional burden.


Take over some of the holiday duties.


Realize how much the caregiver has given and give to them.




Listen to the person’s reason for not participating.


How to cope with the holidays


Practice assessment and planning.


Hold a family meeting--give other members something to do (e.g., someone cooks the turkey,someone cooks dessert, etc.).


Move the dinner to a room that is comfortable for the patient (e.g., family gathers in the bedroom, if the family member is semi-bedridden).


Bring the party to wherever it needs to be brought to.


Be creative (in the living room--use the coffee table for a buffet table, in the bedroom--use the dresser for a buffet table).


With planning and forethought, the holiday festivities need not be all or nothing. Consider: patient, primary caregiver, rest of the family.


©Suggestions provided by John Bogardus, LCSW.





Medication & Treatment


Maintain medication and treatment schedule.


Change of Condition


Medications and medical responses should follow the usual pattern prescribed by the doctor.


©Suggestions provided by Herbert Lints, MD, Internist.




Boomer and seniors, share your favorite holiday recipes and their history for easy to prepare meals for the seniors and caregivers at http://forums.delphiforums.com/elder_care. Nutrition. Click: Holiday Recipes.


Anise Matteson is an elder care consultant, retired Registered Health Information Technician, and writer of reference books for seniors, “Coping with the Holidays: Excerpts from Elder Caregivers NEWSLETTER,” ©2007, included in this article. Contact: cfaalo@yahoo.com.

••••• May 2019 Issue •••••

Medicare: The Robin Hood Syndrome


My articles are objective and apolitical, but Medicare is an important issue for seniors and other recipients as well as its role in the 2020 presidential election and candidates position statement.


To quote Kristin S. Held, M.D.: “No one in good conscience cast a vote for a candidate that is running on such incompetency. Anyone running on this bill has not read it or is a devout socialist intent on completing the fundamental transformation of the United States of America, destroying the U.S. economy and shredding our constitution once and for all.”


“If we are to secure our blessings of liberty, we must identify and vote against any candidate that supports this Medicare for All bill.”1


I equate Medicare for All to Robin Hood Syndrome. Dr. Held refers to MFA as a Utopian scheme that must be paid for.


Enrolling in Medicare is not optional. When you reach age 65 you receive a Medicare card. If you are receiving Social Security benefits you are automatically enrolled and the premium is deducted from benefits disbursement each month. You do not have the option of paying by check or automatic deduction from your checking account.


Insurance coverage for people under age 65 include: COBRA (Consolidated Omnibus Budget Reconciliation Act); employee or union; TROCARE (for active-duty service member, active-duty family member, retired service members and their families); Health Insurance Marketplace; health savings accounts (HSAs).


Advocates are encouraging Medicare for All.


It is not enough that San Francisco has Healthy San Francisco. Now San Francisco wants Medicare for All!


Remember the Affordable Care Act that was supposed to address health insurance coverage for all.




Contact your district supervisor and share your stories and the importance of protecting Original Medicare.


San Francisco supervisors are supporting Medicare for All.


District 4 Supervisor Gordon Mar (“Affordable Housing Crisis,” Sunset Beacon, April 2019) said: “We joined SF Supervisor Sandra Lee Fewer for a rally and resolution in support of the Medicare for All Act, to say loudly and clearly that the City and County of San Francisco believes healthcare is a human right, not a privilege.”


Advocates encouraging an Improved Medicare for All: Barry Hermanson, Member of a statewide coalition formed to advocate for an Improved Medicare for All, HealthyCA.org; Gov. Gavin Newsom (Calif.); two San Francisco assemblymen; a Calif. senator;2 presidential candidates.




Medicare is federally financed. Established under the Social Security Act. Administered by the Health Care Financing Administration of the Health and Human Services Department. Medicare does not cover all expenses.5


The Parts of Medicare6


Part A (Hospital Insurance). Helps cover: inpatient care in hospitals; skilled nursing facility care; hospital care; home health care.


