Archive for April, 2009

What is Incapacity?

Thursday, April 30th, 2009

Have you ever wondered what would happen if you became incapacitated? Incapacity, or incompetency, means that you become either mentally or physically unable to take care of yourself or your day-to-day affairs. To be more precise, you would be unable to take care of your property and yourself and you would be unable to communicate rationally about decisions as to how to do this if you cannot.

Incapacity is a result from serious physical injury, mental or physical illness, mental disability, advanced age and/or alcohol or drug abuse. Although medical science has increased life expectancies, it also has increased the possibility that you will live long enough to become incapacitated. Old age can bring senility, Alzheimer’s disease, or simply the waning of an ability to make a quick and/or rational decision.

Unless you have authorized someone to carry on your affairs in the event of your incapacity, a relative or friend may need to ask the court to appoint a guardian. While you might think that you are years away from becoming incapacitated, an unforeseen accident and a coma can put you in that situation at any time.

When you do not authorize someone to make decisions for you if you become incapacitated, your medical care providers are obligated to prolong your life, even with artificial means, for as long as you respond to such care. In the situation of a coma, you could remain in an incapacitated state for years. Such a decision can devastate your estate, monies that you may rather see go to someone you care about.

If you really want to protect your family and your estate, you would plan now to appoint someone to manage your estate. You might also look into four common incapacity documents. If you make these decisions now, you can avoid a court-appointed guardian that you may not know nor trust.

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Changing the Language of Death

Monday, April 27th, 2009

With the waxing popularity of hospice care for end-of-lfe support and health care, many hospitals, hospice or palliative care services and nursing homes are changing the language of death. In one specific incident, this language has changed from one of a negative connotation with a harsh reality to that of a positive tone and a natural process.

For years, do not resuscitate, or DNR, has been the designation for not prolonging life when a person’s heart stops beating or breathing stops. A new designation, allow natural death, or AND, is becoming the preferred term among some entities, including several hospitals within Lutheran Health Network.

Proponents of the AND designation say it creates for patients and medical staff a more positive approach. It is about what is allowed to occur as opposed to what is not to be done.

Sister Carole Langhauser, vice president of Mission Integration at St. Joseph Hospital. St. Joseph and Dupont Hospitals stated that this change is more than semantics – it’s a philosophy. After all, not one person escapes death, so why make it a negative experience for the dying and their loved ones?

Langhauser said physicians are embracing AND over DNR. A 2004 Hastings Center Report compared real-life accounts of two families dealing with end-of-life decisions. The family that was offered the option of signing DNR for a loved one in the event of cardiac arrest became upset and agitated. Another family facing the same dilemma but who was given the “allow natural death” option reported a better understanding of the option and the fact their loved one would be appropriately cared for.

If you’ve thought about your own death, how do you feel about the DNR? Would you want to put that onus on someone else if you were incapable of making a decision? Or, would you rather die a natural death in words, with those words imparting a philosophy to your loved ones that death is a natural part of life?

Either way, it’s the same process. The only difference is how it is worded.

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New Pediatric Standards of Care for Hospices

Thursday, April 23rd, 2009

More than 1,600 hospice and palliative care leaders, managers and industry experts gathered in Washington, DC this week to discuss issues involving healthcare reform.

“Almost 30 percent of Medicare costs are for care provided during patients’ last year of life, with an estimated 30 percent of that figure covering costs in the last month of life,” said J. Donald Schumacher, president and CEO of the National Hospice and Palliative Care Organization (NHPCO). “We are raising awareness of the important role hospice and palliative care should play in current debates on healthcare reform.”

While many people think of hospice care primarily for elderly persons at the end of life – 66 percent of hospice patients are over the age of 75, reports NHPCO – care for children and families facing serious illness and death also figured prominently at the National Hospice and Palliative Care Organization’s 24th Management and Leadership Conference. The group released its first set of national standards for pediatric palliative and hospice care at the opening plenary session at the Omni-Shoreham Hotel.

The Standards of Practice for Pediatric Palliative Care and Hospice was developed by NHPCO and members of the Children’s Project for Palliative/Hospice Services. The goal is to help hospice and palliative care providers develop safe, effective, and high-quality programming for children and their families facing serious and life-limiting illness.

On Wednesday, more than 400 hospice advocates went to Capitol Hill and met with legislators to emphasize the need to protect hospice reimbursement and promote access to high-quality end-of-life care for all patients and family caregivers.

“We know that hospice gives Americans the care and support they want at the end of life, and we know that hospice provides cost savings to Medicare for each beneficiary that takes advantage of hospice care. Hospice is part of the solution for healthcare reform in this country,” Schumacher noted.

