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MAY 2024
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A Nurse’s Plea The Importance of Clear Decision- Making in Medical Emergencies
It’s interesting how some conversations can broaden your perspective and show you a different point of view. A couple of weekends ago, Marc and I spent a lovely day in a historic part of our town, enjoying one of our favorite spots. The area is known for its charming outdoor dining setup, featuring long picnic tables where you can share space with other groups.
are given equal authority. In our industry, we call them co-agents. Co-agents can disagree, and disagreements often mean decisions are stalled. On that particular week, she had two patients in need of treatment but without a designated decision-maker. She painted the picture of a patient lying in a hospital bed, requiring one course of treatment or another, while the family argued amongst themselves. She felt helpless.
We were enjoying a charcuterie board and glasses of wine when another couple sat next to us.
We got to chatting, and the woman commented that she really needed to get out of the house and enjoy some time away after the rough week that she had at work. Naturally, I asked her what she does for a living, and she responded that she’s an intensive care unit (ICU) nurse. “Oh wow,” I said, “that must be really tough. What’s the hardest part?” I anticipated her response to involve the stress of witnessing patients at their lowest or the exhaustion from tirelessly attending to critical needs. I assumed that, as an ICU nurse, she must face many heart-wrenching scenarios and often feel overwhelmed by the gravity of her cases. Whether it’s letting go of a patient she’s bonded with or being around so much tragedy, gore, and tough moments, working in the ICU must be an extremely difficult. But, without skipping a beat, she said the patients’ families are the most challenging part of her job. This caught me off guard. She went on to explain that it’s not that they are cruel or intentionally difficult, but there is usually so much confusion and back and forth between them. “I just wish they’d pick a spokesperson,” she said, sounding defeated. “If the patient is unconscious or unable to communicate, we need a decision-maker.” She explained that the family members of the patients usually will call individually and try to figure out what is going on and, in many cases, disagree over what they should do. This can be extremely frustrating for the doctors and nurses in the ICU who are only trying to help the patient and do their jobs. As I sat and listened, I understood from the other side. “So, you’re referring to situations where the patient does not have an Advance Health Care Directive?” I asked. To this, she responded with something that floored me. She told me that she rarely has a health care directive to work with. Either the patient doesn’t have one, or the family doesn’t know where it is. She said sometimes, even when there is a health care directive, all the children
My heart broke for this ICU nurse because what gets her down and further complicates her already difficult job isn’t managing death or the gruesome medical tasks. No, it’s when the family hasn’t chosen a spokesperson and the right documents aren’t in place. I had never looked at the opposite side of the coin and thought of the weight this puts on our medical professionals. This reinforced the value of our work at Preston Estate Planning. Every client we serve has an Advance Health Care Directive that allows them to appoint a family spokesperson. While this doesn’t prevent the family from discussing the situation and reaching a consensus, it ensures a designated individual can provide the health care team with a clear decision in critical situations. Every client also receives a HIPAA Waiver, which lists the group of individuals with whom the doctors are allowed to share the patient’s medical information. They get an Emergency Medical Information Card to keep in their wallet, and if they are admitted to an ICU unit, this information is accessible at the doctor’s fingertips, facilitating a smoother process for both the patient and health care providers. This experience emphasized the critical need for correctly executed documents that designate a family spokesperson and ensure the right individuals have access when necessary. In these challenging situations, having an Advance Health Care Directive that is done properly and is accessible in an emergency greatly simplifies the process for everyone involved, including the patients, their families, and the dedicated health care professionals working tirelessly on their behalf. We hope you’ll rest a little easier knowing you have protected yourself and your family. –Jennifer Knight
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What Are 529 Plans?
THE ESTATE PLANNING TOOL THAT BREAKS ALL THE RULES
If you’re interested in supporting a family member’s educational costs, keep reading. A 529 plan could be the perfect solution for you. You can easily establish these plans at nearly any financial institution without complex legal paperwork. This savings technique can provide incentive, financial assistance, and even retirement benefits for your child or grandchild. A 529 plan is a tax-advantaged savings plan designed to help pay for education. Contributions to the plan are not considered part of your estate at death. During life, capital gains and earnings from the 529 are tax-deferred for both federal and state taxes if used for educational expenses. The funds in the plan can cover tuition from K–12 and almost all expenses associated with post- secondary education.
Every state sets a cap on how much can be contributed to a 529 plan, but these limits are typically so high that they’re rarely a concern. For example, California has set its limit at $529,000 — a conveniently easy-to- remember figure. Like a gift, the contribution is not considered part of your estate. However, unlike a gift, it is revocable. If you decide you don’t want to pay the intended beneficiaries’ schooling expenses, you can withdraw the entire amount. But be careful — with flexibility comes consequences. If withdrawn, the income earned during the life of the 529 plan will be taxed, and you will pay a 10% penalty. Nevertheless, it might be appropriate if the child or grandchild for whom you created the plan has other goals.
Recently, the SECURE Act added another benefit for 529s. As of 2024, the funds in the plan can be rolled over, income tax and penalty-free, to a Roth IRA account for the benefit of the child/grandchild. However, the plan must be at least 15 years old, and the funds will be subject to Roth annual contribution limits, which in 2024 is $7,000 for those under 50, and an additional $1,000 catchup contribution for those 50 and older. Beneficiaries can “roll over” up to $35,000 in their lifetime. While 529 plans are beneficial in the right circumstances, a word of caution: Don’t prioritize your children’s or grandchildren’s educational needs over your retirement needs. Make sure you are financially secure and able to provide for your future before you consider creating the plan.
