The Perfect Time to Start the Conversations
Tis the season to gather with family and good friends, share a meal, perhaps a drink or two, watch some sports or movies, and get caught up on all the happenings in each others lives. This year, consider setting aside time to start one of the most important conversations you can have with a loved one – expressing your end-of-life wishes.
Identifying and communicating your wishes for care at the end of life is called advance care planning. The plan you create – called an advance directive – is written guidance to your family, friends, loved ones and healthcare providers about YOUR values and wishes concerning future healthcare choices. One of the first step to creating a plan is starting a conversation with your loved ones.
It doesn’t have to be a difficult conversation and you don’t have to know all the answers to begin. But when it comes to determining the care that is right for you through the end of life, there are important things to consider and critical conversations to have, sooner rather than later.
What do you need to consider?
An advance directive is a document that generally contains three sections: 1) a designation of your power of attorney; 2) instructions for health care; and 3) designation of primary physician or healthcare provider(s). Click here, for instructions and a New Mexico Advance Directive that you can download and use.
Now, let’s take a look at what one should consider when planning for each of these.
I. Power of Attorney
When designating your healthcare power of attorney (POA) and alternate POA, you should know that there are many terms used for this role that mean the same thing. Healthcare agent, medical proxy, surrogate decision maker, power of attorney are just a few, but they all refer to the person you designate to make healthcare decisions for you if you are unable to do so.
There is one term you should consider in distinguishing the type of POA and that is a “durable” power of attorney. The major difference between a general POA and a durable POA is that the durable version lasts even when you become indefinitely or permanently incapacitated. In other words, if you wanted to give your agent authority that extends beyond the time you are able to act for yourself, you would choose a durable Power of Attorney.
Choosing your Power of Attorney is a big decision. It should be someone you trust and who is at least 18 years of age. They can be your spouse, next of kin, a family member, a friend, a member of the clergy, a neighbor, or a professional who specializes in providing this service. You cannot however, appoint your primary care physician or any healthcare practitioner involved in your care. Once you have chosen your POA, make sure that person knows and that those close to you – your loved ones, your medical provider(s) and care team know who you have chosen.
Considerations when choosing a healthcare POA:
- Are they assertive? You want someone who is comfortable speaking with healthcare providers and advocating for you.
- Are they comfortable talking about death? They will need to speak openly about death and dying.
- Do they live nearby? While not a requirement, when a health crisis occurs having someone local can be important.
- Will they respect my decision? They need to understand where you are coming from and be willing to honor your requests.
And one last thing to think about when it comes to POAs. With the privacy and security rules imposed by HIPAA (Healthcare Insurance Portability and Accountability Act), you may also want to sign this HIPAA Release Form to explicitly specify the access your POA will have to your medical information and the duration of that access.
II. Instructions for Health Care
It can be a challenge to think about the types of care you might or might not want in advance of a health event, but it’s not impossible. Providing instructions for your care – also known as a Living Will – is a key part of the advance directive. It’s what will guide and support your POAs decision-making when you are unable to and what will lead to you receiving the care that aligns with your values, beliefs, preferences and specific medical issues.
In general, the questions to consider here are whether or not you want your life to be prolonged, whether that includes the use of artificial nutrition and/or hydration, and any directions you may have for pain relief and/or organ donation. If you would like to provide additional instructions for your care, there is space provided to write those “other wishes.”
Those with serious illness may want to work with their healthcare providers to sign medical orders that define the scope of treatment they would and would not like. If you’ve lived in other states, you may have heard these types of medical order forms referred to as a POLST or MOLST. In New Mexico, we use the term Medical Orders for Scope of Treatment or the NM MOST form. EOLONM has recently translated this form into a dual language English/Spanish NM MOST form which English speaking clinicians can use to discuss with their Spanish speaking patients.
The NM MOST form is often printed on brightly colored green card stock paper (Wausau Astrobrights Terra Green) so that it stands out from other documents. Once complete, place it on the refrigerator, the back of the front door, or another prominent location so it can be easily found during an emergency.
Most health care professionals are familiar with this form and will abide by it. But if you would like to make sure that health care providers outside of the hospital or acute care setting (i.e., in patients’ homes, in a long term care facility, during transport to or from a heath care facility) honor your advance directives to withhold or terminate care, you may also want to complete the NM EMS DNR (Emergency Medical Services Do Not Resuscitate) form.
