Resolving Legal And Financial Issues For The Elderly Client

Sponsored by National Business Institute
August 16, 2007
By Thomas J. Murphy
Murphy Law Firm, Inc.


A & B – The Client Interview and the Drafting of the Plan

Much of the challenge with estate planning clients is not so much the creation of innovative techniques or other applications of law but rather determining the client’s factual situation. This means focusing on two areas – the family history and dynamics as well as the client’s financial situation. It means knowing what to ask since often the client, convinced (or wanting to be convinced) that they have a simple estate, will not realize that certain aspects of their situation could dramatically change the advice provided by the attorney.

The best way to address this is through the use of a thorough questionnaire. My questionnaire is attached to these materials. It is sent to the client before the first meeting for completion by the client. This is important for several reasons. First, it forces the client to get organized so that time is not wasted in the office while the client goes through files trying to retrieve documentation. Second, it ensures that the attorney will have the documentation that is needed in formulating a plan. Third, it emphasizes to the client that there may be more issues at hand than the client initially realized. However, do not make your questionnaire so long and detailed that the client is intimidated from attempting to complete the questionnaire. Take care to emphasize in your cover letter to the questionnaire that there may be many areas that do not apply to that particular client. Finally, the questionnaire provides a written explanation by the client of the situation and is very convincing evidence of what the client told the attorney if, years later, a child or other heir takes aim at the drafting attorney. For this reason, I always retain the original copy of the questionnaire for my files.

With this in mind, here are topics of particular concern that should be covered in the questionnaire and discussed with the client at the outset of the engagement:


Often overlooked. While a foreign accent will tip off the attorney to inquire about this, this is not obvious with a Canadian client. Having a non-citizen, either client or spouse, can radically alter the planning, often requiring use of a QDOT trust and other mechanisms.

Length of time in Arizona.

Important for determining community property issues although quasi-property rules will normally call for a similar result. ARS 25-318; Sample v.Sample, 135 Ariz 599 (CA1, 1983)

Armed forces veteran.

Are they a veteran? If so, are they retired military? When did they serve, since service during periods of armed conflict will often result in special treatment? Do they have a service connected disability? This is important for two reasons. First, it will impact the client’s eligibility for veterans benefits, which can be very generous. In my practice, the most important – and most overlooked – benefit is the Aid and Attendance benefit for at-home care. The second reason concerns burial. The burial is at a nominal cost to the client’s estate. But more important to many clients is that fact they do not have to worry about future endowment problems for the cemetery. In other words, the client often wants to be assured that, twenty-five years from now, the cemetery will not be run down with weeds and overgrown grass. This should not be an issue with the VA. But warn the client that, with the World War II generation dying off quickly, that these cemeteries are filling up. This may require burial at a veterans cemetery that may be a considerable distance (ie, hundreds of miles) away from the client’s home. This is not a problem for those clients seeking burial in the Phoenix area.

Children from current marriage.

If the children are minors or young adults, clients are nearly always insistent upon some form of a dynasty trust that protects the funds from youthful indiscretion or other wasteful behavior. Most of my families have distributions at ages 25 and 30 with the trust terminating as to that beneficiary with a final distribution at age 35. Do not tiptoe around this issue. Ask the client if any child has financial problems, a substance abuse problem or a bad marriage.

Always mention if any child or other family member, such as a grandchild or sibling, is disabled or otherwise receiving public benefits. This is more prevalent that one might think. This necessitates some very technical drafting issues through the use of supplemental benefits trusts (aka special needs trusts) that many estate planning attorneys are not proficient or comfortable with. This topic exceeds the parameters of this seminar. For more information on Special Needs Trust, visit my website or read one of the authoritative treatises on the topic. The treatise generally considered the best is Third-Party and Self Created Trusts: Planning for the Elderly and Disabled Client by Clifton B. Kruse, Jr., 3rd edition published by the ABA. Or consider purchasing tapes and materials from the annual SNT conference at Stetson University College of Law, to be held October 19 – 21, 2005 at Clearwater Beach, Florida. or 813-228-0226.

Finally, do not ever overlook the existence of loans or gifts to the children, especially if they are in unequal amounts or if not all children are aware of the loans/gifts. In my experience, this is probably the single biggest cause of family discord after the client has died. Establish if it is a gift or loan. If a gift, is it an advance of an inheritance? If a loan, is it to be forgiven? If so, is the forgiven amount to be included in the beneficiary’s share of the estate? Obtain whatever documentation exists verifying the gift or loan since these may disappear post-mortem. Has a large expense been undertaken for one child but not another, such as paying for a college education?

