DYING, ILLNESS, AND AGING WITH GRACE

A headings-only version of a helpful document (see links for more info below)

A to-do list for organizing all the essential information and important documents in and of your life.

   

Essentials:

Put these together in one place, for those taking care of your estate after you die.

---***Will ("last will and testament," specifying who will inherit your assets if there is no joint ownership, or beneficiaries whose names are not filed at an institution)

---***Durable financial power-of-attorney form (without which no one can make decisions and act for you if you are incapacitated)

---Revocable trust (in addition to, and privater than, a will; changeable anytime during your lifetime; and harder to dispute in court)
---Letter of instruction (for important final instructions, such as where you want your ashes scattered, who you want notified of your death, or how you want your funeral or memorial service to be performed).
 

Bank accounts:
---List of all bank accounts & online log-in info.

---List of safe deposit boxes (and locations)
  

Health care confidential:

---***Durable health care proxy/power-of-attorney form

     (so your designee can make health-care decisions on your behalf if you are incapacitated)

---***Living will (how you want to be treated in specific medical circumstances)

---Alternative: An Advance Health Care Directive, combining your Living Will and naming a Health Care Proxy/Power of Attorney with authority to make medical decisions for you.

---A personal & family medical history (including your list of medications)

---A HIPAA Authorization that grants permission to release protected health information about you to designated parties
---Do Not Resuscitate Orders (DNR), IF and when you wish to be resuscitated (review regularly)

---Personal & family medical history (including your list of medications)
   

Proof of ownership (and debts), with dates:

---Documentation of housing and land ownership.

---Documentation of cemetery plots (cemetery deeds)

---Documentation of vehicles owned.

---Documentation of stock certificates and savings bonds.

---List of brokerage and escrow mortgage accounts.

---Any partnership or corporate operating agreements.

---List and proof and loans made to others and debts owed to others

    (what has been paid and what is still owed)

---Tax returns--last 3 years (some say 6).

    "Helps your personal representative file a final income-tax and estate return, and if necessary, a revocable-trust return."
   

Retirement and life insurance:

---Copies of life insurance policies (name of carrier, policy number and agent associated with the policy)

     "Be especially careful with life-insurance policies granted by an employer upon your retirement."

---List of (and details about) pensions, annuities, IRA’s, and retirement plans.

    ("An IRA is considered dormant or unclaimed if no withdrawal has been made by age 70.")
   

Marriage and divorce:

---Marriage license.

---Divorce judgment and decree.

---Copies of most recent child support payment order.

---Copies of life-insurance papers benefitting or covering children.

---Qualified domestic relations order.

 
Financial and legal information, a checklist:

[This general list repeats items listed above, in a different order:]

• Names, phone numbers, and email addresses of lawyers and financial advisors
• Names, addresses (especially of your legal residence), phone numbers, email addresses, date and place of birth, and Social Security numbers of everyone named in your will and other documents, and everyone important in your life, for your executors and guardians of minor children.
• Location of all vital and legal documents (including birth and death certificates, adoption records, prenuptial agreements, marriage certificates, divorce decrees, military records, immigration and citizenship documents, property deeds, recent tax returns, wills).
• Location of all vital and legal documents (including birth and death certificates, adoption records, prenuptial agreements, marriage certificates, divorce decrees, military records, immigration and citizenship documents, property (housing, land, and cemetery) deeds, vehicle titles, recent tax returns, do-not-resuscitate orders (DNRs), wills and living wills and related documents).
• List of property you own, with values (include real estate, vehicles, jewelry, furniture, other assets)
• A list of all financial assets and accounts, with bank account numbers and branch locations.
• A master list of all your accounts (savings, checking, credit card, stocks, bonds, mutual fund shares, other investments, escrow mortgage, insurance, frequent flier accounts, etc). List each institution, type of account (checking? savings? money market?), owner or policyholder (you? you and spouse? you and child?), account number, contact information for institution, where certificates are.
• Details about principal income and about your retirement savings accounts and other assets, including names, addresses, phone numbers, and social security numbers of principal beneficiaries.
• Details about your debts (especially to whom and how much). Include mortgages, loans, other debts. And proof on debts paid. For family history:
• List of employers and dates of employment.
• Education and military records.
• List of jointly owned property, and names of co-owners.
• A list of where you keep all pension documents, and folders on IRAs and 401(k) accounts
• Proof of loans made and debts owed (plus details on who and where)
• A list of computer user names, access codes, and passwords, or instructions on how to find them.
• Details on all forms of insurance (life, health, dwelling, car, etc.).
• A list of safe-deposit boxes, with an inventory of the contents. List all irreplaceable valuables (jewelry, heirlooms, photo negatives) and critical documents (marriage license, birth certificate, divorce papers, stock and bond certificates) that are stored under lock and key and photocopy the documents for your home office files.