If the NM EMS DNR form is signed by you or your POA and your physician, and indicates that you have discussed this with your provider and that resuscitative measures should be withheld if you go into cardiac or respiratory arrest. The measures to be withheld include external chest compressions, intubation, defibrillation, administration of cardiac medications and artificial respiration. The NM EMS DNR Order does not effect the provision of other emergency medical care, including oxygen administration, suctioning, control of bleeding, administration of analgesics and comfort care. Along with your NM MOST form, keep this in a prominent location so it may be easily found during an emergency.
III. Designation of Primary Physician or Healthcare Provider
Part III of the Advance Directive is just as it sounds – it lets you designate the name of a healthcare provider you would like to have primary responsibility for your health care. It includes space for the providers address and contact information as well as a place to designate an alternate provider, in case your primary is unwilling or unable to act in that capacity. If you do not have a permanent primary physician or healthcare provider you may leave this section blank.
Once you complete the advance directive form, you will sign and date it. It’s sometimes recommended, but not required, to request two others to sign as witnesses. Give a copy of the signed form to your primary provider and any other healthcare providers you may have, to any healthcare institution where you may receive care, and to any POA(s) you have named. Talk to the person you have assigned as your POA. Make sure they understand your wishes and are willing to take responsibility.
Talking About The End of Life
Talking with the important people in our lives can bring loved ones closer together. It also helps us create the foundation of a care plan that’s right for us — a plan that will be available when the need arises.
But while we know advance planning is a good idea, many of us have not done so. According to a recent survey conducted by AARP of 2,000 adults, “54 percent had not completed a medical power of attorney or advance care directive, and a whopping 62 percent of those said they had not gotten around to it; 15 percent said they did not know how; and 13 percent said they did not like talking about these things.”
Let’s start the new year with the resolution to start the conversations.
The choices are yours. Consider your options and make a plan.
Here are some other helpful resources to get the conversations started:
- Making death conversations fun! by Kevin Pho M.D. A list of games designed to help people have end of life conversations in a painless and fun way.
- The Conversation Project – The Conversation Project® is a public engagement initiative of the Institute for Healthcare Improvement with a goal to help everyone talk about their wishes for care through the end of life, so those wishes can be understood and respected. They offer a range of free tools to help with talking to loved ones and healthcare providers about your wishes. See their Conversation Starter Guide, What Matters To Me workbook, and Guide To Choosing a Health Care Proxy, to get you started.
- EOLONM’s Volunteers Book and Movie Lists – The volunteers at End of Life Options New Mexico are enthusiastic about books and movies, esp. novels, self-help books, documentaries and dramas on the topics of death and dying. Over the years, we’ve put our heads together to form these lists of our favorites. Watching a movie or giving books as gifts can be a good way to get the conversations started.
Gratitude for Helping Hands and Caring Hearts
That’s an apt description for our appreciation for the incredible group of EOLONM volunteers and supporting partners who do the important work of helping people find quality of life at the end of life here in New Mexico.
From the beginning, EOLONM was powered by the strength and commitment of dedicated volunteers from all over the state. The legislative action teams that formed as far back as 2012 in communities in the north, south and west, grew over the years. People were passionate about educating the public about end-of-life options and advocating for the passage of the Elizabeth Whitefield End-of-Life Options Act in 2021. Many of those same volunteers, about 30-40, stayed through the transition when our advocacy coalition turned into a nonprofit organization intent on providing the services to help people learn about and access all end-of-life options, including medical aid in dying.
In our very first year of service, End of Life Options New Mexico received many more inquiries from folks who wanted to support our mission by volunteering. That spurred us to establish the processes and create the resources needed to recruit, train, support and operationalize a volunteer program.
Our volunteer corp has grown considerably and is now stronger and has more depth than ever before. In 2022 alone, more than fifty people contacted us interested in volunteering! We have now trained two groups of volunteers, one in the Spring and another in the Fall of 2022. These groups account for thirty-four new volunteers added to the approximate thirty veteran volunteers.
Volunteers currently serve our mission by conducting outreach and education (i.e. presentations, trainings and information tables) or providing one-to-one client support to those who request it (I.e. answering questions, supporting individuals and families with resources, and facilitating access to end-of-life options). EOLONM volunteers make a one-year commitment to become active volunteers, participating in orientation and volunteer training modules, shadowing and being mentored by veteran volunteers before serving.
