1st Senior Home Protection

Life Long Independence Self Survey

HAVE YOU DONE YOUR LONGEVITY PLANNING YET?
Take the “Life Long Independence Self Survey.” At the end, you will be presented with a score and how you can improve your score.

1: I have a Power of Attorney undated in the last 2 years.: Yes
No
2: I have a health care proxy, living will, and/or health care power of attorney updated within the last 3 years.: Yes
No
3: I have a HIPAA power with my treating physicians updated within the past 2 years.: Yes
No
4: I have put my health care wishes, emergency numbers and prescription medications on the Internet through Life Ledger.: Yes
No
5: I have put my legal documents on the Internet through Docu Bank.: Yes
No
6: I have checked my home for dangerous conditions for falling, such as scatter rugs, unlit steps, floor wires or cords.: Yes
No
7: I have created a network for home repair that is affordable.: Yes
No
8: I have created a check in with neighbors to make sure I am okay.: Yes
No
9: I have a telephone near my bed if I cannot get up for a call.: Yes
No
10: I have wall sensors or other detection devices in case I fall at home.: Yes
No
11: I take excellent care of my books and credit rating.: Yes
No
12: I am aware that the IRS will provide me with a volunteer accountant, if I cannot handle my taxes.: Yes
No
13: I am aware that services are available to argue healthcare claims with my health insurance company, if they refuse to pay.: Yes
No
14: I am aware of my budget and expenses.: Yes
No
15: I am aware of my total after tax income.: Yes
No
16: My total after tax income is equal to or greater than my expenses.: Yes
No
17: If not, I have a plan for increasing my income.: Yes
No
18: I understand annuities and have made a reasoned decision to buy or not to buy.: Yes
No
19: I understand reverse mortgages and have made a decision to apply or not to apply.: Yes
No
20: I understand long term care insurance, and have made a decision to buy or not to buy.: Yes
No
21: I am satisfied with my leisure activities.: Yes
No
22: I get satisfaction from volunteer activities.: Yes
No
23: I am in good communication with family.: Yes
No
24: I am in good communication with friends.: Yes
No
25: I have selected fiduciaries for my health care if I cannot make my own decisions.: Yes
No
26: I have chosen fiduciaries for my money if I cannot handle it myself.: Yes
No
27: I have communicated with my fiduciaries and they understand my wishes.: Yes
No
28: I feel spiritually and/or intellectually fulfilled.: Yes
No