Outlining end-of-life wishes for yourself and your loved ones
Nicole Plottel says elder law wasn’t her top choice upon graduating law school and returning to her home town of Chico at age 27. But, as a new hire in a local law firm in 2006, she found herself working under Neil Harris, whose specialty was exactly that. And that’s how Plottel found her calling.
“I found satisfaction in actually helping people in crisis, in their final years, and seeing some of their stress alleviated,” she said during a recent interview at the Vallombrosa Avenue firm she runs with Harris. “I never wanted to litigate—I wanted to help people. And with elder law, I was able to see the immediate effects of that.”
In their practice, Harris & Plottel, they specialize in helping people with estate planning, which includes assigning powers of attorney for health and financial decisions, creating wills and living trusts, among other things. A lot of people mistakenly think of it as “death planning,” Plottel said. “In reality, a lot of it is life planning.”
What she means by that is, much of the estate plan is put in place to ensure our final years are comfortable and that we don’t have to worry should we lose the ability to make decisions because our wishes are known. No matter what you call it, it’s never an easy topic to broach.
“I find the younger the client is, the more abstract the concept of ‘end of life’ or ‘death’ is, and the easier the conversation is,” Plottel said. “The older they are, the closer to death they are, the more comfortable they are with death. But the ones in, say, their 60s, who know they need to do this planning but have been putting it off—and then they receive a terminal diagnosis and are forced to address their mortality—they have the hardest time with it.”
One of the first things Plottel or other staff will discuss with a new client is assigning a power of attorney, or multiple powers of attorney, if need be, as health decisions are often quite different from financial ones. When it comes to health, she recommends people complete an advanced health care directive.
“A lot of people say, ‘just pull the plug!’ but that’s not really the whole conversation,” Plottel said. “You really have to sit down and have a quality-of-life talk.”
As an example, she painted a picture of an active older woman who loves gardening and spending time with family but falls ill and needs antibiotics to get better. “Technically, antibiotics are life-sustaining treatment,” Plottel said. But those antibiotics could bring her back to an active life. Compare that story to one of a woman who’s been suffering with dementia for many years and has no meaningful relationships because of it. If she falls suddenly ill, those same antibiotics might be viewed differently.
Erica Schultheis, who does community education and PR for Butte Home Health & Hospice, sees first-hand the difference an advance directive can make. She’s witnessed family members argue over treatment options, which is hard on the health care providers, too, as they end up unclear on what the patient wants.
“It’s important to get these things lined up in advance because nobody has a crystal ball—what if there’s an accident tomorrow?” Schultheis said. “It becomes difficult for family or friends to decide—does this person want CPR? And when you’re faced with that decision regarding your mother or your father … it’s a decision that weighs heavy on the person making it, so having a bit of guidance is definitely nice.”
The cost of health care is probably the biggest fear Plottel sees among her clients.
“What was once considered a nice nest egg—a house and couple hundred thousand dollars in the bank—can now get spent pretty quickly,” she said. “People are worried about wiping out their entire life’s work in five years.” To put it in perspective: The average cost of staying in a skilled nursing facility can run between $7,500 and $10,000 a month.
This is one area where Plottel says she finds the most satisfaction because she’s able to help people navigate the various systems to best protect their assets. Depending on assets and income, Medi-Cal actually will pay anywhere from a small portion to the entire bill for that facility, Plottel said—it’s just a matter of knowing to apply.
Plottel acknowledged that none of the conversations regarding what to do if X happens or who will do what if Y happens are easy, but says they do help in the end. “We all have this romantic notion that we will die at home, in our sleep, and we’ll be in charge of all of our faculties right up till the end,” she said. “But it doesn’t always go the way we plan it to. So, it’s important to know, ‘Who will make decisions for me if I lose the capacity to make them for myself?’”