Mark Dimor founded The BioContinuum Group in 1993 after 15 years in healthcare advertising, communications, and medical education. Mark works to identify practical strategies for changing patient and practitioner behavior and improving patient care, and to implement those strategies using education and social media. In addition, he was his wife's primary caregiver as she fought cancer for three years and ultimately passed away. Which is to say, he understands the issues that Everplans is addressing both professionally and personally.

Yesterday on his blog, Mark wrote an incredibly flattering piece about Everplans. In the piece, he discusses Everplans' role, as he sees it, in opening the channels for conversation around tough end-of-life issues and supporting patients, caregivers, and families as they navigate these complicated areas. We're re-publishing the piece here today. Visit The BioContinuum Group's blog for more information and opinions on these topics, and follow Mark on Twitter @MarksPhone.

Those who follow me know my areas of interest. They revolve around a somewhat narrow constellation of topics. One area is adult learning and how it works to drive an educational strategy for patients and HCP (healthcare providers). Another area is social media and how we must think goals and strategy when we want to apply social media to solve a communications, education, marketing, or brand problem. Finally there is the topic of hospice and palliative medicine (HPM) and how important that service is for both patient and caregiver.

One organization that’s also looking at the practical aspects of HPM and EOL is a company I was recently introduced to called Everplans. Everplans is a website that addresses, in a new and practical way, the topics of end-of-life and death. (Yup: yet another bummer post by me.) But I must say that after having faced these issues with Donna’s passing 18 months ago, and now in the middle of organizing my own life, this website comes as a welcome resource. Dare I say a bit of light for my darkness?

The site is broken down into categories that apply to all of us: Long Before Death, Eldercare & End-of-Life, After a Death, and Be There for Someone. These buckets are further broken down into key components or steps. These steps are presented simply, clearly with articles and tools, links and explanations, designed to educate and take action. The site is a one-stop resource for anyone interested in planning or learning: those in their 20s and 30s, and those facing the passing of a loved one, post death realities, and what to do and how to do it when a friend or family member dies. I know that for me, I winged the practical considerations at Donna’s death and stumbled along the way—largely I was on autopilot and just pushed through those first few weeks. Everplans could have served as my checklist and backstop resource. It may have even helped me face the grief of doing this alone.

More than ease of use, this site and the practical steps it presents are part and parcel of my larger reference point: HPM gives so much to the patient and caregiver. HPM is about treating the entire patient clinically, emotionally, and spiritually, while considering the same gestalt of the family. This is especially critical during the end of life and after the death of a loved one. I believe when we bring the services Everplans offers into caregiving, when these issues and tools are part of a family discussion, it opens emotional receptors within us that connect us to our loved one. It not only takes the worry and struggle with these topics off the table; it opens the conversation to include topics we may not want to address. And in addressing these issues openly we free ourselves and our loved ones from struggling with them, especially when they are least able to. Everplans is part of HPM, part of how to better live our lives.

In my opinion HCP and HPM providers should be pointing patients and families to Everplans (or sites similar) in order to guide patients through their options and to ensure critical paperwork is completed and put into the electronic medical records. Eliminating a potentially emotional and difficult task will aid the continuity of care and the well being of the patient, the caregiver, and family. 

After David S. Kime Jr.'s funeral, as his family and friends made their way to the cemetery, they made a pit stop in Kime's name: to a Burger King drive-through. Kime, a WWII veteran who died at age 88 on January 20 in York, PA, was a long-time fan of the Whopper Jr., and his family chose to honor him by purchasing his favorite sandwich.

Kime's daughter Linda placed the burger atop the spray of flowers on the casket at the cemetery, and said that the tribute was a way of honoring her father through "the things that brought him joy."

We think this is a wonderfully unique way of remembering someone who has died, and we're interested to hear your thoughts. Have you ever been a part of an unusual tribute like this one? What is your idea of a special tribute?

via York Daily Record

In the Huffington Post today, religion reporter Jaweed Kaleem looks at the rise in home funerals, and offers a number of compelling stories of families caring for their own after a death. (A warning: the personal stories Kaleem reports on are both inspirational and also truly heartbreaking.)

While most American funerals are arranged by funeral homes, there is a growing movement toward home funerals: ceremonies that a family organizes themselves, often taking place in the family's home, with the family responsible for preparing and sometimes burying the body. Most states have made home funerals legal, and many states do not require the engagement of a funeral director after a death.