Also helpful:
• Essential Document Locator Checklist (A Place for Mom)

SOURCES:
• The 25 Documents You Need (CAPTRUST Financial Advisors, 4208 Six Forks Road, Suite 1700, Raleigh, NC 27609.

    CAPSTONE'S list provides helpful explanations.
• The 25 Documents You Need Before You Die (Forge Financial Advisors, Fairport, New York).

"According to the National Association of Unclaimed Property Administrators, state treasurers currently hold $32.9 billion in unclaimed bank accounts and other assets. (You can search for unclaimed assets at MissingMoney.com)."

• The 25 Documents You Need Before You Die (Marc R. Gillespie, Financial Planner)

A similar list, organized by similar categories: Marriage & Divorce, Bank Accounts, Life Insurance and Retirement, Proof of Ownership, Health Care Confidential, The Essentials.
• The 25 Documents You Need Before You Die (Rachel Donnelly, Lantern Co.)

• Gender-affirming surgeries in the US nearly tripled before pandemic dip, study finds (Carla K. Johnson, AP News, 8-23-23) The increase likely reflects expanded insurance coverage for transgender care after the Obama administration and some states actively discouraged discrimination based on gender identity. The dip in 2020 can be attributed to the pandemic.

• What is gender-affirming care? Your questions answered (Patrick Boyle, Association of American Medical Colleges, AAMC, 4-12-22)

    As states move to restrict certain treatments for transgender youth, experts explain the many types of care, the need for them, and their impact.

    "Katherine Imborek, MD, has seen the gender-affirming care provided at UI Health Care’s LGBTQ Clinic in Iowa City change the lives of transgender youths and adults. “It decreases depression, anxiety, and suicide attempts,” says Imborek, co-director of the clinic. To her, that care is “a medical necessity, like providing insulin to a person with diabetes.”

   "But a growing number of lawmakers, including in Iowa, view some gender-affirming care as medically unsound for youths and even a form of child abuse. Iowa is among 15 states that have enacted or are considering laws to prohibit certain gender-affirming treatments for youths and to impose penalties on health care professionals who provide it, according to the Williams Institute at the UCLA School of Law in California.

    "Gender-affirming care, as defined by the World Health Organization, encompasses a range of social, psychological, behavioral, and medical interventions “designed to support and affirm an individual’s gender identity” when it conflicts with the gender they were assigned at birth. The interventions help transgender people align various aspects of their lives — emotional, interpersonal, and biological — with their gender identity. As noted by the American Psychiatric Association (APA), that identity can run anywhere along a continuum that includes man, woman, a combination of those, neither of those, and fluid.

    "The interventions fall along a continuum as well, from counseling to changes in social expression to medications (such as hormone therapy). For children in particular, the timing of the interventions is based on several factors, including cognitive and physical development as well as parental consent. Surgery, including to reduce a person’s Adam’s Apple, or to align their chest or genitalia with their gender identity, is rarely provided to people under 18."

    This long article and explanation is worth reading. It includes several "fictional case vignettes," composite cases written to illustrate certain diagnostic characteristics and to instruct on treatment techniques

• Gender Affirmation Surgery (Cleveland Clinic) A clear explanation of various surgical and other options. "Gender affirmation surgery refers to procedures that help people transition to their gender. Gender-affirming options may include facial surgery, top surgery or bottom surgery. Most people who choose gender affirmation surgeries report satisfaction with results, including the way their body looks and works and improved quality of life." Clear explanations of nonsurgical gender-affirming options and surgical gender-affirming options, as well as what those options involve.

• Gender Affirmation Surgeries (Fan Liang MD, Johns Hopkins Medicine) Surgeries are not required for gender affirmation, but many patients choose to undergo one or more surgical procedures.  Liang presents an excellent overview and explanation of various options for gender affirmation surgery.

• Tim Walz's Policy for Transgender Minors Explained (Mandy Taheri, Newsweek, 8-11-24) Minnesota Governor Tim Walz, named as Vice President Kamala Harris' running mate, has a legislative history of supporting the rights of transgender minors and gender-affirming care, which has come under fire from top Republicans, including former President Donald Trump and his running mate Ohio Senator JD Vance.

