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