The Oregon Caregiver FALL/WINTER 2023 www.ohca.com 14 LEGAL & REGULATORY Living Longer Means Women Need to Plan Ahead to Promote Quality of Life and Care By Eugenia Liu, J.D., Oregon Health Care Association It is no secret that women have been proven to live longer than men. The Centers for Disease Control and Prevention (CDC) reported that in 2021, the life expectancy for women was 79.1 years while the life expectancy for men was 73.2 years. Furthermore, the gap in life expectancy between men and women grew in 2021 to 5.9 years. When these numbers are viewed through the lens of senior living, this means that more than 70% of the resident population in assisted living and more than 60% of long-stay residents in nursing facilities are female. Yet, women still face barriers to aging, including lower wages or reliance on marriage for retirement or Social Security benefits, that lead to less financial security. For women, wellstructured end of life plans can help empower them to live their best lives as they age by giving them control over decisions around where they want to live, how they want to live, what type of care they want, and who makes decisions for them when they can no longer do so themselves. Health Care Decisions Living longer can certainly have its benefits, but it can also bring about tough questions and answers regarding the type of care, treatment, and services that an individual wants as they age. If an individual outlives their spouse, domestic partner, or significant other, then who makes and honors those decisions when that individual reaches a point where they no longer have the capacity to make those decisions for themselves? Providers often default to family members, but family members may not be the best choice if they have been estranged or hold different values and belief systems. What if there are five children but none of them can agree on a decision that honors that individual’s choice? Perhaps a best friend who has known the individual for years with a deeper understanding of the individual’s values, preferences, and choices would be better suited to step into that individual’s shoes. Planning for health care decisions may include the following: • Advance Directive for Health Care: An advance directive is a legal document that appoints a healthcare representative for an individual and provides instructions on the individual’s treatment goals and care preferences. Choosing a healthcare representative is a critical step to ensuring an individual’s wishes are honored because that representative is obligated to follow the preferences, wishes, and choices of the individual when making decisions on behalf of individual. It is important for an individual to share information about their life, values, wishes, and choices, including care setting preference, such as home, hospice, assisted living/ residential care, or a nursing facility, to help the healthcare representative make the right decisions. • Portable Order for Life-Sustaining Treatment (POLST): Unlike an advance directive, which is a legal document, a POLST is a medical order that outlines an individual’s wishes for treatment near the end of life. A POLST is used when an individual has a serious progressive or advanced disease near the end of their life, and it is completely voluntary. • Death with Dignity: Oregon allows terminally ill individuals to end their lives through the voluntary request for and self-administration of a lethal dose of medication. It is important to note that long term care settings are not required to participate in the death with dignity process and individuals may want to ask facilities about their death with dignity policies. Management of Financial Assets It is equally important to plan for the management of assets while one has the capacity to do so. Designating a trusted individual to make financial decisions can help mitigate the risk of financial abuse, which is typically perpetrated by someone close to the individual including friends, partners, and relatives. Financial power of attorney documents, wills, and trusts are all tools that can help individuals direct how assets should be used and/or distributed, including requests related to payments for care. Funeral and Post-Death Considerations End-of-life planning does not stop at managing health care decisions and assets up until death; there are also post-death considerations. Some wish to donate organs (or even whole bodies), some wish to be cremated, and yet others wish for a green compostable burial. While there are default rules in Oregon around who can make such decisions, such as a spouse, adult child, or parents, those default rules may not reflect an individual’s wishes, preferences, and choices. If an individual has specific wishes about the disposition of their remains, it is important to outline those wishes to make sure they are followed. End-of-life discussions and planning can be difficult and challenging, but a good life plan can promote smooth transitions between care settings and ensure an individual lives their best life on their terms. Eugenia Liu is the SVP and General Counsel at OHCA.
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