Children from prior marriages.

Nothing complicates the planning of an estate as quickly as the existence of children, especially adult children, from a prior marriage. Have the client set forth exactly where these children stand in regards to the current spouse and the any children from that spouse. Or, where will stepchildren (ie, the new spouse’s children from a prior marriage) figure into the plan, if at all?

These are very touchy situations, fraught with ethical dilemmas and potential for multi-family conflict. Make sure your fee agreement covers your right to fee if you are called as a witness in subsequent probate litigation.

Involvement of children.

Inquire of the client if a meeting with the children should be held. Some clients resist this, some welcome it. I prefer that the children be involved to some extent, especially if there is any Medicaid/ALTCS planning to be done. There are often concepts and strategies that are difficult for the client to fully understand. Having a child present creates comfort and reassurance for the client. The attorney can also make sure that the children receive the information first hand rather than through the parent who may not understand some of the subtle issues.

Problem children.

Are there children that can be expected to settle scores and cause trouble? The client may want to have these children eliminated from certain decisions, such as health care or end-of-life issues when the client becomes incapacitated.

Inheritances from other family members.

Inquire if the client anticipates or has received an inheritance from a parent or sibling since this could dramatically affect the size of the client’s estate. Many times an income stream from a family asset is indicative of a much larger interest in the underlying asset (ie, the real estate that is the source of the rental check could be worth millions).

Other advisors.

Determine who are the accountants, insurance agents and financial advisors that the client may be using. These advisors may be telling your client something very different than what the attorney is. Make sure everyone is on the same page and understands the concepts involved. Unfortunately, other advisors may be quick to criticize something they do not understand and, since they have had a much longer relationship with the client, these advisors often have more credibility with the client. The attorney can never be too careful here. The attorney also needs to confirm certain information, such as beneficiary designations.

Pending or anticipated claims or lawsuits.

This is something the client may not want to discuss or may think that only the other lawyer needs to know about it.

Health issues.

Always phrase this question not simply in terms of health but also in terms of any medication that is being taken and determine what condition the medication is being taken for.  If there are serious health issues, especially if it has rendered the client home-bound, then consider retaining the services of a geriatric care manager to conduct an assessment and care plan. For several hundred dollars, this is usually a very wise investment that can give practical guidance to the family.

Pre-paid planning for funeral and burial.

Does the client desire to be cremated or buried? Where will the burial be? Will organs be donated? Will an autopsy or other post-mortem examination be done? Who should be notified? What kind of marker and epitaph? It is often best to have these arrangements made in writing while the client is alive. ARS 36-831.01. If client does pre-pay, keep record of receipts since I have had mortuaries inexplicably lose any record of pre-payment. Pre-planning also greatly alleviates the grief of immediate family members who are spared the emotionally wrenching decision of choosing a casket and the like. Family members are also in a very vulnerable state that could lead to unnecessary expenditures. See my attached form entitled “After Death Instructions”.

Paying for the nursing home.

Always review the cash flow of any client in a nursing home. If the monthly costs of care exceed the client’s monthly income, then a spendown in one fashion or another is occurring and future eligibility for Medicaid/ALTCS must be considered. This centers around accelerating the client’s eligibility for ALTCS while minimizing potential exposure to estate recovery by AHCCCS. This is a topic that far exceeds the scope of this seminar. The point here is simply that this is a complex area of the law with far-reaching consequences if it is ignored or done incorrectly. For further information on nursing home planning, visit my website.

Reverse mortgages – the next big thing?

After having acquired a (much deserved) seedy reputation, I expect that, over the next few years, our clients will begin to hear much more about reverse mortgages, especially given the enormous increases in the values of residential real estate. RMs are not the panacea that they will undoubtedly be marketed as, but the new and improved RMs (usually a Home Equity Conversion Mortgage aka “HECM” guaranteed by the FHA) will deserve our consideration and will soon give LTC insurers some real competition. A RM can solve three problems at once – it allows the client to stay at home, the client will not outlive their savings and they will not be a burden to their children. A RM exchanges equity for cash flow. It eliminates a mortgage payment while boosting income that is tax-free and the client can access these funds even while on AHCCCS.   The loan amount is not based on income or credit scores but rather on the client’s age, the location of the home and the home’s value (and not the equity) based on section 203-b of the National Housing Act. There is no repayment of the borrowed amount until the client and spouse die or neither lives in the home. The borrower must be at least 62 years old and reside in the home, which the client is free to sell at any time.

