U.S. Alters Rule on Paying for End-of-Life Planning

[phantom power]

WASHINGTON — The Obama administration, reversing course, will revise a Medicare regulation to delete references to end-of-life planning as part of the annual physical examinations covered under the new health care law, administration officials said Tuesday.

The move is an abrupt shift, coming just days after the new policy took effect on Jan. 1.

Many doctors and providers of hospice care had praised the regulation, which listed “advance care planning” as one of the services that could be offered in the “annual wellness visit” for Medicare beneficiaries.

While administration officials cited procedural reasons for changing the rule, it was clear that political concerns were also a factor. The renewed debate over advance care planning threatened to become a distraction to administration officials who were gearing up to defend the health law against attack by the new Republican majority in the House.

http://www.nytimes.com/2011/01/05/health/policy/05health.html?_r=3&hp

[elocs]

1. I read about this here this morning (more than once):

http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=439x119605

[hedgehog]

2. I just went through this with my mother. She had a series of hospital admissions

caused by general weakness/heart failure. The day after her last admission my father went to bed thinking she was going to be OK. In fact, he was thinking that this time the doctors would find the root cause of the problem. At 2AM, he was awakened with a request that he give permission for my mom to go on a respirator. Although my mom had signed a DNR, he agreed. Unfortunately, instead of getting stronger, my mother continued to weaken. She made clear that she wanted off the respirator. She did get strong enough to come off the repirator, but the family had to stand firm to ensure she wasn't placed on it again as she continued to weaken. She passed peacefully in her sleep a few days later.

If my mother's clear and original wishes had been followed, she probably would have died that first night when she had trouble breathing. The problem is that no one, especially her doctors, had any idea that this time she wasn't going to rally. In the end, knowing her wishes made it possible for us to allow nature to take its course without feeling guilty.

I guess I have a couple points here: everyone, regardless of age, needs to have a written statement about what you want to happen to you, to have a person assigned to carry out your wishes and have that person understand your thoughts on the matter. Check your state regulations on this matter. There was an excellent article in the New Yorker last August on end-of-life issues.

The second point is that very often medicine is a crap shoot. Had my mother rallied, we would have been grateful she was on the respirator. Because she didn't, one of my siblings is upset that her wishes weren't followed right from the start. Medical people are only human, and the people in the ICU are tuned to do everything possible to keep people alive. The people at the hospital did their best, and that's all I could ask of them. It was up to us, the family, to take the final responsibility for deciding the level of care.

[lapislzi]

3. That is a good, brave post.

I am heartsick because my mother-in-law called me the other day to ask my advice for elder care planning (I just recently got married). Dad-in-law has been in the hospital for close on 2 months now with a variety of ailments. Now, I did good estate planning for both my dad and grandma--protected the assets, dotted the i's, crossed the t's well within the look-back period.

How do I tell her it's too late for her to do much of anything?

[hedgehog]

4. I wish people in this country would admit that what happens at the end of life

is pretty much a crap shoot. You might eat right, exercise, follow the best advice and end up lingering with Alzheimer's. The way things are set up now, all of your assets must be spent down (maybe in only a couple months!) to pay for your care before you get any government aid. Meanwhile, someone who smoked like a chimney and drank like a fish might kick off in a day with next to no medical bills. The good guy ends up leaving his family nothing, while the other guy passes his assets on.

And I don't want to begin to talk about taking out insurance for long term care. Right ow I'm paying a mortgage, paying of credit card bills, paying off student loans, saving for retirement and helping out my dad. There ain't no money left over for long term health care insurance!