California Estate Planning, Wills & Trusts
Laurie Shigekuni  |  Estate Planning Attorney

The Law Offices of Laurie Shigekuni
Office Locations:

2555 Ocean Avenue
Suite 202
San Francisco, CA 94132

225 S. Lake Ave.

Suite 300

Pasadena, CA 91101
Contact Information
Ph:  (415) 584-4550
       (800) 417-5250

Fax: (415) 584-4553


Estate planning prepares for the future and provides security for your loved ones.

Estate planning documents are more than just legal paperwork. They express how you wish to care for your loved ones. In crafting your estate plan, you decide who will care for your children in the event of your death. You determine whom to trust with medical decisions if you become sick. You arrange for your loved ones to receive most or all of your assets on your passing, in an estate plan crafted to minimize taxes and legal fees.

Whether your assets are valued at less than $10,000 or over $4,000,000, our law firm can tailor an estate plan to meet your distinct needs. Our firm has the experience, integrity, and understanding to guide you through the process. Call us for a free half-hour initial estate planning consultation.

Estate Planning Tips From Our Office:

An Attractive Option for Care at Home called PACE

September 1 , 2015

Last winter our office published a newsletter on a senior health program called PACE ("Program of All-Inclusive Care for the Elderly"). We've heard positive reports about this program from our clients and professional contacts in the community. PACE is a national Medicare and Medicaid option inspired by the On Lok senior adult day health center in San Francisco, which was founded in 1971. Many other PACE programs following the On Lok model are now offered in counties throughout California. In this article we discuss eligibility for the current On Lok Lifeways PACE program in particular. Other PACE programs have similar requirements. Click here to find out if a PACE program is available in your zip code.

In our last article we introduced a hypothetical couple, Grace and Steve Robinson, who need to arrange care for Steve’s father, Chris. Grace and Steve live in Chicago; Chris wants to stay at his home in San Francisco; Chris recently got lost walking near his home, fell on some unfinished pavement, and suffered a broken leg and head trauma. His injuries will require months of rehabilitation. He will also need someone to check on him at home because he has memory issues.

The need for varied long-term care options is growing as the U.S. population ages. By 2050, the Census Bureau estimates that the population of people aged 65 and older will be 83.7 million, almost double the comparable estimated population of 43.1 million in 2012. An estimated 58 million will need some form of long-term care during their lifetimes.

PACE is a Medicare program, also supported by Medi-Cal in California, for adults age 55 and over living with disabilities. The program provides long-term care for elderly individuals through a managed health care program. It provides comprehensive health services, which Medicare and Medi-Cal partially fund with monthly capitation payments based on each participant’s financial eligibility.

Services at PACE program sites include interdisciplinary assessment and treatment planning, primary care, physician and nursing services, master’s-level social work services, restorative therapies, physical therapy, occupational therapy, and speech-language pathology, personal care and supportive services, home care coordinated from a PACE center, nutritional counseling, meals, transportation, and recreational therapy. Participants are able to continue living independently in their own community. Anyone can leave the PACE program at any time; it is not a contract for life.

In order to qualify for the PACE program, individuals must: (1) be aged 55 years and older, (2) reside in the service area of a PACE program, (3) be certified by their state of residence as meeting the need for the nursing home level of care, and (4) be able to live safely in the community upon enrollment.

If Chris Robinson enrolls in the PACE program, he will more likely be able to stay at his home in San Francisco and receive the care he needs instead of having to move to Chicago. Because he lives in San Francisco, On Lok would be his local PACE provider. Chris' rides to and from his medical appointments would be provided by the PACE program’s van. Likewise, his physical therapy for recovery from his broken leg would be covered. Chris would be able to participate in the adult day services at PACE, eat lunch at the On Lok PACE Center, and also potentially receive further care at his home from visiting PACE staff.