There are several drawbacks. The primary drawback is the cost – the origination fees and mortgage insurance premiums are 4.5% of the maximum loan amount (and not the amount of funds actually loaned). A sizable RM balance will effectively prevent the client’s children from inheriting the house. And the home must be sold when the last surviving borrower fails to live in the house for 12 consecutive months.

There are several good websites for information about RMs. See, (maintained by Financial Freedom who are the largest RM lenders) and or for information on lenders.

C – Asset Titling

Appropriate titling of assets is a relatively inexpensive and easy way to avoid probate. ARS 14-6101. If a client may be dealing with a health issue or is terminally ill, the shorten time frame makes it much easier to earmark certain assets for certain children.

However, always warn the surviving parties that they take title to any claim allowed in the probate estate. ARS 14-6102.

The bottom line here is: it is usually better to name the person in a payable-on-death or beneficiary capacity than as a joint owner. This makes intent much easier for third parties to discern.

Bank & brokerage accounts and securities

Avoid jointly titled property unless the parties are married and the property is community property. I have had far too many litigated cases where there was dispute as to why a child or other relative was placed as a joint tenant on a deed or bank account. If jointly titled accounts exist, then have the client establish the reason why son or daughter is on the account title – ie, for convenience and probate avoidance or for survivorship? Otherwise, in a post-mortem setting, it is a question of the decedent’s intent that will likely result in litigation. ARS 14-6211 & -6212; O’Hair v. O’Hair, 109 Ariz 236 (1973); Safley v. Bates, 26 Ariz App 318 (CA1, 1976)


It is a little more difficult to challenge jointly titled real estate. First, there is a presumption that the deed accurately reflects the ownership interest in the property. Boone v. Grier, 142 Ariz 178, 182 (CA1, 1984). There is also a presumption of capacity when executing a document. Gollaher v. Horton, 148 Ariz 537, 541 (CA1, 1985). Second, the parole evidence rule prohibits the introduction of extrinsic evidence that contradicts the writing in question. Taylor v. State Farm Insur., 175 Ariz 148 (1993); Long v. City of Glendale, 208 Ariz 319 (CA1, 2004). Third, the Statute of Frauds prohibits the introduction of evidence regarding an oral agreement pertaining to real estate. Long, supra.

The best and easiest route is to execute a beneficiary deed, IAW ARS 33-405. See my article in the June 2002 edition of Arizona Attorney that provides some drafting tips.

Life Insurance & Annuities

When naming beneficiaries of life insurance and annuities, be aware of some fairly recent developments, such as the case of May v. Ellis, 208 Ariz 229 (2004), that held that insurance policies are protected from creditors of probate estate. The 2005 legislature codified this holding by amending ARS 20-1131 and 33-1126. All death benefits from a life insurance policy are exempt from creditors. The cash surrender value of an existing policy or annuity are also exempt if the policy is at least two years old and names a spouse, child, parent, brother, sister or dependent family member as beneficiary.   increased creditor protection of life insurance policies and annuity contracts

Retirement plans.

Make sure that valid, current beneficiary designations exist. Do not simply assume all is in order since, with the consolidation of many banks and brokerage houses, records are misplaced or lost with increasing frequency. Second, make sure they are current. Be especially vigilant if the client has been divorced since the designations often still reflect the former spouse. The provisions of ARS 14-2804 (where the divorced spouse is disinherited) does NOT apply to 401(k)’s and other ERISA plans. Egelhoff v. Egelhoff, 121 SCt 1322 (2001). Third, consider obtaining copies of the signature cards for any POD accounts since banks are often sloppy in maintaining these designations. For a horror story on this that cost a client of mine $1 million, see the now-depublished case of Estate of Moore, 435 Ariz Adv Rep 9, 97 P3d 103 (CA1, 2004)

D – Changing The Will to Exclude The Disabled Spouse

This aspect of planning is two-fold. Both deal with a spouse who is receiving ALTCS benefits. One aspect to avoid disqualifying the spouse who is on ALTCS when the other spouse dies. The other aspect is to avoid the estate recovery process when the spouse receiving ALTCS benefits dies. Both aspects are governed, in part, by federal statutes and regulations, primarily 42 USC 1396p, 20 CFR 1103 et seq and Social Security POMS SI01120, as well as state statutes, such as ARS 36-2934.01 and the AHCCCS Policy and Procedures Manual.