Part B (Medical Insurance). Helps cover: services from doctors and other health care providers; outpatient care; home health care; durable medical equipment (e.g., wheelchairs, walkers and hospital beds, and other equipment and supplies); many preventive services (e.g., screenings, shots, and yearly “Wellness” visits).


Part D (Prescription Drug Coverage). Helps cover: cost of prescription drugs. Part D plans are run by private insurance companies that follow rules set by Medicare.


Medicare also administers its own managed care plan.7


Eligibility Requirements8


Any citizen or long-term U.S. resident who is 65 or over and has worked long enough (or is the spouse of someone who has worked long enough) to qualify for Social Security retirement benefits.


People under 65 who are disabled and have been entitled to Social Security disability payments for 24 months or those of any age who require dialysis treatment or kidney transplants are entitled to Medicare hospital coverage. (Wives, husbands and children of Medicare beneficiaries who require dialysis or kidney transplants).


People who have reached 65 but have not worked long enough to be eligible for Social Security benefits may purchase Medicare hospital coverage.


The State of Medicare3


Medicare will become insolvent in 2026. It’s giant trust fund for inpatient care won’t be able to fully cover projected medical bills starting at that point.


Medicare provides health insurance for about 60 million people, most of whom are age 65 or older.


To fully understand Medicare and the negative implications of Medicare for All, I respectfully recommend you request a copy of Medicare & You for information describing the Medicare program. Visit Medicare.gov, call (800) 633-4227 or write U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services, 7500 Security Blvd., Baltimore, MD 21244 to get the most current information.


The State of Social Security4


Social Security will become insolvent by 2034.




Medicaid is intended to provide basic medical and health services for low-income individuals and families.


It is authorized under the Social Security Act. Jointly funded by federal and state governments. States have the option of joining the program or refusing to participate.


The federal government establishes basic guidelines and requires that certain services be provided free of charge, but each state administers its own program.


Eligibility Requirements


Categories of eligibility: 1) Categorically needy – includes individuals and families receiving some form of


federally subsidized welfare payment. 2) Medically needy – individuals or families who are ineligible for welfare but lack the funds to pay for medical care.


*Medi-Cal in California.


OVERVIEW: Medicare for All Act of 2019 – H.R.1384


Rep. Pramila Jayapal (D-Wash.) and more than 100 cosponsors introduced the Act.10


OBJECTIVE: Improves and expands Medicare program, so that every person living in the United States is guaranteed access to healthcare with comprehensive benefits.11




Comprehensive Benefits and Freedom of Choice. 1) Comprehensive health care coverage including all primary care, hospital and outpatient services, dental, vision, audiology, women’s reproductive health services, maternity and newborn care, long-term services and supports, prescription drugs, mental health and substance abuse treatment, laboratory and diagnostic services, ambulatory services, and more. 3) Patients will have complete freedom to choose the doctors, hospitals, and other providers they wish to see.


[REBUTTAL: #2 resembles the Affordable Care Act marketing.]


No Private Insurance Premiums, Co-Pays, or Deductibles. Enrollment would not require any private insurance premiums or deductibles. Upon receiving care patients would not be charged any co-pays or other out-of-pocket costs.


Long-Term Services and Supports for People with Disabilities and Older Americans. Recipients of all ages and disabilities will receive long-term services and supports through home and community based services unless the individual chooses otherwise.


Reducing Health Care Spending and Improving Care. Would: 1) simplify the healthcare system by moving to a single-payor model; 2) prevent healthcare corporations from overcharging for the costs of their services and profiting off illness and injury; 3) provide global budgets.


Reducing the Cost of Prescription Drugs. 1) Would allow Medicare to negotiate drug prices. 2) Authorizes Medicare to issue compulsory licenses to allow generic production if a pharmaceutical company refuses to negotiate a reasonable price.


[REBUTTAL: Medicare has Part D Copay Tiers. Tier 1 - Preferred Generic. Tier 2 - Generic. Tier 3 - Preferred Brand. Tier 4 - Non-Preferred Drug. Tier 5 - Specialty Tier. (Source: SCAN Classic (HMO) 2018 Medicare Advantage.) Or, Tier 1 - Generic. Tier 2 - Preferred. Tier 3 - Non-preferred. Tier 4 - Specialty. (Source: www.mymedicarematters.org/costs/part-d/)]


Transition. 1) One year after the date of enactment, persons over the age of 55 and under the age of 19 would be eligible. 2) Two years after the date of enactment all people living in the U.S. would be eligible.