If Chris makes this choice, it may involve some sacrifices from his point of view. Not everyone is willing to give up a trusted current treating physician for a different health team. In addition, it is a major and possibly daunting change in lifestyle to agree to be transported to an adult day health center for care and activities on several days of every week. He would not have to join group activities that he didn’t enjoy, but the program might ask him to come to the center often enough for the staff to see how he is getting along and provide care accordingly. Note that at some PACE centers, it is not necessary to go to the center. Instead, at home care may be provided.

If Chris is eligible for Medicare Parts A and B, but he is not eligible for Medi-Cal, he will have to pay between $3,800 to $4,700 per month for On Lok services. If Chris receives both Medicare and Medi-Cal, he will owe less out of pocket but he may have to pay a “share of cost.” That amount depends on his income, which might include Social Security, a pension, IRA distributions or other income sources.

The typical cost in 2015 for a PACE participant who qualifies for Medicare Part B only is approximately $6,750.52 for San Francisco, $5,408.08 for Fremont, and $4,710.62 for Santa Clara County. Without Medicare or Medi-Cal coverage, the cost is approximately $9,037.99 for San Francisco, $6,665.13 for Alameda County, and $5,738.34 for Santa Clara County.

On Lok does accept participants who qualify for Medi-Cal only, and accepts participants who do not have U.S. citizenship or green cards, but do qualify for Permanent Residence Under Color of Law (PRUCOL) status.

When Congress enacted the Balanced Budget Act in 1997, PACE became a permanent optional Medicaid benefit that states could choose to provide at their option. This authorizing statute integrated PACE services into a single program that can be provided seamlessly to elders who are "dual eligible" for both Medicare and Medicaid services -- provided their states elect to include Medicaid services under PACE. Medi-Cal is California’s version of Medicaid, the health coverage program for low-income individuals that is jointly funded by the states and the federal government. As of February 2012 it was covering close to 7.6 million people in California. California has elected to include support for PACE services as part of Medi-Cal coverage.

Medicaid (Medi-Cal in California) covers most of the costs not covered under Medicare. For example, for nursing home costs, Medicaid pays for around 58%, private insurance covers 24%, and Medicare pays around 15%. Medicare covers nursing home services for up to 100 days following a hospital stay. Medicaid is used for any additional services after the first 100 days.

PACE centers are expensive: capital investments run as high as $2 million to $2.5 million for a program that serves 250 clients. But they are not as expensive as nursing homes.

A PACE participant is likely to receive less expensive care with greater personal independence than he or she would receive by going to live at a nursing home. PACE programs allow aging people with disabilities to reduce high-cost inpatient services and to extend the periods when they are able to live independently with serious health conditions. Nationally, since 2010, fewer than 10 percent of PACE clients have ever entered nursing homes.

The Kaiser Commission on the Future of Medicaid has noted that PACE produces modest savings on out-of-pocket costs to patients. The centers emphasize coordinated care and efficient management of insurance. Given the flexibility to use pooled funds from Medicare and Medicaid, private insurance, donations and fees, PACE programs have a variety of methods of meeting client needs while keeping costs stable. This resource is a valuable option for many people seeking long-term care.

Chris Robinson: One Story Describing a Need for Long-Term Care

December 1, 2014

Imagine two people, Grace and Steve Robinson, of Chicago, receiving a call on Monday morning from a hospital in San Francisco concerning the condition of Steve’s father, Chris. It appears Chris suffered a broken leg and experienced head trauma when he was walking in his suburban neighborhood. He is a seventy-five year old man who suffers from Alzheimer’s disease. Chris forgot the route back to his house; he ended up walking down an unfinished area of the road, and broke his left leg. Recovering from his leg injury would require months of rehabilitation.

Four years ago, when Steve’s mother died, he and Grace offered to pay for live-in help to take care of Chris in their home and arrange for health care in Chicago. Chris resisted his children’s efforts to move him from his home in San Francisco for the following reasons: he loved his home and the close-knit community he had built around him. Chris also wished to remain autonomous and be able to cook and clean without the help of a third party. After he had suffered the broken leg, however, Chris realized that he needed additional assistance. He was thinking that he needed to move in order to get the help that he needed.

