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End of Life Care and Advanced Directives

A new study, reported in the Journal of the American Medical Association, shows that when medical personnel know what kind of end-of-life care a patient wants, then the patient is more likely to be spared overly aggressive care and may die at home rather than in a hospital. The patient’s quality of life is usually better and they are more likely to get Hospice care. As a side benefit, the Medicare program saves over $5,000 per person when the individual has an Advanced Directive. Treatment at end-of-life accounts for more than 25% of Medicare expenditures.

Advanced Directives include: Health Care Proxies, Living Wills, and Powers of Attorney for Health Care. These documents let families and health care providers know what type of care a patient may want, and may allow a family member to make medical decisions for a patient who is incapable of expressing her wishes at the time of care. This is the most important planning tool that you can have and everyone (over age 18) should have one in place, no matter what.

It is vital that, in addition to executing an Advanced Directive, you tell your named Health Care Agent what kind of care you want. There are checklists and guides online that can help you with this difficult discussion. But, it may be that you just need to discuss your basic feelings about medical care, quality of life, and end-of-life issues. You may not have to discuss various disease states and specific wishes. You just have to let your family know how you feel about basic care options.

Another recent study, published in the medical journal The Lancet, found that even though about one-third of Medicare beneficiaries had an operation in their last year of life, the surgery didn’t usually help. Areas of the country with higher surgical rates also had higher death rates. You shouldn’t make any specific medical decisions based on this study, but it is indicative of the need to carefully consider surgery for those near the end-of-life. The key issue is that until death happens you don’t really know if the end is near. The tendency is to keep trying to save life. What needs to be done is a thorough review and discussion of the situation to help determine if death appears to be near and then what treatment options make sense.

As difficult as it may seem, it is important to think about medical care options, now and in the future. There will be some time when you are close to the end of your life and the medical care you get may make the difference between as good an end as possible, and a miserable death. You should discuss this with your family and loved-ones and ensure that you have an Advanced Directive for health care. See your Elder Law Attorney to ensure it is properly drafted and executed.