As we enter into the holiday season, I’ve invited my dear friend, Gabby Daikon, to share her experience with grief after losing her mother as a young adult. I met Gabby about a year ago through her grief journals and later joined her for virtual Yoga Nidra and “bad bitch” meditations. In a year that has been unpredictable, these practices have brought me comfort, and I hope her words will be a comfort to you.
Grief is all-consuming and yet different for every individual.
For me it felt like a fog, a fog that I knew was there but I couldn’t get to the other side of it. I hear that is what Seattle is like, I guess grief is like Seattle. I have never been but I hear it is beautiful but always cloudy. I think grief is similar in that it feels constantly dreary but also has a weird comfort and connection to the true essence of life. I am sorry if you live in Seattle and that offended you. I truthfully have no idea what Seattle is like.
Grief is a journey
My grief journey has been a bumpy ride, to say the least. I have struggled tremendously, found support, struggled again, learned to surrender and the ride keeps on going. I found that my biggest mistake was pretending to be OK. I held all of the burdens of my losses inside of myself and made myself sick. Truly sick.
Ride the waves
We run and hide from any negative emotions, but the more we tense and grip, the harder they hit. Instead, float on the tides. Let your emotions move you around without crashing over you; brutally. Wade into the fears, float with them, don’t judge yourself, and usually, you can come out without drowning.
Grief-positivity
My true healing began when I learned how to surrender to the pain, the grief, and all of the parts that make this life. It is so sad that grief is such a large part of life and yet rarely spoken about. I believe that when we begin to speak about it we can all heal and find the beauty in our journey.
Yoga Nidra provides a moment of reprieve
I found Yoga Nidra at a time when I truly needed it. I felt this constant pain of anxiety because I had this undercurrent of grief that I just could not truly access. Yoga Nidra was the first time I felt at peace for 45 minutes. I am not saying it healed me completely but it gave me a moment of reprieve and sometimes when we are deep in the grief journey that is all we can ask for. A moment of reprieve.
Yoga Nidra is a guided meditation
Yoga Nidra gives us the opportunity to float with the currents. During Yoga Nidra there are no moving postures, simply lie wherever you feel comfortable and allow yourself to feel supported. It is a guided meditation – you are not left alone with your thoughts, you are supported by the meditation. During this time you may be having trouble feeling rested, Yoga Nidra is equivalent to 3 ½ hours of deep REM sleep to the body. It also helps move energy through the subconscious mind and welcome what the mind needs to welcome without the tension and anxiety attached to it.
Yoga Nidra makes you an observer of the mind, an observer of grief, being able to welcome it without having it drown you. I invite you to just take a few deep breaths, allow what comes to come, and know that you can handle it.
Grief is personal
There are scientific benefits that I can list but the truth is that grief is not some scientific formula, we just have to do what we can to get through and for me, that was writing to my Mom and other loved ones when I truly needed her and Yoga Nidra. With the loss of a key family member there is so much more loss that people don’t speak about- like; the family dynamics, your personality, a self-identity, and so much more. So if you are deep in your grief all I can offer is my truest empathy and compassion because there are no magic words, it is just hard, and sometimes we just need people to understand how hard it is.
Use the promo code GALS to get a discount on one of Gabby’s services
Looking to reduce stress and anxiety? Improve your mental clarity? If so, consider adding Yoga Nidra to your wellness routine. Use the promo code “GALS” and you can get a discount on Gabby’s services.
For the month of November, we want to focus on caregivers. While family caregiving can be rewarding, it also takes a toll. Most family caregivers hope to add a professional service to their loved one’s support system, but figuring out how to do that is just one more thing to add to your already-full plate.
What types of care are there? Who provides these services? How much do they cost? What limits are there? How do I pick the right service for my family?
You’ve got the right questions, and Google is overwhelming. So we called in an expert. Our friend Perry Brown, President of our local Right at Home care team, was kind enough to provide us information about the types of care options available and the most common questions you may have. If you’d like to know more about Right at Home, we encourage you to check out their website here and sign up for their newsletter. If you are ready to talk to someone about in-home care, Perry and his team would be happy to help. You can reach them by phone at (615) 360-0006 or by email at info@rahnashville.net.
