Bob Carlson

Blues singer Etta James (of “At Last” fame) is in poor physical and mental health these days. Fortunately she has enough money to pay for round the clock at home care. Unfortunately, there’s a dispute between her son and her husband over controlling the money. The son says he has a power of attorney. The husband says she was in poor mental condition when she signed the document. It’s all in court now, and in the media.

The rift began last November when Mills, James’ husband of 41 years and tour manager, filed a petition to gain access to three of the singer’s bank accounts, estimated to total around $1 million. He said he needed to pay for her business affairs and mounting medical bills. Mills says he spends around $30,000 a month for private medical care, which includes two full-time nurses and a round-the-clock doctor.

The following month, James’ son Donto, a bassist in his mother’s band, filed legal papers asking the court to grant him conservatorship of his mother’s estate. He also asked that the court appoint an independent administrator to handle her finances. There has been no mention of a living will.

Donto, who is Mills’ stepson, also questioned whether his mother is getting proper care by her $20,000-a-month live-in doctor, Dr. Elaine James.

“There are a lot of allegations flying everywhere,” said Sandoval.

This kind of dispute not only wastes a lot of money but diminishes the dignity and legacy of Ms. James. These types of things easily can be avoided by having a complete estate plan prepared when you have no expectation of needing it and updating it regularly. A complete plan includes a financial power of attorney, health care documents (living will, health care power of attorney), and of course a will and any other necessary documents.

Last week newly-issued Medicare regulations said doctors would be compensated for time spent discussing with patients end-of-life medical treatment options and preferences. The provision was not included in a proposed version of the regulations issued last July, and thus avoided the public comment period. Some critics believed the provision was snuck into the final version to avoid public discussion. The government said it was withdrawing that section of the regulations because the public did not have an adequate opportunity to comment. You’ll still be able to discuss the issue with your physician, and it is covered in the initial Welcome to Medicare physical exam. Here are a few passages from The Washington Post coverage of the move:

The decision is not likely to have much effect on patients and doctors already discussing options for care in the last stages of life. For example, voluntary end-of-life planning is covered as part of the “Welcome to Medicare” doctor visit, available to seniors within the first year of joining the program.

Discussions about how to face the end of life are an accepted part of care for someone with a terminal illness, and the administration’s reversal is unlikely to have much effect on that. Long-standing federal rules require hospital patients to be informed of their right to spell out in a living will or similar document their wishes about being kept alive by artificial means if there is no hope of a cure.

However, many doctors and public health advocates say the government should take a more direct role in encouraging people to plan ahead. They say it would save families the ordeal of having to make agonizing decisions when a loved one is incapacitated.

Opponents counter that such decisions are highly personal and that government should stay out. They worry that explicitly including end-of-life counseling in Medicare rules could send an indirect message that people facing serious illness should be nudged toward hospice care, giving up on seeking a cure.

The government quietly issued regulations just before Christmas providing that Medicare starting Jan. 1, 2011 will pay doctors for time spent advising patients in developing Advance Medical Directives and in end-of-life medical care issues. The 2010 health care reform law provided that Medicare beneficiaries will be covered for an annual physical. Previously only one welcome-to-Medicare physical was fully covered. The new regulations provide that advance medical planning and end-of-life advising will be covered as part of that annual physical. We’ve long advised that a complete estate plan include medical care documents such as a medical power of attorney, an advanced directive, and a living will or similar documents. The new regulation doesn’t pay for an attorney’s fees to help prepare the document. Instead it pays the doctor for time spent discussing the issues such as the care a patient might want under certain circumstances.