Elizabeth Knox, vice president of the National Home Funeral Alliance, is a proponent of home funerals:

"A lot of people don't want to do anything with touching dead bodies. They consider it creepy. But it can actually be the first step to healing and acceptance of death. Slowing down the process allows all involved to absorb the loss at their own pace. It's an organic emotional and spiritual healing not available from limited calling hours at a remote location."

Kaleem reports that while home funerals are legal in most states, they can still be difficult to orchestrate. And in places where they're hard to organize, funeral homes can actually serve as helpful partners in coordination.

"It's nearly impossible to do a home funeral in some places, but funeral homes and home funerals can often coordinate activities to get around that hurdle…newer generations of less traditional funeral directors are more likely to be interested in helping make arrangements for home services."

If you're interested in learning more about home funerals, see our article Choosing to Have a Home Funeral Service. The other resources we recommend are the National Home Funeral Alliance, the Funeral Consumers Alliance, and the Home Funeral Directory.

via Huffington Post

Do doctors die differently than the rest of us? Maybe.

Yesterday over at BoingBoing, editor Xeni Jardin shared an essay about the approach many doctors take toward end-of-life care. The article, by Dr. Ken Murray (a Clinical Assistant Professor of Family Medicine at USC), looks at the widespread delivery of overtreatment, or "futile care," to patients at the end of life, and how many doctors choose not to undergo these types of final—and often ineffective—treatments themselves. Dr. Murray writes:

It’s not a frequent topic of discussion, but doctors die, too. And they don’t die like the rest of us. What’s unusual about them is not how much treatment they get compared to most Americans, but how little. For all the time they spend fending off the deaths of others, they tend to be fairly serene when faced with death themselves. They know exactly what is going to happen, they know the choices, and they generally have access to any sort of medical care they could want. But they go gently.

Why don't we all "go gently," following in the course that many doctors themselves believe in? "The trouble is that even doctors who hate to administer futile care must find a way to address the wishes of patients and families," Dr. Murray writes.

So what can we do to die more like our doctors? We can think about the types of end-of-life treatments available to us, create the legally binding documents to ensure we receive the treatment we want, and communicate with our families about our decisions. Dr. Murray's advice: "If there is a state of the art of end-of-life care, it is this: death with dignity. As for me, my physician has my choices. They were easy to make, as they are for most physicians. There will be no heroics, and I will go gentle into that good night."

via BoingBoing (via Zócalo Public Square)

Following last weekend's piece by Ron Lieber about getting your sh*t together, which we blogged about, the NYT has published an opinion piece by Tim Krieder, "You Are Going to Die." Mr. Krieder recounts how he and his sister recently toured a retirement community for his mother, how impressed he was with the facility (yet how sad he was at the fact he was there), and how it made him realize just how little there is he can do about the fact that his mom is getting older, is now at the point in her life where she is moving into a long-term care facility, and at some point, will die. 

"You are older at this moment than you’ve ever been before, and it’s the youngest you’re ever going to get… Pretending death can be indefinitely evaded with hot yoga or a gluten-free diet or antioxidants or just by refusing to look is craven denial."

We're on the same page here at Everplans; we know that no one wants to think about death, or deal with it. It's so hard. And we also agree with Tim (and the universe) that death is inevitable. And that's the reason for our whole mission here at Everplans. Even a little bit of decision-making and planning ahead can make a huge difference at the end - both for the person who is passing and for their families.


This weekend, New York Times writer Ron Lieber shared the story of Chanel Reynolds, whose husband died tragically and suddenly in 2009. In the aftermath of her husband's death, Reynolds struggled to piece her life together, not just emotionally but also financially. She realized that though she and her husband had drafted wills, they had not signed them; though her husband had retirement and investment accounts, she didn't have the login or password information to manage the accounts; though her family had had a steady income, they had little emergency savings. With funds from her husband's life insurance policy the family was able to keep their home and survive financially. But Reynolds recognized the toll that the financial stresses had taken on her, and decided to create tools to help others avoid the financial confusion she had endured.

Her website,, is what Reynolds created. (Because don't we all have a little voice in our heads screaming that thought—if not those exact words—at us?) The site is a great resource for people beginning to think about estate planning, financial planning, and sharing key information with family members. Reynolds has put together useful checklists and simple articles outlining the basics of wills, living wills, power of attorney, and other topics.

