Pre-Aging Agreement

Wishes and Issues

What are the most important wishes/issues facing your loved one(s) today and in the foreseeable future? The intent of this plan is to provide a basic template to best insure happiness, security, safety, and peace of mind for your parent(s), family members(s), or loved ones.

Living Situations

  • Evaluate current living situation
  • Potential future options
  • Drastic situation/change

Support Team

  • Primary caregiverSupport caregivers
  • Family members
  • Friends/Neighbors
  • Community
  • Church
  • Other organizations/clubs
  • Maintenance help e.g. landscaping, cook, and housekeeper
  • Pet care
  • Life alert/emergency response

*Include contact names, telephone numbers, e-mail addresses, and permanent addresses*

Medical Assessment

  • List of Physicians and Dentists
  • Physical therapist
  • Current Medications and Vitamins- List including name, dosage, reactions, and reason for taking
  • Allergies/other issues e.g. implant devices
  • Prescriptions- pharmacy, cost, and applicable insurance/ co-payments
  • Evaluate smoking/drinking habits
  • HIPAA rules

*Include contact names, telephone numbers, e-mail addresses, and permanent addresses*

Legal Documents

  • Birth information/date(s)- exact legal name(s)
  • Social Security number(s)
  • Bank Accounts- CD’s, Stocks, Bonds
  • Investments
  • Trusts
  • IRA & 401K
  • Life Insurance
  • Other insurance policies
  • Real Estate
  • Mortgage & property taxes
  • Identification- Birth Certificate, Social Security Card, Passport, and Driver’s Licenses
  • Credit card information
  • Will- Living Will, Advanced Directives, Power of Attorney, Medical Power of Attorney
  • Marriage documents
  • Divorce documents
  • Safety deposit box- location, keys, combinations
  • Citizenship papers
  • Business contracts
  • Legal agreements/documents
  • Property deeds
  • Titles
  • Location of Tax returns- Federal & State

*Include contact names, telephone numbers, e-mail addresses, and permanent addresses where applicable*

Financial Review

  • Finances
  • Insurance
  • Medicare/Medicaid
  • Veteran’s benefits
  • Pension
  • Social Security
  • Disability insurance
  • Property
  • Other income
  • Debts
  • Evaluate budget situation

Death and Dying

  • Life support
  • DNR (Do Not Resuscitate) orders
  • Organ donation
  • Final plans- burial or cremation
  • Final resting place, plans, and wishes
  • Financial arrangements