• States that protect transgender health care now try to absorb demand (Jeff McMillan and Hannah Schoenbaum, AP News, 8-15-23)

    "States that declared themselves refuges for transgender people have essentially issued an invitation: Get your gender-affirming health care here without fearing prosecution at home.
    "Now that bans on such care for minors are taking effect around the country — Texas could be next, depending on the outcome of a court hearing this week — patients and their families are testing clinics’ capacity. Already-long waiting lists are growing, yet there are only so many providers of gender-affirming care and only so many patients they can see in a day.
    "For those refuge states — so far, California, Connecticut, Colorado, Illinois, Massachusetts, Maryland, Minnesota, New Jersey, New Mexico, New York, Washington and Vermont, plus Washington, D.C. — the question is how to move beyond promises of legal protection and build a network to serve more patients."

---State actions on gender-affirming care for minors (AP News interactive) Several Republican-led states have taken steps to bar access to gender-affirming care for transgender minors, which for people under 18 typically involves puberty blockers or other hormone treatments. Some Democratic-led states are instituting protections. Chart shows the status of gender-affirming care for minors in the states.
    Restricted
    Restrictions not in effect
    Restrictions struck down by court
    Gender-affirming care protected.
Apparently no stand has been taken in states represented in grey.

• Gender-affirming Care for Transgender Patients (Nita Bhatt, Jesse Cannella, and Julie P. Gentile, Innovations in Clinical Neuroscience, NIH, National Library of Medicine, April-June 2022) "It has been well established that gender is a social construct, not an inborn reality of biology, nor is it binary. This is contrasted with sex, which is generally defined as the biological characteristics (i.e., reproductive, chromosomal, hormonal) of a person established at birth, and is in fact also nonbinary, although it is most often characterized as male or female. Even after “checking under the diaper” and with karyotyping, the sex defined at birth may be established as male or female, but it also may be established as intersex or be within other nonbinary variations.Gender, however, is a social construct that may be cisgender male or female, but individuals may alternatively be identified as nonbinary, genderfluid, genderqueer, or transgender male or female, among other identities (Table 1). Indeed, the binary construct of gender is one of Western context and is not absolute.

     "Fundamentally, it must be emphasized that the gender of a person cannot be externally read or assumed. Gender identity is an internal self-identity and may or may not correspond to how a person dresses, how a person grooms their hair or facial hair, what a person calls themselves, or how they speak. How a person externally represents themselves, such as through apparel, hair style, voice, or behavior, is known as their gender expression.4 For various reasons, including but not limited to comfort, safety, self-realization, laws, institutional guidelines, and conformity to social norms, the gender expression of a person may not necessarily correlate to their gender identity. For this reason, the only way to know the gender of a person is by asking them, and even when asked, gender and gender identity is subject to change and is not necessarily a permanent quality. 

 

This lengthy and important article "discusses some of the most significant health disparities faced by transgender patients, common challenges they experience, and how providers, regardless of specialty, can positively intervene to better provide an inclusive environment with gender-affirming care."

• Families with transgender kids are increasingly forced to travel out of state for the care they need (Arleigh Rodgers and MIchael Goldberg, AP News, 7-10-23)   

"At least 20 states have enacted laws restricting or banning gender-affirming care for trans minors, though several are embroiled in legal challenges. For more than a decade prior, such treatments were available to children and teens across the U.S. and have been endorsed by major medical associations.
    "Opponents of gender-affirming care say there’s no solid proof of purported benefits, cite widely discredited research and say children shouldn’t make life-altering decisions they might regret. Advocates and families impacted by the recent laws say such care is vital for trans kids.
    "The perceptions of most parents, Marx said, don’t align neatly with the extremes of full support or rejection of their kids’ identities.
    “Most parents exist in a kind of gray area,” Marx said. “Most parents are going through some kind of developmental process themselves as they come to understand their child’s gender.”

• Indiana lawmakers advance ban on all gender-affirming care (Arleigh Rodgers, AP News, 2-22-234)
     "Krisztina and Ken Inskeep’s son came out as transgender when he was a teenager, a transition they told an Indiana Senate public health committee on Wednesday that offered a remedy to years of his mental health struggles.
     "Still, an Indiana Senate bill that the couple called “cruel and arrogant” — banning gender-affirming transition treatments for those 18 and under, the very care they said kept their son alive — passed the committee 8-3.
     “If it weren’t for the support of doctors and health care professionals, we’re convinced that our child may not have survived,” Krisztina said.