Living Will Registries -- Worthwhile Eldercare Services

Photo by Patrick W. Moore

My mother, who lives in Washington State, recently updated her estate planning documents including her will, her financial and healthcare powers of attorney, and her advance medical directive.  As a part of the package of documents, her attorney included information on the Washington State Living Will Registry.

I’d never heard of a Living Will Registry, but based on what I’ve learned it’s a great idea and a great service that Washington State provides to it’s citizens -- elderly and otherwise.  The Registry provides a central repository for citizens to deposit copies of their advance medical directive and healthcare power of attorney and it also stores information about emergency points of contact.  When you deposit your healthcare documents with the Registry, you receive a wallet card and stickers to affix to your driver’s license and insurance card.  Medical facilities throughout Washington State will look for that wallet card and stickers if they provide you with emergency treatment, and your doctors will be able to retrieve your emergency contact information and your guidance concerning treatment from the Registry.

If you’re the victim of a medical emergency, your emergency contact information and your wishes for care will be available to the doctors treating you.  Your loved ones can be notified quickly about the emergency and your doctors can begin treatment in accordance with your wishes.  Your doctors will not have to ask your loved ones if you have an advance medical directive, and your loved ones will not have to search for a copy to bring to the hospital if you do have one.  Your doctors will always have your most up-to-date guidance concerning care.

So far there are living will registries in three states -- Washington, Vermont, and Nevada.  The US Living Will Registry also provides services through a number of healthcare networks in other states, and you can always just register as an individual with the US Living Will Registry for only $125 for a lifetime membership.  Whether you take advantage of this service through your state, through your healthcare network, or as an individual, the Registry provides a vital service to ensure that you receive healthcare according to your wishes.

Extreme Solutions for Long Term Care

The American Association of Retired Persons magazine recently carried an excellent article describing the expense associated with long-term-care and the extreme measures some people have to take to provide that care to their loved ones.  This blog post describes the article and discusses some solutions to the problem.


Many people do not know that Medicare only covers a total of 100 days of skilled nursing home care and rehab.  When that coverage ends,  nursing home care is paid from your own pocket if you don't have long-term-care insurance.  For the couple profiled in the article, nursing home expenses of $7,500 a month, plus miscellaneous expenses drained their savings of $75,000 over the eight months after Medicare payments ran out.  In order to avoid financial ruin, the couple got a divorce and Medicaid took over the nursing home payments after the institutionalized ex-husband became indigent.  Other couples will try to preserve life savings by having one spouse file papers refusing to pay for an institutionalized spouse.  Without resources, the institutionalized spouse quickly becomes indigent and is provided Medicaid care.


Generally, if a nursing home patient is married, spending down assets to qualify for Medicaid often means that the healthy spouse is left with insufficient assets to live in retirement.  Medicaid only pays for nursing home care after an individual has spent down his or her assets, except for a nominal amount, usually $2,000.  The non-institutionalized spouse can keep the couple's home, but just half their savings.  Transferring assets to the children is not an option because Medicaid looks for gifts the patient made within a five-year period before applying for Medicaid assistance and then denies coverage for the number of months that those gifted funds could have paid for.


Some point to the huge cost of Medicaid, $333.2B in 2007 and charge that those who get divorces or file papers refusing to pay are gaming the system and avoiding their responsibilities.  Other experts point out that Medicaid and Medicare don't do enough to help people stay in their homes and avoid expensive nursing home care.  According to James Firman, CEO of the National Council on Aging, "powerful state nursing home lobbies make it very difficult to break the institutional bias in Medicaid."  AARP research shows that 90% of Americans prefer to remain in their homes as they age.


The Community Living Assistance Services and Support (CLASS) Act was passed as part of health care reform in March, and it would essentially set up a government-run insurance program to help pay for long-term care in the home or elsewhere.  The program will collect premiums from all working Americans who don't opt out, and after five years these participants would be eligible for modest cash payments that could be used to help pay for in-home care.  An analysis of the CLASS Act in the Washington Times concluded that although the program would work for awhile, by 2021 the premiums would be insufficient to provide the promised benefits and the program would be insolvent.  Only time will tell if the CLASS Act is a solution or a disaster.