Let’s Look at Types of Care You May Want to Consider
When an older loved one or adult with a disability needs caring support at home, it can feel daunting to know which professional care services are best. Who can help with bathing and meals? Is a registered nurse needed for wound care? Can hospice care happen at home?
The Global Coalition on Aging and the Home Care Association of America state that almost 70% of Americans who turn age 65 will need assistance at some point to care for themselves. These senior care industry leaders also report that “already 40% of adults aged 65+ need assistance with daily living activities.” The fast-growing care needs of the country’s increasingly older population can leave care recipients and their families confused over in-home care options. The complexity of nonmedical and medical services available also may jeopardize a loved one from getting the timely and attentive care they need.
To help simplify the professional in-home care choices, Lorraine Grote Johnson, Director of Care Quality at Right at Home, a leading in-home care agency, notes that it is important to understand the differences between home care and home healthcare. Grote Johnson, a registered nurse for more than 35 years in both hospital and home settings, gives the following overview of common care services available in the home.
Home Care
In-home caregivers are the extra hand to provide personalized support to a loved one in their own familiar home surroundings. Home care can be part time, full time or live-in assistance ranging from light housekeeping and meal preparation to personal grooming and toileting. At-home caregivers can provide care services such as being a companion who helps write the grandchildren to driving the care client to medical appointments and to complete errands. Home care allows a loved one to stay safe and independent at home as long as possible. Grote Johnson points out that home care staff members are not legally allowed to take on skilled medical care such as dispensing medications and working with tube feedings. Most at-home caregiving services are covered through private pay.
Home Healthcare
Home healthcare is skilled nursing care that is prescribed and directed by a physician and supervised by a registered nurse. Home healthcare is suited for complex health issues that require a higher level of medical assistance, or when a loved one is recovering from an injury or recent illness. A professional skilled nursing team can accommodate a client’s numerous medical care situations such as monitoring vital signs, medication setup and management, dressing changes, and continence care.
“Generally, home healthcare is delivered by Medicare-certified companies and may include physical therapy, occupational therapy and speech therapy,” Grote Johnson said. “A registered nurse makes a care plan and supervises a home health aide who helps a client with activities of daily living such as bathing and dressing. The RN does supervisory visits in the home at least once every two weeks.”
Medicare and other health service providers that pay for home healthcare determine the number and length of nurse visits to the home. Private pay skilled nursing care has no limit on in-home service hours. Specialized palliative care and hospice care also fit within the realm of home healthcare.
Palliative Care
Palliative care is specialized support for people living with a serious illness or transitioning toward death. Palliative care focuses on pain relief, comfort and reduced stress for an ill loved one and balanced overall health for the patient and family members. Palliative care serves not only the dying but also those with chronic diseases such as cancer, congestive heart failure, kidney disease and Alzheimer’s. A specially trained palliative care team includes doctors, nurses, professional caregivers and other specialists who work together to improve the quality of life for the care client.
Hospice Care
Originating in Europe during the Middle Ages, hospice, which is derived from the Latin word for “hospitality,” is care that aids the critically ill and dying with medical, emotional and spiritual support. Hospice or end-of-life care is a type of palliative care, but the ailing person is no longer seeking curative treatment. The aim of hospice care is to extend comfort, peace and dignity to individuals in the dying process. Hospice programs also support a patient’s family with counseling and bereavement care. Hospice teams of doctors, nurses, social workers, chaplains and other caregivers provide care in patients’ homes or at a hospice center, hospital or in-patient care facility.
“Hospice typically serves a terminally ill person with a life expectancy of six months or less,” Grote Johnson explains. “In some cases, a hospice patient’s health improves to the point where the individual no longer needs the specialized care. Also, if a person starts to feel better, they may want to negate hospice and start receiving curative medical treatment again. At any point, a hospice client can change their mind about their care.”
Tips for Choosing At-Home Care
Because of the quickly expanding number of at-home services on the market today, Perry Brown, President Right at Home Nashville advises those in need of care and their families to consider the following tips for choosing at-home care:
Select services only from a professional, licensed agency. Make sure you see actual proof of certification and licensing for the agency.
Be certain that the caregiver who works with your loved one is insured and bonded.
Get a detailed care plan or treatment plan upfront. Ask about goals of the suggested services.
Review the caregiver’s qualifications, experience and amount of supervision on the job.
