Is This Proposed Medicare Benefit Enough?

A recent article in the Wall Street Journal entitled End-of-Life Talk Proposed as New Medicare Benefit highlighted an issue encountered as patients approach the very end of their lives.  While there may be doctors who are willing to discuss end of life plans with their patients, they are not currently being reimbursed by Medicare for the time they spend in these important discussions.  Does this result in doctors opting out of these conversations altogether, or they are waiting until it is essentially too late to talk about it?

A Frontline special a few months ago highlighted the fact that many doctors continue to pursue medical options to the very end of a patient’s life, even when there is no hope and when continued treatment creates additional physical trauma for patients and their families.  Obviously doctors have the ultimate goal of healing their patients, but when the end is inevitable, lack of training has been cited as one of the reasons many medical doctors never have end-of-life discussions with their patients.

While we may not be able to control whether or not doctors are adequately compensated for these end-of-life discussions, or whether they are trained in bed-side manner and the appropriate things to say at this stage, we can agree that there is a need for communication about this final stage of our lives.

Therefore, it is probably best to look to the end of our lives from the standpoint of what is in our control.  This is not a topic of conversation we look forward to, but avoidance of such an important topic can leave both our families and our doctors without guidance on our preferences at a tremendously difficult time.  Therefore, while we are healthy and well, we need to consider the realm of possibilities which may lie ahead for us and begin to have discussions about our preferences.  While we certainly won’t be able to predict exactly how our end will come, we can recognize some likely scenarios as a place to start.

Consider the possibilities.  How might your future play out?  What are the proactive things you can do today to lay the groundwork, helping to ensure you family has guidance on what you would want to occur.

You may be one of those people who simply go to bed one night when you are old and never wakes up in the morning.  You could contract a debilitating disease and be unable to communicate for yourself for many years.

Whatever lies ahead for you can be easier to handle if you have prepared for and had the critical conversations with your designated decision-makers.  The biggest single problem can be the fact that you may not be able to communicate your wishes as you near death, because of disease, medications, etc.  If this is the case, your Health Care Power of Attorney (HCPOA) will be called into action to make those decisions for you.

  1. Have you selected a HCPOA, as well as an alternate agent for your medical decisions?
  2. Have you completed a Medical Directives/Living Will form to specify the end-of-life treatments you do/don’t want enacted?
  3. Have you discussed your wishes with your Health Care POA and provided them with copies of your HCPOA document?
  4. Do you feel confident that your HCPOA understands your preferences and has the ability to carry these out if needed?

Because none of us know exactly how our future health and end-of-life will occur, proactive conversations and prepared documents can provide the necessary guidance for the end-of-life decisions which may be needed.  Decisions will be made when the time comes, even if you have avoided the topics.  The danger is that decisions made without knowledge of your preferences, or made after much arguing and battling, can make the end of life even more difficult for everyone involved.

Plan ahead and put the necessary documents in place.  Have the conversations so you are comfortable that your agents will act in accordance with your wishes.  Then go live your life and know that you are prepared and have laid the groundwork for what lies ahead.

If you are struggling with conversations about later life issues, attend our “Conversations on Aging” event, August 26th in Charlotte.

Click here for additional information and to register for this free event.