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PAW-SOME ADVENTURES GEAR UP YOUR PUP FOR A HIKING ADVENTURE
Setting out on a hiking adventure with your furry friend is a rewarding experience, but ensuring their safety and comfort on the trail requires careful
consideration of essential gear. Before heading out, consider your dog’s unique needs and preferences so it’s an enjoyable and bonding adventure for you both. Here’s an introduction to some must-have hiking gear for your canine companion.
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Food and Water One of the most important aspects of hiking is staying well-nourished and hydrated. Packing
more water than you think may be necessary is crucial, especially on a trail where natural water sources may be scarce. An ample supply of dog- friendly food is also essential, with the quantity adjusted based on the hike’s duration. A collapsible bowl will be handy for feeding your canine companion during breaks. First-Aid Kit Safety should always come first. A dog first-aid kit is indispensable for addressing unexpected issues on the trail. These compact kits typically include dressings, bandages, and tools for removing ticks or thorns. Being prepared for minor injuries ensures you can safely complete the hike without making any injury worse. Boots While some dogs may resist wearing boots, they can be a lifesaver in challenging terrains. Opt for boots that protect without compromising comfort. Though you likely may avoid trails with terrain that could harm your dog’s paws, having boots in your pack is, at least, a proactive measure for unforeseen circumstances, ensuring your canine companion’s paws are protected if needed. Waste Bags Be responsible out on the trail. That means bringing poop bags. Attach them to the outside of your backpack or tote bag for convenient access once your dog has completed its business. The “leave no trace” practice will help maintain the pristine beauty of the trail for everyone to enjoy. Emergency Harness Preparedness is critical, and an emergency harness adds an extra layer of safety. A proper harness will allow you to carry your dog on your back in an emergency. This versatile harness ensures that you can provide assistance in challenging situations.
Grilled Red Curry Beef Satay With Peanut Sauce Inspired by StarTribune.com
Ingredients
• •
1 1/2 lb flank steak 1/2 cup unsweetened coconut milk
For sauce: • 1 cup unsweetened coconut milk • • 1 tbsp brown sugar • 1 tbsp fish sauce •
• 2 tbsp lime juice • 1–3 tbsp Thai red curry paste • 1 tbsp fish sauce
1–2 tbsp Thai red curry paste
1/2 cup creamy peanut butter
• 1 tbsp lime juice
Directions 1. Freeze flank steak for 30 minutes. Cut crosswise, against the grain, into thin slices. 2. In a medium bowl, whisk together coconut milk, lime juice, curry paste, and fish sauce. Add steak and toss to coat. Cover and chill for 8 hours. 3. In a small saucepan over medium heat, combine coconut milk, curry paste, brown sugar, and fish sauce. Bring to a gentle boil for 3 minutes, stirring occasionally. Add peanut butter and stir until well blended. Remove from heat and add lime juice. 4. Thread the marinated meat onto 12 long skewers. Grill until beef is medium rare, 1–2 minutes per side. 5. Transfer satay to a platter and serve with peanut sauce.
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Inside 1
Health Care Directive Lessons Learned From an ICU Nurse
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Maximizing Educational Savings With 529 Plans
Paws and Paths
Grilled Red Curry Beef Satay With Peanut Sauce
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Explore the Historic Fortifications of the Highlands
Scotland’s Must-See Castles DEFENDING THE HIGHLANDS
From the heights of Castle Hill to the idyllic waters of Loch Duich, the historic castles of Scotland stun tourists and history enthusiasts alike. Today, these castles are well-maintained and ready to receive visitors from around the world. If you want to explore the beauty of the highlands from the rocky ramparts of Scotland’s greatest castles, these are three landmarks you need to visit. Edinburgh Castle Located amidst Edinburgh’s Old Town — a World Heritage Site — the daunting and long-standing Edinburgh Castle on Castle Hill is a bulwark that has defended the Scottish capital for nearly a millennium. The military still uses parts of the formidable ramparts, but the rest serves as a can’t-miss tourist destination. The castle also houses the Crown Jewels of Scotland, known as the Honours, and famed cannons, like Mons Meg, one of the grandest pieces of medieval artillery ever constructed and given to King James II in 1457 A.D. Dunnottar Castle Dunnottar Castle is located on the northeastern coast of Scotland and is surrounded on three sides by the waters of the North Sea. There is evidence
that ancient Picts lived in the area long before a monastery was consecrated on the grounds in 1276 A.D. In 1392, Sir William Keith
seized the holy site’s strategic location by building its first stone fortification, The Keep. An even
more unorthodox move came in 1593, when George Keith, the 5th Earl Marischal, built The Lion’s Den at Dunnottar Castle to house his pet lion.
Eilean Donan Castle There is a reason Eilean Donan Castle is one of the most photographed castles in the world! Situated on a tiny island at the mouth of Loch Duich, this formidable fortress began as a monastery in 634 A.D. before being converted to a fortress in the 12th century to protect the area from Viking raids. Now administered by the Conchra Charitable Trust, this castle houses rare artifacts, such as a sword rumored to be from the famed battle of Culloden in 1745.
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