Approximately 25% of Medicare in the US is spent on patients in their final year of living. That comes out to more than $125 billion annually. What surprises many caretakers is how much health care costs are not covered by private insurance or Medicare. A recent study by the Mount Sinai School of Medicine found that for the last 5 years of their lives, Medicare recipients paid, on average, an extra $39,000 from their own pockets. For more than 40% of the families, it was more than they could afford.
Most dying patients don’t want their family troubled with end-of-life responsibilities. Sadly, many never share their wishes. This gives critical decisions to doctors or family members who may not know their loved ones preferences. One example is the desire for most Americans to die at home. According to 2009 government data, only 24% of people age 65 and over actually do so.
End-of-life preferences should be shared before a health emergency occurs. A widely used non-profit web site that helps facilitate communication is TheConversationProject.org. In 2010 a group of medical professionals, clergy, and media shared their own stories and put together a site to help others. Their main premise is:
“It’s not easy to talk about how you want the end of your life to be. But it’s one of the most important conversations you can have with your loved ones. This Starter Kit will help you get your thoughts together and then have the conversation. This isn’t about filling out Advance Directives or other medical forms. It’s about talking to your loved ones about what you or they want for end-of-life care.”
Only one third of Americans prepare a living will or appoint a health-care proxy, who makes the critical medical decisions if the patient cannot. Charles Sabatino, director of the American Bar Association’s Commission on Law and Aging, advises: “Choosing a health-care proxy is even more important than a living will, since that person will be interpreting your wishes and making sure they’re carried out.” The web site CaringInfo.org provides “state-specific advance-directive forms that can be completed without a lawyer or prepared by one as part of estate planning.”
To be even more assured that a patient’s preferences are followed, many Americans have completed a Physician Orders for Life Sustaining Treatment (POLST) form. This is signed by a doctor and is more binding than a living will. Only 15 states, including New York and California, have legally adopted this form. Complete details are at polst.org.
Penelope Wang, “In Search of A Better End”, Money, December 2012
Photo: Eric Vondy (flickr CC)