Chris, like millions of Americans, needs long-term care services. According to the U.S. Department of Health and Human Services, long-term care is a range of services necessary to meet personal care needs. Long-term care does not have to be medical in nature, but can be assistance with the basic personal tasks of every day life. These activities range from bathing, dressing, eating, and caring for incontinence. It is estimated that 70% of people turning 65 can expect to use some form of long-term care during their lives. While one-third of today’s elders may never need long-term care support, 20% will need it for longer than five years. On average, women need a little over three years of long-term care and men require a little over two years of care.

We'll be writing about a long-term care program called Programs of All-Inclusive Care for the Elderly (PACE) in future posts, that is useful for people like Chris.


The Flickering Screen

Nothing like September for getting on with deferred projects. One of these for us, and possibly for you as well, has been to take a closer look at estate planning for computer data and online accounts.

Digital inheritance is in flux in terms of legal requirements, corporate practices, and levels of privacy available to the consumer. In the absence of specific California laws, general inheritance and estate administration principles have to govern the handling of deceased persons' computers, files and accounts. How such general principles apply has not yet been fully worked out.

At our office we are not specialists in the legal or technical aspects of personal privacy. We cannot promise any specific outcome for possible estate planning steps mentioned here. We don't recommend any particular services or companies in the oddly burgeoning business of digital "vaults" and "message from the grave".

What we can do is to offer some basic suggestions and cautions about digital legacies. These suggestions should not be taken as legal advice; if you have specific computer-related arrangements in mind for your estate plan, you should seek legal advice about your particular situation.

