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Missouri Healthcare Power Of Attorney

Missouri Healthcare Power Of Attorney

MISSOURI HEALTHCARE POWER OF ATTORNEY: A must-have estate planning document

This article focuses on the importance of having a Missouri healthcare power of attorney and what it does. A Missouri healthcare power of attorney is a document in which you name a power of attorney, called an “agent”, to make healthcare decisions for you if you become incapacitated and cannot make them yourself.

In Missouri, the document allows you to state whether you want one or two doctors to determine if you are incapacitated. The state standard is two doctors, but you can opt out and decide one.

Once you are incapacitated, your agent can not only meet with your doctors and review your medical records, but decide:

* what type of treatment
* which doctor / which hospital
* whether to put you into skill nursing or other long term care facilities such as assisted living
* whether to put you into hospice, either at home or at a facility
* whether to withhold artificially nutrition and hydration (tube feeding), if you specifically grant that power to your agent

So, in a nutshell, your Missouri healthcare power of attorney literally puts you life into the hands of another person. That should usually be your spouse or an adult child (or children together if you think they can make decisions together). But it’s important to point out that you can choose whoever you want to make these decisions and generally that should be a person nearby who’s judgment you trust and who you are sure will act if necessary.

In the document you can also decide whether you want to donate organs and provide specifics about your wishes as to when you pass away if you want to be buried or cremated and information about the type of funeral services you want. It also contains a HIPAA Waiver which will ensure that your agent can review your medical records as needed and discuss your care with your doctor(s).

You should also have the second part of a Missouri healthcare power of attorney, which is a Missouri healthcare directive (sometimes referred to as a Missouri living will), which at our office is a second part of the healthcare power of attorney document. The point of the healthcare directive is to provide detailed instructions to your agent if you are terminally ill or persistently unconscious (a coma, for example). You want to prevent your agent from having to guess how far to take medical treatment if you are not able to decide and that’s the point of this document. It’s invaluable to provide these instructions to your agent so they don’t have to guess, which puts both of you potentially in a tough spot.

A Missouri healthcare power of attorney document can be drafted by an experienced Missouri estate planning or elder law attorney.

Family Fighting Over Powers of Attorney…

Family Fighting Over Powers of Attorney…


Squabbles over who can act on your parent’s behalf through a Power of Attorney and the decisions made in that role can cause problems within any family.

Even when mom or dad plans ahead and creates the Power of Attorney (POA) legal document before they’re impaired by a health condition, there can be ongoing strife among family members.

Sometimes the decision of who to appoint in the Power of Attorney role, from the parent’s standpoint, is very clear and easily made. Parents will put their faith in the oldest child, or choose one child over another based on who lives closest or whom they trust because of their skills, especially with financial decisions.

In my own practice, I often see years of responsible living by one child making all the difference when it comes down to deciding who should be in charge.

In other cases, a parent is suspicious about their child and doesn’t trust them 100 percent with their money. Sometimes if the oldest isn’t chosen, there’s emotional backlash toward parents and siblings because they are insulted by the decision.

In Missouri., multiple people can be appointed Power of Attorney.  The downside to selecting multiple people is that can result in arguments later, if they cannot agree on a decision.  Luckily in Missouri, we allow separate Powers of Attorney for healthcare and financial decisions, so the duties can be separated between siblings.

In some families, having a child in the healthcare field as a doctor or nurse makes it very easy to decide who should be in charge for healthcare decisions in a power of attorney.  The same is true for families with a child who is an accountant or financial advisor.  They make easy selections for who should be in charge for financial decisions in a power of attorney.

Be aware, however, that even if the appointment of POA is smooth and didn’t involve much gnashing of teeth, that doesn’t mean bickering won’t begin once the person granted POA assumes duties related to parents’ financial and medical decisions. Many times, the challenge to the POA happens after the parent passes away, when transactions and other decisions by the POA are second guessed by the other children.

While the parent is still alive, a sibling may try to trump the person appointed POA by saying their parent was incapacitated when making the decision. When that happens, it can result in an expensive guardianship fight in court.

Here are other common situations seen by elder law attorneys:

“The Sibling Rivalry” : An ongoing sibling rivalry can chip away at the “power” that someone granted Power of Attorney holds and cause kids to argue over daily and long-term decisions. When the siblings don’t trust the person granted POA, what I see most often  is constant questioning about decisions. One or multiple siblings may appear to be always on the POA holder’s back, challenging each health care and financial decision.

