End of Life Care
Nearly one-quarter of Medicare’s budget is spent on patients in the last year of life (Kaiser Family Foundation). Unfortunately, many of the tests and life-prolonging procedures done are unwanted by patients and decrease the quality of life with little impact on quantity. And, many patients and families take on a great deal of costs and emotional burden in this process.
So, how can you make sure your end of life care wishes are met?
- Take advantage of the Medicare-covered end of life care discussion with your physician. As of January 1, 2016 health care practitioners (doctors, nurse practitioners, and physician’s assistants) can be reimbursed through Medicare for speaking at any time with patients and their families about different options for treatment and end of life care. Previously, they could only be reimbursed for the discussion during the one-time “Welcome to Medicare” visit. Studies show only about 14% of physicians have billed for this service and many said they have no formal system for assessing/addressing this need, so you may need to be the one who asks to have the conversation.
- Talk about your wishes with your family members, especially those designated to help with your care. The Conversation Project offers a “starter kit” to help you get started and to guide what to discuss. Our care managers work with many clients and families on advance care planning and the most important aspect is open and specific discussions. For example, a simple “I don’t want to be hooked up to machines” may not be sufficient guidance for your loved ones (and may be simplifying things in an unrealistic way). Instead, our care managers talk about specific scenarios and how you would define quality of life in different circumstances. We also help provide you and your family with educational materials (on topics like such as CPR’s effectiveness/effects at the end of life, artificial hydration and nutrition, and various aspects of treatments).
- Document your wishes. You can find advance directive forms at Empath Choices for Care, and Florida’s Health Finder offers printable forms as well as resources and an overview of healthcare advance directives and Florida law. Make sure your documents are readily available and copies given to appropriate parties, not locked away in a safety deposit box!
- Though these steps will help ensure your wishes are carried out, advocacy at the time of need is also crucial. Your healthcare decision makers should be prepared to ask questions and talk to providers who may not know your wishes (for example, if hospitalized you will likely be followed by a hospitalist instead of your normal doctor). A care manager can help provide guidance, support, and tips during this stressful time for your loved ones. It is important to work with providers who will coordinate with you and your family as a team. Look for our related post coming soon about palliative care.
Important Update Regarding the Healthcare Surrogate Designation:
In the past, doctors had to certify that you were unable to make your own healthcare decisions for the document to go into effect (and thus your decision maker to be able to get information and act on your behalf). Now, you can designate in the document that this stipulation doesn’t have to be met. You can check two options: 1. the person designated can immediately be allowed to access your protected health information (PHI) and 2. the person has immediate authority to make healthcare decisions for you. Remember, if you’re able to speak for yourself, your decisions still supersede those of the designated representative if they conflict.
The important benefit of these provisions is that a person can help you navigating through health situations when you’re unwell (being able to receive your PHI is especially important, and without this provision, the only option available has been an inconvenient process of signing individual forms with multiple providers). Many people need the valuable assistance of an advocate not only when they are certified as incapacitated. And, waiting for the doctors’ certification can be problematic (and stressful) when dealing with time-sensitive critical issues.
*PHI (personal or protected health information) is information about your health status, provision of care and payment for health services as protected under privacy laws (primarily referring to HIPAA) which cover what information can be collected, shared and how it must be protected especially when transferred or stored electronically.