  • Distinguish between the right to make use of a password-protected account and the plain ability to do so. The law of ownership and control over assets does not change simply because a computerized process is involved. For example, you can't give your beneficiary or trust administrator the right to take over your online brokerage account simply by handing over the login information; the account will have to be retitled in the name of the person you have named to control it. Similarly, ownership of the content on a Web site is governed by copyright and trademark law, not by who has the password. In general the rights of others to control your various electronic files and accounts after your death may be affected by many factors, including your own instructions in your estate plan, relevant inheritance law, and the terms of your agreements with the companies involved.
  • On national trends in digital inheritance rights, some interesting sites to watch include Midwestern attorney Jim Lamm's Digital Passing or the collaborative Digital Estate Resource weblog. However, these sites are not based in California and they won't necessarily tell you what your specific rights may be. Watch for further coverage on this subject in consumer finance columns.
  • It's beyond the scope of this article to engage the fraught subject of inheritance rights to copies of digitally protected media such as purchased music recordings or e-books. However, this Wall Street Journal article and this more substantive American Bar Association analysis suggest that ownership by a trust may be a way to preserve rights to purchased media after the death of the original purchaser.
  • As with banking and investment accounts, transfers of ownership and control are often easiest to resolve by agreeing on advance instructions with the corporation involved. Just as you might provide for a bank account to be transferred through beneficiary listings, you can provide for your Google or Facebook account powers to be transferred through instructions left with the respective companies. As with banking and investment accounts, it's important to keep these quasi-beneficiary listings updated if your family relationships change or if there are deaths among those close to you. It's a sign of these agreements' incorporeality that a useful checklist of popular social media sites' procedures happens to appear on a New Zealand attorneys' site. Obviously the policies mentioned there may be somewhat different in the U.S. and any such policies may change over time, but the checklist is a useful starting point to help you think about questions to ask, and subjects to look up, on Internet platforms where you currently have accounts.
  • If there are things you do not want your family, friends, or other estate administrator(s) to see in your online accounts, it is probably best to leave instructions accordingly with the company that hosts the account(s).
  • Regardless of the rights situation, you can save everyone a lot of time by listing all your accounts and their login information for your named executor(s), successor trustee(s) or other estate administrator(s). That way your estate administrator will know which accounts you have, and if he/she can demonstrate a legal right to access an account, the password will be ready to hand. Likewise, there will be less fuss after your death about accessing files such as tax or banking records on your home computer.
  • You can start by writing a list of all the accounts or password-protected devices that you want the administrator of your estate to control, together with the information necessary to access their contents. If some are related to your work it may be clearest to write those down on a separate list. Types of accounts might include:
  • Personal computers or devices
  • Email accounts
  • Internet service accounts
  • Weblogs or Web site accounts
  • Multipurpose services such as Google or Yahoo
  • Photo accounts such as Flickr or Shutterfly
  • Cloud storage services such as Dropbox
  • Social media logins such as Facebook, Twitter, etc.
  • The multipurpose OpenID login
  • Electronic accounts such as TreasuryDirect or brokerages
  • Automatic bill paying authorizations managed online
  • Shopping accounts such as Amazon, EBay or PayPal
  • Online subscriptions to services such as Netflix or digital magazine or newspaper editions
  • Content purchasing accounts such as E-readers or iTunes
  • Don't forget logins to places such as online discussion forums or multiplayer gaming environments where you might want to have farewell messages posted.
  • For each account or device, write down the login, associated email address and/or phone number, password, and answers to security questions. If you can't remember a password, write down the email address where a "Forgot Password" response would be sent on request. If you have given instructions directly to a company about what to do with your account at your death, say so in the list you are making so your estate administrator will not try to override those instructions. If you keep multiple backups of your files, explain what is kept where.
  • Here are some ways you could provide the list to your successors:
  • You could place your login information list in a sealed envelope addressed to the administrator(s) of your estate and store it with your estate planning documents, preferably in a locked security box or safe deposit box.
  • Alternatively, you could place a flash drive with this and other essential electronic information (for example, copies of business or tax preparation data) into the same kind of sealed envelope with your estate planning documents.
  • You could encrypt the folder on the flash drive, possibly using a free service such as TrueCrypt, and provide its password separately in personal letters to the people you expect will resolve your estate. (Public knowledge about the relative security of different encryption services is especially volatile. Read the latest information on tech discussion sites and decide what risks you are willing to take.)
  • If you are willing to take the privacy risk, after encrypting the folder you could upload a copy to a cloud backup site such as Google Drive (less secure) or SpiderOak, or even as an attachment to a draft email on a Web-based email account. This can also be a way to store items such as PDF copies of passports, travel tickets or credit cards in case of theft during international travel. Just remember that anything you place online may be at risk for being read by third parties.
  • You could use the same method to leave messages that you want to have sent or posted in specific ways after your death.
  • Do not write computer passwords into your will. A will ordinarily is filed as a public document upon its maker's death. Also, for security reasons it should be easy for you to change your passwords without changing your will.
  • Don't write computer passwords into your trust either. People do often feel safe writing banking or investment account numbers into trusts because a trust is less likely than a will to become a public document. If a trust does have to be submitted to a court, a county assessor, a bank, or some other office, it is usually possible to redact private information first. However, computer passwords are really more sensitive than account numbers, or at least they are easier to abuse furtively, so it's best not to put passwords in the text of a trust.
  • If you do give instructions in your estate plan, or in an accompanying letter, about certain accounts, files, digital rights, etc., describe what you mean specifically -- don't use generic labels whose interpretation might confuse people later. Terminology in this new field of digital inheritance is still a little wobbly. For example, it could be unclear whether the term "digital asset" includes the right to take over control of an account as distinct from the right to the items in the account. (See this discussion at the North-Carolina-based Digital Estate Resource site.)
  • Shop and monitor carefully if you think about using any of the services that offer to create trusts for digital assets or to hold passwords, files or messages for delivery upon your death. These services have proliferated as part of the Web 2.0 boom: the Digital Beyond site's voluminous "Digital Death and Afterlife Online Services List" makes macabre and sometimes unintentionally funny reading. As in any new industry, some companies are inevitably better run than others. And as with cemeteries, a promise of perpetual care can't literally last forever. The question realistically is whether a given service will function "perpetually" enough for your purposes. If you do sign up with one of these services, keep an eye on its corporate fortunes and be ready to rescue your data if it shows signs of fizzle.

