Features
End-of-Life Care
Posted on: August 24, 2007
By: Peter C. Sisson, Certified Elder Law Attorney
In the first half of the 20th century, life-saving medical interventions such as sophisticated resuscitation, complicated surgeries, life-saving treatments, ventilators, feeding tubes and other life-support were rarely used or even available. Today, there is great emphasis on curing medical problems sometimes to the exclusion of recognizing that hospice care may be what the family wants.
Surveys indicate that older people are often more afraid of death than younger people. But for all Americans — young and old — there is a great fear of death and the families of those loved ones, who are near the end-of-life, often agree to try interventions that may be ineffective in prolonging life. Estimates are that about 30% of Medicare reimbursements are spent on people in the last year of their life.
According to the Dartmouth Atlas study on death:
The Dartmouth Atlas project uncovered some startling differences in what happens to Americans during their last six months of life. In some parts of the country, nearly 50% of people are in the hospital at the time of death, rather than at home or in a nursing home or other non-hospital setting. In these areas, the likelihood of being admitted to an intensive care unit during the last six months of life is also higher than average – as is the likelihood of being admitted to an intensive care unit during the hospitalization at the time of death. In other parts of the country, the likelihood of a hospitalized death is far smaller, and people who are dying are much less likely to spend time in hospitals during their last six months of life.
The Atlas asked why this was so – why someone living in Miami was so much more likely to receive a great deal of high-tech, expensive medical services, while someone with the same condition who lived in Minneapolis received so much less. The answer appears to be that the capacity of the local health care system – the per-capita supply of hospital beds, doctors, and other forms of medical resources – has a dominating influence on what happens to people who are near death. Those who live in areas like Miami, where there are very high per capita supplies of hospital beds, specialists, and other resources, have one kind of end of life experience. Those who live in areas like Minneapolis or San Francisco, where acute care hospital resources are much more scarce, have very different kinds of deaths.
The question, then, is which is better? From the dying person’s perspective, more is not necessarily a good thing – more visits to doctors for someone who is very sick can be stressful and exhausting. For many people a hospitalized death is something to be avoided if at all possible. People who live in areas with very high utilization of hospital resources do not live longer than people who die in areas where utilization is lower – and if extension of life is not the goal of intervention, what is? From society’s perspective, the cost of this kind of intervention is high, and takes resources away from places where the money might be spent more productively.
Some people are content to leave decisions regarding their death in the hands of others. By doing so, they may expose themselves to unnecessary and futile treatments. They may experience numerous visits to the emergency room in the last stages of their life. Their dependency on others often results in great stress to family members when loved ones lose their capacity and didn’t make their last wishes known. Families are often forced to make decisions about life-support and treatment without knowing whether their loved one would have wanted these interventions. Do not let this happen to you.
Every senior should take the time to put a living will and health care power of attorney in place. For access to a free advance directive, go on-line to: www.abetterwaycoalition.org. Every senior should register his or her advance directive with the Idaho Secretary of State’s office. Call (208) 322-2814 for more information on this important step in making sure your advance directive is available to medical providers when you most need it. Finally, every Idaho senior should contact his or her treating physician and discuss putting in place a POST (physician’s order for scope of treatment).
Because the team at Sisson & Sisson recognizes the great need in the Treasure Valley for solid advice about issues of importance to seniors, we offer free educational workshops to the public at our office at two convenient times each month. Sisson & Sisson also publishes a free monthly educational newsletter called Elder Law Today. If you are interested in receiving this free information or in reserving your space at an upcoming educational workshop, please call (208) 387-0729.
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