Discuss all financial costs and evaluate options for saving money on home care, including long-term care insurance, a reverse mortgage, Veterans Aid and Attendance benefits, etc. Reference Right at Home’s information on how to pay for home care.
For securing skilled nursing care and home healthcare, Grote Johnson offers additional suggestions. “Choose a company that knows and maintains federal and state regulations,” Grote Johnson advises. “Make sure the company does criminal background checks on their nurses and caregivers and verifies their licenses. Ask whether the nursing staff has gone through a thorough orientation and if they know infection control practices and what to do in emergencies. Also, make sure skilled nursing staff members have critical thinking skills and completed competency testing, and that home health nurses have the proper qualifications, because they are taking your loved one’s life into their hands in what could be life-or-death situations.”
Availability of qualified at-home services varies by locales across the country, so Brown recommends reviewing at-home agencies online, then visiting with the agencies in person. “Be sure to check references of the in-home agency candidates and their specific caregivers,” Brown explained. “Talk to others in the community who are familiar with the agencies and their reputations. In getting the best care possible for your loved one, every question and concern matters.” For additional information about choosing home care, home healthcare, palliative care or hospice care in your area, talk with local medical professionals for referrals, or contact the National Association for Home Care & Hospice, or use the U.S. Administration on Aging’s Eldercare Locator.
As we approach Halloween and Día de los Muertos, it seemed appropriate to get a little more matter-of-fact about deathcare resources. One end-of-life resource that we want to highlight is the option of engaging a “death doula” for those who are facing the end of their lives.
Our guest blogger this week is Ellen Abbott. We met Ellen in her role as Care Manager for Visionary Care Consultants but soon learned that we shared an interest in helping people through some of the most difficult transitions of life. Ellen completed her certification as a death doula in 2019, so we asked her to tell us more about what a death doula is and how they serve those at the end of their lives.
You may have heard recently about a “death doula” or an “end of life doula” and wondered who they are and what do they do? As a death doula myself, I’m happy to tell you!
What is a death doula?. We use midwives to educate and assist families to help bring babies into the world, why not have the same for those who are towards the end of their journey here?
There is a growing movement among end-of-life professionals in the United States to bring back the role of a non-medical person who stands in the gap between doctors, hospice, and the family of a dying loved one. This person guides the family and the client around the maze of the healthcare system, educates on hospice, offers practical information about death and provides emotional support around the entire process.
Who do death doulas serve?
A death doula serves the dying person as well as their loved ones. The goal of a death doula is to make sure that their client’s final wishes and needs are carried out before, during and after their death. This creates a healing and easier transition for the client and family.
When should a death doula be called?
You don’t have to have a terminal diagnosis to hire a death doula. There are some doulas who focus on helping their clients plan so that they know what they want at the end of life, and instructions on what the family needs to know to carry out those wishes. This is extremely helpful to the family and client since the topic of death and final wishes are not popular conversations in today’s world.
How do death doulas charge for their services?
Every death doula is different. Most offer free consultations and then an hourly rate of anywhere from $30-$100 an hour. Some offer packages for legacy planning along with being present for the client at the time of death. In middle Tennessee there is a Death Doula alliance, made up of local doulas that have been trained specifically for this role. They come from all backgrounds but usually from nursing, social work, counseling or clergy.
Over the last century, death has been viewed as a medical failure even though we all know one day we will die. A death doula helps to normalize these conversations and talk about these topics that no one wants to bring up. The death doula starts with the end in mind, to ease client’s fears, knowing they have a plan and someone at their side when the time comes.
After the US Supreme Court issued its decision in Dobbs on June 24, 2022, women’s equality and reproductive freedom were completely diminished by the state of Tennessee. How does the Dobbs decision impact estate planning? Here are some questions to consider:
Question: Will children born outside of my marriage have a claim to my estate?
Our opinion: Yes. Tennessee law dictates that Minors inherit from their parent’s estate.
How would a forced pregnancy affect a man who did not intend to become a parent?
We are not family law attorneys, and if you become aware of a pregnancy by a previous sexual partner, we encourage you to speak to an experienced family law attorney to discuss your options. Please keep in mind that many issues related to child support, pregnancy, and parental rights will be subject to new interpretations of the law under Dobbs.