Since digital estate planning is a new and changing area, these are only suggestions. We can't say they're accepted practice because there's no such thing as yet. There is, however, common sense. It's important common sense that you should provide password information to your successors so that, if they have a legal right to read your files or post a farewell message on your Facebook, they won't be held up by trouble hacking in.

When public benefits meet estate planning.

We've decided to share a resource with the public that we created some time ago for internal use. It's our links page for Web sites at the complex intersection of estate planning law, seniors' rights, and public benefits. For convenience it includes some general-purpose starting points for free legal research as well.

This past year we sent out a link to the page in one of our private client newsletters, but until now we haven't provided access to it for the general public.

One reason we've hesitated is, a page with links to so many different kinds of Web sites is subject to a lot of your-mileage-may-vary types of warnings. Here they are:

The links on our resource page go to all kinds of sites for all kinds of entities, including government agencies, law libraries, and activist organizations. For your protection, always do your own independent checking and critical thinking about whether to trust any law-related Web site, even if reached it by clicking something on our page.

Further warnings: This Web site and the material on our links page is not legal advice. Material on either this page or the links page is no substitute for legal assistance tailored to your particular circumstances. The links are NOT meant to provide a comprehensive review of any legal subject, we're not responsible for the information or suggestions you might find at any of these links, and just because a site is intended for legal self-help doesn't mean that trying to be your own lawyer is a good idea. It often isn't.

Having said and heartily meant all that, we hope the site is helpful. Here's the link.

Understand POLSTs before you sign one.

People agree to things too easily in pressured settings. During the front-desk formalities at an emergency room, for example, it can almost seem foolish to insist on reading and understanding every paper before signing it.

This is a major reason why estate planners urge people to prepare advance written instructions for medical care in case of emergency or incapacity. An important function of an Advance Health Care Directive is to protect its creator from having to make important, potentially life-ending decisions in unfamiliar, authoritative settings.

However, some concern now exists that, if a real crisis hits a patient, a typical Advance Health Care Directive may not be clear enough. For example, paramedics arriving at a house might not understand whether to start CPR, or a junior nurse in a hospital might not know whether to give antibiotics or place an IV line.

To answer this concern, the California legislature has developed simpler, clearer, grimmer documents known as "Requests Regarding Resuscitative Measures." The oldest document of this type is the simple “Do Not Resuscitate” or DNR order. As of January 2009 the Legislature added the POLST, or “Physician Orders for Life-Sustaining Treatment”. It is now addressed in the California Probate Code provisions beginning with Section 4780.

POLSTs and DNRs can be helpful in enforcing a seriously ill patient's wishes, especially for someone who wants to die at home without the physical violence of CPR or the bureaucracy and disruption of an ambulance to the hospital. However, they should be approached with care, particularly during admissions to hospitals or nursing homes. In such contexts, people could literally sign away their lives without knowing it.

Between the two kinds of resuscitation forms, a DNR form seems less likely to be signed by accident: it's a simple form, and the words "Do Not Resuscitate" are clear. A POLST, on the other hand, is at a scary middle level of complexity: it’s detailed enough to confuse a patient about its possible meaning, yet so clear in its instructions to a trained medical technician that it might be obeyed without even beneficial kinds of second-guessing.

So it's especially scary to think that a POLST might be included in a mind-numbing stack of paperwork to be signed in a situation like a nursing home admission, where patients may feel afraid or socially awkward about asserting their real wishes, or without sufficient information or discussion about the amount of authority that a POLST carries.