Avoiding AHCCCS/ALTCS disqualification.

Since other portions of this seminar will deal in detail with AHCCCSS eligibility issues, they will not all be repeated here. The issue revolves around the amount of funds that the non-ALTCS spouse can retain. For 2007, this amount is between $20,328 and $101,640. Let’s assume that the non-ALTCS spouse has $50,000. The problem is what happens to this $50,000 if the non-ALTCS spouse dies before the ALTCS spouse? If the will of the non-ALTCS spouse leaves the entire estate (ie, all $50,000) to the ALTCS spouse, then the ALTCS spouse will be over-resourced and lose ALTCS eligibility.

Rather than simply disinherit the spouse, a “supplemental benefits trust” can be created for the benefit of the surviving spouse who is receiving ALTCS benefits. This is basically a fully discretionary trust. The theory is that, since the surviving spouse has no right to a distribution, the trust corpus is deemed unavailable for ALTCS eligibility purposes. AHCCCS Eligibility Manual 708.02 & 803.04; 42 USC 1396p(d)(2)(A)

To draft a testamentary trust that will not render the surviving spouse ineligible for benefits, I use the following language:

A-3.     Supplemental Care Trust.

  • (a) My ….., ________, is currently receiving Public benefits. As long as ——(first name) is receiving means-tested public benefits (such as those offered as Supplemental Security Income or Arizona Health Care Cost Containment System), (First Name)——’s share of my estate shall be distributed to the trustee of the Supplemental Care Trust as set below.
  • (b) Trustee. I hereby appoint my ——–, —————–, to serve as Trustee of the Trust created for my ——-, ——————–(full name).
  • (c) Purpose of ——–(full name) Supplemental Care Trust. It is my intention by this trust to create a purely discretionary supplemental care fund for the benefit of (full name)———. It is not my intention to displace public or private financial assistance that may otherwise be available to him.
  • (d) Distribution of Income and Principal. The Trustee may pay to or for the benefit of (full Name)—— such amounts from the principal or income of the Trust, up to the whole thereof, as the Trustee in Trustee’s sole discretion may from time to time deem necessary or advisable for the satisfaction of his supplemental needs. As used in this instrument, “supplemental needs” refers to the requisites for maintaining (full name)——’s good health, safety, and welfare when, in the discretion of the Trustee, such requisites are not being provided by or are unavailable from any public agency or private resource. The following enumerates the kinds of supplemental disbursements which are appropriate for the Trustee, to make from this Trust or to or for the benefit of my beneficiary. Such examples are not exclusive: medical, dental and diagnostic work and treatment of which there area no private or public funds otherwise available; medical procedures that are desirable at my ‘Trustee’s discretion, even though they may not be necessary or life saving; supplemental nursing care and rehabilitative services; differentials in cost between housing and shelter for shared and private rooms in institutional settings; care appropriate for my beneficiary that assistance programs may not or do not otherwise provide; expenditures for travel, companionship, cultural experiences, and expenses in bringing my beneficiary’s siblings and other appropriate persons for visitation with my beneficiary.
  • (e) Trust Intent. I declare that it is my intent, as expressed herein, that because the beneficiary is disabled and unable to maintain and support himself independently, the Trustee shall, in the exercise of Trustee’s best judgment and fiduciary duty, seek support and maintenance for (full name)—- from all available private and public resources, including but not limited to Supplemental Security Income (SSI), Federal Social Security Disability Insurance (SSDI), Arizona Long Term Care System (ALTCS), and Arizona Health Care Cost Containment System (AHCCS). In making distributions to (full name)—- for his supplemental needs, as herein defined, the Trustee shall take into consideration the applicable resource and income limitations of the public assistance programs for which (full name) — is eligible or potentially eligible. In determining distributions, the Trustee shall consider the needs of (full name)—- and shall consider other funds known by the Trustee to be available for the specified purposes.
  • (f) Trust Asset Separation. The income or assets of (full name) —-, as well as any other beneficiary interest (full name)— may have in any other trust should not be commingled with the assets of the Trust.
  • (g) Discretion of Trustee. Under no circumstances may (full name) —- compel a distribution from the Trust for any purpose. The Trustee’s discretion in making non-support disbursements as provided for this instrument is final as to all interested parties, even if the Trustee elects to make no disbursements at all. Further, the Trustee may make arbitrary determinations. The Trustee’s sole and independent judgment, rather than any other party’s determination, is intended to be the criterion by which disbursements area made. No court or any other person should substitute its or their judgment for the decision or decisions made by the Trustee.
  • (h) Trustee Powers: The Trustee of the Trusts created herein shall have all powers conferred by Arizona law, to include those powers delineated in A.R.S. §14-7233.
  • (i) Amendment of trust. Notwithstanding the irrevocability of this trust, it is my intention and a material purpose of this Trust that it comply with all applicable laws regarding (1st name)’s eligibility for public benefits. In particular, it is my understanding that the terms of this trust, as a third party trust, comply with the eligibility criteria set forth in 42 USC 1396p(d)(4)(a), 20 CFR 416.1210 et seq., Social Security POMS SI 01130.005 & SI 01150.120-127 and Arizona Revised Statutes section 36-2901 et seq. In accordance with ARS 14-10410 et seq., the trustee is authorized to amend, modify or reform this trust to comply with any new applicable law, regulation or other authority that may affect (1st name)’s eligibility.

