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January 10, 2017


I've long since neglected to update my entries!  I have had strange events in my life in 2016 and finished my second book.  I'll begin there.  IMPARTING: Before I'm Parting  picks up where I left off on this BLOG.  Through only 41 pages of text (book totals 71 pages w/preliminary pages, Index, References and Appendices), you'll enjoy ways of discovering what makes you YOU.  You'll not be taken through the painfully boring chronological path, but a spontaneous and fun path of discovery.  Prompting my work on IMPARTING was wondering about the person and life of Johanna, who lived five generations before me.  I sit with her spinning wheel and wonder what possessed her to leave all she knew, her people, her home, her world, and set sail on perilous seas (actually, by steamboat, I think) with no guarantee of surviving the journey.  Trans-Atlantic trips of her era took up to six weeks.  Boats could (and did) run aground or run out of food.  My great-grandmother told the story of how her boat ran aground and no food was left.  Fortunately, they were stuck in the New York harbor so rescue was available.  


Striking me was the notion that I did not want family members to follow wonder about my artifacts and my life.  But I had not a clue how to begin.  Writing a chronological review felt worse than having a huge cavity being drilled on without novacaine!  A better way was needed.  IMPARTING helps you in your discovery by engaging stream-of-thought to begin in forming the major building blocks of what makes you YOU.


IMPARTING concludes with helping you to continue your work of putting your affairs in order, by leading to the nuts and bolts work of transitional planning (what will you do if/when you can no longer drive or live in your home), suggesting ways and aids to pare down your stuff (ignoring your stacks of stuff becomes a decision to dump it on your loved ones!), reviewing your financial picture, and the perils of failing to do your legal planning (Will, powers of attorney, etc).  Finally, end-of-life and funeral planning is addressed.  What we proactively plan for is that much less we burden our loved ones!



November 15, 2015


Making a Positive Legacy


I've done a lot of work on my geneology this year.  I've reached back to as early as 1752, and my 5th-great grandparents.  For all but my parents, grandparents, and to some extent my great-grandparents, all I know about the many other ancestors that have culminated in me, is their birth and death dates.  How I would love to know more!  


What were their lives like?  Presumably farmers.  However, what were those lives like?  What brought joy to them?  What was hard for them?  What was important to them?  What life events most impacted them, why, and how did they manage it?  In other words, all I have is "the dash"--from this date to that.  


What's important about YOUR dash?


This is where "taking care of your affairs" begins, in my mind.  Dig deep.  Find words for what's important to you.  Let our ancestors know what your life's precious days stand for.  Don't leave them with just "the dash."



September 8, 2015


Driving Well Or Driving You Crazy?


My grandfather valued his car more than his home.  His garage was in fact much bigger than his house!  His 2-car garage probably was twice as big as his itty bitty house, enveloped by a a beautiful front and back yard that rolled from one side street to the next.  His family and his cars were his life.  It was hard enough when my grandmother died after there more than 50 years of marriage.  He struggled for the next seven years, trying to find meaning.  But at least he had his car, and at least he knew when to hang up his keys.  He never turned his keys over to anyone, he just stopped driving.  He savored having his car--like his last buddy, with him to the end...He used this last treasure to end his life by carbon monoxide poisoning, but elderly suicide is for another day.  


Then there's someone in the neighborhood.  I've know this person for decades and is a nonagenarian.  Overlay age with a degree of dementia and you have a recipe for impending peril.  I've tried in every way I know to help this person dignifiedly come to a useful outcome--at least get evaluated.  Although my friend took some initial steps, follow-through fell through.   




I've developed  


July 17, 2015


Deciding When It's Time To Say Goodbye

He stumbled along.  My heart seared standing witness.  He'd become blind with inoperable cataracts.  He'd lost so much weight; impossible it was to fathom how he could even stand let alone stumble along.  He slept 95% of the day.  Every opportunity I found to wrap him in my arms for hours at a time, trusting that some measure of comfort was being received by his heart.  Increasing special care was the norm of the day, cleaning up his biologicals, throwing another few bedpads in the washer, administering pain medication and a host of other palliatives.  With increasing intensity and bewilderment, THE question hauntingly echoed in my heart and mind's deepest chambers...when is it time to say goodbye?


As I found solace in writing after my mom's passing (resulting in the publication, Birthing Death),  I penned the piece below:


One of Heaven's Jewels...Or  How To Sit Atop A Fence For A While

Here I am, sitting atop a fence, straddling my sadness and his struggle. 

The signs are not yet clear enough for me—does he want to go Home?  Does he want to stay a while?

What does his Independence Day look like to him?

He stumbles, he runs into things he can no longer see. 