It is a good idea for some people to sign a POLST, but here are things to know about POLSTs before agreeing to them:

  • People shouldn't reject "life support" in general before understanding that many kinds of routine care fit under that description. In popular culture, "life support" can be thought of as something dramatic, invasive, possibly painful or grotesque – for example, CPR, or something like a breathing machine, or systems used to keep a body alive after brain death. They may think of “life support” as heroic measures to be taken (or not) when there's little real hope for recovery. In fact, however, the POLST addresses life support measures that can include temporary emergency care for a person who is likely to recover well – perhaps antibiotics, emergency steps to clear a patient's airway, or a temporary IV line to feed and hydrate a patient recovering from a crisis.
  • A POLST is a mortally important document, not an afterthought. Emergency medical responders are trained to look for a POLST. The state standard calls for printing it on attention-getting "Pulsar Pink" heavy paper, and good practice calls for it to be placed prominently in a patient's medical file, or in an obvious spot at home like the refrigerator door. It is not the same as an Advance Health Care Directive, but is meant to supplement one and can override one. On the other hand it covers more kinds of detail than the DNR. POLSTs are typically recommended when a patient becomes ill enough to face decisions about specific life-extending procedures such as the use of feeding tubes or respirators.
  • If POLST or DNR gives a different instruction than an Advance Health Care Directive, the instruction that was signed more recently must be followed under Probate Code Sec. 4781.4. This is true no matter how much time the patient spent thinking about the respective documents. You may have spent several evenings at home choosing language for an advance health care directive, but if you sign a POLST in a hospital waiting room on the morning you go in for surgery, then the POLST is what the medical team will obey first if something goes seriously wrong.
  • Two people sign a POLST. One is either the patient or the person acting as the patient's health care agent under a Durable Power of Attorney for Health Care. The other person to sign is the patient's doctor. The doctor's involvement is one reason for worry about people signing POLSTs too easily: doctors are so respected that they may be obeyed even if they don't interpret a patient's stated wishes correctly. Be sure the doctor writes down what you really want. The possibility of involving a health care agent is another reason for worry: the health care agent might also interpret or "remember" the patient's wishes wrong. If you choose the option in an Advance Health Care Directive to give your health care agent immediate authority, then your agent can sign a POLST on your behalf even if you have capacity to make your own health care decision. It is better for you to sign your own POLST with a doctor you trust, while your head is clear and there is no emergency or other pressure hanging over your head. A POLST can be obeyed without any requirement for the doctor or the agent holding power of attorney to be present.
  • Sometimes people may be asked to sign new durable powers of attorney for health care on forms when they get to hospitals or skilled nursing facilities, even if they have already signed more detailed and considered documents with their own lawyer. If new POLSTs are placed in front of people in such circumstances they may be persuaded to agree to choices that they don't feel they are given the time to think through. It is a good idea to execute an Advance Health Care Directive even if you also have a POLST. It is helpful to appoint an agent to make health care decisions. Advance Health Care Directives do that but POLSTs don't.
  • Electronic copies of POLSTs are available for download from the California Coalition for Compassionare Care, in English, Spanish and Chinese. (If you print your own POLST, buy some Wausau brand "65# Cover Pulsar Pink card stock" at an office supply store. Emergency staff will look for this heavy pink paper.)

In other words, the basic rules apply: read everything before deciding whether to sign it, and don’t sign if you feel pressured, ill, or uncertain. A POLST may be helpful at some time in your life, but if you choose to fill out and sign one with your doctor, you should take time to understand the form fully and make sure the decisions it expresses are entirely yours.

You don't have to fear advance care directives.

This summer's health care debate took a surreal turn when conservative speakers, using phrases like "death panels," projected their fears of totalitarian government onto a group of ordinary medical documents that include living wills and California's more detailed Advance Health Care Directive.