Healthcare for Veterans and Native Americans. 1) Preserves the ability of veterans to receive their medical benefits and services through the Veterans Administration. 2) Native Americans to receive their medical benefits and services through the Indian Health Service.


[REBUTTAL: Veterans’ benefits: You may join a Medicare drug plan, but if you do, you can’t use both types of coverage for the same prescription at the same time. For more information visit va.gov, or call the VA at (800) 827-1000.13 Indian Health Services: If you’re getting care through an IHS or tribal health facility or program without being charged, you can continue to do so for some or all of your care. Getting Medicare doesn’t affect your ability to get services through IHS and tribal health facilities.14


Costs to Federal Government15




Sen. Bernie Sanders (during 2016 Presidential campaign): About $14T over a decade.


Committee for Responsible Fiscal Budget: $28T through 2026.


Economist Kenneth Thorpe: $24.7T through 2026, excluding long-term care benefits (likely about $3T)


Urban Institute: $32T through 2026 including long-term care benefits.


Center for Health and Economy (American Action Forum): $36T through 2029.


Sen. Bernie Sanders proposed 2017 legislation…: $27.7T through 2028 assuming steep provider cuts and $32T assuming no provider cuts.




Debt impact would depend not only on the cost to the federal government but also on any funds the government might choose to raise through premiums, taxes or both.


NB: Enacting this type of Medicare for All would mean increasing federal spending by about 60% (excluding interest) and financing a $30T program would require the equivalent of tripling payroll taxes or more than doubling all other taxes.16


Commentary: There is not sufficient funding for this legislation.


Groups Backing the Legislation


Some of the many groups backing this “groundbreaking” legislation: Healthcare – Now, Labor Campaign for Single Payor, National Nurses United and Our “Revolution.17




Freebies are called “charity.”


Individual(s) make a monetary donation which in turn enables the charitable organization or company to provide in-kind support and/or in-kind services.


NOTHING IN LIFE IS FREE! Even when it is stolen. The victim paid for the item(s) the thief takes.




Medicare: The Cost of Aging by Anise J. Matteson, Westside Observer, July 2018. http://westsideobserver.com/health.html#jul18.


…Series to be continued…




2,10San Francisco Bay View (March/April 2019)




5,8,9READER’S DIGEST, You and Your Rights


6,13,14Medicare and You 2019


7Taber’s Cyclopedic Medical Dictionary








Anise J. Matteson is a retired Registered Health Information Technician, and writer of reference books for seniors (Elder Diary: Starter Kit, visit www.caringboomers.blogspot.com.) Information is educational only. For specific questions, contact Medicare, your physician or an attorney. matte59@lycos.com.



Let’s Talk Boomer Legal and Advance Care Planning



Getting your “powers of attorney” completed — the Advance Health Care Directive and the Durable Powers of Attorney — is probably more important than executing your Will or your Trust. Why? Because, as is discussed below, the Executor of your Will is only authorized to distribute your “stuff” when you are dead; an Executor has no authority to do anything while you are alive; and nothing to say about your health or finances. While a trust can have effect in your lifetime as well as after your death (if you cannot manage your affairs, the trustee can “step up to the plate” to handle only those assets which are in the trust), again, it is limited in its scope. Meanwhile, should you have an accident or stroke, or should you lose your ability to make health and financial decisions for any reason for any period of time, your agent whom you named in your Advance Health Care Directive will have the authority – in writing – to discuss your situation with your doctors, ask for and receive medical reports, relate your concerns to the doctors and hospital personnel and make the kinds of decisions you would want made about your health care, including end of life care, nutrition, hydration and hospice care. And, the agent whom you named in the Durable Power of Attorney for Property and Finances will have authority, again, in writing, to handle those matters for you at your bank, brokerage, with your government benefits, with your property. If you have not prepared these two documents in advance, had them witnessed or notarized (a DPAP must be notarized because it controls property and finances), you could well find yourself in a CONSERVATORSHIP of your PERSON, your ESTATE or both. You do not want to be in any type of conservatorship.