He stands and stares into something I cannot see nor fathom.

How he stands seems impossible, how can he have any muscles?

He’s weighed in at 3.3 pounds today--15 is normal.

 

This precious soul came into my life from Heaven’s grace seven years past.

My heart was instantly held captive. 

He snuggled up to me, wriggled his head up to mine and promptly began “cleaning” my face.

He’d move onto the rest of my noggin, then my ears and the back of my neck.

 

For 7 years he’s my steady friend now til the end.

I technically rescued him (from a household of 20 other dogs), yet he has rescued me…

Through the tidal waves I knew were coming reflecting my mother’s passing.

Jojo helped see me through.

 

Now I return the favor to him, seeing him through these last days.

But how to do this?

For humans we have hospice.

For furry friends, we have…indecision…the not knowing WHEN…

Do I wait for God to bring him home, but then watch seemingly and needless suffering?

Do I send him along his way with the help of his vet?  Am I acting a sliver too soon?

What is right?  What timing is right?

 

Meanwhile, I’m sitting atop the fence, waiting for a clearer sign.

Perhaps a second sleepless night stirred by his fleeting cry is the sign.

I’ll find that out tonight.

 

Knowledge is one thing.  Inner wisdom is another.  But what do I do when the internal signs are clothed over with sadness?  Am I reading the signs right?

 

So goes the life of sitting atop a fence with one of Heaven’s Jewels.

 
A Couple Days Later...

The second night came indeed,

And sadly required me to take heed.

I held Mr. JoJo in my arms as my soul’s rivers flowed

And watched Mr. Vet deliver the final blow.

I held this lifeless body near as the would slice down, my bones did sear.

I buried him I mom’s garden near, and now he “cleans” her face so dear.

*****************

You see, whether 2 or 4 legged, end-of-life's pain is just as palpable--for both caregiver and care recipient.


SUE E. FABIAN, J.D., M.Ed.
ElderWISE Advisor/Advocate
Elder Law Attorney
​Certified in Gerontology


June 24, 2015​

Deciding To Dump Your Crisis In Your Kids' Laps

Sleepwalking.  That's how the great majority "tackle" aging.  

  • "I don't need to do my Medical Power of Attorney, I have time."    
  • ​"I don't want to think about it."
  • "I'm too young."
  • "I don't have enough to worry about."
  • ​"My family will take care of it."
  • "My spouse knows what I want."
  • "After I'm dead, I don't have nothing to worry about."


Sound familiar?  

Myths.  Every one of them.  


Let's take the "I'm too young" or "I have time" rationalization.  

1.  Does it occur to you that the Number 1 reason for death and disability due to accidents is car accidents?  It is the fifth leading        cause of death in the US.  

2.  Does it occur to you that the most hotly contested cases about end-of-life care concern those in their 20s, 30s and 40s?

      Karen Ann Quinlan was the first such notorious case.  She was 21 when she overdosed.  In Michigan, it was Michael Martin,         41, hit by a train.  In Florida, it was Terry Schaivo, when at 27 she suffered a lack of oxygen for unknown reasons.  


How about the "I don't want to think about it" rationalization.

     A decision NOT to decide IS a decision!

     By not deciding to address basic legal planning, much less Life Care Planning (more on that in another blog), you are actively deciding to dump the inevitable crisis in your loved ones' collective lap.  This amounts to the proverbial, "My family will take care of it" excuse.  Would YOU like to be put in that position?  Having no legal authority to do the things that need to be done either medically or financially?  Needing to go to a lawyer in a moment of crisis to figure out what could have been figured out well beforehand?  It's not a pleasant experience.  


"My Spouse Can Take Care of It" is part of this rationale.  

     Really?  Are you sure?  

     In Michigan, the clear (actually muddy) answer is, "it depends"  when considering medical decision-making:

  • It depends on whether a particular doctor at a particular hospital or other health care facility agrees to talk with the spouse when the spouse cannot present any legal authority (a Medical Power of Attorney) that s/he has a right to protected health information.  HIPAA (a federal law that protects one's health information) can be invoked at any time.  How does the doctor know you and your spouse are not at odds?  Or that your spouse prefers you over another family member who may have medical training?  
  • It depends on whether a narrowly applicable law fits your particular circumstance.  In Michigan, for instance, if one is on Medicaid, then a "kinship" law allows health providers to speak to family members in order of priority.  But millions have private health insurance where kinship laws become inapplicable.  


     Regarding financial decision-making, your family or spouse is in a more precarious situation.  Unless your spouse is a joint owner on assets, s/he has NO ability to manage your finances.  Worse, if a non-asset financial matter needs to be addressed, like a contract issue (think real property transactions, signing facility admissions contracts, needing retirement asset information, etc.).  At that point, your spouse is in probate court obtaining Guardianship or Conservatorship to handle these matters.