The main (if not only) occasion for their fury was a proposal to create a small Medicare fund that would have paid doctors for the time they spent helping patients to prepare "living wills." The idea was to help people, if they wished, to record their own highly individual decisions in advance about what type of care they wished to receive, or not receive, if they became terminally ill. Nobody was going to force people into these consultations. But somehow, in this summer's debate, a program that would have helped people assume more control over their own treatment became portrayed as its own opposite -- as a pressure campaign to save money by urging patients to accept a speedy death. The proposal has been dropped from the Medicare bill, and the national political focus has moved on, but some damage may have been done to the reputation of an essentially benign type of document.

Living wills have existed for many years as ordinary, conventional tools in medical and estate planning. A living will is a useful, safe document so long as it is created by voluntarily and correctly filling out a form document that was drafted with the patient's interests in mind. (Note: the Physician Order for Life-Sustaining Treatment (POLST), a new type of form allowing doctors to withhold specific types of treatment, is worth approaching with caution. We’ll discuss POLSTs in a later article.)

Documents such as the California Medical Association's detailed Advance Health Care Directive can relieve family members and medical providers from the uncertainty of guessing when a person who is near death would have wanted to be kept alive. An important purpose of a health directive is to prevent hospital administrators and insurance bureaucrats – or intrusive relatives – from “playing God” with the lives of patients. Documents of this type got more attention nationwide following the drawn-out and highly publicized death of comatose Florida patient Terri Schiavo. Many people decided that beyond a certain point of incapacity, they would not want to be the subjects of dramatic or cumbersome medical interventions.

More detail on the actual proposals underlying last summer’s controversy is available in this Washington Post discussion transcript. The discussion clarifies that Sarah Palin, who introduced the notorious "death panels" phrase, may in part have been thinking about a separate group of proposals to review the costs of publicly funded treatment. These other proposals included a call for an advisory board on limiting Medicare costs. Certainly medical cost-cutting pressures raise important moral concerns, whether they're imposed by public agencies or by private insurance companies, but those concerns exist for all patients, whether or not they write living wills.

As part of our office’s estate planning services, we help clients to fill out Advance Health Care Directives using the version provided by the California Medical Association. Copies of the CMA form in English or Spanish can be ordered directly from CMA at or at 1-800-882-1262. CMA provides an online sample of the document, including its detailed explanatory section.

Q&A: California end-of-life instruction documents.


Documents that explain people’s end-of-life wishes have been much in the news, yet little explained. Following is some basic information about end-of-life decision making.

What are the kinds of end-of-life instruction documents?

A Living Will can express your preferences regarding each of the methods of artificial life support, or you can use this document to reject all artificial life support if you wish to die a natural death. (California law now prefers Advance Health Care Directives for this purpose.)

A Durable Power of Attorney for Health Care allows you to name an “agent” to make health care decisions for you in case you are unable to make your own decisions. You can choose a backup agent to act if your first choice is unavailable.

An Advance Health Care Directive, in the popular form provided by the California Medical Association, allows you to express your wishes regarding life support and other issues.

A Physician Order for Life-Sustaining Treatment (POLST) is a new type of form allowing doctors to withhold specific types of treatment, especially for people who are seriously or terminally ill. We suggest that patients exercise caution in considering whether to sign a POLST.

What is the most widely used health care instruction form in California?

The California Medical Association (CMA) publishes an Advance Health Care Directive Kit that allows you to: 1) Create a Durable Power of Attorney for Health Care 2) Choose among prepared statements, or write your own statement, regarding which life support methods (if any) shall be used in your care, for how long; and 3) State whether you wish to be an organ or tissue donor. The CMA Advance Health Care Directive Kit includes instructions and explanations. The forms are $6.00 for members of the public. You can order one at, or by calling 1-800-882-1262.

What are other sources of information about end-of-life decisions?

The California Medical Association Web site, at, provides information about Advance Health Care Directives. A nonprofit organization called H.E.L.P. provides a detailed Web site at with suggestions and questions to help seniors with end of life decisions and funeral planning.

