MONEY Ask the Expert

How To Pick a Pro to Manage Your Money When You’re Gone

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Robert A. Di Ieso, Jr.

Q: Are there professional administrator services for private wills? I’m single with no family or appropriate friends. – Paul, Calif.

A: Everyone needs a person or institution to act as executor and administer the estate though the probate process.

Because your executor will be in charge of collecting the estate’s assets, inventorying the property, paying claims against the estate (including taxes), and distributing assets to beneficiaries, you want to give the job to someone who is financially responsible and trustworthy.

That could be someone you know, say a relative or close friend, but it can also be an institution, or what you referred to as a professional will administrator.

Because of the complexity involved, many individual executors have to hire professionals to help. So even if you do have someone close to you take on the role, having a reliable and impartial professional as backup would be smart.

How to find the right pro

You could name your lawyer, accountant, or financial adviser as your executor, but Greg Sellers, a certified public accountant and president of the National Association of Estate Planners and Councils, warns against it, no matter how good a working relationship you already have.

“If your executor is also the one drafting your estate planning documents, there is the opportunity for them to do some self-dealing,” says Sellers. “While they may be legally bound to carry out your wishes, it presents a chance for conflicting interests. They could have undue influence on the documents, could charge higher than normal fees.” And acting as an executor may not be in the normal scope of what your accountant and financial adviser do.

Sellers recommends using a corporate trust company, either one affiliated with a financial institution like your bank or full-service brokerage, or an independent trust company. These companies have teams that manage estates full time. You don’t need a trust to use a trust company; they take on jobs just handling will administration.

What a pro will charge

Of course, hiring a professional will mean paying a fee (leaving a little less for your heirs). Some states set maximums that an executor can charge, but Sellers says that except in rare circumstances, executor fees should not go above 5% of the value of the estate.

The fee will likely land on the high end of the scale if your estate has lots of moving parts, such as a small business, personal property that needs to be sold, or investment accounts in more than one place. The total value of your assets matters too: the larger the estate, the smaller the percentage a professional executor will deduct.

This one-time fee will be paid from your estate after your death and is typically non-negotiable, Sellers says. While companies are upfront about the likely fees, they will not settle on an amount until they find out exactly what being executor involves, which can’t be known until your death.

Once you’ve settled on a company to be you executor, Sellers recommends letting it know and sending a copy of your will (though it isn’t necessary—you can simply note who you picked in your will).

Any company has the right to reject the job, which is why Sellers recommends naming a backup. If both your first and second choices reject the job, the probate court will assign an executor.

TIME Culture

See Which States Allow Assisted Suicide

Brittany Maynard was one of hundreds of people in five states who've taken advantage of death with dignity laws

Few issues are more personal—or divisive—than ending a life with a doctor’s lethal prescription.

The issue has sparked national debate recently, after Brittany Maynard, a 29-year-old woman who had terminal brain cancer, went public with her decision to end her own life. She did so on Saturday in Oregon.

Maynard is one of more than 750 people in Oregon who have ingested a lethal dose of prescription medication since the Death with Dignity Act went into effect in 1997. While Oregon has had increased participation over the last 16 years and has spurred similar legislation in other states, aid-in-dying laws remain a lightning rod of contention and deliberation.

Advocates say competent patients should have a right to choose how they die if they are already in the process of dying from a terminal illness. Opponents counter that such a precedent is ripe for abuse.

The battle has been shaped over many years. In the 1990s, Jack Kevorkian assisted in the deaths of more than a hundred terminally ill people to much public outcry. In 2009, politicians sparred over a provision in the Affordable Care Act concerning end-of-life consultations – called “death panels” by critics – to help control health-care costs. (Roughly 28%, or $170 billion, of Medicare is spent on patients’ last six months of life, according to Medicare Newsgroup.)

Here is how aid-in-dying laws look today, and a snapshot of the ways in which they are implemented:

dignity
Sources: Oregon Health Authority; CompassionandChoices.org; NotDeadYet.org; New York Times

TIME medicine

The Right—and Right Time—to Die: How Doctors Should Help

Jauhar is a cardiologist and the author of Doctored: The Disillusionment of an American Physician.

