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Isobel's Conditions

This is a true story.  Whilst all the facts are not available, and certain details are changed to protect those concerned, this is what happened on the face of it.  It was deeply concerning for the carer who was heartbroken for Isobel.  The carer asked us if there was anything that could be done to help people like Isobel.  Isobel's Conditions were developed to provide you with greater control and protection for you and your attorney.

Incapacity nor full time care is not inevitable, though it may be inevitable if we become very ill.  If we become ill with dementia for example, it can rob us of a great deal including recognising people but we still suffer anxiety, fear, anger, sadness and depression not to mention the capacity remains for laughter and joy.  We do not become inanimate objects without feelings and needs.  What we as individuals would like for ourselves in such situations varies immensely, and is utterly unique and incomprehensible at times but the point is, we can do as we wish.  We can have a certain degree of control and provide a certain degree of guidance and we can record it.  This can help ensure our best interests are considered.  Additionally, providing as much clear guidance as possible and recording information can prevent court proceedings, challenges and accusations saving everyone a lot of money, time and stress which is increasingly common.

You may also wish to give it some thought if a beneficiary should also be a sole attorney.  You may have more than one attorney.  You can choose whether the decisions are made jointly (ie they all have to agree or the decision cannot be made) or jointly and severally (ie individually) eve though there is more than one attorney. We can discuss to help you decide what is best for you.  The point which is being considered here is “What was best for Isobel?”.  What would you want for yourself in similar circumstances? 

​​​A set of questions have been devised that will form an additional document called Isobel’s Conditions to be attached to your Health Lasting Power of Attorney.  These can be developed so that your unique situation is covered.  All documents must be signed in the right date order so as not to invalidate the contents of any one of them.
You may well add guidance "that should any needs arise with your beneficiaries then please do organise to liquidate all the shares" for example and/or say, "but don’t remove me from my home unless there is medical necessity as deemed by a medical professional that is involved in my care" and have that recorded.  You may take a completely different view based on your personal circumstances and would prefer all of your estate to be dealt with by your attorney and move into some form of care , that you have previously chosen, paid for from the estate, should certain circumstances arise.  The point here is twofold:  a) that the choice is entirely yours and b) that you may record those wishes to ensure they are adhered to.   You don’t have to leave it all to chance and trust.

 

Record Your Wishes

Recording a set of questions, you can guide your Power of Attorney.  Isobel's Conditions may be built on to give guidance to an attorney that is unique to you and your wishes.  For example, an elderly in-law relative was extremely concerned that she was not a burden on her family so as to allow them to live their own lives to the full.  She sold her larger family home and acquired a sheltered accommodation flat in the nearby radius of her family.  Despite various health care needs including almost losing her sight and severe arthritis, she remained mentally competent and living at home with family and other support until her death.  However, the back up plan in the event she needed care was verbal and reliant on the family co-operating.  The family would discuss the following :  1)  going to live with one of daughters one of which had already cared for one of the fathers at his end of life  2)  the extent to which external care could be relied on (for example meals on wheels was already in operation) to enable her to stay in her home  3)  going into a care home  4) using the sale of the accommodation to ultimately pay for any required care.  (These kind of things can also be recorded in our Advanced Care Plan because they are not usually not written down).  It was lucky the daughters were both caring and working off the same page but a grandchild was not agreeing, although believing she was being helpful. The elderly relative had a wish to stay in her own home until she died and wanted to be transferred out of hospital if possible.  Again, this was not recorded anywhere, only something that one of daughter's knew of.  It became difficult when she had become ill and there wasn't agreement  about her being removed from hospital for her care.  She did not want more hospital care, she said she now wanted to be left alone, sent home and to die peacefully but the grandaughter was against it as well as one of the daughter's.  There was nothing written down anywhere.  She became increasingly distressed at the thought of more medical care and it was finally organised there be no more medical interventions.  She was greatly relieved but still wanted to go home, but it was not agreed.  No family member was aware of her right to die at home, no family member felt confident enough to take her out of hospital to her home.  Ultimately, each member of the family was invited by her to visit.  Once all journey's and visits were done, she quietly passed away in hospital.  Another story.  Whilst you may not always get 100% of your wishes, you will have a greater chance if you record and clearly indicate your wishes.   Carers and family members can have the heavy burden of decision making, often all believing they want what is best for you but do not agree. A Letter of Wishes, an Advanced Care Plan or a Living Will can also help with this.  This relieves the burden & disagreement is removed and in the end, your wishes were included as far as is possible. 

Isobel's Story

Isobel was an elderly lady who ended up living alone.  She had no children but did have nieces and a nephew.  She was wealthy in that she owned a substantial property on the coast and had a significant amount of savings, shares and investments.  Her estate was to be left to the nieces and nephews.  A nephew was made Power of Attorney for Health and Finance. 

 

Isobel developed dementia.  She wanted to stay in her house, be cared for and die there, she could well afford it.  This was not recorded anywhere although the nephew and nieces knew this and so did the full time carer.   A full time carer had been hired which the estate could easily afford and had worked with Isobel for at least two years.  As the dementia progressed the carer learned Isobel would only eat certain foods otherwise she would not eat and become distressed.  She would only do certain things to move around, for which she needed help, otherwise she did not move around.  Isobel liked to go outside when she could in the grounds of her wonderful house by the sea.  The nephew lived overseas so was not around to know the day to day care of his aunt.  Every now and then the nephew (with the Powers of Attorney) would visit the house but did not go into the room of his Aunt to see her any more.  The same full time carer remained looking after Isobel.  The full time carer became ill and had to go into hospital for three of four days.  She organised replacement cover with full instructions to care for Isobel until she returned a few days later.

 

During the carer’s absence the nephew went to his solicitor to exercise his right as Power of Attorney and within those three days had organised putting Isobel into a care home.  He wrote to the carer telling her that the family had decided that it was best Isobel went into a care home and that she was no longer needed.  The nephew no longer needed to wait for Isobel to die.  The house was sold, the estate liquidated and most of the assets distributed pre-death.  She remained in the care home for a further three years refusing to eat most of the food she was given, hardly ever moving out of her bed and reliant solely on seeing the care home staff. 

 

To the carer, it did not matter Isobel had dementia.  It was still Isobel, who would only eat her favourite food and who liked to be taken outside and follow a particular daily routine.  The estate could easily afford to keep Isobel’s care running at home and her needs were not specialised at the time such as to require specialist nursing care.   The caregiver was keen to ensure that she attended to Isobel’s wishes for as long as possible, ones that made her content during her end of life period but this was taken away from her and Isobel.   Anyone dealing with dementia patients will know how difficult it can be to learn about the patient and handle their behaviour and keep them calm and content.  In the end, Isobel may have needed specialist care, but it turned out this was not the case.  This carer asked if there was anything that could be done to help people like Isobel in future.

We have developed the Right to Die at Home plan, Isobel's Conditions, the Advanced Care Plan and better use of the Letter of Wishes as needed.  Our planning and forethought on behalf of our clients has been extensive.  We believe in our work and the meaning of the word professional. 

Be in control.  Be Certain

Trained by and Member of both Society of Wills Writers and Estate Planners & Society of  Mediators

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