​I could write more, but enough preaching for today!


May 15, 2014

Medical Powers of Attorney: 

Did you know that only about 25% of the US population even bother to complete a Medical Power of Attorney (MPOA)?  Even less give a copy of their MPOA to their doctor.  You can get FREE forms from your state representative!  No excuses not to do one.  If anything, it relieves your loved ones from having to guess what end-of-life medical treatment you would want, then having to live with their decision, forever second-guessing themselves.  If you are reluctant to do one for yourself, consider the gift you are giving to your loved ones by relieving them of this supremely weighty guessing.


SUE E. FABIAN, J.D., M.Ed.

ElderWISE Advisor/Advocate

Elder Law Attorney

​Certified in Gerontology

February 15, 2014

Medicaid Planning

Medicaid is a government program that provides medical care coverage for individuals with limited income and assets.  It is the primary means of paying for long term care for our country's elders.  The application process for those facing nursing home stays is often anything but easy.


After having countless individuals and their families apply for Medicaid for long-term nursing home care for more than a decade, it is clear to me that the application process is fraught with peril for the unwary.  While a public benefit program's application process should be "user friendly," and many are, this is NOT the case for Medicaid coverage for long-term care.  The process is especially complicated for one of a married couple.  I've cleaned up more than one such application after the nursing home social worker attempted to apply for Medicaid on a resident's behalf.


To successfully apply, one has to be aware of several important concepts: 


*  Community Spouse Resource Allowance

*  Community Spouse Income Allowance

*  Shelter Standard

​*  Minimum Monthly Maintenance Needs Allowance

​*  Heating & Utility Allowance

*  Snapshot Date


In addition to understanding these concepts and how they are utilized in certain formulas used in computing how much in income and assets the well spouse can keep, there are certain planning opportunities available to ensure eligibility and preserve assets.  


For an individual with too many assets, there are also some actions that can be taken to create eligibility, such as purchasing a funeral contract.  


While in many instances I would say to someone seeking public benefits to go to the appropriate agency and apply on your own, this is NOT the case with Medicaid.  


Elder Law Attorneys are especially qualified to assist in the Medicaid application process.  Whether it be me or another elder law attorney, do yourself a big favor and seek one out to assist you in the Medicaid application process when you or your loved one is facing nursing home care.


SUE E. FABIAN, J.D., M.Ed.

ElderWISE Advisor/Advocate

Elder Law Attorney

​Certified in Gerontology



December 23, 2013

What is Elder Law?Unlike most other areas of law, elder law encompasses a broad base of law.  Needs of older adults can touch upon probate; estate planning; qualifying for public benefits such as Medicare and Medicaid; end-of-life planning such as appropriate medical care, Medicare benefits advocacy, funeral planning, hospice care and more.  Property law is sometimes involved.  Patient advocacy education is crucial.  So, and elder law attorney must have a broad legal base, unlike, for instance, a criminal attorney who focuses in a distinct body of law. In one of the website revolving pictures, you’ll see a colorful tree with “Elder Law” depicting the trunk.  In the branches of elder law that I practice, the following branches are illustrated: ·      Patient Advocacy (knowing what questions to ask and what to look for when monitoring your loved-one’s care) ·      Probate Law (Guardianship and Conservatorship and required annual reports, Decedent’s Estates, Involuntary Comittment) ·      Estate Planning (Wills, Trusts, Medical Power & Financial Powers of Attorney) ·      End-of-Life Planning  (When to invoke Hospice, emergency Wills and Medical Power of Attorney, case-conferencing with medical staff) ·      Public Benefit Planning & Advocacy (Medicaid eligibility planning; Medicare advocacy: (a) maximizing the skilled nursing facility100 day benefit, (b) determining whether the hospitalized individual is under “observation” status versus “inpatient” status—a key in getting Medicare to pay for subsequent nursing home rehabilitation, (c) premature discharge from the hospital. Additionally, I am a Geriatric Care Manager.  Such a professional assess the proper level of care for a frail elder, answering questions like: “Is Mom safe at home?,” “Should more services be engaged?,” “Is it time to move Dad into a facility?,” “Which nursing home is best?,” “How do I evaluate assisted living facilities?”  The questions can be endless and relentless.  A Geriatric Care Manager is trained and experienced to guide you through the long-term care system—a very fragmented and ill-coordinated patchwork of facilities and services, to help you develop a proper plan of care.Being a combined Elder Law Attorney and Geriatric Care Manager allows me to better dovetail the legal plan as a function of the care plan.  Please contact me with any additional questions. Thanks!