I've tried to fight a patient's inevitable death, but I know that's not always the best care—and America needs to talk about what is

As doctors, we are expected to prolong human life, and we do—but often regardless of the costs. Brittany Maynard, the 28-year-old Oregon woman with an inoperable brain tumor, puts a human face on this tragedy. Maynard has decided that she does not want to suffer through a painful, protracted death and is planning to end her life with doctor-prescribed pills, obtained through Oregon’s Death With Dignity Act; she may have died by the time you read this. In Oregon, more than 1,100 people have obtained life-ending prescriptions since the law’s passage in 1997, and about 750 have used them safely and appropriately. By numerous accounts, the law has been a success. And yet many doctors, not to mention laymen, continue to regard its goals with suspicion. I have been one of those doctors.

I once cared for an 88-year-old patient with a severely leaky heart valve. When she was hospitalized with worsening kidney and heart failure, a critical-care specialist decided to forgo aggressive treatment. But unwilling to give up, and against my better judgment, I transferred her to the cardiac intensive-care unit. Her stay there was a disaster. She was unable to be weaned from a respirator. Her liver failed. Even as it became clear to me that she was going to die and that my interventions had been for no good purpose, I became very reluctant to change course. We checked blood tests several times per day. I inserted a pressure catheter in her pulmonary artery to monitor her hemodynamics. I started her on dialysis. The breathing tube remained in her throat till the end. Eventually she succumbed to multi-system organ failure and sepsis, nearly a week after I’d moved her to the ICU.

At their core, my actions were a kind of deception—convincing myself, despite the evidence, that I could save my patient and stay the inexorable course of her disease. Perhaps I was embarrassed by my impotence or afraid to see a beloved patient pass. I don’t know. But it was the kind of deception that many in my profession practice.

Of course, it isn’t only doctors who medicalize the terminal phase of life. Patients and their families do too. I once took care of a middle-aged man in the ICU who’d had a cardiac arrest and ended up with significant brain damage because he had been out so long. His wife would not accept the terminal nature of his condition. “He is going to pull out of this,” she told me adamantly. When I asked if her husband had ever expressed any preferences about being on life support, she told me what I expected: they had never discussed it.

That conversation is often the crux of the problem. Most people never have it, thus families and doctors are left to substitute their own judgments and prejudices for those of the patient. What does a dying patient want? What is the minimum quality of life that is acceptable to him or her? As Maynard has so poignantly shown us, these are questions we need to ask before it is too late. And it’s not just families who need to have the tough talk. As a nation, we need to rethink our approach to dying and death. Our reluctance to confront mortality is the cause of too much suffering.

Most Americans die in a hospital or a nursing home. Almost one-third of the $554 billion we spent on Medicare in 2011 was used to treat people in the last six months of their lives. Nearly every colleague I’ve talked to recognizes that this wastes precious resources and prolongs suffering. But they—I—have not been taught a different way.

Hospice is one alternative. The modern hospice movement started in 1967, when Dame Cicely Saunders, a nurse, opened St. Christopher’s Hospice in London. Saunders formulated three principles for easing the process of dying: relief of physical pain, preservation of dignity, and respect for the psychological and spiritual aspects of death. Though it’s been slow, progress has been made. The number of American hospitals offering palliative care has nearly doubled since 2000, growing to nearly 1,500 programs—the majority of hospitals. Yet even as reflective an observer as Atul Gawande admits in his new book, speaking no doubt for the majority of physicians, “The picture I had of hospice was a morphine drip.”

Doctors witness death and dying nearly every day. Disease may win in the end, but we must strive to never lose sight of the patient at the center of it all, and we must empower our patients to make their own decisions in the terminal phase of their lives. Maynard’s terrible tale reminds me of what an elderly woman with terminal heart disease once told me: “My husband said the hardest thing to do is to die; I always thought it would be easy.”

 

Jauhar is a cardiologist and the author of two books, Intern: A Doctor’s Initiation and the recently published Doctored: The Disillusionment of an American Physician

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME Soccer

South Africa’s Soccer Captain Senzo Meyiwa Has Been Shot Dead

Australia South Africa Soccer Mayiwa Obit
In this file photo dated May 26, 2014, South Africa's goalkeeper Senzo Meyiwa makes a diving save against Australia during their friendly soccer match in Sydney Rick Rycroft—AP

Armed men entered a house where Meyiwa was staying, but the motive remains unclear

South African national soccer captain and goalkeeper Senzo Meyiwa was fatally shot on Sunday by armed men who broke into the house where he was residing.

Two gunmen entered the house, located in the Vosloorus township near Johannesburg, while an accomplice waited outside, the Associated Press reported.

Authorities said there were seven people in the house at the time of the shooting, which reportedly came after an “altercation.” A motive for the murder remains unclear.