A Power of Attorney is a document that authorizes someone of your choosing, your “agent” or “attorney in fact” to make financial and property decisions for you should you be unable or incapable of making them. There are several types of powers of attorney: a Durable Power of Attorney means that the power you have authorized will endure after you are incapacitated. You could sign a durable power of attorney now that is immediately effective, meaning that your agent may act tomorrow, even though you are still competent to act.


You may want to execute a “springing” Power of Attorney, which means the Person you authorize to act must wait for an event to take place before s/he may act. You may want your power of attorney to come into effect on a specific date, say, your 80th birthday. Most people want a power of attorney to come into effect when your primary doctor has determined that you are no longer able to make financial decisions in your best interest. This determination requires a doctor’s intervention and medical examination.


There are “general” Powers of Attorney which can be short range or specific to a particular event. For example, you will be out of the country when the escrow on your house closes and you authorize a trusted person to complete the necessary paperwork for the sale. Or you authorize your accountant to make inquiry into your bank accounts.


These must be signed and notarized powers of attorney; they may have a limited time period: “From January 1, 2012 to April 15, 2012, from today to the sale closing”.


There is a short (3 page), Uniform Statutory Form Power of Attorney available on line; as well as longer, more complex DPAPs drafted by attorneys. Please be advised that a Durable Power of Attorney is a very powerful legal document and can be very dangerous if misused. You want your agent to have the widest scope of powers available. However, it is just such a broad set of authorities that presents the greatest risks of abuse. Choose your agent(s) wisely. If your DPAP is effective immediately, your agent should have a copy. If not, your primary agent should at least know where to find the document should it become necessary to use it.




Only a few years ago, Advance Care Health Directives were not considered important, if they were even known about. You may or may not recall the Terri Schiavo story which was all over the news for a period of time until she died on March 31, 2005.


Basically, Terri had been in what is known as a “persistent vegetative state” for about five years following some medical event. Her husband repeatedly stated that Terri and he had discussed the possibility of either of them being unable to communicate their wishes about healthcare and life saving measures; and that Terri had expressed her wish that she not be kept on life-saving procedures. However, Terri’s parents argued forcefully that she should be kept alive. The bottom line was that TERRI DID NOT HAVE A SIGNED HEALTH CARE DIRECTIVE. Everyone got involved, including the President of the country. We cannot say for certain that had Terri had a written advance health care directive, things would have gone more smoothly with fewer participants. However, what became clear was that a signed writing was the minimum necessary for a hospital or a court to acknowledge a person’s end of life wishes.


An Advance Health Care Directive is a document which authorizes someone of your choosing, your “agent” or “attorney in fact” to make health care decisions for you should you be unable, incapable, of making them. You may write in your own words or simply initial choices presented on a printed form. The agent named on this form has authorities you give her/him: about where you want to live if you become too ill to live at home; who may visit you in a hospital; about kinds of end-of-life care you may wish or not want; about any kinds of religious or spiritual services; about burial, cremation; and the person named in this document has the authority to claim your body at the hospital.


There are short forms and long forms. You can contact the California Medical Association to get an Advance Health Care Kit in several different languages (www.cmanet.org); there is an Aging with Dignity: Five Wishes booklet available which includes an advance health care directive.


You’ll want to be sure that your agents agree with your end-of-life decisions and will represent them to your doctors. As with a Durable Power of Attorney, you may give your agent immediate authority to handle your health care even though you are still capable of making decisions. Or, you may choose to have the document effective only after your doctor or doctors, in consultation with your agent, have determined that you lack the capacity to manage your health care. Which kind of document you choose is important; but making that decision is NOT an excuse for not executing a document as soon as possible. As long as you are competent, you may always amend it, replace it. But if you do not have one, chances that you will need a conservatorship of your person are great, too great to wait.




