Receiving a diagnosis is one of the key triggers that it is time to update your estate plan.  Parkinson’s disease is a progressive and unpredictable condition that affects each person differently.  You and your family need to be able to ensure that if you go through a prolonged period where you are incapacitated someone will be able to step into your shoes and manage your property and finances when you are unable to do so.  The most important documents that can be established to plan for your incapacity include Powers of Attorney, Health Care Directives, and a POLST.  

Power of Attorney

A Power of Attorney is a document that enables someone to make financial decisions on your behalf.  In Minnesota we have two different types of Powers of Attorney: a Statutory Short Form Power of Attorney and a Common Law Power of Attorney.  A Statutory Short Form Power of Attorney is a document created by the Minnesota legislature that is designed to be a “check the box” document for equal accessibility to all.  A Common Law Power of Attorney is a document that can be specifically drafted for you by an attorney.  This document has provisions that are specific to your goals.  

In the Power of Attorney you elect someone to be your “attorney-in-fact.”  Your attorney-in-face is the person who has access and control of your assets.  You can determine what powers you want to delegate to your attorney-in-fact; you can give them full control of your assets or you can outline specific items that you would like assistance with.  The Power of Attorney can be “durable,” meaning that it lasts through any period that you are incapacitated, which is what would be recommended for someone diagnosed with a potentially debilitating illness such as Parkinson’s disease.  If you are unable to manage your assets, it is important to ensure that the document would be durable so your attorney in fact would be able to continue to act.  You can also designate whether your attorney in fact has the ability to make gifts to themselves when they are acting for you, which may be prudent if the person is a spouse or child.  Lastly, you can provide provisions where your attorney in fact has to prepare an accounting, which is a detailed record of the transactions they have performed on your behalf.  This accounting could be provided to you or to someone that you designated in the Power of Attorney.  This can provide some oversight to the person acting for you – if your attorney in fact knows that they have to report their activities to you and/or someone else they will ensure they are always acting in your best interests. 

Health Care Directive and a POLST

A Health Care Directive and a POLST, which stands for “Provider Orders for Life-Sustaining Treatment,” are two documents that appoint someone to make health care decisions for you.  Unlike the Power of Attorney, which is typically effective upon signing, the Health Care Directive will usually provide that you are still responsible for your own decisions until a doctor has determined that you are not capable of decision-making.  If you are incapacitated, your Health Care agent has the ability to make decisions about where you live, what type of care you may receive, and what may happen with your remains upon your death.  Additionally, you can provide detailed instructions within your Health Care Directive to your agent and care team about what type of treatments you do or do not want to receive.  For example, a person with Parkinson’s disease may want to consider including instructions in their Health Care Directive for their agent about what type of care they would like to receive if they begin to experience dysphagia (difficulty swallowing) or cognitive issues.  These instructions may include identifying goals with artificial feeding and nutrition, care settings, and hospice or palliative care.  By identifying the factors that make your life worth living, you can provide direction to your agent within your Health Care Directive to enable them to make difficult decisions when you are not able to make those decisions yourself.

A POLST is a standing medical order on certain treatments, such as a Do Not Resuscitate (DNR) Order, Do Not Intubate (DNI), or orders regarding withholding of artificial nutrition and hydration.  This is a document designed for seriously ill individuals where health care providers expect imminent death.  This is a medical order that can be signed by a health care professional.  This can be a helpful document to add in later stages of the disease.  This can prevent receiving resuscitative treatment that first responders are required to provide absent a directive like a POLST.

Additionally, you want to ensure that upon your death your estate can be managed and transitioned to your heirs in the easiest and most efficient manner.  Typically this type of planning includes naming beneficiaries on your assets, executing a Will or establishing a Revocable Living Trust.  Which planning tool is appropriate for your family will depend on the type of assets you have, your specific family dynamics, and what your goals are both during your life and after your death.  A Will is a document that states who will be in charge of your estate after your death; in Minnesota this person is called your Personal Representative.  The Personal Representative’s job is to collect your assets, pay off your expenses and distribute your assets according to the instructions contained within your Will.  This process occurs through probate, which is a court proceeding.  A Revocable Living Trust is an alternate method of managing with your assets after your death.  Your Trust appoints a successor Trustee, which is the person who has control and access to the assets held by the Trust.  Similarly to the Will, a Trustee is responsible for gathering together the Trust assets, paying off expenses, and distributing the assets according to the terms of your Trust.  The difference with a Trust is that there is no probate court proceeding.  Additionally, while a Will only controls your assets after your death, a Trust controls your assets during your life.  This can be helpful for incapacity planning – you can act as Trustee during your life, and if you are incapacitated, the successor Trustee you choose can step in to manage your assets when you cannot.  

It is important to get these documents in place early in your diagnosis.  By acting early, you will alleviate any concerns about what would happen if you lost capacity or died suddenly.  Knowing that your estate plan has been taken care of can give you greater peace of mind – you have taken the burden off of yourself and your family and spend your energies living your life.