We think Ms. Reynolds has created a valuable resource with useful, practical tools. We'd like to thank her for linking to Everplans on her homepage, and for taking on these issues that we at Everplans think are so important.

via New York Times

Today we're turning our blog over to Everplans' Contributing Editor Lauren Thaler Kahn. Lauren is the founder of Punchwell Press, an editorial-driven marketing company based in San Francisco. Lauren's mother died in 2010 of pancreatic cancer, and her father died from complications associated with cancer when she was a baby. She blogs about her experience at My Infinity Game.

When I was a kid, my mother would sneak into my bedroom the night before my birthday. She’d carefully set up little signs, banners and balloons all around my room so that the first thing I saw when I woke up would be her birthday wishes for me. I’d make my way into the bathroom and see that she’d replicated her festive display there, and in my closet, and in the kitchen. I’m pretty sure she loved my birthday more than her own. 

Three years ago, while my mom lay in bed 13 days before her death, I woke up on January 10th to the same time honored birthday tradition. The handwriting wasn’t my mother’s, but with the help of her nurse she made sure that I was surrounded by her birthday love when I woke up. 

That day, my 27th birthday, was difficult. My mother wanted me to have a celebration, filled with friends, cake and singing. I didn’t want any of that. But I did it for her. I went out in the morning and bought my own birthday cake and snacks and paper plates while she lay in bed. When people started singing, and the cake came out glowing brightly with birthday candles, I couldn’t hold back my tears, and I left the room. My mother followed me, helped by her friends who half carried her, half walked her to find me. 

I was celebrating my birthday for her, and she was celebrating my birthday for me. We were both trying to be strong, but the tragedy of it all just came crashing down that day. Neither of us could carry on the celebratory charade any longer. We hugged, cried and finished out the day quietly. 

After my birthday, my mother deteriorated quickly. Four days later she stopped talking and seven days later she slipped into a cancer coma. I think she used her last ounce of strength to live for my birthday that year. 

Yesterday marked my third birthday since her death, and I was finally in the mood to celebrate. January has been a dark month for the last two years, but for whatever reason—maybe it’s simply the passage of time or maybe it’s that I’m getting used to accruing life experiences without her—this month doesn’t sting like it did last year. 

You see, the older I get the more I turn into someone who is different from the daughter I was when she died. There are three years of Lauren my mother will never know. As the years start piling up, my new experiences—everything from my wedding, my business, and new friendships to the iPhone 5, Homeland and Hurricane Sandy—are whisking me away into the future, a place that’s farther and farther away from my mother.

My birthday still brings up difficult memories, but as time goes by it becomes more and more meaningful to experience things like my birthday with people who are on this ride with me. It also means that I am better equipped to find things to fill the void of her absence. I woke up to sunshine yesterday, which doesn’t necessarily beat my mom’s cheerful birthday décor, but in San Francisco sunshine is always a good sign.

In today's McSweeney's Internet Tendency (a daily humor site) there's a short piece by Camille Campbell called #Eulogy. It's a fictional eulogy with a darkly funny punch line (which we won't spoil for you here). Though McSweeney's Internet Tendency is a humor site and the piece is obviously funny, #Eulogy also offers an uncomfortably insightful take on modern relationships, online personas, and online memorialization.

via McSweeney's

In light of the recent changes t​o the tax code, today we're turning our blog over to Victor Adefuye, a lawyer and financial planner, to h​elp us better understand what exactly changed in te​rms of the estate tax and related estate planning taxes in the fiscal cliff compromise.

It’s January 4, 2013, and by all accounts, we’ve survived the Mayan Apocalypse and, even more scary in some circles, the dreaded "fiscal cliff." The sudden and drastic increases in taxes and spending cuts that were supposed to strike as the ball dropped on January 1, 2013 were narrowly averted by last-minute negotiations and palace intrigue, as both houses of Congress overwhelmingly passed into law a compromise bill that preserved current tax rates for most Americans, with some small exceptions. We can all breathe a little easier today.

A brief history of the estate tax from 2000-2012

Despite all the talk about the appropriate income tax rates for the “wealthy,” few areas of the fiscal cliff debate drew more attention from financial advisors and attorneys than the anticipated changes to estate and gift tax laws. In 2001, under the changes to the tax code popularly known as the “Bush Tax Cuts,” the estate and gift tax exemption amount was raised over the subsequent 10 years from about $700,000 in 2001 to $3.5M in 2009. This meant that individuals who died in 2009 could pass property valued at $3.5M to their heirs without paying any estate tax. Over this period, the highest rate was lowered from 55% to 35%. The Bush Tax Cuts also abolished the estate tax entirely in 2010, so for those families who had wealthy family members die in 2010, their estates avoided paying any estate tax. 