However, there are laws in Tennessee that protect minor children from being disinherited by their parents.
For example, if a man dies, all of his minor children are able to inherit from him. While he can disinherit unknown, nonmarital adult children through his will, he cannot disinherit minors, even if he has a Will.
So let’s say a man lives in Tennessee and gets a sexual partner pregnant. If he dies while the child is a minor, the mother can petition (on behalf of the child) for a share of the estate. She will have to prove paternity but the child can be acknowledged in multiple ways. This includes communications with the father or testing the paternity via the DNA of the father or his other children.
Yes, you can be proven a father even after you are dead. It doesn’t matter if this child is born before or after the children of your current marriage or relationship- if they are under 18 when you die, they can ask the Court for a share of whatever you left behind.
Question: What is the impact of Dobbs on Estate Planning for those who expect to need fertility treatments?
Our opinion: We don’t know yet.
This is a really tricky area. My best guess is that matters related to artificial reproductive technologies (ART) will be legislated faster than before. We will know more about the impacts on individuals and families as matters work their way through the courts.
As your Estate Planning Attorney I will recommend that we plan for everything, including unborn children
If you’ve ever made an estate plan with an experienced estate planning attorney, you’ll know that we ask some pretty personal questions about your family planning.
That’s because we usually try to make our plans flexible enough so that future children can be included without needing to pay an attorney to update your Will or Trust. However, we will probably need to update documents more frequently given recent changes to the law.
Additionally, we will want to make sure that we try to be specific enough in our drafting to disinherit unplanned offspring from outside of relationships. The same goes for any previously frozen biological material that could potentially grow into a fetus. Yet another impact of Dobbs on estate planning to consider!
As fetal cells attain more rights, estate administration may become more difficult
As cells are legislated to have rights of their own, it will become more difficult to administer estates. For example, let’s say that a man dies after having frozen embryos with his ex-wife. By many state laws, those are now “children” under the legal definition. It would not be unfair for the ex-wife to say she is the mother of children who outlive him and should inherit his estate. If at some point those children were implanted-whether in the ex-wife or someone else- they would have needs as they grew older and the father’s assets could pass to them. However, it’s more likely that these cells would never be implanted or may be implanted but not be carried to term, at which point, who inherits from the embryo?
Question: What else should we be thinking about?
Our opinion: A lot of things will need to go through the Courts before we have final answers. In the meantime, here are some things I expect:
Higher insurance premiums
Higher medical bills
Fewer OB/GYNs
Fewer fertility clinics
More single fathers.
Push to create a biological/DNA database to track parents/putative parents.
Doctors will be unwilling or unable to provide appropriate medical treatment for women undergoing miscarriages. This will make undergoing fertility treatments especially dangerous if you have had problems carrying a pregnancy to term.
By effectively creating a system where there are two patients in one body, the law in many states now creates a conflict in the standard of care. The doctor will not be able to take direction from the pregnant person. This will cause more lawsuits against fertility specialists and other OB/GYNs. More lawsuits mean higher malpractice rates, which mean even higher costs for patients.
Many surrogates will no longer be willing to help couples create families.
Frozen embryos will no longer be intentionally destroyed.
Fertility clinics may become unwilling to create embryos for future use if they will be unable to destroy the biological material.
Many more babies will be available for adoption. So will older children.
Fewer women will consider using ART, because the inherent risks of pregnancy will no longer be treatable.
There will be fewer medical advances for difficult pregnancies due to women choosing not to have children.
Young adults will begin long-term contraception at earlier ages.
These are just some things I’m considering as we enter this new legal landscape.
In conclusion
The implications of the Dobbs decision is completely unknown. However, we do know that it will have a huge impact on Estate Planning. If you’re looking for an attorney in Nashville who can create a thorough will, look no further. Attorney April Harris Jackson will consider everything, including the implications of Dobss on family planning.
The stress of leaving home and becoming an adult can be difficult for anyone. It is especially tough for college students and young adults who have to face the uncertainty of their future. They have to support themselves and are going to gain the power to make decisions on their own, for better or worse. However, there are a few legal documents that they can get to make the transition easier.
What legal documents does every college student need?
