We've all heard the figures. The cost of end-of-life care is astronomical. I continue to see the unattributed fact that people in the United States spend more on their healthcare in the last year of their lives than they do for the entire rest of their lives.
Even among the elderly, 30 percent of all Medicare funds are spent on the 5 percent of recipients who are dying. In a 2010 broadcast, CBS News reported that 20 to 30 percent of those Medicare dollars pay for procedures that have no meaningful impact.
The report quoted one doctor who said we spend up to $10,000 a day to maintain someone in an intensive care unit. And some patients are there for weeks, or months, at the end of their lives.
It would be one thing if these were procedures that these people wanted. But, the doctor maintained, they often don't.
But the issue really isn't that it costs more. It's that we're not really deciding.
Relaying results of a UCLA study, The Los Angeles Times reported March 20 that "People who are dying often receive care that is poorly coordinated and not in line with the patient's values or goals."
It continued, "Studies have shown that when a patient's desires are taken into account, death is less likely to occur in an intensive care unit, physical distress is reduced, and death comes no sooner."
Today, the Tampa Bay Times — one of the papers my mother subscribed to before she moved from Florida — reported that 7 in 10 Americans say they want to die at home. Yet 7 in 10 die in hospitals. And if you read the CBS report, it's not a comfortable way to go — attached to tubes and machines, and often restrained to prevent the tubes from getting ripped out.
Reading these reports can only make me feel good about how we were able to bring my mother home to die last month. I am absolutely certain that she, and Medicaid, spent less on her care in her last year of life than in the 85 years that led up to it.
And more importantly, she died as she wished, in a cheerful sunny room, with her children and friends nearby. I don't think she was in pain. And other than giving her sponge baths and moving her position so she didn't get bedsores, we tried not to poke and prod her.
But really, it was my mother who made it happen. She had The Conversation. She didn't need tips on how, but she would appreciate the efforts of TheConversationProject.org.
She talked to each of us individually, and more than once, about her end-of-life wishes. She spelled them out in writing, she gave them to her doctor, and she asked us to honor them. I always thought she was a little extreme, actually. As my sister pointed out, she had a "Do Not Resuscitate" order covered in plastic and tacked to the wall by her kitchen phone!
That's probably because my mother knew more about the health care system than most of us. Growing up, she worked for two doctors. And after she retired and moved to Florida, she volunteered for an ambulance service for 15 years. She apparently knew that it's not enough to just write a living will and expect that it will be followed.
CNN Money reports that "Even when the person who is dying has made his wishes known, they may be ignored, or his medical team may not be aware of them. A 2010 study in the Journal of Palliative Medicine found that only 15% to 22% of seriously ill elderly patients had their preferences in their medical records."
And, "Studies by the Agency for Healthcare Research and Quality show that 65% to 76% of doctors whose patients had documents outlining end-of-life wishes weren't aware they existed."
Wow. I guess we better make sure our spouses and kids know what we want!
Thank you, Mother. You sure made it easy on us. We didn't have to argue among ourselves, or try to figure out what to do when the doctors asked us what we wanted to do.
The least I can do is provide the same direction for my children, and have The Conversation before it's too late.