Free Knocking on Heaven's Door: The Path to a Better Way of Death by Katy Butler

for
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    knocking on heaven’s door
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    the crispest green apples and freshest red oak lettuce—for an
    expensive, overheated shoe box of an apartment, with over-
    cooked food, in what she called a “hen house.” But she was
    terrified of running out of money and of disasters she couldn’t
    foresee and exhausted by maintaining the house and its acre of
    trees and grounds while taking care of my declining father. To
    my dismay, she’d already had a real estate agent in to price the
    house. Our family had lost so much; I did not want to lose that
    house as well—that island of beauty and order, that reminder of
    the life my brothers and I had once lived.
    Armed with a referral from the catastrophe doctor, I drove my
    parents to West Hartford to meet a new lawyer, this one a pio-
    neer in a specialty called “elder law.” He was a ferrety little man
    in his forties with a straw moustache. His own father had been
    struck by Alzheimer’s disease in his late fifties. By the time the
    old man died in a nursing home, there was nothing left for his
    widow or children.
    The lawyer sat us down at a blond conference table and told
    my parents to transfer all the mutual funds they held outside
    their IRAs into my name. If my father had to enter a nursing
    home, we would first “spend down” their IRAs. Then Medicaid,
    the program intended for the poor, would pick up his bills, just
    as it covers 45 percent of the more than $137 billion that the
    nation spends annually on long-term care. If my parents didn’t
    sequester some money, the lawyer said, my mother would risk
    what he called “spousal impoverishment.” Medicaid would not
    cover my father’s nursing care until they spent down most of
    their assets.
    If, on the other hand, some money was moved promptly into
    my name, that money could be used to pay for my mother’s care
    when she got frail, and perhaps even for an inheritance for my
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    katy butler
    brothers and me. The scheme, I hoped, would give my mother a
    backup plan and stop her stampede toward assisted living. She
    could stay in the house that felt like an anchor to us, hire more
    help, and manage on her own.
    “Do it now,” the lawyer said, fingering his moustache.
    Changes in the law were afoot to make what we were contem-
    plating more difficult. Technically, the scheme was not illegal:
    parents transfer assets to adult children legitimately all the time,
    and as long as my father needed no Medicaid help for at least
    three years (since extended to five) nobody would scrutinize the
    financial transfer.
    It was the sort of thing my father, when he could speak,
    would have called “sharp practice.” He sat in a chair, a compli-
    ant, voiceless witness.
    The lawyer laid out a sheaf of documents for us to sign: far
    more extensive (and expensive) than the living wills and “durable
    power of attorney for health care” documents they’d signed years
    earlier. First came updated wills and new “advanced directives”
    declaring that they wanted no life-sustaining treatment if they
    were in comas or likely to die within six months. (The documents
    said nothing, I’d later realize, about dementia or tiny internalized
    life-support devices like pacemakers.) Then came new “durable
    power of attorney for health care” forms, giving my mother and
    me the authority to make my father’s medical decisions when, in
    the sole opinion of the family doctor, he could no longer make
    his own. Finally, there were documents entrusting me with my
    mother’s medical guardianship, power-of-attorney forms giving
    my mother and me free rein over my father’s financial affairs, and
    similar ones giving me comparable authority regarding my mother.
    My mother showed my father where to sign, and in his new,
    oddly miniaturized and rickety hand, he did. He’d been the
    family money manager and the ballast to my mother’s