Like the Advance Health Care Directive, but narrower in its scope, a California state POLST as it is known, is a document which sets forth your wishes for end-of-life care: do you want CPR (cardiopulmonary resuscitation); kinds of comfort care; nutrition.


However, this form is signed by your doctor with whom you have discussed your situation; and your doctor has effectively agreed to treat you as you wish. There are endorsed POLST programs and developing POLST programs throughout the states.


The California form is a bright pink form which is made to stand out among your papers accompanying you to a hospital. You can find the document on the internet at www.polst.org. This is a newer form; its use is not widespread. For many people, it may be too specific; but you should check it out.




A “living will” is basically a statement about the kinds of end-of-life care that you want your physicians to perform. It speaks directly to the physician, eliminating the need for an agent to act as an intermediary. For many people who do not have anyone they would trust, or want to burden, with making health care decisions, this document makes his or her wishes known to the physician. Even without designating an agent, the AHCD can also direct a physician to provide the kinds of medical care or end-of-life care that the principal wants when he or she is no longer capable of explaining them to anyone. This form effectively skips to the chase: it is about not wanting to be kept on artificial life support. As with the Advance Health Care Directive, it must be completed and executed by the principal while he or she has legal capacity to know what is being signed. It should be given to your medical provider to keep with your medical files.




Your “will,” what used to be known as a “Last Will and Testament” basically is a document that has no effect until you die. You may change it during your life, but must execute a codicil and have it witnessed with the same formalities as the original will. If you change the will too often there can be complications at your death regarding the ‘correct’ or ‘last’ distribution plan. At your death, the person you nominate as your Executor will distribute your property according to the Will. However, your will may have to be probated; see below.




OK, that’s easy; but it’s one of the most misunderstood differences. .A “will” is about property when you die. A ‘living’ will is about your health: keep me alive; pull the plugs. There used to be a separate form in California for a living will. Now, that form is rolled into the Advance Health Care Directive


Helene V. Wenzel is a solo practitioner in estate planning and elder law who prepares wills, trusts, durable powers of attorney, advance health care directives, trust administration and probate. Her elder law practice focuses on planning for incapacity, conservatorships, long-term and nursing home care, asset management and Medi-Cal eligibility. She is past president of the Northern California Chapter of the National Academy of Elder Law Attorneys (www.NAELA.org), the largest elder law association of attorneys in the country. Helene regularly addresses community meetings, attorneys and other concerned professionals about estate planning and elder law concerns.


••••• January 2015 Issue •••••


Coping with the Holidays During Periods of Personal Bereavement



Christmastide is the festival season from Christmas Eve until after New Year’s Day.


Christmas is observed as a legal holiday that commemorates the birth of Christ—a feast on December 25, or as celebrated by some of the Eastern Orthodox faith, on or near January 6. It is observed with religious ceremonies and prayer.


The word Christmas comes from the early English phrase Christes Masse, which means Christ’s Mass.


Many people write Xmas instead of Christmas. This form of the name originated in the early Christian Church. In Greek, X is the first letter of Christ’s name. It was frequently used as a holy symbol.


Christmas is a family occasion—relatives gather to exchange gifts and share their happiness.


The custom of exchanging Christmas gifts is a tradition associated with the gifts the Wise Men brought the Christ Child. Gifts are homemade or bought and wrapped with bright paper and ribbons.


Santa, a symbol of gift giving, creates and atmosphere of cheerfulness.


Family dinner consists of: meat, potatoes, vegetables, dressing, gravy, cranberry sauce, nuts and fruits. Dessert: fruit cake, plum pudding, pumpkin or mince pie. Drinks: eggnog.


Usually the word “White Christmas” is associated with snow at Christmastime. It is also a term associated with churches and social groups celebrated as a way of sharing. Several days before Christmas, members of the group wrap canned goods, turkeys, and other foods in white paper. They distributed these gifts to needy persons in the community. This tradition continues today with receptacles throughout the city for donating food items or purchasing a $10 bag of groceries for supermarkets to donate to a charity. (The World Book Encyclopedia)


Holiday Coping Strategies


This article is intended to provide solace for families coping with an anticipated loss or who have lost a family member this year.