Meyiwa, 27, played for South African soccer club Orlando Pirates and also captained the national side in its last four games.

“This is a sad loss whichever way you look at it — to Senzo’s family, his extended family, Orlando Pirates and to the nation,” Pirates chairman Irvin Khoza said.

South Africa lost another prominent sportsman just a couple of days earlier, when athlete Mbulaeni Mulaudzi was killed in an automobile accident on Friday.

[AP]

TIME Baseball

St. Louis Cardinals Slugger Oscar Taveras Dies in Car Crash

Oscar Taveras
This May 31, 2014 file photo shows St. Louis Cardinals' Oscar Taveras smiling after the Cardinals' 2-0 victory over the San Francisco Giants in St. Louis. Jeff Roberson—AP

The 22-year-old outfielder lost control of his car on a highway in the Dominican Republic

American baseball lost one of its rising stars Sunday, after St. Louis Cardinals outfielder Oscar Taveras was killed in a car accident in his native Dominican Republic.

The Associated Press reported that Taveras lost control of his Chevrolet Camaro on a highway about 215 miles from the country’s capital Santo Domingo. The 22-year-old player was not carrying any documents at the time of the accident, but his body was identified by his family members. Taveras’ girlfriend, named as 18-year-old Edilia Arvelo, also perished in the crash.

“I simply can’t believe it,” Cardinals general manager John Mozeliak said in a press release, while the team’s chairman, Bill DeWitt Jr., said they were all “stunned and deeply saddened” by the loss.

“Oscar was an amazing talent with a bright future who was taken from us well before his time,” DeWitt said. “Our thoughts and prayers are with his family and friends tonight.”

Commissioner of Baseball Bud Selig also issued a statement mourning Taveras’ loss. “All of us throughout Major League Baseball are in mourning this evening, shocked by the heartbreaking news of the accident involving Cardinals outfielder Oscar Taveras and his girlfriend in the Dominican Republic,” Selig said.

Taveras signed with the Cardinals in 2008, and made his major league debut this year after previously being ranked as Major League Baseball’s No. 3 overall prospect.

[AP]

TIME Mental Health/Psychology

Reliving A Friend’s Death May Help Lessen Grief

Nearly 40% of those who did not relive a the death of a loved one showed signs of prolonged grief disorder

Reliving the death of a close friend or family member may reduce the experience of long-term grief, according to a new study in JAMA Psychiatry.

The study assigned 80 people who had lost a loved one within the past few years to a 10-week regimen of cognitive behavioral therapy. Some of them were also assigned to exposure therapy, in which patients were made to relive the death of the loved one. Nearly 38% of those who did not get the additional exposure therapy showed symptoms of prolonged grief disorder, which includes yearning for the person who’s gone, bitterness about accepting the death and difficulty in engaging in life. Only 15% of those people who got the extra treatment showed signs of it.

Painful as it is, reliving a death may improve a patient’s ability to process loss and adapt to it, the study suggests.

“Including exposure therapy that promotes emotional processing of memories of the death is an important component to achieve optimal reduction in [grief] severity,” the study reads. “Despite the distress elicited by engaging with memories of the death, this strategy does not lead to aversive responses.”

Though researchers acknowledge some limitations, the study’s implications suggest some changes in the way doctors approach treatment for those in grief.

“Reluctance to engage with their distressing emotions may be a major reason for not managing the grief more effectively,” the study reads. “The challenge is to foster better education of clinicians through evidence-supported interventions to optimize adaption to the loss as effectively as possible.”

TIME Nepal

Death Toll in Nepal Blizzards Rises to 40 as Authorities Wind Down Search

The body of a victim is moved from an ambulance to the morgue after it was brought back from Annapurna Region in Kathmandu
The body of a victim is moved from an ambulance to the morgue after it was brought back from Annapurna Region in Kathmandu October 17, 2014. Navesh Chitrakar—Reuters

More than 600 people have been rescued, but a few locals are still reportedly missing

Nepalese authorities are being thwarted in their hunt for more survivors of the Himalayan snowstorms that have killed at least 40 people over the past week.

After minor avalanches hampered the search for stranded climbers Monday, Keshav Pandey, of the Trekking Agencies’ Association of Nepal, admitted, “After this we can only hope that those who are missing will establish contact with us or their families,” Reuters reports.

Some 600 people have been rescued so far by the Nepalese army and other groups. Pandey believes it unlikely any more tourists are missing but said that some local porters and guides had not yet been traced.