So, during this holiday season, the Board of Directors of EOLONM would like to extend a heartfelt appreciation and shout out to all our volunteers who assist New Mexicans have quality of life at the end of life.
Required Minimal Distribution’s: An End-of-Year Gift and Tax Strategy
The end of the year is a time that many people give to charity. Why? Maybe it’s their “reason for the season?” An expression of gratitude and kindness? And, perhaps an opportunity to reduce their own tax burden? Whatever the motivation…charitable donations can result in tax savings for the donor and are the lifeblood of nonprofit organizations. A win-win situation!
Charitable giving has long been a strategy to reduce taxes. But with ever-changing tax laws it can be difficult to keep on top of the IRS rules for charitable giving and deductions. Here are some tax and giving strategies that complement one another.
If you are age 72 or older, IRS rules require you to take Required Minimum Distributions (RMDs) each year from your tax-deferred retirement accounts, whether you need the income or not. That additional income could be enough to drive you into a higher tax bracket and can sabotage any efforts you may have taken to minimize your taxes. It could also have adverse impacts on Social Security payments and Medicare benefits.
The charitable individual retirement account (IRA) rollover – aka Qualified Charitable Distribution (QCD) – provides taxpayers with a way of transferring their annual RMDs from their IRAs directly to a qualified charitable organization. While income tax is normally due on each traditional IRA distribution, the account owner does not need to pay taxes on the amount transferred to federal designated charity. A QCD is paid directly from your IRA to a qualifying charity(ies). For a QCD to count toward your minimum annual IRA distribution, it must be made by the same deadline as a normal distribution, which is usually Dec. 31 of the tax year.
Those age 70½ or older (those age 70½ – 71 are not required to take RMDs yet), can use QCDs to donate up to $100,000 total to one or more charities directly from an IRA. For married couples, each spouse can make QCDs up to the $100,000 per person limit for a potential total of $200,000. QCDs are also not counted toward the maximum amounts deductible for those who itemize their giving on their taxes. In other words, the $100,000 can be above and beyond those limits. For these reasons, a QCD can enable a donor to give a larger charitable gift than they could if they just donated cash or other assets. And an added plus…by reducing the IRA balance, a QCD may also reduce the donor’s taxable income in future years, lower the donor’s taxable estate, and limit IRA beneficiaries’ tax liability.
Donors contemplating tax strategies should consult with their financial, tax or legal advisors. For questions or assistance with donations, transfers, or pledges to EOLONM, please contact EOLONM at firstname.lastname@example.org or 505-393-1321 and we will connect you/your advisor with EOLONM’s financial advisor Tom Crow to personally assist you. And click here, for other ways to donate to EOLONM. Our federal tax ID is: 87-1147633.
Gifts to EOLONM Made in the Names of Others
Now you can designate your tax-deductible donation to EOLONM in the name of others you would like honor or memorialize. Whether you choose to honor someone who is living or memorialize someone who has died, you can make a donation and indicate the name of the person you would like to honor in this way. The following designated donations were made this quarter:
In Honor Of
- “Cat,” a gift from Paula Claycomb
- “Janet Smith,” a gift from Janelda Hogan
- “Jay & Margaret Seeley,” a gift from Margaret Seeley
- “Jennifer & Tony Kraus,” a gift from Martha Haile
- “Jerry Milburn,” a gift from Carin Milburn
- “Manuel Gomez,” a gift from Lori Gomez
- “Three friends,” a gift from Cristy Holden
- “TJ and Mary Ray Sivley,” a gift from JoAnn Ruppert
In Memory Of
- “Albie Hyatt,” a gift from Mr. & Mrs. Frank Spring
- “Bluejay” a gift from Susan Fraser
- “Dick Witcher,” a gift from Sharon Shaffer
- “Jimmy Sydney Jones,” a gift from Robin Swift
- “Jerry Ratliff,” a gift from Mr. & Mrs. Jack Ratliff
- “Margaret Alexander,” a gift from Mr. & Mrs. John Gordon
- “Paul Teppema,” a gift from Jeff Teppema
- “Robert McCormick,” a gift from Pamela Candler