Exit Strategies

By Harriet Barovick

1. COMMUNICATE YOUR WISHES

--WILLS Get a trusted lawyer to write one and update it regularly. If you have a complex estate or want to spare beneficiaries the often lengthy and costly process of probate, talk to your lawyer about a living trust, which protects your assets while you're alive. When you die, a co-trustee will distribute them according to your wishes.

--ADVANCE DIRECTIVES Also known as living wills, they are the best way to ensure you'll receive the care you want if you become incapacitated. There are two types: a document detailing specific wishes (e.g., Do you want to be sustained on a respirator?), and one that names a health-care proxy to speak for you when you can't. Experts--who stress that the real point of ADs is to spur conversation with family and doctors--recommend using both. Choose a proxy (probably not your spouse) who is likely to be thorough and levelheaded in carrying out your wishes. Keep the identity of your proxy with you.

2. KNOW WHAT YOU'RE INSURED FOR

Private insurance coverage varies enormously according to age, site of care, type of policy and other factors. Medicare, which currently covers more than 80% of people who are dying, pays for pressing medical issues but does not cover prescription drugs, and is severely limited in its coverage of nonhospice, nonacute chronic care. While hospice-care coverage is thorough, it requires that two doctors declare that the patient has six months or less to live, which discourages many doctors and patients. Even if you're covered by Medicare, consider buying Medigap policies, or private supplemental insurance, to cover what Medicare does not. And if you qualify for Medicaid, the federal and state program for low-income people, you may be eligible for better long-term coverage than Medicare patients.

--LONG-TERM-CARE INSURANCE (LTCI) covers what Medicare and many private health plans do not: "non-medical" day-to-day care at home (help with bathing or eating for an Alzheimer's patient), and long-term care at nursing homes and other facilities. But it costs--anywhere from $500 to $8,000 annually, depending on the dollar amount per day and the period covered. Some plans offer inflation protection. At current prices, dying costs about $1,000 a day in a hospital; $1,000 a week in a nursing home; $100 a day in hospice care. Count on spending about $1,600 for a good policy from a good company. Buy early--when in your 50s, since premiums jump dramatically as you age--but not before age 45, as the government may yet rehaul the health-care system to account for end-of-life needs.

3. EUTHANASIA

If you want physician-assisted suicide, you'll need to move to Oregon, the only state in which doctors may legally administer a lethal dose of medication. Hawaii considers legalizing it next year.

4. TIE UP LOOSE ENDS

Keep all important legal papers, including ownership and other financial documents, birth certificates, insurance policies in one place. Tell your loved ones how you wish your remains to be handled. And don't put off personal details: tell important people what you'd regret not having told them.

5. USEFUL RESOURCES

www.abcd-caring.org (authoritative, fact-filled site of Americans for Better Care of the Dying)

www.elderweb.com (diverse-news site of ElderWeb)

www.hospiceinfo.org (National Hospice Foundation)

www.AARP.org (AARP)

www.medicare.gov (Medicare)

www.hiaa.org (Health Insurance Association of America)

www.agingwithdignity.org and www.nolo. com (good guides to living wills and legal issues)

uslivingwillregistry.com (to register living wills online)

--By Harriet Barovick. With reporting by Anne Moffett/Washington

With reporting by Anne Moffett/Washington