Casualties from the blizzards, which took place unexpectedly during peak trekking season and are said to have been triggered by a cyclone that hit eastern India the previous week, included trekkers from Israel, Japan, Canada, Poland and Slovakia along with several locals.

Baburam Bhandari, chief of Nepal’s Mustang district on the Annapurna mountain circuit where the blizzards hit, told Reuters that army rescuers dug out the body of another Israeli tourist on Monday.

This is the second major disaster this year in Nepal, which is home to eight of the world’s 10 highest mountains. (Annapurna ranks in 10th place.) Sixteen local guides lost their lives this April in an avalanche on the world’s tallest peak, Mount Everest.

Nepalese Tourism Minister Dipak Amatya said he would do everything possible to ensure that the country never again encountered a tragedy of this nature. “There is no point blaming the hostile weather for the disaster,” Amatya said.

[Reuters]

TIME Aging

How to Talk About The End of Your Life

The toughest conversation might also be the most important

The video of Brittany Maynard, 29, describing her choice to move to Oregon for the right to end her life due to her terminal cancer has received well over 7 million views. It’s also left many people shocked, saddened and inspired by her decision.

“I am not suicidal. If I were, I would have consumed that medication long ago. I do not want to die. But I am dying. And I want to die on my own terms,” Maynard wrote on CNN.com.

Talking about death—and the circumstances surrounding it—is uncomfortable for most people. But my colleague Lily Rothman, 28, just wrote her will. “My eventual death was something I’d been mentioning to lots of people, on Facebook and at engagement parties and at my high-school reunion,” she writes. “It wasn’t that I thought death was going to come any time soon or in any special way, it’s just that, as they say on Game of Thrones, all men must die.”

MORE: 5 Tips For Families Facing End-Of-Life Care

Many people argue that it’s time we had more conversations about the end of life and how we want to go. It’s a conversation that can become awkward, especially for adult children bringing it up to their parents, but it allows people to avoid having to make very difficult decisions at the most sensitive times. “It’s critically important for us to have these conversations at the kitchen table,” says Ellen Goodman, founder of The Conversation Project, a nonprofit organization that campaigns for the expression and respect of wishes for end-of-life care. “Too many people are not dying in the way that they choose, and we need to change that.”

Goodman, who had to make medical decisions for her dying mother that they had never discussed beforehand, also created the Conversation Starter Kit, which you can download for free. So far, people in 50 states and 176 countries have downloaded the kit. That’s great news, considering about 90% of Americans believe it’s important to talk about their end-of-life care wishes and those of their loved ones, but only 30% actually have those discussions, according to the Conversation Project. “We would hope that this really tragic story of [Brittany Maynard] has an outcome that will really help people talk about these issues,” says Goodman.

Here are some other preparations you might consider if preparing an end-of-life checklist, from the National Institute on Aging:

  • A living will, which records a person’s wishes for medical treatment near the end of life.
  • Designating a durable power of attorney for health care, which names a person, sometimes called an agent or proxy, to make health care decisions when a person can no longer do so.
  • Talking about a do-not-resuscitate (DNR) order, which instructs health care professionals not to perform cardiopulmonary resuscitation if a person’s heart stops or if he or she stops breathing. A DNR order is signed by a doctor and put in a person’s medical chart.
  • Writing a will—a document that indicates how a person’s assets and estate will be distributed upon death.
  • Naming a durable power of attorney for finances, someone to make financial decisions when the person no longer can. It can help terminally ill people and their families avoid court actions that may take away control of financial affairs.
  • Penning a living trust, which provides instructions about the person’s estate and appoints someone, often referred to as the trustee, to hold the title to property and funds for the beneficiaries. The trustee follows these instructions after the person can no longer manage his or her affairs.
TIME Aging

5 Reasons Why Women Live Longer Than Men

Pink stethoscope with female symbol
Getty Images

Life expectancy in the U.S. is at an all-time high, according to a recent report by the Centers for Disease Control and Prevention (CDC). And while the news that we’re living, on average, to the ripe old age of 78 years and 9 ½ months isn’t that surprising, there is one stat that is: A girl born in 2012 can expect to live to 81.2 years—almost 5 years longer than a boy baby born the same year, who’s likely live to age 76.4. Weaker sex, indeed.