TLDR;
Every college student needs powers of attorney for finances, powers of attorney for medical decisions, and an advance directive for healthcare. They should also fill out a FERPA waiver so that a parent or other trusted adult can access their student records (if needed). Not only are these documents practical in getting help with the big stuff, but they are a great lesson in what “adulting” is all about.
What is a “Power of Attorney” or POA?
A power of attorney is a legal document in which the principal (the person granting the power of attorney) grants another person (the agent) the power to act on their behalf. For example, an agent could help the principal make and carry out decisions about the student’s finances, health care, and other important matters.
In most cases, we create two types of powers of attorney- one for financial issues and one for medical issues. It is important to note that the college student needs to be the one who initiates and discusses their powers of attorney with a lawyer. A parent cannot create a power of attorney document for their child.
How to choose the best agent for powers of attorney
For most young adults, the parents are the trusted partners in making important decisions. Therefore choosing a parent as an agent for power of attorney makes sense for a college student. However, it’s important that the individual assigning the powers choose what is best for their situation. Here are some things to consider:
For medical powers of attorney – choose an agent who will be able to carry out the principal’s wishes
A college student should choose an agent who will be able to make medical decisions according to their personal preferences. Who do they want to have to communicate with the hospital in an emergency? Does that person support their values and would they be able to carry them out in the event of a difficult decision?
For example, when I was in my late 20s and in law school I prepared my first advance directive. When I tried to have a conversation with my parents about what I wanted for end-of-life care, it was unfathomable to them that I would want to discuss it. I also knew that based on my wishes, it would be very difficult emotionally, if not impossible, for my parents to honor my choices. For that reason, I selected my brother and best friend as my agents. In short, a college student needs an agent who can carry out their preferences for medical care.
For financial powers of attorney – choose a responsible and trustworthy agent
A financial power of attorney agent should be trustworthy. They need to be someone who is responsible for their own finances and will put the principal’s best interest above their own.
Anyone who chooses an untrustworthy agent would risk losing all of their savings. What’s to stop an agent from draining a bank account and running off to Fiji? While this is an extreme example, and there are legal remedies for someone who abuses their power like that, it is better to not have to deal with that happening.
What is an “Advance Directive” and why does a college student need one?
An advance directive is a written statement by a patient or their legal representative that outlines their wishes for medical treatment in the event of incapacity or death. Every college student should take the time to document their preferences for medical-related decisions.
For example: In a medical emergency does the individual want CPR if their heart stops? Do they want a ventilator if they cannot breathe on their own? What about a feeding tube or life support?
Although nobody wants to think of these scenarios, it is helpful to have these decisions spelled out. It’s stressful for friends and family to make these types of medical decisions.
I want to make it perfectly clear: Having an advance directive is important for everyone to have, no matter their age or health. It is also important to review advance directives through each stage of life. The treatments that we want at age 30 or 40 may not seem like such a great idea as we reach into our 90s or 100s.
What’s the difference between a power of attorney and an advance directive?
It’s easy to see why people confuse a power of attorney with an advance directive. So, what is the difference? A power of attorney grants an agent the ability to act on behalf of a principal, should they become incapacitated. An advance directive for healthcare, on the other hand, specifically addresses what someone wants if they are unable to make decisions for themselves. It is a written record of what to do (and not to do) in an emergency or end-of-life scenario.
When does a power of attorney or advance directive go into effect?
Financial POA
There is a lot of flexibility when it comes to the terms of a financial power of attorney. A limited power of attorney can go into effect when a specific event happens, such as incapacitation. There are also terms that make a power of attorney go into effect immediately. A qualified attorney can create a power of attorney to suit anyone’s situation.
Medical POA
When it comes to medical care, a healthcare provider will always make an attempt to communicate with the patient first. In the case of incapacity or impaired judgment, however, a doctor will communicate with the medical agent or refer to an advance directive instead. For example, let’s say a patient is in a coma or under anesthesia. The doctor will refer to a medical agent or advance directive when making a time-sensitive decision for their care.
*Click here to learn more about when a POA goes into effect.
Powers of attorney and advance directives are useful at any stage of life
Powers of attorney and advance directives are useful, no matter the age or stage of life a person is in. While most older adults have powers of attorney and advance directives in their estate plan, a younger adult could make use of them too! For example, a college student can give powers of attorney to their parents and create an advance directive just in case they need help. These legal documents can help the student navigate the essential functions of “adulting” like managing bills, health and property insurance, leases, and more. Additionally, in the event of a tragedy, a medical power of attorney will allow the parent to make decisions on the child’s behalf. This is why it’s important to have powers of attorney and advance directives in place, no matter the stage in life.