To all my readers, may you and your loved ones enjoy a Merry Christmas and a healthy New Year.


Evaluate Your Coping Plans


♥ Do your plans isolate you?


♥ Do your plans reflect what a particular holiday means for you?


♥ The most difficult part of the holiday season?


♥ The most difficult people to be with?


♥ Grief triggers?


♥ Traditions you want to include?


♥ Traditions you do not want to include?


♥ People you would like to be with you?


♥ People you do not want to spend the holidays with?


♥ Things that might help you when you are feeling intense grief?



Assert Yourself


Dr. Louis E. LaGrand offers the following advice in his book Healing Grief, Finding Peace:


♥ Your needs come first. Tell family and friends specifically what you can and cannot do.


♥ You may want to eat out, have someone else hold it this year, or have others assume more responsibility.


♥ You don’t have to follow the exact schedule or routines of the past. Consider starting a new tradition.


♥ There is nothing wrong with reducing the amount of time you spend at events or in preparation for the day. Tell all concerned what your level of participation will be.


♥ Find a way to symbolically honor your deceased loved one. Make it a habit to acknowledge the memory of your loved one at major family events. It’s okay if tears flow.


♥ Tell yourself and accept the fact that the holidays will be different. Identify what emotions you are feeling and express them to your grief companion.


♥ Diligently manage your anticipation. Keep things simple and focus on the values, beliefs, joy, and wisdom of the deceased. Remember that laughter and a smile are still important parts of life.



Providing Emotional Support for Kids During the Holidays


1. Be aware of the behavior of adults, particularly parents on a grieving child. Parents must let the child know that adult tears are not a rejection of the child.


2. Don’t avoid long-standing family tradition. Traditions are often comfortable for the children (e.g. decorating the tree, lighting the candles, the big family dinner). Focus on available support from family and close friends.


3. Create a specific time during the holiday season to talk as a family about favorite memories of the person who dies.


4. Provide children with special amounts of attention, praise and emotional support.


5. Take an active role in helping the child cope.


6. Pay attention to cues and talk openly about how natural it is to be thinking of your loved one.


7. Recognize that the child may have questions about the death…Be patient and honest in your answers.


8. Provide reassurance through actions as well as words.


9. Recognize that children need to talk, not just to be talked to.


©Suggestions provided by: Hospice by the Bay, from: Helping Children Cope With Grief, by Dr. Alan Wolfelt—printed with permission of Hospice by the Bay for inclusion in Elder Caregivers NEWSLETTER – October 2003, p. 8.



Tips for Adults on Providing Emotional Support for Adolescents


They should be listened to and allowed to ventilate their feelings, whether they be guilt, anger or plain sadness. (Elisabeth Kübler-Ross, MD, On Death and Dying, p. 185.)


Writing a Sympathy Note


How to write a letter to enclose with a holiday card to someone who has experienced the death of a loved one?


Barbara Kate Repa, Senior Editor at Caring.com has these suggestions:


♥ A handwritten note.


♥ Avoid explanations or excuses for tardiness.


♥ The note can be brief or long. The intent is to convey that you are thinking of him or her and sending support.


♥ Concentrate on extending sympathy rather than personal updates. Do not inject recounting your own loss.


♥ If you do not know what to say, phrases often used are:


With deepest sympathy,


Our heartfelt condolences,


My heart goes out to you and your family.


I’m so sorry for your loss.


_______ will be sorely missed.


Your family is in my thoughts and prayers.


♥ Use the deceased’s name.


♥ Talk about the deceased. Include specific comments about the person who died—an anecdote that captured the person’s personality, comment on how the person inspired or taught you or made you happy.


♥ Skip the unpleasantries (drudging up past disagreements, sums of money owed, comparison to other relatives’ death, apologies or explanations for having been out of touch or less-than-flattering words about the deceased).


♥ Avoid platitudes—clichés about death.


♥ Write from your heart.


♥ Include your return address and full name.





