Florida Elder Law Blog - A blog by Elder Law Associates, South Florida's premier elder law attorneys, who handle elder law, medicaid planning, guardianships and much, much more.
A new study finds that
when medical personnel know what kind of care a patient wants at the
end of life, Medicare can be spared significant sums and the patient is
more likely to die at home rather than in a hospital, at least in
certain areas.
The study, published in the October 5, 2011, issue of the
Journal of the American Medical Association,
found that in regions of the U.S. that tend to spend the most on
end-of-life care, patients who have "advance directives" cost Medicare
about $5,600 less per person. (Advance directives allow patients to
communicate their end-of-life wishes if they are unable to do so
themselves.) These patients' quality of life also appeared to be
better; they were more likely to receive hospice care and to be at home
when they died.
But the differences in
spending and care did not hold up in regions of the country with low- to
average end-of-life expenditures. The researchers speculated that in
these areas, less aggressive care at the end of life is already the norm
and more in line with what many patients want. In high-spending
regions, by contrast, an advance directive may embolden caregivers to go
against the local norm of aggressive treatment and prolonged hospital
care. In 2006, treatment during the last year of life accounted for
more than one-quarter of Medicare expenditures.
Advance directives
typically include a "living will" that gives instructions regarding
treatment if the individual becomes terminally ill or is in a persistent
vegetative state. It may contain directions to refuse or remove life
support in the event the individual is in a coma or a vegetative state,
or it may provide instructions to use all efforts to keep the person
alive, no matter the circumstances. Most participants in the study who
had advance directives specified that they wanted to limit treatment.
"[The study] absolutely
highlights some of the reasons why you should both talk to family,
friends and physicians about the type of care you might want to receive,
should you be unable to make your own decisions," said Lauren Hersch
Nicholas, the study's lead author and a health economist at the
University of Michigan.
Second Study: Aggressive Treatment Doesn't Prolong Life
A related study just published in the medical journal
The Lancet has found that nearly one of every three Medicare beneficiaries had an operation in their last year of life.
Operations were more
likely in regions with a greater availability of hospital beds and
higher levels of Medicare spending. But the higher rates of surgery
didn't necessarily pay off. The regions where doctors were more likely
to operate had higher patient death rates.
"This level of surgical
intensity doesn't seem to be having much in the way of benefit for the
population," Dr. Ashish Jha, the study's author and an associate
professor of health policy at the Harvard School of Public Health, told
ABC News. "Our sense is that there are probably lots of unnecessary procedures that go on at end of life."
Each state has its own laws on advance directives.
Caring Connections, a site run by the National Hospice and Palliative Care Organization, offers state-by-state information on advance directives
Advance medical directives are an integral part of the estate planning services provided by elder law attorneys.
Labels: elder care, Elder Law Attorney, Florida Elder Care, florida elder law, Florida Elder Law Attorney