“Unwilling To Let Go” :  The POA holder must act in the best interest of the person they are representing, even when it comes to making those tough health decisions.  If not, they can be sued.  Having handled these types of cases on both sides, they can be nasty, protracted and expensive.

“Financial Feuds” :  Once siblings start to question what is happening to their ineritance, the battle over finances heads to court, and it can happen whether the parent is alive or has died.

In a frequent scenario, the person appointed POA may decide to pay themselves back for the expenses of caring for a parent, such as driving them to doctor’s appointments and buying food or medications.

In one case I had when I practiced in New Jersey, the only daughter was appointed POA and took care of her mother for years, even as her health sharply declined.  Two brothers, who lived out of state, questioned everything she did, although it was very clear that Mom had decided to reward her daughter in her estate plan by giving her a large share of the estate.  The brothers were incensed but it was clear that years of neglect by her sons had upset her and that she recognized that her daughter going above and beyond and the sacrifices she made for years in taking care of her and making sure her every need was met.

One recommendation I make to clients is that they contact an attorney before the damage within these families becomes permanent.  Often an attorney can act as a buffer between the two sides and bring everyone together.   This not only may salvage the long term relations among family members, but save a lot of emotional turmoil and hurt feelings.

How to choose the people in charge of your estate plan

How to choose the people in charge of your estate plan

How to choose the people in charge of your estate plan

One of the most important aspects in creating an estate plan is creating the people who will carry out your wishes.  This can be especially difficult if you are single and/or have a small family.  In fact, this issue requires the strongest consultation skills because most people understandably don’t grasp the duties involved of a person such as a power of attorney, an executor or a trustee.  This is one of the many values I can bring to my client in helping create their estate plan:  offering advice on who should be put in charge and for what purposes.

This first blog article will cover the process of choosing the individual(s) to be your power of attorney.

I’ve written other articles on the importance of having power of attorney documents.  In most estate plans, they come in two types.  The first document is a durable power of attorney for finance and property.  This document allows you to name someone to make financial and, indeed, almost all non-health related decisions for you if you are unable to do so yourself.  The other document is a healthcare power of attorney.  In this document you name a person (called an “agent”) to make healthcare decisions for you if you are incapacitated.  Such decisions could also allow the decision to put you into a skilled nursing facility, to switch doctors or to change the course of a medical treatment.

Now that you have a better background on what these documents are, it’s time to discuss the who aspect of these documents, as in who you want calling the shots if you cannot.

If you are married, the first person you are most likely and frankly should choose to make decisions on your behalf is your spouse.  So the process of choosing a power of attorney is automatically easier.  But…you are now tasked with choosing an alternate or even better, two alternates (or as many as you are comfortable with).

The durable power of attorney for finance requires, above all, someone who you trust and someone who will act.  Trust is obviously a crucial aspect of this document.  Someone in your life who you love but is a liar or has problems with money or managing money is not a good candidate.  Proximity is a plus as well and that is because if you are single or widowed and unable to make decisions for financial matters, you’re going to need this person to act on your behalf every day.  So being close is helpful.  But close and trustworthy is not enough.  Do they have a busy life?  Would it be better to ensure they will act that just name them and assume?  Always ask if there is any doubt as to whether they can act.

Keep in mind that power of attorney for finance does not have to be a finance, legal and accounting wizard.  It’s better, in fact, to have someone who understands that the document permits them to hire someone to handle these various aspects of your life.  Above all, your POA should be a person of action.

And that also goes for the power of attorney for healthcare decisions (again, referred to as your “agent”).  Remember, as we advance in age, health problems can come on gradually or suddenly, i.e. you may need an agent to take you to your doctor appointments and be there immediately if you are rushed to the hospital (hopefully not!).

Your healthcare power of attorney does not need to a medical professional but it certainly does not hurt.   In my next blog article, I will discuss another aspect of the healthcare power of attorney that you need to consider in choosing your agent:  the healthcare directive.

Evolving right to die laws…

Evolving right to die laws…

The link below is a very in depth article to read about the evolution and growth of Right to Die laws in the United States and around the world.  Right to die laws concern the ability of a person to end their lives prematurely if they are terminally ill.  Interestingly, this ties into estate planning with the need for a strong healthcare power of attorney and healthcare directive (sometimes referred to as an advanced directive or living will) which outlines your wishes as to continuing medical care and life preserving treatment if you are terminally ill, persistently unconscious or there is no reasonable expectation of your recovery from a serious illness or condition.

