Estate and Related Planning for those Living With Rheumatoid Arthritis
Estate, financial and related planning must always be tailored to reflect each person’s unique circumstances, needs, goals and objectives. If you or a loved one have been diagnosed with Rheumatoid Arthritis (“RA”) you planning should be tailored to address the challenges you may now have, or face in the future. RA, like many chronic illnesses can vary significant from person to person: the age of onset, progression and symptoms can vary across a fairly wide spectrum. Thus, many of the suggestions below will be generalizations that will have to be modified to fit your experience of RA.
What is Rheumatoid Arthritis?
RA is a chronic inflammatory condition that may affect many different tissues, and even bodily organs. The most commonly affected tissue are joints, connective tissues. The synovial fluid and membrane thickens leading to cartilage and bone destruction. This can weaken the muscles, tendons and ligaments surrounding an affected joint. Commonly affected joints include writs, fingers, toes, shoulders, elbows, knees, ankles and the cervical or upper spine. Resulting joint deformities can be painful and debilitating. These symptoms are often symmetrical (bilateral).This can result in a loss of potion, instability, deformity. The effects of RA can include fatigue, weight loss and muscle pain as well.
Although RA is associated with joint deformities, the other affects (extra-articular features) can be substantial and may include: inflammation of the blood vessels and eyes, skin ulcers, inflammation of the sac surrounding the heart and/or the lining of the lungs, thickening of lung tissue, peripheral nerve damage and more.
RA, for some, may result in a shortened life expectancy, perhaps by as much as 10 years. This is more likely if there is an early onset of the disease and severe conditions including an impact on organs not only joints. Caution should be exercised in making any general assumptions as many living with RA will have a normal life expectancy.
Depression is common among those living with RA. While this may be attributable in part to the pain and debilitation caused by RA it appears that the inflammatory process that is part of RA itself causes depression.
Who is At Risk for RA?
RA is an auto-immune disorder that has no known cause, although there is a genetic predisposition in that 93% of those affected have the HLA-DR4/DR1 gene. Approximately 1.3 million people, or 1% of the population, are living with RA in the United States. The average age of onset is from 20-40 years and the frequency of diagnosis increases with age. Females are more likely affected then males with a 3:1 ratio.
Financial Planning Considerations
What is the Impact of RA on your Finances: How long might you be able to continue to work? What incremental medical costs might you incur? You cannot use general budget programs and assumptions and must carefully tailor all planning to your specific circumstances.
The Planning Process: If the person living with RA who requires planning is suffering with depression, a common symptom of the disease, advisors may have to enlist family to assist in serving as a catalyst to the process. Family and advisers alike should not defer or dismiss the planning process because the person with RA is disinterested.
Life Expectancy: Since shortened life expectancy is commonly associated with RA, whether or not applicable to you, anticipate difficulties obtaining new life insurance. If the person with RA has existing term life insurance, which might be likely since the average age of diagnosis is after many have entered the workforce, investigate the benefits of converting any term insurance into permanent coverage if advantageous. If more sophisticated estate tax minimization planning is being considered the potential for a shortened life expectancy should be investigated for that particular person with RA as it may impact the application of various estate planning techniques. This is also important to consider when preparing a budget and financial plan.
Organization and Automation: Because RA will commonly affect the joints in the hands and wrists writing and handling paperwork could become difficult or impossible. Endeavor to organize and simplify as much of your financial and legal life as possible in order to minimize the amount of this work that might be required. Ideally, undertake these tasks early on after diagnosis and before progression of the disease hinders your ability to take these steps. Consider going paperless. Computers with voice recognition technology and other features can facilitate handling routine financial and other matters easier in spite of the limitations RA might create. Endeavor to have as many recurring financial transactions as possible on auto-pay and auto-deposit to minimize the transactions that have to be tended to, and avoid to the extent feasible having to handle checks and trips to your bank. It might be helpful to use a single credit card to consolidate all automatic payments.
Impact on Estate Planning Documents
Signature Lines and Affidavits: If you suffer from joint deformities in the hands, ulnar drift, Swan neck deformity of the fingers, it may be difficult to sign documents. If the impact of RA does not prevent you from signing documents it might still be easier to sign only the last page rather than every page if that is the attorney’s custom that prepared your documents. In more severe cases it may be impossible to sign a signature in which case you might have to simply make a mark, e.g., an “X” at the signature line of each legal document. If this is done the attestation that accompanies a will must be revised to reflect that the witnesses are acknowledging that you made “your mark” on the document rather than the standard language that you “signed” the document.
Powers of Attorney: A springing power may be inadvisable in that you might benefit from assistance while you remain competent to handle your own affairs. A springing power of attorney only becomes effective whey you become disabled. However, if for example, it is difficult for you to sign your name or write checks, your agent could help you. But a springing power may not be “sprung” or effective. Therefore, an immediate power of attorney is more advisable in terms of effective date. Most powers of attorney are written in a very broad manner that authorizes an agent to do anything you the principal could do (referred to as a general power). But if your main need for now and the foreseeable future is for someone to help you at your direction you may not need to grant such broad authority. There may be no reason to give your agent authority to sell your home or change beneficiaries on your IRA. Thus, for many with RA, especially at younger ages, a more limited power of attorney might be preferable.
RA affects more than a million people. All phases of planning must consider the impact of your disease and particularly how it is anticipated to affect your health, longevity and finances.