For more guidance on drafting these types of trusts, see the leading treatise on this, Third-Party and Self-Settled Trusts: Planning for the Elderly and Disabled Client, 3rd edition by Clifton B. Kruse, published by the American Bar Association and available through the ABA, and other booksellers.

Avoiding estate recovery

The second aspect of ALTCS planning regards protecting the surviving spouse who is on ALTCS from the estate recovery program, set forth in section 1900 et seq of the AHCCCS Eligibility Policy Manual. The current AHCCCS policy is to largely limit recovery to the submission of a demand for notice and claim in the probate court. Manual sec. 1902.00(d). This means it is imperative to title assets in such a way that probate is avoided.

Many of those techniques have been already addressed but, as to real estate, the probate avoidance objective has been greatly limited by the relatively recent implementation of the TEFRA liens. Under this program, AHCCCS will issue a lien against any real estate held in the name of an AHCCCS patient if the patient is over 55 years old and has been in a care facility for at least 90 days. However, no lien will be filed if the AHCCCS patient is married or has a child who is either under the age of 21 or is disabled. For a thorough discussion of the TEFRA liens, see my article in the March 205 issue of AzCPA, available through the Arizona Society of CPA’s website at

E – Durable Powers of Attorney – Gift Giving Power

For financial POAs, make sure there are adequate provisions for gifting, self-dealing and reimbursement by the agent.

Suggested clauses.

Power to Make Gifts. _____________________. My Agent is authorized to make gifts, to include the forgiveness of indebtedness, to my spouse, my children and descendants and to the spouses of my children and descendants, to include my Agent, in whatever amounts and for whatever purposes as my Agent deems appropriate. My Agent may also make gifts to any tax-exempt charitable organization recognized under Internal Revenue Code (“IRC”) Sections 170(c) or 501(c)(3) and to those persons named as beneficiaries in the Principal’s most recent will or trust, life insurance policy, retirement benefits or payable on death designation. As to any donee, these amounts shall not exceed the largest amount which then qualifies for the annual exclusion allowed for federal gift tax purposes as set forth in Section 2503 of the IRC. The authority to make gifts is non-cumulative and shall lapse at the end of each calendar year. All gifts may be made outright, in trust or to any guardian, conservator or custodian of an eligible donee. Gifts are not required to be in equal amounts and are not required to be made to all eligible donees.

Benefits Received by Agent.______________________ It is my intention that my Agent be reasonably compensated for the services rendered on my behalf and be reimbursed for any expenses paid by the Agent which were incurred on my behalf. Reasonable compensation shall not exceed the hourly wage or salary equivalent which the Agent customarily receives in his or her regular employment. Reimbursement shall include, but is not limited to, monies paid for medications (whether prescribed or purchased over the counter), medical co-payments, fees for medical, nursing and caregiver services or laboratory work, household or personal incidentals, automobile maintenance and repair, lawn services or landscaping, fees for professional services (such as an attorney, CPA or financial advisor), reasonable travel or lodging costs in performance of the duties created by this power of attorney, maintenance and repair of my residence and care of my pets. Benefits authorized to be received by my Agent shall include any imputed rent deemed to exist due to any arrangement, agreement or understanding between my Agent and I which allows my Agent to live rent-free in my residence or other property owned by me.