“Men are biologically and sociologically at a disadvantage from the time they’re conceived to the time they die,” says Marianne Legato, MD, professor emerita of clinical medicine at Columbia University College of Physicians and Surgeons and founder and director of the Foundation for Gender-Specific Medicine. Here’s why:

Females are tougher in utero

Two and a half as many boys are conceived as girls, Dr. Legato says, but they’re so much more likely to succumb to prenatal infection or other issues in the womb that by the time they’re born, the ratio is close to one to one. “They’re also slower to develop physically than girls prenatally, which means they’re more likely to die if they are preemies due to underdeveloped lung or brain development,” Dr. Legato explains.

HEALTH.COM: 10 Biggest Myths About the Flu

Women are less likely to be daredevils

Unintentional injuries are the third leading cause of death in men, according to the CDC; for women it’s only the sixth. Again, you can blame it on biology: The frontal lobes of the brain—which deal with responsibility and risk calculation—develop much more slowly in males than females, Dr. Legato says.

The result: Guys often take many more risks (which you probably already realize if your small son has taken one too many spins off his bike handlebars). “Almost inevitably, a male will take risks that a woman of his same age wouldn’t take,” Dr. Legato says.

Women succumb to heart disease later

Heart disease is the leading killer of both men and women, but men are more likely to develop it—and die from it—as early as their 30s and 40s. Women, on the other hand, typically develop heart disease 10 years later than men. They’re protected from it until menopause, since their bodies churn out estrogen, which helps keep arteries strong and flexible, says Dr. Legato.

HEALTH.COM: 15 Weird Things Linked to Heart Attacks

Women have stronger social networks

Friends make good medicine: People with strong social connections have a 50% lower chance of dying than those with few social ties, according to a 2010 study at Brigham Young University. “Most men tend to hold their stress and worries close to their chest, while women tend to reach out and talk to others,” Dr. Legato explains. The one exception: married men, which also explains why so many studies show that they’re likely to be healthier and live longer.

HEALTH.COM: How Friends Make You Healthier

Women take better care of their health

Men are 24% less likely than women to have visited a doctor within the past year and are 22% more likely to skip out on cholesterol testing, according to the Agency for Healthcare Research and Quality. In fact more than a quarter (28%) of men don’t have a regular physician and about one in five didn’t have health insurance in 2012, according to the Kaiser Family Foundation.

You can blame it on the so-called John Wayne syndrome: “Men often deny illness; they minimize symptoms because they don’t want to go to a doctor and find out something is wrong,” Dr. Legato notes.

HEALTH.COM: 10 Worst States for Women’s Health

This article originally appeared on Health.com

MONEY Ask the Expert

What You Need to Know Before Choosing a Beneficiary for a Health Savings Account

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Robert A. Di Ieso, Jr.

Q: “What happens to the money in a health savings account when the account owner dies?”–James McKay

A: It’s up to you to decide.

But let’s back up a step: A health savings account offers those in high-deductible health insurance plans the opportunity to save pretax dollars and tap them tax-free to pay for qualified medical expenses, with unused funds rolling over from year to year. Unlike a Flexible Spending Account, you have the opportunity to invest the money. And once you hit age 65, the money can be used for any purpose without penalty—though you will pay income tax, similar to a traditional IRA. So for many people, an HSA also functions as a backup retirement account.

When you open an HSA, you will be asked to designate a beneficiary who will receive the account at the time of your death. You can change the beneficiary or beneficiaries any time during your lifetime, though some states require your to have your spouse’s consent.

Your choice of beneficiary makes a big difference in how the account will be treated after you’re gone.

If you name your spouse, the account remains an HSA, and your partner will become the owner. He or she can use the money tax-free to pay for qualified healthcare expenses, even if not enrolled in a high-deductible health plan, says Todd Berkley, president of HSA Consulting Services. Should your spouse be younger than 65, take a distribution of funds and use them for something other than medical expenses, however, he or she will pay a 20% penalty tax on the amount withdrawn plus income taxes (a rule that also applies to you while you’re alive).

Thus, Berkley warns against a spouse taking a full distribution to close the HSA. He says that it’s better to leave money in the account first for medical expenses, then later for retirement expenses both medical and non—since your partner gets the same perk of penalty-free withdrawals for other expenses after turning 65.

When the beneficiary is not your spouse, the HSA ends on the date of your death. Your heir receives a distribution and the fair-market value becomes taxable income to the beneficiary—though the taxable amount can be reduced by any qualified medical expenses incurred by the decreased that are then paid by the beneficiary within a year of the death.

Failure to name a beneficiary at all means the assets in your account will be distributed to your estate and included on your final income tax return.

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