Advance Legal Planning

legal planning

For Good Heart Health

The decisions we make as we age help determine our health care needs, the quality of care, the financial means available for care, the extent of family members’ involvement with our care and assets, and even our longevity.  Advance legal planning and establishing a Will, Living Will, and General Durable Power of Attorney while we are in good health can improve quality of life during senior years.  A sound advance legal plan can reduce the chances of courtroom fees, unnecessary probate costs, and extensive long-term care bills.

Unfortunately, many Americans fail to plan ahead.  Whereas many patients who are already dealing with progressive diseases such as cancer and advanced dementia acknowledge the need for legal planning, often patients who have been diagnosed with heart disease lack the basic legal documents that can guide their future health care and asset management.

According to Dr. Andrew P. Zinn, cardiologist at the Heart House: Cardiovascular Associates of the Delaware Valley, despite the fact that cardiovascular disease is the leading cause of death among older Americans, many individuals underestimate its potential morbidity. “Unfortunately, we don’t always view chronic cardiovascular disease as a potentially terminal disorder.  People often don’t prepare for such eventualities when facing a battle with heart disease,” he says.  Issues like palliative care, durable power of attorney, and living wills are often overlooked by cardiac patients.

One possible explanation for why cardiac patients underestimate their need for advance legal planning is that heart disease is remarkably heterogeneous, according to Zinn. Even patients that have sustained a heart attack may have an excellent prognosis if the heart muscle function is normal. On the other hand, Zinn says, “Advance congestive heart failure is associated with mortality rates that are higher than many cancers.”

As a society, we have become adept at managing a range of chronic conditions, yet we still underestimate the need for planning.  Zinn states that “many patients with chronic medical conditions don’t realize that they are at risk for heart disease. Millions of elderly Americans with high blood pressure high cholesterol and diabetes don’t understand that there are clear-cut associations with the development of various types of heart disease. Therefore, it’s important for patients to have candid conversations with their doctors to better define their risk of heart disease, and their prognosis once they have developed heart disease.”

According to Dr. Zinn, fortunately, there has been tremendous growth in treatment for heart disease over the last 30 years. Patients can feel optimistic that medical therapy, surgical therapy and other advanced techniques are available to treat a full spectrum disorders. Nevertheless, in some cases, palliative approaches or even hospice care are more appropriate options.

In addition to confirming that their legal plans are sound, to support their quality of life, elderly Americans in good health should be aware of their cardiovascular risk. They should pay close attention to the so-called modifiable cardiovascular risk factors.  Zinn lists them as: hypertension, high cholesterol, and diabetes. In addition, the most “modifiable” of all cardiovascular risk factors, he says, is tobacco use. Smoking is not only a risk factor for cancer; it also greatly increases your risk for cardiovascular disease.  Zinn states, “We can’t do anything about the nonmodifiable risk factors (namely age and genetics). However, the modifiable risk factors can largely be controlled through a combination of diet, exercise and medication.”

While many conditions can be prevented or successfully managed for an extended time, individuals with risk factors for heart disease should be sufficiently educated and prepared to deal with heart disease if necessary.  This preparation necessarily includes a Living Will to address an end of life situation and appoint an individual to serve as health care representative and discuss the care plan with the physician; a General Durable Power of Attorney that authorizes an individual to pay bills, deposit money, sign contracts, and handle a large range of other monetary transactions for an individual; a Last Will and Testament that addresses contingencies among beneficiaries, directs payments of bills and guides disbursement of assets after an individual’s death; and often a legal plan for affording long-term care that considers public benefit funding sources.


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About Dana Bookbinder

DANA E. BOOKBINDER, ESQ. is the Founder of Bookbinder Law, LLC and has been advising families throughout South Jersey for nearly two decades on legal issues concerning asset protection for long term care expenses, public benefits eligibility rules, disability planning, and estate planning. Ms. Bookbinder has been certified as an Elder Law Attorney by the ABA accredited National Elder Law Foundation.

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