F – Healthcare POAs and Advance Directives

For health care issues, make sure POA is HIPAA-compliant. If current HCPOA was executed prior to the implementation of HIPAA on April 14, 2003, a new HCPOA should be executed since some health care providers and insurers will not honor pre-April 2003 HCPOAs. To ensure HIPAA compliancy, consider inserting the following paragraph in a HCPOA:

HIPAA Release Authority. I intend for my agent to be treated as I would be with respect to my rights regarding the use and disclosure of my individually identifiable health information or other medical records. This release authority applies to any information governed by the Health Insurance Portability and Accountability Act of 1996 (aka HIPAA), 42 USC 1320d and 45 CFR 160-164. I authorize:

  • any physician, healthcare professional, dentist, health plan, hospital, clinic, laboratory, pharmacy or other covered health care provider, any insurance company and the Medical Information Bureau Inc or other health care clearinghouse that has provided treatment or services to me or that has paid for or is seeking payment from me for such services
  • to give, disclose and release to my agent, without restriction,
  • all of my individually identifiable health information and medical records regarding any past, present or future medical or mental health condition, to include all information relating to the diagnosis and treatment of HIV/AIDS, sexually transmitted diseases, mental illness and drug or alcohol abuse.

The authority given my agent shall supersede any prior agreement that I may have made with my health care providers to restrict access to or disclosure of my individually identifiable health information. The authority given my agent has no expiration date and shall expire only in the event that I revoke the authority in writing and deliver it to my health care provider

“Stand-alone” medical records releases.

The healthcare POA grants decision-making authority to another person. But our clients will typically want other family members and friends to have access to doctors and their staffs during a hospitalization but who are not acting in a decision-making capacity. As a result, I am seeing widespread use of “stand-alone” releases by elder law attorneys. The release is limited to visitation and to speaking with the medical staff. It does not authorize access to medical records. For ease of use, the release is only a one-page document.

The release will list family members and friends. It should also include the attorney and members of the law firm and the employees of the client’s church or synagogue. The specific release provision should read as follows:

HIPAA Release Authority. I authorize my doctors and all other health care providers and their staffs who are involved in my health care treatment to release information regarding my location, my medical condition, my diagnosis and prognosis and any other information about me, to include individually identifiable health information, that is deemed important by my providers to those persons named above.   This authority is intended by me to allow my health care providers and their staff to freely converse and communicate, both orally and in writing, with the persons named above.

This document does not grant health care decision-making authority and does not in any way affect, inhibit or otherwise limit the authority granted in any existing healthcare power of attorney that I may have completed.

This document is effective immediately and is durable so that it is not affected by any subsequent incapacity.

Successor trustees.

A problem similar to the springing POAs will arise with successor trustees who can assume the duties of trustees upon the incapacity of the predecessor trustee. The successor trustee must be able to prove incapacity as provided in the trust agreement but may not be able to do so since he/she is only the designated trustee-to-be. He/she is not yet the trustee.

My suggestion in drafting around this problem is to add a paragraph in the article of the trust agreement dealing with successor trustees that reads as follows:

HIPAA Release Provision. When in the process of determining a Grantor’s or Trustee’s incapacity, all individually identifiable health information and medical records may be released to the person who is nominated as Successor Trustee, to include any written opinion relating to my incapacity that the person so nominated may have requested. This release authority applies to any information governed by the Health Insurance Portability and Accountability Act of 1996 (aka HIPAA), 42 USC 1320d and 45 CFR 160-164, and applies even if that person has not yet been appointed Successor Trustee.

Living wills.

The Schiavo case has brought much-needed attention to decisions made in end-of-life issues. It has caused me to make several major changes to my prototype living will, a copy of which is attached. I have clearly indicated that my client’s living will is not limited to terminal conditions. I have more clearly delineated what is considered a diminished quality of life that would warrant the termination of life support. I have added provisions to address disputes within the family and given added enforcement authority to the agent if such a dispute erupts. See the attached form that seeks to address these delicate and difficult issues.