Right to die differs, however.  In all but a few states in America, it is currently illegal to assist in the death of the patient.  Your healthcare directive can state that you wishes are not to have continuing life preserving care if it is not going to make a difference, but no steps can be proactively taken to end your life.  This is obviously a clear distinction and one that the article covers.

I expect right to die to become a key issue (if it is not already) in the coming years, with an aging Baby Boomer population and many industrialized countries such as India and China having large aging populations.  It is a contentious issue as well, for clear reasons.  Taking someone’s life has never been an accepted medical standard for treating terminal illness.  Right to die could change that for terminally ill patients.

Here is the link to the article:

5 Reasons You Need an Estate Plan Regardless of Wealth

5 Reasons You Need an Estate Plan Regardless of Wealth



5 Reasons You Need an Estate Plan Regardless of Wealth

There are at least 5 reasons you need an estate plan regardless of whether you are wealthy or not.  This is a popular myth in estate planning, that it’s only for those with a lot of money.  In reality, every adult should have an estate plan and the older you get the more crucial it becomes.

So here is why estate planning and wealth have no connection.

#1  If you have minor children, you need to name guardians for them.  

If you have minor children, I want you to imagine who would take care of them if you were gone.  Aunt Leslie?  What is Aunt Leslie doesn’t want to take care of them or she is gone.  Who is the next option?  Does your partner agree?  The reality is that if you or if you are married, if you and your spouse pass away with minor children, SOMEONE will have to be named guardian for them.  Under Missouri law, anyone can file to become the guardian.  But what if you could have a simple document drafted where you said in advance who you wanted to be the guardian?  That is part of your estate plan.  It’s called a guardianship nomination and we can create the document by itself or make it part of your will.  The best part is that you can discuss it with your chosen guardians in advance, make sure they would accept and then plan for having alternates in case they can’t act.

#2  So you don’t own much, but chances are you own something.  

If you don’t own much, guess what?  You still need an estate plan.  The good news is that it’s a simpler plan.  Say you and your spouse have a home with about $25,000.00 in equity.  You have some small retirement accounts and a car.  Do you really want to have your family spend a lot of time, money and effort navigating their way through probate when you can devise a much cheaper option and have it ready to go in two weeks?  Probably not.  We can draft wills just in case you need them, but if your plan is to give everything to your adult kids equally and the kids get along, we can also probably tell you how to avoid probate easily and potentially without a will.

#3  Who will take care of you if and when you become incapacitated and/or disabled?

We don’t like to think about this, but we’re all going to get old.  Not one of us can avoid this fate and life changes.  But we don’t know when or how our lives will be in twenty or thirty or fifty years.  We just don’t know.  If you become incapacitated, however, life will move along regardless.  Bills will still have to be paid, tax returns must still be filed, banking will still have to be done and decisions and choices that we make every day (and take for granted) will still exist.  But who makes them if you can’t?  Answer:  If you get an estate plan, the agent named in your power of attorney.  Contrary to popular belief your spouse cannot make many decisions for you simply by reason of them being your spouse.  You need a power of attorney for that.  And we’ll plan for your spouse being incapacitated as well by naming alternates.  If you trust your kids (hopefully you do) then we can name them as alternates.  If not, we have a plan for that as well.

#4  Planning for disability / incapacity / health problems.  

If you become incapacitated you might have other problems.  Healthcare decision making.  Who will do that?  Answer:  Your agent as named in your healthcare power of attorney.  Say you’re in a coma for a long period of time, decisions have to be made, medical records have to be reviewed.  This is, of course, regardless of your financial status.  The document that allows this to happen is a healthcare power of attorney.  You absolutely need to have this document.

#5  Have an end of life plan.

Americans are living longer than ever before.  But not necessarily the greatest quality of life at the end of their life.  It’s tough to think about but in the age of Medicare, healthcare is about quantity not necessarily quality.  That could mean that near the end of your life a bunch of procedures are done that are not necessary or that cannot heal whatever health problem you have.  Part of any estate plan should be a living will / advanced directive.  In this document, you give a set of instructions to your healthcare power of attorney as to which treatments that you don’t want if you are terminally ill.  You’re not in that condition today, but by creating this document, you are planning for it in the future.  And the effect it has is that it lets your agent know that it’s okay to withhold these treatments.  Better still, it is not an all or nothing document.  There are provisions that allow you to keep trying treatments as long as they are making progress for you.  If not, then you have informed your agent so know they should be withheld.  No guesses need to be made and they’ll have peace of mind knowing that you went to the trouble of creating a legal document to make it clear what you wanted.  That’s powerful and it’s why you need a healthcare power of attorney and living will / advanced directive.