Facts and figures on pediatric care and more information on the new pediatric standards is available at www.nhpco.org/pediatrics. NHPCO members may download the pediatric standards from the site free of charge. Others may purchase the pediatric standards from NHPCO’s Marketplace at 1-800-646-6460. Consumer information about hospice and palliative care is available at NHPCO’s Caring Connections Web site, www.caringinfo.org.

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Your Body for Some Land

Monday, April 20th, 2009

Let children walk with Nature, let them see the beautiful blendings and communions of death and life, their joyous inseparable unity, as taught in woods and meadows, plains and mountains and streams of our blessed star, and they will learn that death is stingless indeed, and as beautiful as life. ~ John Muir

Green funerals are becoming more popular, and not just because they’re environmentally sound. They’re also less expensive in most cases. But now the living can make a decision to become one with nature in death with a plan to increase land for the Texas Parks and Wildlife Department.

Ted Hollingsworth, the agency’s director of land conservation, said. “If tens of thousands of people want to take advantage of this opportunity annually, it could easily double the rate at which we’re adding lands to state parks.”

This news article states that a new embalming fluid will be introduced this month that also is environmentally-friendly, and that cremation services are working to lower the pollution levels. Additionally, shrouds and cardboard caskets are becoming more popular, as people choose cremation as their death care option.

But, in Texas, the Parks service is going one step further by seeking to offer land for ash-scattering in exchange for a small fee. The Texas division plans to become the first government agency in the United States to let families lay cremated remains in protected forests for a fee to help the state buy more land for conservation.

If you truly want to be part of nature’s plan when you die, Texas may have the solution. If you don’t want to end up in Texas, you might have the option in the future to become one with a man-made reef located about three miles off Key Biscayne. Prices will depend on whether ashes are placed in “premium” or “standard” locations 40 feet below the surface. Both plans are the ultimate in “life after life” options.

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Uneasy About Embalming

Thursday, April 16th, 2009

Embalming, as an art and a practice, began in ancient Egypt as mummification, and has grown throughout the centuries to become a necessity at times, a blasphemy to some and a horror to others. Embalming, in most modern cultures, is the art and science of temporarily preserving human remains to forestall decomposition and to make them suitable for display at a funeral. According to Wikipedia:

“Contemporary embalming methods advanced markedly during the American Civil War, which once again involved many servicemen dying far from home, and their family wishing them returned for local burial. Dr. Thomas Holmes received a commission from the Army Medical Corps to embalm the corpses of dead Union officers to return to their families. Military authorities also permitted private embalmers to work in military-controlled areas.”

While the Wikipedia entry marks the American Civil War as a time of great advancement in embalming, this practice still had a long way to go. Arsenic often was used as embalming fluid, which was later found to contaminate groundwater. And, it wasn’t until 1867, two years after the end of that war, that the German chemist August Wilhelm von Hofmann discovered formaldehyde, whose preservative properties were soon discovered and which became the foundation for modern methods of embalming.

In fact, embalmers often had a nasty reputation among northerners and southerners during the American Civil War. The following account is from the book, This Republic of Suffering: Death and the American Civil War,” by Drew Gilpin Faust:

The U.S. Army was deluged with anguished protests from families of dead soldiers who believed they had been cheated by embalmers operating near the battlefront. An officer at City Point, Virginia, protested to Inspector James A. Hardie in 1864 that “scarcely a week passes that I do not receive complaints against one or another of these embalmers…[They] are regarded by the medical department of the army generally as an unmitigated nuisance…the whole systems as practiced here is one of pretension, swindling, and extortion.” In 1863, a case was lodged against Hutton & Williams, “EMBALMERS OF THE DEAD” in Washington. Hutton was imprisoned and the company’s records were seized. The suit alleged that the pair regularly recovered and embalmed soldiers without permission and then demanded payment from grieving families, threatening to disinter or refuse to return the bodies of their conditions were not met.

In the fall of 1864 Timothy Dwight of New York pursued a grievance with secretary of war Stanton against Dr. Richard Burr, a prominent Washington embalmer, claiming that Burr was guilty of extortion for preying upon him in his distress after “the loss of a most excellent Boy.” Burr defended his fee of one hundred dollars to the provost marshal, saying his employees has risked their lives recovering the body from near the picket line and then carrying it several hundred yards under fire. He had then disinfected the body “by means of my embalming fluid and charcoal” and enclosed it in a zinc coffin, sealed it, and shipped it – clearly warranting, he insisted, his charges. On January 9, 1865, General Ulysses Grant responded to the chorus of grievances by withdrawing all embalmers’ permits and ordering them beyond the lines. The distances separating the dead and their loved ones nevertheless continued to encourage embalming, in spite of great uneasiness about the practice and widespread hostility toward its practitioners.