Congress didn’t allow this situation to go on for long, so in 2011, the gift tax was reinstated at a maximum rate of 35%, and an exemption amount of $5M, subject to inflation. By 2012, the exemption amount had increased to $5.12M. A married couple could give away twice that amount, either at death or during their lifetimes as gifts. Any gifts or bequests valued above this exemption amount were subject to the 35% rate.

What was at stake in the fiscal cliff

So this is where we found ourselves on the evening of December 31, 2012. However, the Bush Tax Cuts and subsequent extensions were intentionally designed to expire, including the estate and gift tax provisions. On January 1, 2013, the basic exclusion amount was set to drop down to back down to $1M and the estate and gift tax rate was supposed to rise to a whopping 55%, amounts not seen since 2001. Financial advisors and estate planning attorneys around the country were striking fear into the hearts of existing clients and potential clients, demanding that they review their estate plans and give away as much as possible—to trusts, charities or as outright gifts—to take advantage of the higher exemption amounts before they expired.  But alas, it appears all that anxiety was for naught. The law passed by Congress this week prevented the “worst-case scenario” from happening. In fact, the estate tax law largely remains the same as it was last week.

The current state of estate planning taxes

Here are summaries of the some of the new—or not so new—provisions:

• Estate and Gift Tax Exemption. The estate tax will continue to exclude property valued in the range of about $5M, indexed annually for inflation. In 2013, the exemption will be $5.25 million. This same amount will apply to the gift tax, which means that over his or her lifetime, an individual can give cumulative gifts valued up to $5.25M without having to pay the gift tax. A married couple may give away a total of $10.5 million, either during life or at death. Unlike with the Bush Tax Cuts, this exemption amount is permanent and is not set to automatically expire.

• Generation Skipping Tax Exemption. The generation skipping transfer tax (GST) is similar to the gift and estate tax, but applied to transfers to family members at least one generation away, like grandchildren (or for those unrelated, 37.5 years younger than the donor). Notably, the GST tax is paid in addition to any or gift taxes paid, so, for example, in 2012, any amounts remaining after payment of the 35% gift tax would have been subject to an additional 35% GST. The bill passed by Congress this week left the GST exemption amount the same as the estate and gift tax exemption, and also indexed for inflation and permanent. So, in 2013 just as in 2012, an individual can pass $5.25M and couple can pass $10.5 million in a generation skipping trust or by direct gifts to grandchildren without being subject to the GST tax.

• Tax Rates. The estate, gift and GST tax rates will be 40%, instead of the current 35%. This is the only change between the law now and the law as it was in 2012.

• Marital Exemption and Portability. The marital exemption—where one spouse can transfer unlimited amounts of property by gift or bequest to a citizen spouse without being subject to gift or estate tax—remains unaffected by the new law. Additionally, the rules enacted in 2010 regarding portability, which allowed the transfer of a deceased spouse’s unused exemption amount to a surviving spouse, were left unchanged and has been made permanent.

• Gift Tax Annual Exclusions. In 2013 the annual exclusion amount will increase to $14,000, slightly higher than the $13,000 allowed in 2012. This means that an individual can transfer property valued at $14,000 annually to anyone he or she wishes as a gift, without having to pay gift tax. 

So it turns out all the fear and concern about the drastic changes in the estate tax law was overblown. Unfortunately it took until the final hours of 2012 to get such clarity. The uncertainty was great for financial advisors and attorneys who wanted to encourage clients to do some much-needed planning. For the rest of the country, the uncertainty was considerably less enjoyable, particularly with respect to the questions of income and investment taxes.

Victor A. Adefuye, JD, is a graduate of Duke University and George Washington Law School. He practiced law for four years before becoming a financial representative with the Nemec Financial Group of Northwestern Mutual. His financial planning practice focuses on risk management, estate planning, and investments.


The fiscal cliff deal this week impacted tax rates in a range of areas, including in terms of the estate tax (aka the inheritance tax, aka the death tax). The short story: the estate tax rate will climb from 35% to 40%, with the exemption amount holding at $5 million (adjusted for inflation, which equals about $5,120,000).

In the coming days we'll be exploring this topic in more depth, explaining what was at stake in the negotiations and the implications for the agreement that was reached. So stay tuned.

via Forbes