Hire an attorney to draft a power of attorney
Although there are forms online for creating powers of attorney, having a lawyer draft your document will ensure that it complies with all the legal requirements set forth by the state. Online forms can fall short of holding up in court. With an insufficient power of attorney, or a lack of one at all, a family may have to fight for their loved ones’ wishes in court. The process of going to court under these circumstances is painful, expensive, and time-consuming. Most people want to avoid putting this kind of stress on their families.
Anyone can make their own advance directive
While the subject matter is difficult to think about, the process of creating an advance directive is easy. Just download the form online and prepare it at home. There’s no need for an attorney. To make the advance directive legal, sign it in front of a notary or two witnesses. For your convenience, we’ve included a link to the Tennessee Advance Directive for Healthcare form here. As a courtesy to our clients, our firm will include the preparation of advance directives, along with a notary, as a part of the flat-rate estate planning package or the “Adulting Package”.
Ready for college?
In conclusion
Powers of attorney, advance directives for healthcare, and a FERPA waiver are documents that every college student should have. They are among the many important decisions a college student will make during their lifetime. It’s never too early to prepare for life’s unknowns.
GALS offers an ”Adulting” gift certificate for college students!
Looking for the perfect graduation gift? A gift certificate to our “Adulting” package is a great way to help prepare a young adult for life’s “what-ifs”. In addition to legal counseling, this package includes powers of attorney for finances, powers of attorney for medical care, a FERPA waiver, and an advance directive with a notary. Click here to buy your gift certificate. All you need is the name and email address of the recipient and we will take care of the rest!
Many of our Nashville elder law clients wish to remain in their own homes for as long as possible. With the advances in medications, treatments, and home healthcare options, more people are able to stay in their own homes. Whether you are looking for a home healthcare provider in Middle Tennessee for yourself or a loved one, here are some great guidelines to follow:
1. Determine what level of care is needed.
The level of care that you need is the most important determination when you want to hire a home healthcare provider. This factor will affect many other decisions. For example, are you or your loved one dealing with a specific ailment? If so, it may be preferable to choose a provider or agency with experience in that field. Additionally, do you need round-the-clock care, someone to come a few hours a day, or something else entirely? There are adult day programs that can provide an outlet for social activities and certain therapies. Adult day programs can be used on their own or in conjunction with a home healthcare provider. You may wish to ask your elder lawyer for a list of possible facilities in the greater Nashville area or you can access statewide resources on the Tennessee Department of Human Services website.
2. Understand the difference between Home Healthcare and In-Home Care.
Home healthcare is provided to those recovering from surgery or hospitalization, or those needing continuous medical care. These services include skilled nursing care, physical therapy, occupational therapy, speech therapy, and administration of medication. In-home care on the other hand provides ongoing non-medical assistance following illness or surgery or for chronic disease or disability.
3. Decide if you want to hire someone on your own or if you want to go through an agency.
There are advantages and disadvantages to both options. If you choose to do it on your own, you will likely have more say in who will be providing the direct care, as well as what services he or she will provide, but you will be responsible for handling payroll and taxes. On the other hand, an agency will be able to screen applicants thoroughly and can handle payroll and other paperwork for you.
4. Ascertain how you will pay for the home healthcare services.
An experienced elder attorney can point you toward various resources, depending on your needs. You or your loved one may have long-term care insurance set up for just this situation, or you may be looking to Medicare, Veterans Administration, and/or TennCare/Medicaid to assist with the costs. Medicare will only pay for home healthcare, but not in-home care.
One step at a time
Deciding to hire a home healthcare provider in Middle Tennessee is a big job. Break things down into manageable objectives and avoid becoming overwhelmed. At any point in the process, an experienced estate planning and elder law attorney in the Nashville area will be able to offer practical advice and suggestions. If you are unsure about what to do consider scheduling an hour-long Strategy Session and get legal advice from our attorney. We also have a planning tool called the “Care and Savings Assessment”. We use this tool to help our clients qualify for TennCare.