Chef’s Corner


Everyone is invited to share your favorite holiday recipes for appetizers, soups, salads, meat, potatoes, dressing, gravy, desserts (cakes, pudding, pies), beverages and their history for easy-to-prepare meals for seniors and caregivers at Caring for an Aging Loved One Forum at http://forums. delphiforums.com/elder_care. Nutrition. Click on Holiday Recipes.



Support Groups


Support groups reduce the sense of isolation, become networks for cultivating new friends who understand what you are going through, provide a place where you can really tell it like it is. (Dr. Louis LaGrand. Healing Grief, Finding Peace, p. 169.)


Association for Death Education and Counseling. www.adec.org. Networking Groups: Online year-round on ADEC’s group page on Linked-In. Free for members to join and participate in discussions, share links and resources, ask questions and meet fellow ADEC members. Participation in Networking Groups is limited to ADEC members. To join, send an email to the Networking Group Chair. Bereavement Support Groups: Grief and Families. Grief at Work. Grief Camp. Hospital-Based Bereavement Programs.


Pathways. www.pathwayshealth.org/grief-support/support-groups.html. From September through June, Pathways provides separate support groups for loss of a parent, a spouse or a child. Groups examine common grief issues such as coping skills, loneliness, anger, “normal” grief and lifestyle changes. Afternoons (San Francisco – Weds). (650) 808-4603 or (510) 613-2092.




Caregiver Resilience Group: Meets in San Francisco 94102. (415) 801-0882.


Free Drop-In Support Group: Meets Fri. in San Francisco 94117. (415) 789-3759.


12 Week Grief Recovery Program: Meets Tues. in San Francisco 94131. (415) 691-7807.


Love, Loss and Letting Go: A Grief Process Group: Meets in San Francisco 94114. (415) 767-1585.


Widows Retreat: Brentwood, CA 94513. (925) 308-5494.


Hospice by the Bay Grief Support Groups. (www.hospicebythebay.org/index.php/about/calendar/grief-support-groups)


Free Drop-In Support Group – SF: Comfort, emotional support and healing advice after the loss of a loved one. Weekly. No registration required. Call (415) 526-5699.



Holiday Events


Holiday Bazaar: San Francisco Senior Center. 481 O’Farrell St. (415) 771-7950. Holiday Bazaar Preview Sale. Contact the Senior Center in November for dates and details.


Holiday Meal: Richmond Senior Center. 6221 Geary Blvd. (415) 752-6444. Call in October for information on: Thanksgiving Meal, Christmas Meal and New Year’s Day Meal. Meals are served 11:45 am. It is recommended that you call ahead. Donations suggested.


Holiday Event: Stonestown YMCA – Senior Annex. Hot Lunches: Monday through Friday. Holiday Events Calendar and ongoing events. Contact the Senior Annex. 3150 20th Ave. (415) 242-7135.


Nutcracker Ballet: War Memorial Opera House. (www.sfballet.org) 301 Van Ness Ave. (415) 865-2000. No senior or children discount.


Christmas Concert: Davies Symphony Hall. www.sfsymphony.org. Grove St./Van Ness Ave. (415) 846-6000. Concerts for the kids, adults, the whole family.



Anise Matteson is an elder care consultant, retired registered health information technician and writer of reference books for seniors including Coping with the Holidays: Excerpts from Elder Caregivers Newsletter (2007) and forum host for “Caring for an Aging Loved One. “For specific questions and advice, please contact your health care specialist and other professional service providers. If you require legal advice, you should seek the services of an attorney. She can be reached by email at cfaalo@yahoo.com.



© Castro Courier 2019 No part of this website or artwork portrayed may be redistributed or republished without the express permission of the Castro Courier. Opinions expressed are strictly those of the writers and do not reflect the opinions of the publisher or staff.

Anise J. Matteson is a retired Registered Health Information Technician, and writer of reference books for seniors (Elder Diary: Starter Kit, visit www.caringboomers.blogspot.com.) Information is educational only. For specific questions, contact Medicare, your physician or an attorney. matte59@lycos.com.