If you feel uneasy about embalming, remember this: Regardless of whether embalming is performed, the type of burial or entombment, and the materials used – such as wood or metal caskets and vaults – the body of the deceased eventually decomposes. Modern embalming is done to delay decomposition so that funeral services may take place or for the purpose of shipping the remains to a distant place for disposition. Many states do not require embalming to take place if the body is not traveling a long distance, but the body must be buried within a certain time frame if you decide to bypass this process.

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Posted in Death & Dying, Funeral Arrangements, History of Funerals, Traditions | 2 Comments »

The Beneficiary’s Guide to Life Insurance

Monday, April 13th, 2009

If you become the beneficiary of a life insurance policy, you must file a claim to receive any money. This task could be as simple is contacting an insurance agent and filing some paperwork. But, if this is all you do, you may eventually discover that you have missed out on other benefits to which you are entitled. If you spend time finding hidden policies, you may uncover more money than you expected.

For instance, your spouse or family member may have owned one or more permanent (whole life) or term life insurance policies. The first place to look is in a safety deposit box, where unknown policies might lie with other important papers. Some of these policies often are found within credit card statements. Although most of these policies are not large, you may find enough to pay for that funeral or to pay off several bills. If you’re not sure if your spouse or family member owned a policy and your agent can’t find one, you can contact the American Council of Life Insurance (ACLI). Its members can do a free search for you.

If you feel your loved one carried a group policy through work, you might then look for a certificate of insurance as proof. Look for these certificates in your spouse’s or family member’s personal papers, files, and safety-deposit box, if you can access it. You also can check with your spouse’s or family member’s employer, bank, or credit agency, or study loan paperwork or purchase contracts. Read the following sections for a list of types of group policies your spouse or family member may have owned.

The types of policies you might seek include:

  • Employer-based group life insurance
  • Accidental death and dismemberment policy
  • Travel accident insurance
  • Mortgage life insurance
  • Credit life insurance

When your spouse or a loved one has died, you should notify his or her life insurance company as soon as possible. Usually, you can call the insurance company’s policyholder services department directly, or if the life insurance policy was issued through an agent or an employer, you can ask them to notify the company for you to begin the claims process.

The steps to take to claim the insurance funds include:

  • Filing a claim and signing a proof of death form (be sure to have several copies of a death certificate for this process).
  • You may also need to fill out a Form W-9 (Request for Taxpayer Identification Number and Certification), which enables the insurance company to notify the Internal Revenue Service about any interest paid to you on the policy value.
  • Wait for the company to process the claim, which could take mere days or several weeks.
  • Receive the life insurance proceeds, which often are paid as lump-sum cash payments. If you elect to receive a lump-sum payment, you generally will not owe income tax on the life insurance proceeds that you receive as a beneficiary.
  • Other settlement options are available. It is best to talk with your insurance agent now, before something happens to you, to make arrangements for other options. Talk with your spouse, your kids and your loved ones to make sure they are insured. If they are, then talk with them about making a will. Preparations such as these are not easy for some people to accomplish, but they make life easier for those who are left behind.

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Cost Factors for Hardwood Caskets

Thursday, April 9th, 2009

Wood caskets have been around for a long time, and many wood caskets make some funerals an environmental affair. The amount of benefit to the environment, however, would depend upon whether the casket was placed in a vault or not. Wood caskets are ideal for cremation when the crematory requires the body to be encased in a rigid container.If you think you’d like to purchase a hardwood casket, there are several factors you might consider. These issues will determine the cost of your casket:

Lumber Cost: Main labor costs are harvesting and milling the lumber. And, if you choose a wood that is not native to America, you will need to factor transportation costs. Mahogany, for instance, comes from Eastern Africa, not from New Jersey. Some scarcer woods, such as walnut, also will add to the cost of a casket. Take into consideration the grade of lumber, as the higher the grade, the higher the cost.

Wood Thickness: Caskets usually vary in thickness from four quarters to twelve quarters. Most caskets are four quarters thick and higher-end caskets tend to be the thickest. If you’re not familiar with a “quarter,” it equals one-quarter inch.

Shell Design and Corners: The shell design of a casket means the outer hardwood ’shell’ of the container. There are many shell designs to choose from, ranging from very plain to very ornate. The latter include roping, carved molding and intricate corners. Corners, in some cases, are priced separately. The more ornate a shell and its corners, the more expensive the pricetag.

Finish: The highest-valued finish on a hardwood casket is the hand-rubbed or -polished finish that is glossy and that highlights the wood’s beauty. Other finishes include satin and gloss.

Interiors: The fancier the casket interior, the higher the price. Fabrics such as crepe, velour, linen and velvet are used. The least expensive fabric often is velvet, whicl the most expensive is satin. Additionally, styles can add to the cost. Styles include ruffled, tufted or tailored interiors with a variety of colors to choose from.