Should I Redo My Existing Advance Health Care Directive or Durable Power of Attorney for Health Care?

If your form was executed before 1992, then you should have another one executed. Durable Powers of Attorney for Health Care executed before 1992 expire seven years after the date of execution.

If you executed a CMA Durable Power of Attorney for Health Care before 2000, be aware that any statement you made about life support will not be considered a mandatory statement. The current CMA forms contain health care directions that your agent(s) must follow if instructed to do so. By contrast, the pre-2000 CMA forms contain life support statements that are merely discretionary guidelines for the agent.

You may also want to check whether your current health care directive or estate planning papers include an information release under the Health Insurance Portability and Accountability Act (HIPAA) that allows your agent(s) to receive information from your doctors about your medical condition and mental capacity.

Do I Need a Lawyer to Help Prepare my Advance Health Care Directive?

The CMA’s forms are designed to be used without the assistance of a lawyer. A detailed explanation comes with the Advance Health Care Directive Kit. A lawyer may be able to help you write a more detailed statement in your Directive, to make sure your wishes are stated clearly, to check to see that the form is correctly completed, signed and witnessed, or to explain about privacy laws.

Estate tax changes affect couples with modest assets who have older trusts.

Recent increases in federal estate tax exemption amounts have changed the best practices in trust drafting for married couples who have assets well below the current limits. Many older existing trusts were drafted with lower exemption amounts in mind. If both spouses are still living, such trusts should be restated to reduce potential burdens on the surviving spouse after the first spouse passes away.

As you may know, the federal estate tax exemption amount is the maximum value of total assets a person may own at death before inheritance taxes apply (that is, assuming the person made no large gifts during life). As of 2009, the exemption amount increased to $3.5 million. Current law calls for the exemption amount to become unlimited in 2010 and then fall back to $1 million as of 2011. However, legislation before Congress may stabilize the amount at $3.5 million.

Before the early 2000's, typical 'bypass' or 'A-B' trusts used to provide that, upon the first spouse's death, assets were required to be divided into separately taxable sub-trusts. The intention then was to keep each sub-trust below the federal estate tax threshold, which for many years was as low as $600,000. If a trust that still provides for these mandatory divisions is allowed to take effect following the death of a spouse, it can impose unnecessary burdens on the surviving spouse with no corresponding advantages under current tax laws.

With the recent changes in tax laws, older trusts should be re-examined and possibly redrafted. For more details, see our "Trusts for Married People" discussion.

"... If something happens to me, who will take care of my children? Who will make medical decisions for me if I become sick? When I pass away, will my money reach the people I love?..."

We have the experience to tailor your estate plan to your specific needs.

Introductions to Estate Planning:


Trusts vs. Wills

•  Trusts for Married People
•  Medi-Cal Trusts
•  Other Types of Trusts
•  Other Estate Planning Documents

Estate Planning Tips:

Chris Robinson: One Story Describing a Need for Long-Term Care

You don't have to fear advance care directives

Q&A: CA end-of-life instruction documents

•  Estate tax changes affect couples with modest assets who have older trusts

- Archive (older estate planning tips)


Articles first published in the Hokubei Mainichi community newspaper:

"Transitions for Family Trusts" (8/1/08)

•  "Trust Administration" (9/6/08)
•  "Estate Planning Updates for 2009" (1/24/09)
•  "How Asset Price Swings Affect Estate Planning" (3/28/09)

Helpful links on estate planning, public benefits and legal research

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Legal Disclaimer: The information on this Web site is intended to be used as general information only. Nothing on this Web site constitutes specific legal advice. You should always speak with an attorney first before engaging in any estate planning. In compliance with the requirements of IRS Circular 230, we further inform you that any writing about tax law on this Web site is not intended to be used, or can it be used, to avoid penalties that may be imposed under the Internal Revenue Code.
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