Hardware: Hardware on caskets includes lugs, arms, bars and bar tips. These features support weight, but they also are decorative. The material, design and finish all contribute to the cost of a casket. Plating for metal parts tends to be pricey. Painted finishes may be the least expensive.

Features: Caskets can come with special features. The more features in a casket, the higher the price. For instance, some caskets may feature a “Memory Drawer,” a drawer built into the casket to hold small personal items to accompany the deceased.

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How to Cope with Senseless Violence

Monday, April 6th, 2009

“In every age man faces a pervasive theme which defies his engagement and yet must be engaged. In Freud’s day it was sexuality and moralism. Now it is unlimited technological violence and absurd death. We do well to name the threat and to analyze its components. But our need is to go further, to create new psychic and social forms to enable us to reclaim not only our technologies, but our very imaginations, in the service of the continuity of life.” ~ Robert Jay Lifton

A lone gunman killed at least 12 people and himself this past Friday at an immigration services center in Binghamton, New York. This is just one of many disasters that seems to affect anyone who reads about senseless violence. Other stories over the past few years include what is now known as the Virginia Tech Massacre, last year’s terrorist attacks in Mumbai and the recent arson fires in Australia. How do you cope with your feelings when you read about lives lost through seemingly senseless violence?

Robert Lifton, a psychiatrist, once stated that we are all survivors of Hiroshima. This statement meant that – as readers of stories about disasters – you are the survivor who must face your feelings about senseless deaths (see more about Survivor Syndrome). Therefore, readers must deal with the stages of grief and the guilt that comes with being a person who managed to survive yet another tragedy. But, feelings vary depending upon whether the reader connects with the story or not.

As one researcher put it:

Focus groups to date have indicated that individuals identify with family members when they see disasters on media. Many individuals resent the questions that media personnel direct to family members. Some people report they are “kept awake” by this coverage, that they have nightmares, that they have stopped watching TV news as a result. Age diff erences seem to emerge, with some older individuals being quite practical in thinking that death is not far from them anyway. Many people speak of shock and disbelief when they first hear of a major disaster through the media. They then think about themselves: “That could have been me.”

How to Cope

One way to help dispel some feelings of guilt and grief includes discussion with others. One sociologist has studied how social networking plays a role during disasters, beginning with the shooting at Virginia Polytechnic Institute when a student killed 32 other students and professors and then turned the gun on himself.

“Social networking tools allow people to instantly share their grief, says Jeannette Sutton of the University of Colorado’s Natural Hazards Center. “What more can you do when there’s this kind of destruction of human beings other than saying, ‘I care and I am sad,’” said Sutton.

Another way to deal with raw feelings is to recognize the five stages of grief. Once you realize where you stand in this hierarchy, you might be able to cope better with your sense of sadness, anger and depression. If you find that you are dealing with lower motivation and morale, feelings of guilt, flashbacks or nightmares, you may want to seek help from a professional grief counselor. You might find a local counselor through the Center for Grief Recovery.

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Medicare Part A and Hospice Care

Thursday, April 2nd, 2009

Medicare Part A is the portion of Medicare that is available premium-free to all eligible individuals. This part of Medicare benefits provides services associated with hospital, hospice, skilled nursing care and home health care. While you may have read that Medicare Part A covers all costs incurred with hospice, or palliative, care, this is not the case when it comes to custodial care.

Medicare does not cover care that is or becomes primarily custodial, such as assistance with bathing and eating.

Hospice care is death-care for a terminally-ill person, and Medicare Part A provides comprehensive coverage, at home, for symptom management and pain control. In other words, Medicare Part A will not cover custodial care, but it does cover symptom management and pain control. And, several criteria must be met before coverage is allowed as well:

  • The health-care provider must be certified by Medicare to provide hospice care
  • The patient’s doctor and the hospice care director must certify that the patient is terminally ill (i.e., has a life expectancy of six months or less)
  • The patient must elect hospice coverage for the terminal illness instead of standard Medicare benefits, although Medicare will continue to cover care provided that it is not related to the terminal illness
  • Services include nursing care, medical appliances and supplies, prescriptions, home health aide and homemaker services, medical social services, and counseling

If family members need a respite from custodial care, the family – or the patient – is responsible for that cost. The hospice may arrange for the hospice patient to be moved to an inpatient facility for up to five days at a time to provide respite to the hospice care personnel and the family. In this case, the Medicare beneficiary may be charged a nominal daily fee for the inpatient care.

When you interview a hospice service to learn about their program, ask them your questions about Medicare Part A. A professional service is experienced with this benefit and can answer your questions in detail.

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